In this letter Soper discusses his survey of Anopheles gambiae in Northeast Brazil. The survey was done to assess the malaria
epidemic. It included discussions with Brazilian public health leaders about how to handle it and estimates of cost. Soper
advises Sawyer that he'll be sending a request to the Rockefeller Foundation for $100,000 to set up a National Malaria
Service modeled on the Yellow Fever Service.
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4 (632,544 Bytes)
1938-11-23 (November 23, 1938)
Soper, Fred L.
Sawyer, Wilbur A.
This item is in the public domain. It may be used without permission.
Medical Subject Headings (MeSH):
Fighting Yellow Fever and Malaria in Brazil, 1928-1942
Letter From Dr. Soper to Dr. Sawyer Written At Fortaleza, Ceara, On Survey Of Anopheles Gambiae In Northeast Brazil
November 23rd, 1938.
Dear Dr. Sawyer:
Dr. Wilson and I left Rio on the 13th as planned in company of Dr. Evandro Chagas who had been over the worst of the gambiae
infected district a couple of times during the past six months. We remained in Recife until the 16th when we came on to Natal
by plane. At Natal we were joined by Dr. Manoel Ferreira, recently made head of the Federal Service for Malaria in the States
of Rio Grande do Norte and Ceara, and by Dr. Valerio Konder, the representative of the National Department of Health in the
State of Rio Grande do Norte. We left Nata 1 the same morning and slept the first night at Assu after visiting Sao Goncalo
and Baixa Verde, both of which points have had heavy outbreaks of Malaria following the introduction of gambiae to the region.
The following day we visited the lakes about Assu - lunched at Mossoro, drove to Russas for dinner. At Russas we met Shannon
and got a summary of his findings during almost a month's investigation. We spent the night at Limoeiro and on the 18th
worked up the Jaguaribe River, through Jaguaribe-Mirim, Ouro Branco and Ico to Lavras, spending the night at Cajazeiras just
over the line in Parahyba, because of better Hotel facilities outside of the gambiae district.
Since Shannon's work showed that gambiae was present at Ico but absent from Lavras, we decided to investigate the conditions
between these two towns. Shannon thought there must be some natural barrier which had prevented the extension of the species
up the river beyond Ico although there seemed to be some epidemiological evidence to suggest that gambiae had only recently
arrived at Ico. The caravan was divided into three parties. Drs. Manoel Ferreira, Gastao Caesar and FLS worked the River
Machado close to Lavras and the River Selgado close to Ouro Branco, without finding any evidence of gambiae although larvae
of other anophelines were found. Drs. Evandro Chagas and Valerio Konder investigated possible breeding places along the road
between Ico and Lavras especially in the first ten kilometers below Ouro Branco. Numerous foci of other anophelines were
found and a fairly high incidence of mild endemic malaria was revealed but no evidence of gambiae was found. The third group
consisting of Drs. Shannon, Rouanet and DBW began to work the Salgado River about ten kilometers above Ico and worked down
the river to a point about five kilometers above this town without finding larvae. These results all agreed in confirming
the absence of gambiae from the River Salgado above Ico. The caravan retired to Iguatu, which you will remember from 1934,
to spend a well earned Sunday loafing, sleeping and believe it or not, playing Bidou.
On Monday the 2lst, we lost part of the caravan, the remainder being divided into two groups to further investigate the region
above and below Ico. The previous work had left some doubt as to whether the gambiae at Ico had come up the river valley
from pool to pool or had made the jump from Jaguaribe-Mirim by automobile or truck. Shannon, Rouanet and I went up above
Ico and began working down from the point where operations had been discontinued two days before. Within a few hundred yards
of the point of beginning Rouanet found gambiae larvae. A careful search by the three of us gave only eleven larvae, all
from three small pools and all apparently of the same age. The uniformity in size caused Shannon to remark that we might
very well be dealing with the progeny of a single female. A recheck on part of the stretch worked two days before failed
to reveal any missed foci of gambiae. Before leaving the river four or five houses nearest to the foci which were found were
searched for adult gambiae. In the last of these a single female gambiae were found which Shannon pronounced a multipara
thus confirming his original belief that we were dealing with the original invasion of this point on the river by a single
gravid female. In the meantime DBW and Gastao Cesar worked the River below Ico about Bebedouro, finding gamiae at all points
investigated. Apparently the march of this species is in this case at least directly up the river bed.
Yesterday, we visited the lower Jaguaribe Valley and the town of Aracaty and came into Fortaleza, thus concluding this most
interesting field trip. This morning we learned that gambiae was found the other day by one of Shannon's men west of
Quixada. This is disagreeable news but only serves to emphasize the fact that once the gambiae into a river valley it will
spread up that valley unless blocked at some point by natural or artificial barriers.
I am enclosing herewith Shannon's seven paf6e report on conditions in Ceara as noted in his work up to the 17th of this
month. Were he writing it today some alteration would be made regarding the importance of impounded water and the resultant
irrigation ditches but otherwise it would remain just about as it is. I find it impossible to be as optimistic about final
results at as early a date as is Shannon but cannot force myself to be entirely pessimistic as to final results if we are
able to avoid the spread to the Parnahyba and Sao Francisco River Valleys. The amount of work to be done in the areas already
infested and threatened is enormous; whether final eradication is possible or not, I believe the effort will justify the expense
in the actual reduction of malaria in the region during the time that operations are carried out. The most hopeful factor
in the whole situation is the small proportion of the total infested area which is capable of year round breeding of any mosquitoes.
Much of the States of Ceara and Rio Grande do Norte are as you have seen covered with a dry desert type of vegetation called
caatinga. The caatinga areas have very little cultivation except right along the river beds or where water can be put on
the land artificially. And even along the river beds the available breeding places are reduced to a minimum by the long dry
season each year.
Our trip throughout the infested area coincided with Dr. Barreto's trip through the plague regions of Pernambuco and Ceara
on the final lap of which he spent one day in the gambiae district looking things over with Dr. Manoel Ferreira, who is as
mentioned above the Director of the Special Federal Malaria Service organized just a few weeks ago to attack the gambiae Problem.
Late, this afternoon we had a four way discussion of the situation with Ferreira, Barreto, Wilson and myself present. Barreto
opened his remarks with the statement that he had always been in favor of the fullest cooperation possible with the Rockefeller
Foundation and that he hoped some way could be found for the Foundation to attack the gambiae problem. I said frankly that
I had hoped that we might have a breathing spell to clear the boards before jumping from yellow fever into something else
but did admit that we had been considering what could be done about gambiae even before learning of the extension to the State
of Ceara and the 1938 epidemic. With the present extension of gambiae I feel that any failure to take immediate steps would
be criminal if means can be made available for immediate action. After Barreto's request for a proposal I state that
I have no authorization to enter into definite commitments without consulting the New York office but that after this week's
experience I am willing to appeal to the Foundation for funds immediately with which to collaborate with the Government in
the organization of control work if he and the other responsible authorities desire such collaboration. I give a tentative
estimate of budget for 1939 at seven thousand contos (approximately $350,000.00 USA) of which I am willing to request two
thousand cantos from the Rockefeller Foundation if the Government is willing to contribute with the remaining five thousand
contos. I explain that this estimate is nothing more than a shirt cuff calculation but that it should permit the organization
of as much of the service as would be possible under any circumstances the first year. I insist that the service should be
organized as an anti-gambiae service rather than as an anti-malaria service so that all those areas having malaria but not
gambiae would not feel free to insist on having attention from the service; also, the service to be organized should not have
the responsibility for medical care of the sick in dispensaries or otherwise. JBB objects to this point but we all finally
agree that quinine will have to be distributed by field personnel working in infested districts. Since there is no time in
which to develop a separate organization I suggest that the anti-gambiae service be organized as part of the Yellow Fever
Service, thus permitting us to build on the enormous experience of this service in this very area. (Gambiae is now in districts
which have had to be organized for the control of aegypti in rural areas). Also, and this is most important, the SFA has
a group of trained men who are accustomed to working under discipline which can be drawn upon for the nucleus of the new service.
The idea of the SFA taking over the gambiae problem appeals greatly to JBB, who, we learn, is anxious to avoid having his
five thousand conto malaria budget of next year broken into, although at least one thousand cantos of it had been ear marked
for Ferreira's work. JBB suggests then that we write the yellow fever contract on the basis of 15,000 cantos for the
first nine months of 1939 and depend on getting a supplementary budget later to complete the year. This suggestion is unanimously
rejected by myself and I tell JBB that I am not willing to mix yellow fever and malaria budgets this year since we are turning
the yellow fever service back to the Government at the end of the first semester of 1939.
To get on with the story: We all finally agreed that the present situation requires immediate organization, that the proposed
budget is a reasonable one until further information is acquired, that the present service under Ferreira should be taken
over, there being no obligation on the part of the service to be organized to keep undesirable personnel, and that the SFA
be used to mother the new organization during its first months. Barreto and Ferreira are stopping off in Natal tomorrow and
DBW and I are to proceed to Rio to get action as soon as possible. I promise to send information to New York immediately
for early action.
In regard to the central government, I can say that everything indicates that there will be no difficulty in getting the necessary
budget and in taking over the gambiae control problem. I told Barreto frankly that I had talked the situation over with the
Minister of Education and Health and had promised to make suggestions on our return from this trip. I did not tell him that
the Secretary to the President had communicated with me the afternoon before leaving Rio, stating that we could count on full
support from the executive arm of the Government!
In regard to budgets I believe arrangements can be made to make all necessary disbursements this year from the budget which
Ferreira already has available. Much of the materiel we will want to purchase cannot be gotten before next year in any case
and can be charged to the 1939 budget. As stated above I wish to recommend a one hundred thousand dollar budget from the
Foundation on the basis of five thousand contos from the Government. Thus, if my memory is correct, the requests now stand
at one hundred fifty thousand for yellow fever and one hundred thousand for gambiae for Brazil.
I am cabling you from Recife tomorrow:
Request authorization propose government immediate gambiae organization Budget 1939 Foundation $100,000.00 Government five
thousand contos Answer Rio - Soper
There can be no doubt that we are asking for an enormous headache for quite some time in offering to organize this programme
but I see no way to avoid the issue. And if work is going to be done it must be done on as large a scale as possible from
the beginning. When we came north (I think you should know this before deciding to authorize the amount asked for) we found
Shannon thinking that it would be useless to attempt to do anything this dry season and found Ferreira planning on a full
year's study of the situation before undertaking control.
Incidentally, gambiae or no gambiae, this field is very short of personnel. A few good men in the younger age group who could
be in training for the future are indicated. Likewise, I believe that Bates could be of more value here in the future than
almost anywhere else. Shannon is up here now and is very much interested in the whole situation but in the meantime the overhead
on the yellow fever laboratory goes on without many things being done which might be done with more technical personnel.