I92$ 40° Janil Jule being tired and sleepy I came to the 19. c office alone in the afternnon and found Jarrett hard at work. Most of afternoon was spent on expense books for November and December. Jan. 3. Dr. and Mrs. M. P, Arrive from S. Paulo Lunch at home, Jan. 4. MP and Stra to Nichtheroy for the day. Meet Dr. Otto Olsen of the Secretariat of the League Nations League of Nations who is here following up visit eS RM oer of Reajkcman and Madsen lest year and is attempting to get a coordinated system of reporting on infant mortality in sample districts of various countries. Is also going to visit Argentina and Chile on this trip. Dinner and“ discussion with Capt. and Mrs. Babcock, Jan. 5. Dr. Olsen, Mrs. E. Parsons, Dr. and Mrs. M.P. for dinner. 0.0. was véry much disturbed by Mrs. EP asking if the US were going to cooperate on infant mortality study. MP gives some leaves from history of R.F. in S.P.f4,Neiva in 1918 was called from Mangdinhos to be Director of SP of S.B. Neiva was entomologist rather than hygienist. Tried to assugescontrol of R.F. work. Hydrick n independence. tater when Weiva was forced out of S.P. he requested fellow- ship for general study of SAmerican conditions from RF. This Hackett refused to grant because 1) the R.F. did not see value of such Mar hs 41 Fad study and second) because RF eould not openly give premium trip to party unfriendly:to new government. Since then Neiva has been anti R.F. Selles Gomes was director of Prophylexia Rural. Gov't did not like him and wished to send to Us at cost of R.F. to study trachoma but mostly to La htalady get him out of country so distitute could be appointed.“ x MP was to have been this substitute but warned SG of proposed move. Then R.F. refused fellowship and SG becagse anti-R.F. tunch at Jockey Club with Nave. Jan. 6. Dr. MP and Nanuel Ferreira toflunch at office today. HM returns from S Paulo. Dinner at Copacabana Hotel. To Casino afterwards with Dr. and Mrs. Mario and Dr. and Mrs. Muench. Lloyd George and family were dining at the hotel. .G. looks like his cartoons but is whiter headed than we expected. Jan. 7. Some rcessary sleeping done in the PM . To dinner at Brahma Restaurant with MP and MP tout? Wrenn Jan. 8. MP and MP J.%3 and FS go to 12M Mass at Candelaria Church. So named from large number of candles (58) pyramided to a peak and surmounted by the figure of Mary and the Christ child. To Excelsior and Vista Chineza in the PM. Jan. 9. Dr. Fraga denies k owledge of article of Jan 4 in Correio de veya which said that R.F. was not further interested in new work in Brazil. Jan. 10. Letter from Ricard reports finding stained mosquitoes 5 kilometers from point of Ifberation in Led¥sma. A large number have been found at one and ¥ and 2 kilometers from hatcheries. Lunch with Mario, Tomaz and Muench. Dinner at 125 Bolivar with MP's after long swim sky and sea were gorgeously colored. MP's take train at 10 PM for S Paulo. Jan. 11. Mrs. Parsons, Miss Johnson, Miss Schwarte, Miss Dawson and Mr. Scobie of NCB’ have picnic supper at 125 Bolivar. Etnani comes to Rio - goes to Bahia tomorrow. Jan. 12. Spend morning at office - Lunch at home. Arrive on board Alcantara but a few minutes before sailing at 3 PM. The Alcantara is a 42 192s large new motor ship of the R.M.S.P. This is the lest time this boat is to stop at Bahia and Recife as from now on it is to compete with other European fast boats and will make the trip Rio-lisbon direct. The word "Alcantara" must be moorish. In the tea room is a beautiful painting of the "Alcantara Bridge," Toledo, Spain. Among those on board I have met, Dr. Frag¢,~ Barros Barreto, Afranio Peixoto, Waidefmar Antunes, Ernani Agricola, Borges Viera, Placido Barbosa, Pedro Alberquerque, Eyrico Rangel, Felicio Torres, Miguel Cofito, Amaury de Medeiros Emygdio Mattos, Henrique Aragio0, Theophilo de Almeida, Otto Olsen. Am beaten at chess by Eugenio Coutinho. Leorne Meneschal directs P. Rural in Alagoas. Mu) Met Dr. Miguel Colito for the first time today. A most pleasing personality. Jan. 13. Am sitting at table with Dr. Ernani, Dr. Waldemar Antunes and Dr. Erico Rangell. This evening Dr. Otto Olsen presented me to Dr. Rocha Lima who has been working for almost ~ 20 years in the Institute of Tropical Diseases of ees Hamburg. Ieter I met Mrs. Lima and Mrs. H, yf Ro Aragao. Dr. Lima is most pleasing to meet. , Both he and Dr. Aragao show great interest in the | latest regarding yellow fever in Africa and ‘ end the work of Noguchi. Rewer of Wena ha Lion 4 414 Vides mn “yA Jan.pl4. Arrival in Bahia. Meet Dr. Gouveia de Marros, Dr. Biao, Dr. Guedes Perel De Burke and D& Connor. Dr. Ara¥jo of - Inst. Os. Cruz of Bahia, Dr. Meyeihees, Barros Margate Barretto and others. Dr. Amanry de Medeiros gives the opening oration on Bahia! C. Fraga speaks well of C.R. and especially calls attention to promise of saneamento for Behia made by the governor. Dr AML Barros Barretto challenges the Yo ress to look over his work and “take it or leav as they wish. The new building for the Saude is very nice. The old entrance is from 1674 - the door and the wooden banisters on the sides of the stairway are ancient and very good. The building is decorated inside and out with old tile. Those in the directors office are especially effective. The central stair case is very cramped in comparison with the rest of the building. The CFA has a room which is furnished by CFA on second floor. Jan. 15. Office Sunday AM. Rocha Lima lecture } on Pathology of yf. Peculiar type of distribution VA 43 1/928 of necrosis makes possible definite diagnosis of | yf from all other diseases - Necrosis in yf is neifher central nor peripheral but is disseminated in the intermediary zone. Make calls in PM on various Brazilian doctors. Meet Dr. Costa Pinto and Spiraea. Leave card for Mrs. Waugh. Dr. Hackett's secretary. To Bom Fim fiesta with Dr. P. Alberquerque Dr. Biao, Dr. Burke and engineer. Drs. Connor and Burke explain maps and new jers. Jan. 16, Dr. Connor shows me work of guarda in \ zone 92, Eight houses, 1 steg focus - monthly cycle. All porrdes mst have spigot and be sealed at top. Kerosene tins and smell moring#s are considered feirly safe. Leave zone early for \ conference with Dre Fraga and Barros Barretto. Dr. Connor outlines the program for the immediate— futureas follows: 1. @ésent program in Ferahybea Natal Recife and Bahia until July when new survey will w meade and further reductions made if conditions warrant. 2. Work will be definitely continued in Bahia until Jan 1, 1929 against ‘fWedes Peyptilervee. CFA will also look after oiling fér cilex on private premises, the DNSP to furnish the ofl. (Our funds for yf control only.) , Dr. Fraga agrees that CFA shall have full autho- rity to inspect all boats and craft in bay for breeding of stegomyia. Dr. Gouveia de Barros and later Dr. Fraga visit office of CFA. Talked with Connor over mathematical side of yf. What is critical index of stegomyia? Made calls. Evening session of congress devoted to Barros Barreto lecture on acute infectious diseases _ of childhood in Brazil. se ate eect Jan. 17. 22 houses no steg. foci with Guarda 91. (Burke, Connor, Biao, Soper, total today 74 houses with 1 steg. breeding.) Visit to Institute Oswaldo Cruz. Dr. Aranjo says that he found leptospira in the 2nd rat | examined in Bahia and that a large percentage ! of wild rats are infected. He shows a jaundiced | guinea pig and cultures of ictero hemorrhagisk. Dinner at house of Governor Goes Calmon, Jan. 18. Inspection in zone with Dr. Rogie . Ldama 14 houses 1 focus of stegomyia ie one house with 3 tanks for chickens and ducks breeding. Dr. Time impressed withthe small amount of par p- hanalia carried by the guarda. 4h 1F28 Afternoon session devoted to yf_Dr. Connor \ reads resume of Annual report (report not yet (attached, pp. 4ha-lh) written. r. Ed. Aranjo reports finding ictero Dmlrat gy, hemorrhagiac in rats. Dr. Vianna Junior defends eet WOTK Of Noguchi, ~~ Visit Instituto geographico (Dr. Magalhaes) too late to see more than the setting sun back of the palms and across the bay. Very beautiful sky colorings. Evening visit to top of Nova Cintra to see Bahia by night. Dr. Gouvea de Barros gives paper on work in Recife mentioning especially pest, typhoid (jarras) and malaria. Jan. 19. To be last day of Congress. Find heavy breeding of stegs and culex on abehdoned ship Cex and of ithlex in abandoned tanks of cotton factory. I hold down the chair while Olsen of the League of Nations discourses on their work in Public Health. Speech of Afranio Peixoto on the most | beautiful story in the world eulogizes Connor among other heroes of Hygiene. Connor not i present to hear it. Bell at the Palace of Acclamacao afterwards. To bed at 2 AM. Jan 20. Up and at ‘em at 5:30 AM, Dr. Emygdio Mattos and Dr. H. Aragao visit yellow fever work at 7 AM, Find steg focus on roof of the Asylum. At 9:30 Dr. C Fraga and Dr. A. Fraga visit houses around the square of the Church of Bom Fin. : A loyal son of Bahia does not return to Bahia : without paying his respects to the Senhor de Bom Fim, The church has many wax reproductions of cured portions of the human body and many ; photographs and paintings. One painting of a blue eyed boy who was saved from yellow fever in 1892; three photos of a 15 kilo ovarian cyst operation from which the patient recovered showing different stages of the iaperotomy and giving the names etc., of the doctors who did the operation. 3 PM final reception of farewells at the palace. Dr. Amal} » Dr. Torres, D.A. Peixoto and Dr. A. L. Berros Barret#o made speeches. Dr. Waldemar dines with me at the Fishhouse. Food mediocre, price high. Zeelandia takes Congressistos back to Rio. Jan. 21. Saturday. Downtown in AM and Tennis in PM, Jan. 22. English cemetery - yf cases - churches of Bahia with Dr. Connor - to Rio Vermelho in PM, Call on Waugits. 45 q Jan, 23. + breeding plant protectors found in 1 house out of 20 houses visited. Farewell to Dr. A. L. Barros Barretto. The city of Bahia is now divided into 72 districts each district containing approximately the number of houses yee een at ee a wekk, There are now 18 on regular service; which gives a 4 week cycle of inspection. The nuwse works from 7 AM to 1 PM without inter- mission and then is off for the day. Routine house inspections ere carried out only 5 days in the week. Fiscalization of the work of the nurse is very severe there being 5 guarda chefes assigned to this service. There are also special guardes assigned to the problem of checking up stegomyia foci in vacant houses and to the control of breeding in "places of congregation" ie. hotels, restaurants, pensions, theaters, railway stations, bhhools, barracks and churches. “It is interesting to note that during the ix days that I had the opportunity of working with the guarda we found no breeding in water tanks in the houses and only once in the clay jar. The foci found were, 1 jarra, 1 roof gutter, 1 open hull of semi-abandoned ship, 3 containers of water for chicks and chickens (a1] same house) and 7 clay pots for protecting plants from ents (all seme house. This indicates that the tanks are in the majority of cases sealed and that the recent campaign to;provide all jars with spigots and sealed cloth covers has sroused interest in and centered attention on the jars. Spigots are geing in byithe hundreds and this promises to help control the jarras. Dr. Connor feels that with the number of possible breeding places reduced to their present number that an increased house index will not be dangerous provided always that places of congregation are carefully controlled. Jan 24. Spend AM purchasing tickets on Fiapuhy for Drs. MEC and FIS and cigars for Dr. Burke. Launch comes and goes and~Ztapuhy is not at docks. Finally sails, at 7 PM with Dr. Go¥veia de Barros Dr. Guf¥des Pfreira (Parahyba) and Dr. Amar Machado (Ceara) Dr. Abenatha& (Para) on board. _ All retire early as sea is not smooth in the 1 Stapuhy which has not improved her technique of taking the waves since I last rode her seven or eight years ago. Jan 25. Feel qualmy all day but do not give up the ghost. Dr. Gouveia gets musical and peetical in the evening. The Rio Ipojica south of Recife has three poeos negros, "um df sezdes, um dd 1928 Geer IF 2% ye rife meleita, um rompe perna que nunca indgrgita." prbirta- “sezoes" is from English seasons and refers to seasonal types of malaria. Jan. 26. Arrive in Recife 9 AM, Béa Yiagem looks fine from the sea. Otherwise Recife seems but little changed. Meet Dr. Costa and my old friend Ignacio after 7 years. Meet Mr. Freire again of NCB and Mr. Thomas who is now acting manager. Mr. Davis is Am. consul and has just returned from trip to his district at his own expense. Leave at 3 PM in Whippet and arrive st Parahyba via Paulista at 7:30 PM, Meet Drs. Kerr and Smith, JAK focus found. Work seems to be done rapidly but with very little effort at propaganda. Call on Dr. Guedes Pereira who later returns call. Suggest that it should not be impossible to secure the installation of torneiros here. (Mr. Clark is chief of traffic of G.W. of Brasil in Parahyba) Leave in Ford for Natal at 1:15 PM. Arrive Natal at 11:35 PM, but have difficulty getting in hotel because of lateness of hour. Finally get in Hotel Natal. Sleep in hammock again. Jan. 27. Fiscalize 26 houses with Kerr. 1 steg | Jan. 28 Move to Hotel Internacional. Hotel Natal and Hotel Avenida are both impossible, expecially the Avenida. Call at Palace and DNSP in AM and leave cards. See Dr. Juvenal lamartine only in the afternoon at 2 PM, It is clear that the governor is interested in the problem of Ceara Mirim not only from the stand- point of malaria but also of economic drainage. The malarious region of Rio Grande no Norte extends along the litoral from a point just north of Ceara Mirim (Touros) to the frontier with Parahyba. No careful studies of Anophelines have been made of this region as far as I could find out here. Regions producing in former times lerge quantities GF sugar are now deserted because of malaria, Of these Ceara Mirim is a striking © example. Cajupiranga is another very malearious zone. I explained to Dr. lamartine very carefully that our previous conference occurred after the budgets for 1928 had already been voted and that the present visit is nothing more than a scouting trip and thet nothing may ever come of this prip. This afternoon we visited Pitimbu, close to Natal, on a good auto road with the Governor, his aside and his secretary - Christobal. Dantas who has been in the USA ‘studying cotton end-—whe- speaks American well. Pitimbu had a had reputation 47 1923 for mlaria but according to the foreman is now free from malaria. This he attributes to the opening up of drains in the past two years. Several people questioned but no history of recent attacks could be secured. All children examined did not have spleens except on boy of 14 who came last year from Sao Jose (very malarious) drains examined shewed numerous young Anopheline larvae but no pupae were seen. Many fish in open water. Dr. Adancho da Camara, Chief of Police. Dr. SantiagoyVarella, Director Hygiene Estados” Dr. Jose Ignacio, under Dr. Waldemar in DNSP, Jan, 29. See note on Igiipo Jan 31. At about 8:30 AM a special train left Natal on the Federal line for Caara Mirim carrying the Gov.,myself, Dr. W. de SeAntunes Dr. Santiago Varella and two or three other persons. We arrived at about 10 O'clock and had a sumptuous coffee with cheese, and cakes, etc. After a delay we started out to see the valley of the Ceara Mirim. This valley is very flat and very fertile lying between rows of hills on both sides. The lower course is now abandoned but the chimneys of many abandoned engenhos can be seen in this part. The part now being worked is very productive but is subject to floods because of the blocking of the mouth of the river, The River Ceara Mirim is not easily ‘distinguishable now because of the multiplicity of canals which have been dug. We stopped at a number of engenhos and I examined about 35 children but found no enlarged spleens, Much hookworm is evident. Many fish were present in the deposits of water examined and no larvae were found. Examinationsoof water very few. Mosquitoes seen at Ilha Bella were all culex. Iunch at 3 PM in house of old Baron on outskirts of Ceera Mirim belonging now to Varella family. Return to Natal arriving at 6:30 PM, Resume: Ceara Mirim valley is too big for R.F. and is not properly a malaria problem, It appears to me as largely an economical problem. Malaria undoubtedly exists in the town of Ceara Mirim and in certain of the engenhos during the winter months. Jan 30. Examined yf service with Dr. Waldemar beginning in lower part of city in Rua 15 de Novembro, 24 houses visited gave 1 steg vocus an outside jarra neglected. Surprised to find water piped to many homes with such low pressure that faucets are not used and delivery of water is direct into large earthen jarsset in the ground, ip“below the surface. Thus thorough cleansing or even emptying is almost impossible. When 48 17.2% we went to the source of this supply we found e large spring with a deep round bricked deposit for storage; at the foot of a hill on which is the home of some German priests. On the hillside some meters above the spring is a large tank into which water is pumped from the spring by electric motor. iIt seems that the houses supplied from this upper tank have plenty of pressure but the houses supplied directly by gravity from the lower level have very little pressure and that only during certain hours of the day. Iunched at home of Dr. lemartine who has a high well ventilated house built on American plans with slight modifications, Dr. L. has 10 children 5 or 6 of whom were at home. During the conversation Dr. L. ssked what I thought regard- ing the R.F. cooperation in malaria. I repeated what I had previously said about this being only a scoutingtrip but added frankly that I did not believe that the R.F. would consider the Ceara Mirim valley drainage as an important malaria problem but rather as an economic one; that if the R.F. came in,some time would be devoted to /ustarah , ye preliminary studies and that control demon tretionf{imcl kee ada ite that a demonstration and study in the north OF Saws edesut the Brazil would probably be of value for Brazil SVB Le etter tt north of Alagdas (at least) and along the littoral. | pyle: Dr. L. stated that he would be willing to cooperate ~~ te in every way possible if we cared to come in. «: A description of the conditions found in the Rua 15 de Novembro was followed by a visit of Dr. J.L. to a couple of houses and then to the water supply described above. Dr. L. agreed that this situation must be corrected and suggested that enlarging the tank above and sending all water up to this tank would solve the problem. He thanked me for having called the matter to his attention. I took occasion to show him . . thet \ Oo 5 tnctem it trata Natal is not now a dangerous point from a y-f. standpoint but that as soon as regular traffic by aeroplane with Africa is established Natal as the first Brazilian port of call will become the danger point par excellance. Dr. J.L. insists that plans are underway (weigh) to give Natal a real water service to take the Place of the part time service now had from bored wells. In the afternoon with Dr. S. Varella to the Hospital for Criancas under construction since 1923 promises to be a very nice and useful baild= ing when completed. The State Service and Assistencia abé together with the usual results. Jantei with Dr. Waldemar and Donna Iwlu. Two children Maria Thereza, 8 yrs. old and Maria lucia, lyr. 3 mos. 49 92% Jan. 31. Notice from Dr. Lemartine that he had arranged a passage for me on the mail plane leaving here tomorrow morning (latocoere) This means that I will be in Recife Wednesday AM about 7 and will be abe to see some of the yf work there, visit Dr. Gouveia and easily catch the Gelria on Thurs. at 10 AM, Other wise I should have taken the Itaquatia tonight and arrived in Recife late Wednesday night or maybe not Thursday AM, Igapo - a very malarious place close to . . Netel, just across the RR bridge on the line to re-gaunfinc wake Ceara Mirim. The fever here is usually a benign tertian but occasionally as in 1922 the malignant type becomes epidemic. Many fatal cases occurred in 1922.) Cosi Caled at the palace this afternoon and took up the following points with Dr. Lamartine: 1. No immediate results expected from this trip as far as malaria control is concerned. 2. Future campaign if undertaken must be on health and not seeonomic basis with radius of action limited to populous centers after preliminary study. 3. Article of Correio da Manha saying RF is withdrawing from Brazil not justified anymore than it was in 1916 when RF entered Brazil. 4. Dr. Connor to visit Natal soon and to call on Dr. lemartine. (Waterworks) 5. Dr. Waldema¥s relation to our work — YF | ‘+ 6, Thanks for courtesies extended. \ The Gov. offered to turn the state over to me for six months if I return to Natal and I promised to put his fattening secretary (Dantas) on a diet for those months.) Call off Dr. Waldemar and go to his home for coffee. Return to Hotel six PM and receive fare- well call of Dr. lamartine, his secretary, sdjudante de ordens, the prefecto Dr. 0. Grady who speaks English and the chief of police. All set to leave hotel at 3 AM tomorrow. Feb. 1. First awoke at 11:30 PM last night to be sure and not miss the 3 AM plene. The flying field is about 20 km from Natal. We arrived there at 4 AM after a wild night ride ina Chevrolet truck. At the field we found a biplane and a monoplane, the latter being the machine of our trip. Because of low hanging clouds and resultant darkness we did not teke off until 5 AM. Preliminary arrangements included the searching of the flying field with the headlights of the Chevrolet truck for possible stray animals which might be dangerous on the take off. The plane followed the course of the beach from Natal to 30 IF 23 Recife where it arrived at 6:45 AM. Some bumpy air was encountered the first few minutes in the air but after that the trip was just pdain flying. Dr. Connor met me at the flying field. We first visited a "jarra" factory where new models are being made and then on into the staff house for coffee. Then to see guarda at work in down town section. Jarras all practically non-existent now. Visited jarras with attached and sealed j fitters. The follow up calls made at homes where foci had been found were very éntereating resulting | in some broken jarras and destroyed barrel/s. i Dr. MEC says the only real serious problem now c is that of the militares. The "festa das Pocas" was later visitdd which had been vigorously 1 controlled by Julius Cesar. No jarras found in : use here now. A visit to the Presbyterian School found Miss Douglas and Miss Kilgore still on duty. Mr. Burt, of Consulate, lunahes at staff -house. Dr. Connor and I open joint account at Nat. City Bank. (Mr. Goodman manager). Call on Dr. Goweia in PM at Dept of Hygiene. See many old friends. We go at Leites with Dr. Souze Pinto and Dr. G. Cardoso. 2. RAE near mee Lane TRI RA Feb. 2] Sail on Gelria for Rio. Finish reading "An American Saga", Carl Jensen. Feb. 3. Bahia. Tennis with Dr. Burke. Feb. 6. Arrive Rio 6 AM Feb. 7. lLlanch with Dr. and Mrs. Biel of K.C. at Hotel Gloria. Rev. John R. Scotford, Cong. preacher from Cleveland, with letter from McKinley Warren, Feb. &. Feb. 9. Lunch with Miss Dawson and Schwarte, Mrs. P, and Mr. Ledeie. Aedovy Feb. 10, Feb. 11. Rev. John Scotford, Cong. preacher from Cleveland Ohio and mother dine at 125 Bolivar. Bow Feb. 12. Grippe all day. Harve girls and Miss Cobb dine at 125 Bblivar. Feb. 13. Dr. A. lintz, Dr. Decdo Perreiras, D.A. Andrade and I have session from 5#30 PM to 8 PM, Dr. Lintz tries to show us the sdvantage of tilel!l!! We are of difficult 51 FRAY conviction! For new contract with R.F. I insist on the organization of a unified malaria service as part of the state department of Hygiene. It seems that Decio now has the whip hand and it is somewhat doubtful if this measure goes across. However it is the goal toward which we must work, Feb. 14. Prepare proposed contract for State of Rio and submit to Andrade. Fey. 15 Dr. and Mrs. Biel to lunch at 125 Bolivar. Feb. 16. , ¥eb. 17, Feb 18 Génnor wires "Rumoug yellow ‘\l Y F fred Q fever Sergipe being investigated." bj Feb. 18. Leave Rio on Central at 7:30 Am with ” Iuud Raanlee Campo Bello, hoje Barqy omega de Mello at “NO, Sl ampo Bello, hoje Bar ome e oa oe 12:30 PM, We are met by Dr.CPampos Porto of the ra 4e ty Aerqufat Jardim Bota¥ico who says that Walthersis Arvwrnreg pp an full but that we will be taken care of at the ed Jardim, After visiting the milk freezing and butter plant we go to the Jérdim in an old Ford, piloted by one Schubert, passing the military T.B. sanitarium enroute, At the Jardim we are met by Mrs. Cempos Porto, Florita, Estella Rabico (Capetao Ki-Ki), Dr. Machado, chimico of the agricultural college, and Mario. A purple tree flower called "quaresma" (Lent) is everywhere in evidence. Feb. 19. Stroll to Iago Azul. Mrs. Parsons reports a hard bed. Children's Carnival at af ee _ ne Feb. 20. Visit to Dr. Machadds sitio. a Feb. 21. Leave Jardim (816 Mts.) at-2 PM horseback and arrive at Maceiras (4960 mts.)at 4:30 PM, My mule) Prenstal Influsnce, is entirely impervious to all forms of physical stimuli with the exception of blows rained upon the head between the ears. A delightful cabin with apple and pear trees forms the uppermost station of the Jardim. All the comforts of home except spring beds. Feb. 22. Leave Maceiras at 6:30 AM and arrive at foot of Agulhas Negras at 9 AM. Reach top of peak (2951 mts) at 10:35 AM and get baek to base at 11:30 with clothing soaked with perspiration. Return to Maceiras arriving about 2 PM. Lunch, dinner, bridge and bed. 52 172% Feb. 23. Leave Maceiras at 7 AM and arrive at Jardim at 10 AM after side trip to Walthers. See Donati. Take 1:40 PM train for Rio. All reach Rio with new appreciation of spring beds. Feb. 24. Holiday. ("Day of the Constitution") Afternoon at office. Letter received regarding trensfer of Kerr to Psraguay. Feb. 25. Sat. ) Heavy rains. Feb. 26. Sunday ) Feb. 27. Annual report seaked by rain. Mrs. Parsons insists that she has no responsibi- lity in helping collect funds from the government exen tho' the responsible man is assigned to her service by Dr. Fraga; that Alfredo always has collected these accounts and that our bookkeeping staff is no more full of perfection than is her service. Consultation with Dr. Fraga. He has n of aspect cases of yar other than our notices of Sergipe cases of kst week. Asks about fellow- ship and about possible help for School of Hygiene in Rio. Promises to send proposed list of candi- dates and proposed project before Congress to me soon for transmissal to N.Y. Feb. 28. Pedro Dias was informed by phone that the Bank of Brasil in S. Paulo had refused to receive the money for the State Treasury from the National City Benk destined to pay the first installment of the Medical School. To Megiunhos with Alfredé> to see about old accounts of 1918-1919. Good promises received. Feb. 29. Annual report. Mar. 1. Mrs. Parsons and Mame LeDoux to dinner. Mar. 2. 3. Saturday - Still running fever. 4. Sunday. Afternoon at office. Evening to see Merjon in Gentelhomme de Paris. 5. Dr. Fox, Quarantine officer of Port of N.Y. calls in Rio. 6. = 7%, Dr. Fox and Mrs, Dr. Warner and Mrs. Parsons and Schoenfeld to dinnér. 93 172% March 8. Dr. M.P. arrives and dines at 125 Bolivar. Mario says that all county health units except those in which the R.F. is interested have been taken from his direction and are now in charge of Dr. Salles Gomez, long autagonistic to the work of the Foundation. Merio should soon be out of this mess as he has brought up his pepers all in order for a fellowship and FUR has written promising approval. FJR believes we should arrange no new work with Sao Paulo as long as part time basis is used. March 9. To the PrevgPtorium for TB boys on Raqueto (Dr. Madeira is chief of service) run by TB League with help of 120 contos from Federal Government per year. In charge of Spanish order of Sisters. To Igha das Flores to see immi- gration station in PM. Capacity for 4000 under. pressure. pholere and typhus taken to Ilha Grande. Other sickness handled here. In time of epidemics all immigration through port of Rio; now mostly through Santos. 10 cases of Trachoma waiting deportation. Dinner with Mario at Brahma. Mar. 10. Saturday. % (A. Mar, 11. Dinner with Dr. and Mrs. Peter Warner. (Capt'n. Navy) and Dr. and Mrs. Charles Foxsat home of Warner's. Supper at Hotel Palace with Fox's. Mar. 12. Connor and Burke have gone to Araca ju. Branardod Burke writes under date of March 4th "They? | \ were trying to slip the word to Rio that Sergipe had yellow fever without letting sex criado know anything about it, so I just rested my foot on | the floor board until I was satisfied they were not in front of me, which however, resulted in neglecting other observations." Connor reports 95% of houses in Recife without jarras of the old type. Conference with Dr. Fraga and Dr. laFayette about Sergipe. Fraga is also informed thet ellowships are not available this year. March 13. Dr. Waldimiro advised that Foundation help not available in 1928 for Food Chemist. March 14. Lunch with Schoenfeld at Jockey Club. Annual Report finally sent on today's boat. March 15. Idle day at office. March..16. Sail at 4 PM from Rio on "Avelona" of Blue Star line. Meet Dr. Pedro Xisto, rooming with Rev. Smith in Santos, and Sir. Guillermo de Ezcurra of In Nacion B. Aires. The conversational wu efforts of the three of us, one Brazilian one Argentine and one American lasted until 2:30 AM in spite of the arrival of the Avelona Santos at 6 AM the following morning. I was particularly interested in Ezcurra's discussion of the Argentine political situation and did 911 I could to keep the discussion on Argentine politics and away from Brazilian politics and literature. Irogoyen{ Hippolyto) was really the secretary or assistant of the organizer of the party which finally broke up the old aristocratic policy of passing the Presidency around from one great family to another. At the time #f he took over the machinery of the party and had himself elected president. For years he ruled all Argentina even the provinces without appearing at public meetings. He has been described as the President that nobody saw. He worked entirely through agents who came to him for orders and they went out and fulfilled those orders and reported to him on conditions in their section of the country. BS this respect he was very much like Borges Mede who ruled Rio Grande so long.) When he came to the Presi- dency, he surrounded himself with unknown mini- sters of little talent. He believed in direct rule of the president andninisters were to him but high class secretaries. Congress was allowed to meet, his message was sent to it by a servant and it was not consulted in matters of government "To the victors belong the spoils" was the order of the day and all public employees were changed. Interndly then the government was bad but externally seems to have been goad. Strongly nationalistic, Irogoyen refused to enter the war with Germany or permit the cooperation of the R.F. in health matters in the Republic. When his term drew to a close he elected Dr. Alvear, the present President, to succeed him. Dr. Alvear had the following qualifications: 1. He had spent threellarge fortunes which he Kad inherited. 2. He had lived a great many years away from Argentina and hence had no political alliances. 3. He had always shown himself tractable. In office however, he failed to agree with Erogoyen on the question of federal intervention in the provincial elections of the province of Buenos Aires. Since this divergence of opinion, the party has been split inte? the personalistas for Irogoyen and the antipersonalistas those opposed to his domination of the Party. The Minister of Public Instruction under Irogoyen was a primery school teacher from the interior. He was burlesqued in a play which ran for three Jojou 55 1923 years in BA of unknown authorship (at the time. Iater discovered that it was written by an en- ployee of the Ministerio.) The minister is first shown receiving the telegram in his tiny rural school in Ja notifying him of his appointment. When he arrives in BA he asks the servents of the ministry how to behave on various occasions. When asked by Congress for an explanation of his educational programme he says that he believes in "Sound minds in sound bodies" and in shoes for every scholar. (Not so bad for hookworm | at that. . March 17. St. Patrick's Day in AM. See the gash in the side of Mont Serrat and learn from the paper that on the 7th of March the prefecto was notified of the crevasse on the side of the hill; the prepéyto notified his engineering service to report but nothing had been done when the catastrophe occurred. Result 107 people killed by 300,000 cubic meters of earth. ’ 900,000 bu. met. are still expected to fall. Leave Santos at 8:25 AM arriving in SP at 10:19. M.P. not at office because of operation on one of his boys but comes to hotel at 2 PM, We go over the local situation which remains largely unchanged and then call on Borges Vigra. Borges reports that the work on the Institute should soon begin as the final contract is to be signed Monday. Borges promises me a letter giving the actual work mw being done by the Institute. M.P. reports that some doctor, enemy of Paula Souga's, but whose identity MP does not know is reported to have said that the only salvation of the S.P. of S.P. would be Geraldo's recall from Europe. The work of destruction goes on apace. M.P.'s proposed trip to the US has been given as the reason for the transfer of all non- Rockefeller posts to Dr. Salles Gomes. The Rockefeller serviwe has not yet been touched; the state service hewever has gone back to the Delegacia de Sande plan with Pascale and others of our old service acting as delegados. Afranio Amaral has returned from the US and gave to the newspapers an interview in which he states that the Institute of Butantan does not yet exist - in fact never did exist but that now it is to come into being under hismble auspices. Jayme Pereira, who has recently become professor of physiological chemistry, by concurso and is therefore untouchable rose to the occasion in the medical society and insisted that this inter- view must have been erroneously reported by the papers and that he expected a public denial on the part of Afranio. Some Dr. Rebello, of the Police, stood with Jayme on this and the firends of Amaral esid notbine - A 1F2% Mario believes nothing can be gained by going to Julio Prestes now and explaining the position of the R.F. on full time employees for public health work. More rope must be given although it seems that the higher powers are beginning to realize what is happening. Two months more should bring matters to a head. Accidentally meet Dr. AT Pinto on the street. He has "good news for me" but what I want is money and not any more good news. He promises money for the end of April as he now has a government job which is to pay 1:450$ per month. I tell him he must pay as otherwise I must protest his notes. AdASs Td 1 Hotel and early to bed. March 18. Sunday. Dr. Pedro Dias calls at 8:30 AM and we visit the local of the new medical school where we find Dr. Souza Campos waiting. The excavations for the foundations are finished, much lumber for forms, cement, rock and gravel and iron are already on the ground. A short branch line of the trolley line has been made and the power lines are just about ready. I explain to Pédro Dias the money available and the manner of payment and it is agreed that we will send 600 cnntos per month beginning with April which will mean 6,000,000$000 paid by the end of 1928 leaving 409:000$000 to bepid in 1929. It would semm that the work will go forward rapidly from now on. Dr. Souza Campos insists that everything is being weighed and messured on arrival at the ground; and that they found a shortage of 600 kilos on iron delivered. On our return to the Hotel, Dr. P.D. and I have a long talk over the local situation. He says that: he always was antagonistic to P. Souza but that he realizes that his organization of the SP was good; that he recommended Moreno and others as director and not W. Oliveira; that W.O. had been P.S.'s right hand man and fully in his confidence but that as soon as P.S. is out he became his enemy; that he is trying to destroy all the work of P.S. When I ask why P;D{ takes pencil and draws picture of a burro with a rider. He refuses at this point to name the rider but later admits that it is Arthur Neiva and Selles Gomes. Pedro Dia$s only connection with the SP has been through the section for the verificagao dos obitos. Since P.S. left this service has become continually worse. Few cadavers are now received and generally these are four or five days old and putrid. P.D. understands that the service is to be discontinued. I ask why? and am told thet Paulo Souza inaugurated this service and that the enemies of PiS. are 132% now riding. (I suspect that the unknown doctor mentioned by Mario Pernambuco yesterday is none other than Pedro Dias.) P, Dias insists that he it was who secured the approval of the budget for the* School of Hygiene with the promise of 800 contos from the State; that B.V. in the absence of Paula Souza is with- out great influence. Julio Prestes asked P.D. if he were not in favor of the School of Hygiene as part of medical school; he replied that he had had that idea for the=betterment of the school!!! but that the arrangement between the Gov't and R.F. provided for certain things and that he had promised Paula Souza before he left and had promised me in front of the Secretary of the Interior to make no move toward such inclusion of the school in the Faculdade; that in the face of the previous understanding the government should dther approve this budget. and get on with the work or should return the money already spent. The result was approval. I discuss with P.D. the R.F. attitude on full time. He cites the case of Dr. Nicolas Moreno who had a good practice and abandoned it entirely to devote himself to food examination and is now reduced from 3 to 2 contos per month and from full to part time. P.D. agks bluntly who will explain to Julio Prestes our attitude on full time. I tell him that my relations are through the Director de SP to whom I explained this attitude some months before the chande was made. I further state that I believe it will be difficult to secure R.F. cooperation beyond 1928 in face of present facte of all part time émployees. That such discontinuance of our service is disagreeable because of our long association of 10 years here and that we are sorry to see the situation as it is in a state where we have spent much over 1000:000$000 in public health work. (I suspect this interview will go in a few days or less to J.P.) Dr. P.D. says that he is responsible for the appointment of Afranio Amaral and that although A.A. knows this he has not even coffe to call since his return, Furthermore the inter- view on the now existence of Butantan has reflected on P.D.'s choice of a director. (Yes the world is still round.) P.D. says that a1] Amaral ever knew about snakes etc., he learned from Vital Brasil. March 19, Conference with Dr. Waldemiro de Oliveira mostly devoted to accounts with *P.D. insists that there had been active blocking of the Institute plans by Neiva et Cia. Neiva is starting a new Biological Institute. 58 R.F. and to Nurse's Training. When I mention possibiadity of talking health work to Julio Prestes, W.O. changes the subject immediately. To Santos by car and Rio by Andalucia. Arrive at office at 11 AM March 20. March 20, Reports from Bahia indicate thet Gee ot Arawjo called tissues from Sergipe positive oO Y for yellow fever. Tissues have also been sent to Rocha Lima in Rio and to N.Y. Reports from i Connor at Estancia say no new cases have appeared, | Conference with Dr. Fraga who feels cases may be y.f. I discuss freely with Frage the details of the S.P. situation in Sao Paulo and suggest that a visit of his in the near future might be of value in preventing the passage of the new project by Congress. Meet Dr. Carins 7 in Fraga's office. He recently returned from a hospital inspection trip to the USA. March 21. Rio. March 22. Rio. Andrade brings in counter proposal of State of Rio, Not satisfactory. March 23. Connor reports Sergipe cases probably Poe ber or not yellow fever. March 24. Very hot. To Petropolis in PM March 25. Petropolis. Heavy rain. _ March 26. Return to Rio. Kerr arrives on fat luptsdh Zeelandia. Telephone call from Rocha lima says | case of Estancia (Maria de Lourdes) if§ positive for y.f. case was diagnosed y.f. by Dr. Rocha lime, Wire Connor and also write Dr. Russell. Muench and Kerr leave at 7:30 PM for Bello Horizonte, March 27. Advise Drs. Fraga and leFayette that March 31. Sat. Hospital propaganda meeting at bldg. of the Empyegados do Commercio on the Avenida. Very hot. Mrs. Parsons introduces Miss Dorothy Morse wholms been 5 years in Chile with the ME Mission as nurse. Mrs. Parsons considers available for work in Arthur Bernardes Hospital on return from the EUA. Dr. A, Lintz from state of Rio suggests con- ferenge tomorrow. April 1. Meet Dr. Iintz at Cruz Vermigha at 11 AM, Dr. Renato Machado shows us his installation for ear nose and throat work. Dr. Castro Aragjo is also present. Discussion of contract forces 59 to the conclusion that old contract must be renewed. April 2. Dr. Fraga says Rio is now without anti- steg service and hence vulnerable to y.f. if imported from Sergipe only 3 days away. (Wire Gonnor of Fraga's fear. April 3. April 4. Visit Estrella, halfway between Rio and Petropolis with Drs, lintz and Dr. Godoy of D.C. Inst. where new study ofbiology of mosquito and also of malaria is to be made. The land and buildings are to be furnished by a real estate company and the State of Rio is to furnish some funds for installations. The work is to be done under direction of DaC. Chagas who goes to Europe rext Saturday. Kerr returns from Minas. April 5. Thursday 4 holiday. April 6. Sexta Feira Santa. Dr. Kerr and I take the 5:30 AM Barca for Nichteroy and the 6:30 train for Capivary, only to find that Drs. Aleides Lintz and Decio Pérreiras had arrived at 4:30 AM examined one or two ditches by flash- light beifig much annoyed that Dr. Andrgdeand- had not received them and had then proceeded to Rio Bonito on the 6:10 train. The high water from the river is backing up on the lowlands about Capivary and we find the tiles doing heavy duty in a reverse direction. Andrade demonstrates that his men do not know how either oil or paris green should be applied. good lunch is enjoyed in spite of Holy Friday. e Three cornered baseball helps the return trip Oe Ct g to an phexpected Pleasantness. Kerr and I arrive £u ‘ a home at 7:30 P.M, Sabado de Aleluia. April 7. Office in AM | call on Dr. Fraga in PM and discuss y.f. in north. Dinner and bridge at Muench*S. Moonlight. Sunday. Easter. Mass at Cathedral. Monday 9. To Quimados with Andrade and Kerr. Impression of service only fair. Some tiles should be deeper and many more must be used. Tuesday 10. To Sante Cruz with Andrade, Souza Finto,and Kerr. Dr. Janotzkopf is engineer in charge of the wireless station. Towers 250 meters high. Ditches are in good shape except . dbs , that floods have done some damage and one line of tile is blocked. Trip to Santa Cruz in 2 hours. Andrade breaks front spring. First ride in new model Ford. Shock absorbers are very good. Wednesday 11. Bishop Every and, Morres Jones to lunch. No Grace. Trip to Manguhhos. Thursday 12. Klotz confirms disgnosis of y.f. in Sergipe case. Fraga advised. On Wednesday Dr. Thomsz and Kerr went with me to Oswaldo Cruz Institute. Dr. Godoy the present director and Dr. Chaves insisted that funds will be available for some payments within | a month. We call on Dr. Aragao and suggest work on leptospira and y.f. in north. Dr. Rocha Lima is in S Paulo. Friday. Dr. Magalhaes from Bahia is in town. Saturday. To Petropolis. Capt. and Mrs. Watson and Miss Priscillia, Dr. and Mrs. Soper and Mrs. Parsons are weekend guests of Mr. E.V. Morgan at the Summer Embassy. This house is the home of the Prince heir apparent to the Brazilian throne. He is the grandson of the last Emperor Dom Pedro II. One of his brothers died of overwork for the Red Cross during the European War and another was killed flying for the English. His father was the Conde d Eu. The house is large with plenty of room for all. Capt. and Mrs. Babcock and Commander and Mrs. Wilson were dinner guests. Sunday 15. Tea at the home of Madame Mesqhuta and the Baroneza de Bom Fim. Their home and its furnishings are very interesting. -The Baroneza and Madame Mesquite and Mr. Downs | of U.S. Steel Co. are dinner guests. at Monday 16. Return to Rio. Dr, Maga lhges from wey Bahia lunches with us at 125 Bolivar. He says “Age that one suspect case of y.f. in Bahia proved og! ge of vomito preto et Patrocinio CMité before the appearance of cases in Estancia. Conference with Dr. Aragao and Dr. R.L. over Mac. R. and yf. | eoadnonkitd Tuesday J D. Tomaz and I call on the secretaries to the Ministers of the Interior and of Tegende faner* and secure freedam from Customs on materials. Postage and telegrams sre to be peid in cash and the bill presented to the Min. of the Interior at the end of the month. to be plague. Also that there was an epidemic |~ xo 61 There are but 3 Mgcacus Rhesus in Rio. Final publication of work of Stokes, Bauer and Hudson a arrived today. A very interesting piece of work, Can it be confirmed for Brazil? Tuesday and Wednesday (17th and 18th) largely spent visiting the Minister of Interior and the Minister of Fazenda. The minister of the Interior promises to pay our telegrams and postage from his budget. The arrangement being that we will pay cash and present the bill at the end of the month. At present we are paying only telegrams and the yellow fever service is paying neither telegrams nor postage. April 21. National Holiday. "Tirdydentes" i.e. "Toothpuller." However, better be a toothpuller : AL and be known to posterity as "0 homem do Cayyisao" & on ekr from statue in front of the Congress with a- aK shroud which completely covers the body than a q Gyoun Pasteur with but a bust statue on the Avenida Pasteur and that with a shirt open at the neck with the bosom exposed to the breezesthat blow. Letter from Dy. Russell announces that Dr. Janney will not return to Brazil. ames | QuetB, daughter of . Ar¢ternoon ride to Ti juga and Paul and Virginia. Very hot dusty day. April 22, To Post 6 in A Mg” Dr. and Mrs. Jansen de Mello. In PM to Jockey Club with Mr. Nave and Miss McKinnon. The Jockey Club was apparently built to ecyipse Palermo in Buenos Aires and I believe does so. Sunday supper at German Restaurant in LefRe with the Muenchis. LEME 9g April 23. Dr. Connor arrives on drania. Epide- miologically refuses to consider Sergipe cases NO cee” as y.f. Believes that epidemiology of y.f. is more certain than is pathology. Visit Mr. Morgan at lmbassy. Visit Hengino and consult Drs. Rocha Lima and Henrique Aragao. Discuss possible commission. Consult Dr. Barros Barretto and suggest DNSP commission. Dr. Fraga is at Caxambu hence get no definite action. Dinner with Dr. Connor at Copacabana. (Muench's and Kerr present also.) Dr. Kerr returns from Oliveira. April 24. Swim at Post 6 with Connor at 7 AM. Visit Mr. Dawson and later in the day Dr. le Fayette de, Freitas. Dr. leFayette agrees to wait and wthéH program and likes idea of DNSP STUDY commission. Connor sails at 5 PM on Jelria. G Arai 62 AB April 25. Dr. M,. Pernambuco arrives from Sao Paulo. Says all of assistants except Dr. Waldemar de Rocha have been taken from him as well as 400$ budget for extras in office. He says that Rosalvo Salles is to ask 6 mos. leave and thet W.0. is going to try to put in local physician. I authorize him to stand pat and hold his own candidate. M.P. reports that there is talk of change of Sec. of Int. in which case Paula Souza and R.F. should be in better position in Sao Paulo. There is no need now for my proposed trip to Sao Paulo. "Let sleeping dogs lie." Dr. Pedro Diss and Dr. Borges are notified of transfer of funds, viz second 600 contos thru me for Medical School and 1st 20 contos through me for the Institute. Nave and Kerr, Miss McKinnon and Miss Pullen dine at 125 Béliver. April 26. Swim with Mario. Dinner with Mario, Kerr and Muench's at Central. Received payment of 15 contos from Oswaldo Cruz. Visit from ship for medical zoology. Dr. Andrade and Dr. Lintz call and discuss Rio contract. Dr. Lintz holds that service cannot be independent and at same time autonomous and finally suggests letting me talk to the president of the state on Monday. I accept this proposal. At the same time I explain to him how useless it is to maintain two services of malaria in the state of Rio. We finally go to the bank but are unable to secure money without the proper autho- rization of the signature of Dr. lintz.* Wire from Dr. Russell insists that case in Sergipe is y.f. and thet preceding cases must have occurred. Letter sent to Connor by air mail. April 27. Kerr sails on Cap Arcona for BA and Paraguay. No news from Fraga. Saturday. 28. All day at office - cleaning house. Sunday 29. Swim Post 6. Find Drs. R. Lima H, Aragao and Dr. Jacob neurologist in the sea. Tea at Copacabana in honor of Dr. Jacob. Meet Dr. Austrelgesio. Monday 30. Wire from Connor says 411 children | Fartuse and young adults in Estancia tobe autopsied by Uparoretiny / Biao regardless of caZuse of death.