These pages represent an excellent illustration of the difficulty of identifying yellow fever cases, and the reluctance of
administration to acknowledge that yellow fever was back. The epidemic would break out in 1928.
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9 September-12 November 1927
Soper, Fred L.
This item is in the public domain. It may be used without permission.
Medical Subject Headings (MeSH):
Cause of Death
Fighting Yellow Fever and Malaria in Brazil, 1928-1942
Extracts From Parahyba Station Journal Regarding Suspect Yellow Fever Cases In Jacarau.
Late in the afternoon I received a letter informing me of the presence of fatal cases of a disease with the symptoms - high
fever, black vomit, jaundice, hemorrhages - in a village called Jacarau about five hours auto drive north of the Capital.
After conferring with Dr. Guedes, I made arrangements to visit the place tomorrow.
September 20. Tuesday.
Left the Capital at 6:00 a.m., stopping at Sape, Mamanguape and Rio Tinto to enquire if any notice of the disease had reached
those places. The pharmacist in Mamanguape had heard of the cases of yellow fever (and heard of them by that name), but the
doctor in Rio Tinto had heard nothing. Rio Tinto has a susceptible foreign colony of about 84 people, and has maintained
its own anti-larval service since the development of cases among the Germans there last year. The service is copied exactly
after ours, even using copies of our forms.
In Jacarau I visited the families of the deceased, filled out the epidemiological reports, visited three persons who were
sick, verified the presence of abundant Stegs in six out of seven houses I visited.
After studying over the symptoms related, and the spacing of the cases in the various families, I made the clinical diagnosis
of yellow fever in the seven cases (six fatal) that occurred between July 2 and September 14.
I reached the Capital about midnight.
September 21. Wednesday.
Sent a long telegram to Dr. Connor relating what I found and spent the rest of the day writing up the data.
Had a long conference with Dr. Guedes, who thought that the cases were yellow fever from the information on the epidemiological
reports that I read to him.
Dr. Connor replied by wire that he thought, from the incomplete information that I had sent him by telegraph, that the cases
were of malignant influenza. I made plans to return in a couple of days to observe further the cases which were ill when
I visited the place first. There certainly were no indications pointing to yellow fever among the three persons that I saw
September 22. Thursday.
Left Parahyba about noon, taking with me one of the guardas to make some inspections while I talked with the officials. I
made a survey of Mananguape, and a partial one of Sape, arriving at Guarabira about 9 p.m.
September 23. Friday.
Talked with Dr. Guedes, the Prefeito, and arranged with him to leave the guarda working in the city during the day. The doctor
was out of town, but the Prefeito had heard nothing of the cases in Jacarau.
Then I drove on to Jacarau, stopping at Duas Estradas, which is on the railroad and has the telegraph station nearest to Jacarau.
Learned of a severe epidemic of dysentery in Duas Estradas in May, 1927, but nothing suspicious of yellow fever recently.
In 1926 there were reported to have been some cases of yellow fever in Duas Estradas. Arriving at Jacarau at 10 a.m., after
driving two and a half hours over very bad roads.
I found the three cases that had been sick on September 20, all much improved, and up and around. But I saw three more children
and one adult quite sick, who had taken sick since my last visit. No other developments of interest. On the way back to
Guarabira I visited the village of Serra de Raiz, which is located on top of a high, isolated serra, about the most easternmost
of the state. Nothing of much interest was learned there.
In Guarabira the guarda had found about 50 per cent of the houses with Aedes foci. Our anti-larval service was stopped in
Guarabira in April, but the Perfeitura continued a service until July 31, after a fashion. I reported my findings to the
Prefeito and to the doctor in charge of the post of the P. R. The doctor had nothing of importance to report.
September 25. Sunday. Capital.
Dr. Connor drove up from Recife, arriving at the house at 7 a.m. We discussed the situation in Jacarau at length, and various
other less important matters. The things of importance which we discussed included:
1926 Epidemic - Dr. Guedes remarked that prior to the 1926 epidemic there appeared cases of yellow fever on a fazenda belonging
to a relative of his, which was very isolated in the region of Caramatu, pointing out the similarity of the occurrence now.
September 27. Tuesday.
Left Capital at 5 a.m. for Jacarau, my third visit, in company with Dr. Ulysses Nunes, of the Saneamento Rural, who is making
the trip in place of Dr. Guedes, who finds himself unable to go on account of urgent matters in his office.
All the patients that were sick on my previous visits are better today, but the two with slight Jaudice show that more markedly
today. In these cases the diagnosis would certainly be influenza, if seen in any other circumstances. Therefore, I made
the same diagnosis in these cases.
Returned to Parahyba via Rio Tinto, where I talked with the yesterday installed new Prefeito of the municipio of Mamanguape,
also one of the superintendents of the Cia. Rio Tinto. I explained that Dr. Connor had reviewed all the data upon which I
had based my diagnosis of yellow fever, and had come to the conclusion that the Jaracau cases were not of yellow fever. Hence
we were not instituting any anti-mosquito service. I requested to be notified immediately of any suspicious cases.
The Treasury of the Municipio of Mananguape is empty, but the Cia. Rio Tinto is going to finance two guardas to work the city
of Mamanguape. I offered to send the Guarda Chefe from Parahyba for a couple of days to get them started.
My company, Dr. Ulysses, left the Capital with the idea that the cases in Jacarau were yellow fever, and found nothing to
change his opinion. We reached the Capital about 10 p.m.
September 28. Wednesday.
Had a short conference with Dr. Guedes Perreira, talking over Jacarau situation more at length. Dr. Guedes still thinks that
the cases were of yellow fever. There were no new developments nor new opinions expressed.
Visited Dr. Texiera Vasconsellos in search of mortality data for Parahyba Capital, requested by Dr. Connor.
Wrote up in final form the various notes taken yesterday in Jacarau.
October 10. Monday.
Went to Jacarau alone via Mamanguape, returning via Rio Tinto, my fourth visit. I found all the people there recovered.
In Rio Tinto I advised Mr. Rueger that it was probable that the cases in Jacarau were not yellow fever.
From the subsequent history of the epidemic in Jacarau I am led to change my diagnosis of the nature of the disease. I think
now that the cases were not yellow fever, but I am very much interested in determining what they were. What killed the six
people? Malaria and plague seem well ruled out. There is meningitis in Brazil, but none here in the North, and no mild cases
have as yet been recognized.
The chief purpose of my visit was to take blood from four-year old Francisco Fernandes for a Pfeiffer, to be done in Bahia.
But I have no faith in the Pfeiffer reaction, and the result will not influence my diagnosis one way or the other. I got
October 21. Friday.
Received telegram from Bahia saying that the Pfeiffer on Francisco Fernandes of Jacarau was negative. But, as I have previously
stated, this does not carry any weight with me.
Nov. 5. Saturday.
Answering the accumulated correspondence of two weeks. Nothing noteworthy had occurred in my absence.
In the afternoon Dr. Guedes informed me that he had just been informed of new cases of yellow fever in Jacarau. Only very
meager details were submitted.
Nov. 7. Monday.
Dr. Connor and I went to Jacarau, a little over two hours drive from Guarabira. We interviewed the sister of the child who
had died on November 1, and took the history (see ficha No.PA-17). Symptoms were very similar to the other cases, but not,
in our opinion, yellow fever.
Returned to Parahyba via Rio Tinto and Mananguape, advising the officials in Rio Tinto of our diagnosis.
In Parahyba we conferred with Dr. Guedes, Dr. Connor saying that in his opinion the cases were not yellow fever, being possibly,
In this case, through the poor local telegraph service, a good opportunity for a post-mortem was lost. The "leading citizen"
of Jacarau telegraphed me on October 30, but the telegram was not received at this office. Had it been, there is a good chance
that a doctor would have been in Jacarau when the child died, and an autopsy would have been secured.
Nov 12. Saturday.
Guarda Chefe and I both worked on the follow up visits.
Called on Dr. Guedes, talking over the Jacarau situation with him. With the assistance of Dr. Ulysses Nunes, translated the
ficha (epidemiological report) regarding the last case in Jacarau, so that Dr. Guedes could send a copy to Rio.
Dr. Guedes is very much worked up over the situation in Jacarau, being positive that the cases have been yellow fever.
In the afternoon I called upon Pres. Suassuna, to tell him of my trip. In the course of the conversation the matter of Jacarau
came up. The president remarked that he was quite satisfied that the cases were not yellow fever, upon epidemiological grounds.
And he remarked that Dr. Guedes was unduly excited about the matter - and was inclined to get too excited under similar emergencies.
The president impresses me as a very intelligent, alert and energetic person, of a type all too rare in Brazil.