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The Institute of Inter-American Affairs and Its Health Policies in Brazil during World War II.

In March 1944, the U.S. Institute of Inter-American Affairs (IIAA) celebrated the second anniversary of its "cooperative health and sanitation program" in Latin America.(1) George C. Dunham, the director of the IIAA's health and sanitation division, evaluated the program's accomplishments and goals. Although Dunham took most of his examples from Brazil, the IIAA's program was not restricted to that country. The institute had signed agreements with all but two Latin American republics: Cuba and Argentina.(2) In March 1944, the IIAA had 181 North American technicians working in eighteen Latin American countries. Most were physicians, nurses, sanitary engineers, construction engineers, architects, entomologists, and business managers.(3) By January 1944, another 13,000 nationals of the other republics were employed by the program, of whom some 600 were qualified technicians, working on a range of projects such as malaria control, environmental sanitation, hospital organization, dispensaries and health centers, professional training, and health education.(4) Of the original 821 planned projects, 451 had been concluded by July 1945.(5)

Roots of Cooperative Action

The IIAA's health and sanitation program was a product of the Good Neighbor Policy instituted during Franklin D. Roosevelt's administration, as a direct answer to Nazi economic and political expansion and its effects on the Americas. Although the program began to operate in 1942, its roots went back to the 1930s. U.S. Assistant Secretary of State A. A. Berle Jr. indicated to the Buenos Aires Conference of Foreign Ministers of the American republics in 1936 the beginning of economic cooperation in the hemisphere. He outlined the diverse aspects of the Nazi policy that was threatening the interests of the United States in Latin America.(6)

The main economic issue highlighted by Berle was related to the trade between Latin America and Europe, particularly with Germany. During the 1930s, Latin American countries had been the chief suppliers of raw materials for rebuilding the German war machine. Germany had introduced the so-called barter agreements to Latin America to tie its trade to its economy. Through this implementation, commodities imported from Latin America were paid in blocked currency, which means it could only be spent in Germany.(7) So the new economic hemisphere policy, referred to by Berle, was to shift Latin American trade to the United States.

The United States was concerned with this commerce that "offered a fertile field in which the Axis power could carry on propaganda activities."(8) The political dilemma became more evident in 1937, when "Nazi and Fascist propaganda" began to be "exported in large scale."(9) Significantly dangerous in the political discourse of that time were the would-be fifth columns: Germans, Italians, Japanese, and their descendants living in the American republics. An American governmental publication alerted that some 1,400,000 "Axis aliens" and approximately 4,450,000 citizens of German and Italian descent lived in Brazil, "most of whom lived in the South and Southeast."(10)

Feelings of insecurity increased within the United States after the fall of France in 1940, and the U.S. government, for the first time, felt that the German military threat could possibly reach the Americas. After the Nazi expansion in North Africa, Berle believed that "it was perfectly possible that aggressive powers might commence to operate in the Atlantic."(11) The War Department realized that northeastern Brazil could be reached by the power of German aircraft from western Africa. Concerned with U.S. security, Under Secretary of State Sumner Welles suggested to the American ambassador to Brazil to have a "personal and confidential" talk with the Brazilian minister Oswaldo Aranha over the importance of the Fernando de Noronha and Natal areas, "both within ferrying range of European bombers operating from West African bases, and both of which could be used to facilitate the transfer of planes, men and munitions to the Western Hemisphere."(12) If the Nazis conquered the Brazilian hump, they could reach the Caribbean and the Panama Canal. Under this threat, by the second half of 1940, the focus of U.S. foreign policy shifted to hemispheric defense and cooperation.(13)

American business leaders were also discussing the need for economic cooperation with Latin American countries. One of these businessmen was Nelson Rockefeller, who in a memorandum submitted to Roosevelt on June 14, 1940, pointed out that U.S. economic position and security should be instituted "in the frame of hemisphere economic cooperation and dependence." He proposed a specific policy toward Latin America and suggested that the United States consume the region's agricultural and mineral products, increase investments there, and establish a program of cultural relations.(14) This proposal brought Rockefeller to a key position in the debate of how to deal with Latin America, leading to the creation of a specific governmental agency responsible for inter-American affairs.

In August 1940, the Roosevelt administration created the Office for Coordination of Commercial and Cultural Relations between the American Republics. A year later, the agency's name was changed to the Office of the Coordinator of Inter-American Affairs (CIAA), and from March 1945, until its termination in May 1946, it was called the Office of Inter-American Affairs. The official function of the CIAA was "to provide for the development of commercial and cultural relations between the American republics and thereby increasing the solidarity of this hemisphere and furthering the spirit of cooperation between the Americas in the interests of hemisphere defense." Nelson Rockefeller was nominated as coordinator of the new agency, answering directly to the president, with the formulation of the office's policies done in agreement with the State Department.(15)

The interest of the CIAA in the field of health and sanitation began in 1941, when the coordinator became aware of negotiations to establish U.S. military bases in Latin America. Rockefeller relied on advice from the staff of the Rockefeller Foundation, which had been working on public health in Latin America, therefore realizing that some of the areas proposed for these bases had unhealthy conditions. The coordinator suggested to the War Department that his office organize a "public works improvements" program around the planned military bases. The original blueprint intended to build water systems and hospitals and provide sanitary improvements, but the plan was made smaller, focusing on sanitation around the proposed bases. After the Japanese seized important production areas in Asia, the issue of securing the supply of raw materials for the war effort became as important as the fight on the battlefield itself. The health and sanitation plan was then extended to target-producing areas in Latin America that could compensate for the loss of supplies now in the Japanese domain.(16)

Adhesion of Brazil to the Allies' cause became imperative for the United States. In Brazil, both the military and economic interests of the United States fit into the CIAA's health and sanitation project. The military interests focused on the northeast coastline, where the Joint Military Commission for the Preparation of Defense in Northeast Brazil planned to muster a large number of armed forces.(17) Economic pressure for establishing the health and sanitation plan in Brazil focused on the need for rubber. This economic pressure was, however, subordinated to military interests. After the Japanese seized the rubber production areas in Asia, the short supply of this commodity became a serious threat to the Allies' war effort. Roosevelt had appointed the Baruch Committee to study the rubber problem, and the committee concluded that the war effort would collapse if an alternative for rubber was not found.(18) Because it was recognized that organizing plantations of new trees would take too long, the wild rubber trees of the Amazon became an alternative source for the supply of the Allies' armies as well as for civilian needs. To extract rubber from the Amazon jungles, however, would require an effort to overcome the deadly diseases of the region, mainly malaria. Consequently, the earliest health and sanitation project of the CIAA focused its attention on the Amazon basin and in the northeastern Brazilian cities that would receive American military personnel.(19)

The Institutional Setting of the IIAA and SESP

The Japanese attack on Pearl Harbor accelerated the creation of the CIAA health and sanitation program for Latin America. The Third Meeting of the Ministers of Foreign Affairs of the American Republics was summoned to deliberate on the defense of the hemisphere. The meeting, held in Rio de Janeiro in January 1942, approved two important resolutions for the United States. The second resolution recommended that the American republics mobilize their agricultural and mineral resources to support the war effort, and the thirtieth resolution recommended that the American countries organize public health programs through mutual bilateral agreements.(20)

As a result of the Rio conference, Brazil and the United States signed the master agreement on March 3, 1942--in reality, a series of agreements that ranged from the production of strategic materials to a health and sanitation program. A U.S. technical mission was also sent to Brazil that same year "to assist in the expansion of Brazilian production."(21) The economic mobilization of Brazil's resources was designed to increase the supply of strategic materials for the war, such as rubber, quartz, tantalite, chromium ore, mica, and iron ore. On March 14, 1942, Secretary Sumner Welles and the Brazilian minister of finance, Arthur de Souza Costa, signed the health and sanitation agreement. Welles's note stated that the "program would be initially designed for the Amazon basin area for the special purpose of aiding in the stimulation of rubber production," while Souza Costa's note stressed that this collaboration would "stimulate progress ... on the economic possibilities of the areas in question."(22)

Thus, the American and Brazilian notes stressed different perspectives on the master agreements. To the United States, the agreements had an immediate military purpose: they meant the utilization of the military bases in northeast Brazil and the access to rubber and other strategic raw materials needed for the war. The master agreements fit, however, into the Brazilians' plans for broad economic development; therefore, the note from Souza Costa stressed the "progress" and the "economic possibilities" the agreements could bring to Brazil.

President Getulio Vargas's Estado Novo, or New State (1937-1945), consciously pursued a policy of national development based on industrialization and state intervention. Private investments were encouraged, but the federal government expanded its authority to practically all sectors of Brazilian society, from wage policy and social welfare to heavy public investments such as the steel plant at Volta Redonda. The Vargas administration used the economic war effort to accelerate state intervention, planning, and economic development.(23)

Some American officials also had more grandiose plans. The health and sanitation agenda, for instance, was not limited to the Amazon basin but planned for the CIAA to have a continental magnitude. The program was presented to Roosevelt, who endorsed it on March 24, 1942, and instructed Rockefeller to administer the plan. The coordinator was also "directed to work with the State, War and Navy Departments, and likewise to consult with and cooperate with the governments of the other American republics." The IIAA was specifically created as CIAA's subsidiary corporation in charge of the health and sanitation program. The IIAA's official goal was "to aid and improve the health and general welfare of the people of the western hemisphere in collaboration with their governments."(24)

The activities of the IIAA were carried out in concert with the governments of the Latin American republics following bilateral contracts. Agreements were signed for a period between three to five years, and to carry them out, each republic created a cooperative agency known as the Servicio Cooperativo Inter-Americano de Salud Publica (Inter-American Public Health Cooperative Service). The cooperative agencies, or servicios, were frequently organized as part of the Ministry of Health. The chief of the field party representing the IIAA in each republic was appointed director of the servicio by the ministry of the host republic and answered simultaneously to the local minister and to the president of the institute. Grants from both the IIAA and the government of the host republic financed the cooperative agency.(25)

The cooperative public health agency in Brazil, the Servico Especial de Saude Publica (SESP) (Special Service of Public Health), was created on July 17, 1942, by a basic agreement signed by Jefferson Caffery, the U.S. ambassador to Brazil; George M. Saunders, representing the IIAA; Gustavo Capanema, the Brazilian minister of education and health; and Oswaldo Aranha, the Brazilian minister of foreign relations.(26) President Getulio Vargas soon appointed George Saunders as director of the newly formed agency.

Among the doctors who planned the health and sanitation program in Rio were Dunham and Saunders from the CIAA, Fred Soper from the Rockefeller Foundation, and Servulo Lima from Rio de Janeiro's department of health.(27) The basic agreement established the SESP's functions: the sanitation of the Amazon valley--mainly malaria control and medical assistance to rubber tappers--and the training of public health professionals, such as doctors, sanitary engineers, and nurses.(28) The headquarters of the SESP opened in Rio de Janeiro in August 1942, but the field operation soon concentrated in the Amazon region. Belem, the capital of the state of Para, became the center of field operations and personnel training.(29)

Malaria Control on U.S. Military Bases of Northeast Brazil

Negotiations on the establishment of U.S. bases in Brazil began as early as May 1940, when the secretary of state informed the U.S. ambassador in Rio de Janeiro that the Brazilian government was considering to offer the United States the use of its military bases in the northeast in exchange for military aid.(30) In February 1941, the Brazilian ministry of war officially proposed an agreement regarding war cooperation. The arrangement involved the use by the United States of Brazilian naval and air bases, the acquisition of industrial war material from the United States, and the supply of "raw materials for the munitions acquired from the United States."(31) A final agreement about the bases was only set, however, with the master agreement of 1942.

The Brazilian government cooperated with the United States in several military areas before a final agreement on the bases issue was set. First and most important, the Brazilians had accepted that Pan American Airways construct eight airfields on its territory. By 1941, the Airport Development Program, a military airfield construction project, was in the process of constructing airfields along the northeastern coast of Brazil. The goal was to establish two air routes to Brazil: a main route via Puerto Rico, Martinique, Trinidad, and Dutch Guyana and a secondary route from Texas via Panama, Colombia, and Venezuela. This chain of airfields allowed the movement of troops and military aircraft to the Brazilian bulge and, from there, to Africa and elsewhere. These airfields turned out to be essential for they allowed military materials to be delivered to the Allied forces in Africa and the Middle East.(32)

Military defense agreements were further extended in 1941, when both governments signed the Brazilian-American Joint Planning Agreement. Its goal was to conduct a survey on the military requirements of northeast Brazil, to prevent any possible menace from the Nazis. A planning group studied the Brazilian bulge and prepared what was called the Northeast Brazil Defense Plan. The plan proposed the cities of Natal and Recife, located at the eastern extremity of the northeast, and Belem, the entry port of the Amazon basin, as sites for the largest air bases and military supply facilities.(33) Other U.S. bases, however, would be built in the cities of Amapa, Sao Luis, Fortaleza, Maceio, and Salvador.(34)

The Brazilian-American Joint Planning Agreement also allowed the U.S. army to perform an independent medical survey on the Brazilian northeast to prevent any possible health hazards for American troops. In 1941, three medical reports were presented to policy makers. The first, a short general description about health conditions in Brazil, was issued by the Office of the Surgeon General.(35) The second, the independent survey made by the U.S. army, was carried out by George Dunham and focused its attention on the military strategic areas of the Brazilian bulge. It described the diseases prevalent in those areas, public health and sanitation services, and food production and distribution.(36) The third and longer report was prepared by the Brazilian-American Mixed Sanitary Commission to "study the aspects of climate, medical resources, nourishment, hospitalization, local geography as it affects health and disease, all with a view to mobilize local resources and on the concentration of the troops."(37) The members of this commission traveled by boat, railroad, airplane, and automobile, traversing a total of 13,020 miles in its three months and sixteen days of fieldwork.(38) It was an amazing task, considering Brazil's size and the travel conditions of that time. These reports, taken together, formed an incisive picture of the nosological conditions prevalent in the Brazilian northeast in the early 1940s.

From all diseases reported to be existent in the northeast, Dunham, who would be the strategist of the IIAA's health and sanitation program, considered malaria the major concern for military personnel in Brazil.(39) The U.S. War and Navy Departments also agreed that malaria was the number one health hazard that could menace American troops abroad.(40) Dunham reported that in the Brazilian northeast, "malaria prevails throughout the littoral zone, and in the interior where conditions are favorable for the breeding of Anopheles mosquitoes.(41) Malaria was endemic in the surroundings of all American airfields in Brazil, but particularly prevalent in the cases of Belem, Recife, and Natal. Because of the importance of these cities in the South Atlantic route, it became mandatory to enforce malaria prevention and control around these particular bases. Therefore, malaria control was one of the most important military concerns in the Brazilian northeast during World War II.

Malaria control in the U.S. bases of northeastern Brazil was a major task of the IIAA's health and sanitation program, enforced by the Brazilian SESP. The strategic importance of this control, however, led to a joint effort between American and Brazilian organizations, including the U.S. army, the Brazilian Servico Nacional de Malaria (National Malaria Service), the Servico de Saude dos Portos (Port Health Service), and the twin organizations SESP-IIAA. Controlling activities can be classified under three major categories: (1) environmental sanitation such as drainage, landfills, and major engineering work in the city of Belem; (2) temporary control measures, such as the use of larvicide in breeding places and, later, residual spraying in the military barracks; and (3) measures classified under "malaria discipline," such as the wearing of protective clothing, the application of repellents, and the imposition of restricting the movement of soldiers in these areas. The spraying of DDT was instituted in 1944 and was used in all barracks and in native houses in the surrounding areas.(42)

The Amazon Program

As in the case of controlling malaria in the U.S. bases in northeastern Brazil, the SESP's health policies developed in the Amazon region (the Amazon Program) were dictated by the military goal: to improve health conditions in the rubber-producing areas.

Increasing the output of rubber was one of the most intimidating supply problems the United States had to face after the outbreak of World War II. The vice president of the Rubber Development Corporation (RDC) explained why: "Many heavy bomber landings consume thirty kilos of natural rubber and in ten to fifteen of such landings the work of a seringueiro (rubber tapper) for one year is consumed."(43) The Roosevelt administration took effective measures to ensure a rubber supply in June 1941, when the RDC was created to stockpile rubber, while other government agencies made efforts to organize rubber plantations in the Western hemisphere. However, after the Japanese invasion of Malaysia and the Netherlands East Indies, two rubber colonies in Asia, the immediate need for rubber surpassed the efforts of cultivation. Because it would take years to cultivate rubber plantations, the wild rubber trees in the Brazilian Amazon valley became a solution to the rubber problem.(44) By the master agreement of 1942, a fund of $5 million was established to increase the annual volume of Brazilian rubber exported to the United States, "not less than 25,000 tons." This agreement also provided that the CIAA would carry out "a program of improvement of sanitary conditions" in the Amazon valley.(45) This was the origin of the SESP's Amazon Program.

The Amazon Program's main goal was to protect workers against disease--mainly malaria--and improve their productivity. Policy makers were well aware that they should protect the Brazilian rubber tappers against malaria to augment the output of rubber. In April 1942, Caldwell King, in a reconnaissance trip to the Amazon for the CIAA, supported the belief that "basically the Amazon problem depends on manpower." He claimed that if the plan to extract rubber was to be successful, health protection should be provided to workers. King stated that in the lower lands of the valley, for every fifty colonists, twenty would die and another twenty "will be poor producers because of illness."(46)

The SESP's Amazon Program followed a plan, initiated with the free distribution of Atebrine, a drug invented in the 1930s to combat malaria. The SESP delivered Atebrine to rubber tappers scattered along the most populated areas of the Amazon valley and in regions where the production of rubber was intense? Until the end of 1946, the SESP distributed more than 17.7 million tablets of Atebrine throughout the Brazilian Amazon.(48) Atebrine was, however, just an emergency measure that had to be followed by more effective malaria prevention and control. The first measure in permanent control was to make local surveys of malaria infection. In its second step to permanent control, the SESP selected the thirty most important centers of population and production in the valley as headquarters of health districts from which the agency directed malaria control through health posts.(49) The thirty health districts were to be divided into subdistricts, and the subdistricts were divided into small zones overseen by sanitary inspectors, "to cover all potential and actual breeding Anopheles places in a zone" once a week.(50)

The Amazon Program, however, was not successful. To control malaria using traditional methods in the Brazilian Amazon--an area of more than 1.3 million square miles and the site of the world's largest and densest tropical forest--proved impossible. Only after 1945, by the use of DDT, a new chemical developed during the war, malaria control in the Amazon became manageable. The limited success of the SESP's policies of malaria control were followed by a corresponding limited success in the production of rubber. The Brazilian rubber exports to the United States in 1945 did not increase above the 11,973 tons achieved in 1944, an amount well below the established goals set by the master agreement of 1942.(51)

The Rio Doce Program

The demands of minerals for the war effort soon led to the expansion of the SESP. One of the agreements signed on March 3, 1942, provided that the Brazilian government would increase the output of the Itabira iron ore mines in the state of Minas Gerais and would deliver the ore over the Vitoria-Minas Railway to the port of Vitoria in the state of Espirito Santo. The output and delivery of the iron ore were of vital importance to the war effort. The iron ore deposits of Europe had fallen into Nazi domain, causing a severe shortage of iron for the British steel industry and forcing Britain to rely on Brazil for much of its needed iron ore. Brazil also supplied the U.S. Metals Reserve Company with a large inventory of iron ore.(52) To develop the natural resources of the Rio Doce valley, the Brazilian government formed, in 1942, the Companhia Vale do Rio Doce (Rio Doce Valley Company), which incorporated the Vitoria-Minas Railroad, the only means of transporting the iron ore between the mines and the port of Vitoria. The Vitoria-Minas Railroad, which has part of its route on the Rio Doce valley, was of vital importance, and because of its deteriorating condition, the Brazilian government commissioned an American company to rebuild it.(53)

As was true in the Amazon valley, disease in the Rio Doce valley presented obstacles that had to be overcome to augment the output of minerals required by the Allies. A virulent type of malaria prevailed primarily in the upper part of the Rio Doce valley and, by coincidence, the most malarious area was located exactly where the improvements on the railroad were needed most. The employers of the railroad were aware that to maintain six employees at work, ten must be carried on the payroll. The Export-Import Bank in Washington warned the Office of Inter-American Affairs that "unless the health conditions in this region are improved, the completion of the reconstruction of the railway will be delayed, and large numbers of men brought in for the work will become incapacitated," and suggested the CIAA assist in this matter.(54) As a result, the CIAA summoned a conference in Rio de Janeiro to discuss this subject. Attending were the Brazilian minister of education and health, the head of the Brazilian division of the CIAA, a representative of the Export-Import Bank, and a representative of the Rockefeller Foundation. Capanema, the Brazilian minister, suggested the Rockefeller Foundation be in charge of this health program, but its representative declined. The consensus was that the SESP would be responsible for another health and sanitation project in Brazil, the Rio Doce Program.(55) An agreement was signed between the IIAA and the Brazilian government on February 10, 1943, originating the Rio Doce Program with the goal to organize public health services for the workers engaged in the production of iron ore and the rebuilding of the railroad.(56)

The Mica Program

The war also demanded the increased output of two other strategic minerals from Brazil: mica and quartz, mostly needed for radar and radios. The demand of mica for the Allies' armies increased in 1943, partially because the British were not able to maintain the level of their production of mica in India. The deposits of mica in the Rio Doce valley became vital for the Allies, and the U.S. government contracted to purchase all exportable surplus of mica from Brazil.(57) The SESP's Mica Program was a by-product of the Rio Doce Program and had its roots in a conference at the Office of Economic Warfare in Washington, where Rockefeller was informed of the scarcity of mica. The Foreign Economic Administration appealed to the CIAA to intervene on the subject. The coordinator immediately sent a letter to the chief of the Brazilian field party requesting that "all possible medical care in mica areas" be rendered.(58) As a result of this request, the SESP created in October 1943 the Mica Program to give medical care to workers in the mining areas of the Rio Doce valley. In January 1945, this program was extended to include the quartz mining areas of the state of Goias.(59)

The Rio Doce Program and the Mica Program were successful in achieving their goals to control malaria and to provide health care for workers. One of the main reasons for this success was the fact that, geographically, the area encompassed by these programs was much smaller than the Amazon. In fact, the Rio Doce Project did not encompass all the valley of the Doce River but only the area bordering the extension of the Vitoria-Minas Railroad and the mica mining areas of the valley. Also, the Rio Doce valley did not pose so many natural obstacles to mankind as did the Amazon region. These circumstances combined to produce the good results of the programs, either in public health or in the realization of economic goals.


The programs the IIAA-SESP developed in Brazil during World War II originated for a military reason: to control malaria around U.S. military bases in northeast Brazil and to increase the output of strategic raw material for the Allies' armies. Malaria control around the military bases was successfully achieved and enforced by a joint effort of Brazilian and American agencies. The Amazon Program was very limited in terms of achieving success in controlling malaria, at least until 1945, when the use of DDT changed the pattern of malaria control and brought a very effective decline in the disease's transmission. This record on malaria control was reflected in the limited increase in the output of rubber, although malaria cannot be solely blamed for these poor economic results. The Rio Doce Program and the Mica Program were successful in providing health care for workers and in helping to increase the output and exportation of strategic minerals for the war.(60)


(1.) Health and Sanitation Division Newsletter (hereafter HSDN), no. 41 (April 1944): 1.

(2.) "A Health and Sanitation Division em 18 paises," Boletim do SESP, no. 4 (January 1944): 6.

(3.) "Field Personnel," HSDN, no. 41 (April 1944): 6-9.

(4.) George G. Dunham, "The Cooperative Health Program of the American Republics," American Journal of Public Health 34, no. 8 (1944): 818-19.

(5.) "Programa cooperativo inter-americano," Boletim do SESP, 24 (July 1945): 7.

(6.) Speech of the Honorable A. A. Berle Jr., assistant secretary of state, on Latin American Series, Washington, DC, November 19, 1940, p. 2, FDR Library, Berle Papers, Ambassador to Brazil: Correspondence, 1945-1946, Box 77.

(7.) Office of the Coordinator of Inter-American Affairs, History of the Office of the Coordinator of Inter-American Affairs: Historical Reports on War Administration (Washington, DC: Government Printing Office, 1947), p. 3.

(8.) Ibid., p. 12.

(9.) Speech of the Honorable A. A. Berle Jr., p. 2.

(10.) Coordinator of Inter-American Affairs, Basic Data on the Other American Republics (Washington, DC: Government Printing Office, 1945), p. 25.

(11.) Speech of the Honorable A. A. Berle Jr., p. 5.

(12.) Sumner Welles to Jefferson Caffery, May 8, 1940, p. 2, FDR Library, Sumner Welles Papers, Latin America Files, 1919-43, Box 168.

(13.) Brian Stevens Van de Mark, "Anxious Days: The Foreign Policy Debate in America during the Summer of 1940" (master's thesis, University of Texas at Austin, 1983), p. 7.

(14.) Office of the Coordinator of Inter-American Affairs, History, pp. 7, 279.

(15.) Ibid., pp. 3, 7, 176. I use here the name Office of Inter-American Affairs or the abbreviation CIAA to designate the agency.

(16.) Claude C. Erb, "Prelude to Point Four: The Institute of Inter-American Affairs," Diplomatic History 9, no. 3 (1985): 250-51.

(17.) Ibid., p. 262.

(18.) Angela Maria de Menezes Pecanha, "Fundacao Servico Especial de Saude Publica-FSESP: Um estudo de desenvolvimento institucional" (master's thesis, Fundacao Getulio Vargas, 1976), p. 7.

(19.) Erb, "Prelude to Point Four," pp. 261-62.

(20.) "Ata final da terceira reuniao de consulta dos ministros das relacoes exteriores das republicas americanas, Rio de Janeiro, 15 a 28 de janeiro de 1942," pp. 5-6, 26-27, FDR Library, Sumner Welles Papers, Latin America Files, 1919-1943, Box 187. The delegates also recommended that all American countries sever diplomatic and economic relations with the Axis powers.

(21.) Coordinator of Inter-American Affairs, Basic Data on the Other Republics, pp. 28-31.

(22.) Health and Sanitation Program Agreement between the United States of America and Brazil, Effected by Exchange of Notes Signed at Washington, March 14, 1942, Department of State Publication 2063, Executive Agreements Series 372, pp. 1, 3.

(23.) Thomas E. Skidmore, Politics in Brazil, 1930-1964: An Experiment in Democracy (New York: Oxford University Press, 1967), pp. 43-44; Octavio Ianni, Estado e planejamento economico no Brasil, 1930-1970 (Rio de Janeiro: Civilizacao Brasileira, 1971), pp. 22, 48.

(24.) Office of the Coordinator of Inter-American Affairs, History, pp. 115-16, 231-33.

(25.) Institute of Inter-American Affairs, The Program of the Institute of Inter-American Affairs (Washington, DC: Government Printing Office, 1949), pp. 4, 5-7; Office of the Coordinator of Inter-American Affairs, History, p. 235.

(26.) Brasil, Ministerio da Saude/Fundacao Servicos de Saude Publica, Normas legais e regulamentares da fundacao SESP, 1942-1979 (Rio de Janeiro: FSESP, 1979), p. 9.

(27.) Dunham to Rockefeller, April 16, 1942, National Archive (hereafter NA), Record Group (hereafter RG), 229, Department of Basic Economy, Health and Sanitation Division, Monthly Progress Reports of Field Parties (E-143), Brazil, Box 1999.

(28.) Servico Especial de Saude Publica, Boletim comemorativo do 10 aniversario do SESP do Ministerio da Educacao e Saude, 17 de julho de 1952 (Rio de Janeiro: MES, 1952), p. 9.

(29.) HSDN, no. 1 (October 1942): 2.

(30.) Welles to Caffery, May 8, 1940, p. 1.

(31.) Memorandum from the War Department to the secretary of state, February 7, 1941, NA, RG 59, Decimal File, 1940-44, Box C115.

(32.) Steton Conn and Byron Fairchild, The Framework of Hemisphere Defense (Washington, DC: Government Printing Office, 1960), pp. 119, 249, 250, 303-4.

(33.) Ibid., pp. 290-91.

(34.) Luther S. West, "The South Atlantic and Caribbean Areas," in Preventive Medicine in World War H, vol. 6, ed. Ebbe Curtis Hoff(Washington, DC: Office of the Surgeon General/Department of the Army, 1963), p. 122.

(35.) Tom F. Wayne, "Medical and Sanitary Data on Brazil Compiled by the Subdivision on Medical Intelligence Preventive Medicine Division, Office of the Surgeon General," September 10, 1941, NA, RG 165, General and Special Staffs, Military Intelligence Division Regional Files, 1922-44, Brazil 2400, Box 210.

(36.) George C. Dunham, "Preliminary Report of Medical Survey of Northeast Brazil," September 9, 1941, NA, RG 165, General and Special Staffs, Military Intelligence Division Regional Files, 1922-44, Brazil, Box 210.

(37.) Eurico G. Dutra, "Reserved Note No. 173-150, April 9, 1941," in Mixed Sanitary Commission, "Report to the Surgeon General of the Brazilian Army," 1, NA, RG 165, General and Special Staffs, Military Intelligence Division Regional Files, 1922-44, Brazil, Box 211.

(38.) Mixed Sanitary Commission, "Report to the Surgeon General of the Brazilian Army," pp. 9, 11.

(39.) Dunham, "Preliminary Report," p. 1.

(40.) Office of War Information, "Advance Release for Monday Afternoon Papers, May 7, 1945," 2, NA, RG 208, NC-148, Entry E-198, Box 1048.

(41.) Dunham, "Preliminary Report," p. 1.

(42.) West, "The South Atlantic and Caribbean Areas," in Preventive Medicine in World War H, pp. 145-65.

(43.) Statement given to press by F. W. Utz, executive vice president, Rubber Development Corporation, Rio de Janeiro, March 9, 1945, appended to dispatch 523 from the U.S. Embassy to the secretary of state, March 12, 1945, NA, RG 59, Decimal File, 1945-49, Box 5465.

(44.) Warren Dean, Brazil and the Struggle for Rubber: A Study in Environmental History (Cambridge, NY: Cambridge University Press, 1987), pp. 87-93.

(45.) Agreement between the U.S. of America and Brazil, effected by exchange notes signed in Washington, March 3, 1942, Department of State Publication 2098, Executive Agreements Series 371, pp. 3-4.

(46.) Caldwell King to Berent Friele, April 28, 1942, 1-2, attached to memorandum CO no. 1061, from the Brazilian Division to the coordinator, May 12, 1942, NA, RG 229, Records of the Department of Basic Economy, Health and Sanitation Division, Monthly Progress Reports of the Field Party (E-143), Brazil, Box 1599.

(47.) "Projects in the Americas," HSDN, no. 8 (January 1943): 1.

(48.) Leonidas M. Deane, "Observacoes sobre a malaria na Amazonia brasileira," Revista do SESP 1, no. 1 (1947): 30.

(49.) "Report of the Brazilian Field Party for the month of November, 1943," 3, NA, RG 229, Report of the Department of Basic Economy, Health and Sanitation Division, Monthly Progress Reports of the Fields Parties (E-143), Brazil, Box 1600.

(50.) "Public Health in the Amazon Valley, Brazil, 1942-43," HSDN, no. 42 (May 1944): 3.

(51.) "The Health and Sanitation Division Reports on Its Program in the Amazon Valley," HSDN, no. 112 (July 1947): 7; Dean, Brazil and the Struggle for Rubber, pp. 4, 93.

(52.) Memorandum from R. K. West to James Drumm, July 11, 1942, NA, RG 229, General Records and Central Files, 1. Basic Economy, Country Files, Brazil, Box 83; "Public Health Activities in the Rio Doce Valley, September 1942 to September 1944," HSDN, no. 64 (February 1945); 1; "Valley of the Rio Doce," HSDN, no. 137 (July-August 1950): 1.

(53.) "O aproveitamento das riquezas do vale do Rio Doce," Boletim do SESP, no. 17 (December 1944): 3; "Public Health Activities in the Rio Doce Valley," p. 1.

(54.) Memorandum from West to Drumm, July 11, 1942.

(55.) Memorandum from the Brazilian Division to the coordinator, July 15, 1942, NA, RG 229, General Records, Central Files, 1. Basic Economic, Country Files, Brazil, Box 83.

(56.) N.C. de Brito Bastos, SESP/FSESP: 1942-evolucao historica-1991 (Recife, PE: Comunicarte, 1993), p. 31.

(57.) Report on the survey made by Dr. John W. Seddon on the mica mining region in the Governador Valadares area, 1, attached to the report for the Brazilian field party for July, 1943, NA, RG 229, Records of the Department of Basic Economy, Health and Sanitation Division, Monthly Progress Report of Field Parties (E-143), Brazil, Box 1600.

(58.) Rockefeller to Christopherson, September 17, 1943, NA, RG 229, General Records, Central Files, 1. Basic Economy, Country Files, Brazil, Box 83.

(59.) E. H. Christopherson, "Health and Sanitation Program in Brazil," 6, April 11, 1945, NA, RG 229, Records of the Department of Basic Economy, Health and Sanitation Division, Monthly Progress Reports of Fields Parties (E-143), Brazil, Box 1601.

(60.) Although planned as a temporary project related to the war effort, the U.S. Institute of Inter-American Affairs' (IIAA's) program continued after the war and became the matrix for the foreign aid policy the United States developed after the Truman administration (Point Four). The Servico Especial de Saude Publica (SESP) continued its agreements with the IIAA until 1960, when it became a foundation under the Brazilian Ministry of Health. The SESP was only dismantled in 1991.


Professor in the Department of History Universidade Federal Fluminense and the Universidade do Estado do Rio de Janeiro

Andre Luiz Vieira de Campos, Ph.D., University of Texas, Austin, is a professor in the Department of History at Universidade Federal Fluminense and the Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
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Publication:Presidential Studies Quarterly
Geographic Code:1USA
Date:Jun 22, 1998
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