January 2, 1943
Dear Wilbur:
This is the first letter I have attempted to write since our arrival about two weeks ago.  During this period Mr. Allen and I have visited all of the ranking officials and various organizations concerned with our particular interests and I think so far as protocol goes we are now about finished and hope shortly to devote our full attention to the problems of relief and certain health problems closely related thereto.
Although there is a great deal of material still to be gathered, our ideas are beginning to take shape.  The relief program will concentrate very largely on milk for children up to about fourteen years of age.  Unfortunately, the distribution will have to be limited to the larger centers.  So far as we have learned, children in the rural areas are still able to secure milk from the herds of goats, sheep, etc.  The clothing program for children, however, will have to be on a much broader scale and will include urban and rural areas.
It would be reasonable to consider a nutrition study of the urban population for the purpose of determining to what extent deficiencies have already appeared.  Conversations with some of the local medical practitioners emphasize the fact that cases are beginning to come to their attention, more particularly rickets and deficiencies resulting from lack of Vitamin A.  No careful study, of course, has been made, and it may be that we would not under ordinary circumstances be justified in proposing such a study, particularly in view of the likelihood that it is the intention of the allied governments to bring in as rapidly as possible adequate supplies of food.  From another point of view, however, it seems to me we should now set up a nutrition team with the idea not only of gaining information which would be of value here but accumulating experience which cannot but be of great service as other areas which have been under axis domination for considerable periods are liberated.
In a recent cable to Mr. Davis, we suggested that Youmans should come over as soon as possible.  I believe he is probably the individual of first choice because of his experience in the Marseilles area and his consequent knowledge of French medicine and French psychology.  I presume that he will be interested but that he may have some difficulty in leaving Vanderbilt. Both Mr. Allen and I very much hope that, it will be possible for him to get away soon.  He will need associates, of course, I would suggest especially a good pediatrician, a good laboratory man, and at least a nurse.  If all of them speak French, so much the better.  It will be particularly important for the nurse to know French, and if more than one can be secured, competent in the public health field and with reasonable Facility in the language, we could use two or three.  The remainder of the team's personnel will have to be procured locally.  I have no doubt but that we can find individuals who will meet the needs quite adequately.  It also seems clear that there will be no difficulty in securing adequate quarters for clinical work as well as laboratory.  Day before yesterday I visited the Department of Surgery in the City Hospital where teaching is carried on and found an excellently-equipped laboratory normally used for research in that Department but now quite unused because of lack of personnel.  We could probably use part of that set up for the team's laboratory needs.  If that prospect should fail, I am sure we could find another place.
It would be necessary for Doctor Youmans to arrange for essential chemical supplies to be brought by him or shipped to arrive by the time he does, and also it would be desirable to consider some glassware since that seems to be one of the things which is lacking. Rubber tubing is scarce, and certain special pieces of laboratory equipment will probably also have to be brought.  I shall try to find out soon with more definiteness exactly what we can count on regarding laboratory equipment here.
Since my arrival, I have had the problem of typhus very much in mind, and I am convinced that there is an excellent opportunity here for further field work by our group.  The Director of Health for Algeria estimates that since January 1942, there have been 200,000 cases of the disease and between 50,000 and 60,000 deaths.  Last April, in the City of Algiers alone, 800 cases were hospitalized.  Also, since January 1942, the health service has vaccinated 1,500,000 individuals against typhus.  During this same period of time, 28 Algerian doctors had the disease and 11 of the 13 who died had not been vaccinated.  This brief array of figures is sufficient to indicate that the disease is here in considerable quantity.  The Director of Health anticipates that the epidemic will be continued in 1943, and we will very shortly be entering upon the season of greatest prevalence.
Last week when we visited the Pasteur Institute of Algiers and conferred with Dr. Edmond Sergent, a good deal of our conversation centered about the problem of typhus.  I informed him of the anticipated arrival of the U.S.A. typhus mission which desires to obtain local strains of Rickettsia.  Dr. Sergent is thoroughly convinced that in order to have an effective vaccine it is necessary to employ the indigenous strains.  As you know, the vaccine used here is the mouse or rabbit-lung type.  He is definitely opposed to anything but a killed vaccine.  So far as I can judge there has been a very considerable amount of vaccine employed in both Algeria and Morocco.  For this reason North Africa may not be as good an area in which to try out Cox Modified Vaccine as one would wish for.  On the other hand, there may still be areas of adequate population in which an immunization campaign has not been carried on.  The facts concerning the matter we will hope to determine in due course.  If the area is not particularly attractive for a carefully controlled experiment with vaccine, it is certainly ideal for a study aimed at breaking the transmission cycle by an attack on the vector.  We told Dr. Sergent something of the work which has been recently done in the United States on improving insecticides and inquired whether or not he would be interested in having the Pasteur Institute cooperate with us in a field trial.  He replied that he would be very happy to do so and that we could count on them for all support.  The Director of Health is equally interested.
The stage is therefore set, I believe, for a field trial at any moment we can get personnel and material over.  Dr. Sergent's wide knowledge of conditions in Algeria and his knowledge of the psychology of the Arabs, particularly will be a tremendous asset in carrying on a study of this nature.  Not only will there be an opportunity to determine whether under local circumstances a civil community can be rendered louse-free but there will be undoubtedly an opportunity to step into an epidemic situation and perhaps determine whether its progress can be checked by an attack on the louse.  I believe the study should include some work with fumigants, particularly methyl bromide as well as the insecticidal powders.
Doctor Davis, I suppose, would be the logical person to carry on this field study in collaboration with Dr. Sergent.  He would do well to bring an entomologist with him.  The Mexican work, I presume, is just getting under way, and I would hate to injure its progress by suggesting his immediate withdrawal, but as soon as conditions permit, I do believe he should be assigned here where we will be seriously up against the whole problem of typhus control among the civil population.  The Army of course, is vitally interested and would like to see us carry out such studies as early as possible.
We shall probably be cabling about these matters in the near future.  Meanwhile I hope this letter will get on its way shortly and reach you without undue delay.
Please extend my very warmest greetings to everyone in the office, and best wishes to you and the others for a happy and prosperous new year.
Sincerely,
George K. Strode,
Associate Director.