Previous Contribution

Among the various contributions made by the Yellow Fever Cooperative Service of the Yellow Fever Histopathology Laboratory and National Yellow Fever Service towards national science, we can mention:

• - After the creation of the Yellow Fever Histopathology Laboratory, located in Manguinhos campus, all materials collected in Brazil by Northeast pioneer labs, and viscerotomy samples obtained as of 1931 from all over Brazil and nearby countries are gathered together, giving origin to the current Yellow Fever Collection;

• - Invention of Parreira-Genofre Spindle (1930) (a device with four holes for the fingers and a conical part for perforation, idealised by Parreira and designed by Genofre), which was later improved by Dr. E. R. Rickard, and named 'viscerotome' (patented by Soper in 1930 on behalf of Dr. João Tomás Alves). The use of the viscerotome allowed laypersons to collect sample from people who were suspected to have died of yellow fever with the least body violation possible. This was very important to minimize the resistance to viscerotomy due to cultural and religious factors found in Brazil, which had to be faced by Brazilian doctors (Franco, 1969);

• - Two new lab techniques were developed and implemented in Brazil: viscerotomy and protection tests in mice that broadened yellow fever diagnosis possibilities;

• - Despite the fact viscerotomy focused on yellow fever, it allowed the discovery and mapping of many other diseases: Henrique Penna, examining slides considered negative by other pathologists for yellow fever, observed an intriguing lesion that he later found to be a visceral leishmaniasis case, also known as Kalazar. It was the first report of this disease in Brazil, and this allowed Penna to publish his discovery in Brasil Médico magazine (1934, 48: 949-950);

• - Detailed mapping of yellow fever cases, presence of a vector, and life conditions of Brazilian people, forming a well-documented frame of the social and economic situation at the time, and of the problems faced by the campaign to fight yellow fever. The mapping activity allowed the conduction of a systematic study of the population and their environment;

• - Identification of thousands of mosquito species and other arthropods captured by the Yellow Fever Service;

Instructions created and published by the Yellow Fever Service to guide people in charge of performing viscerotomy.	Schematic representation of the viscerotome

http://profiles.nlm.nih.gov/ps/access/VVBBKQ.pdf#xml=http://profiles.nlm.nih.gov/pdfhighlight?uid=VVBBKQ&query=(viscerotomy)

- Studies of infections acquired by or artificially induced in insects, birds and mammals suspected of "hosting the virus which was spreading in the forests" (Benchimol, 2001). As a consequence, the Rockfeller Foundation and Instituto Oswaldo Cruz established a partnership to conduct research in the areas of origin of such infections. Evandro Chagas traveled to Ceará and Sergipe, the main endemic locations, and found the first "in vivo" case in Brazil, in the city of Aracajú. He visited the areas where positive cases (confirmed by viscerotomy) had been found, seeking the support of state governments to assemble an operational base, preferably in the state of Ceará, where incidence was higher. However, he only found support in the state of Pará, where the disease was rare and sporadic. Still, a successful and full approach was conducted in the state of Pará, which resulted in the foundation of a research institution focused on local nosology, named Instituto de Patologia Experimental do Norte (Experimental Pathology Institute of the North Region), nowadays, Instituto Evandro Chagas (Evandro Chagas Institute). The Histopathology Laboratory received samples for yellow fever diagnosis confirmation from all over the world, and it is possible to see reports on malaria, schistosoma, leishmaniasis, Lutz disease, drepanocytosis, hepatic atrophy, and other diseases associated to liver lesions. In a retrospective study involving hepatic viscerotomies (collected from 1934 and 1940), obtained from Yellow Fever Collection materials, Dias and Coura managed to prove that typical cases of "black fever" or Lábrea hepatitis were experienced by those people studied by Madureira Pará and other pathologists who worked for many years on hepatic viscerotomy studies in the former National Yellow Fever Service (Instituto Evandro Chagas, 1986). This work was published in the magazine of Instituto de Medicina Tropical de São Paulo (São Paulo Tropical Medicine Institute) in 1985 (27(5):242-8). Therefore, the YFC materials and documents feature the first cases of Lábrea Fever occurred in Brazil.

• - Discovery and description of the wild epidemiological cycle of yellow fever;

• - Eradication of urban yellow fever as of 1933-34, and the recording of the last cases of transmission derived from the wild form, but transmitted by Aedes aegypti in Sena Madureira (State of Acre), in the beginning of 1942;

• - Establishment of a Vaccination System bound to the Yellow Fever Service Directorate for the supplying of anti-yellow fever vaccines in large scale in Brazil;

• - In the Yellow Fever Laboratory, in Rio de Janeiro, studies were conducted to check if Aedes aegypti could be infected by stinging vaccinated individuals and if it transmitted the vaccine virus to Rhesus monkeys. The results were presented in the 10th Pan American Health Conference (1928), when Soper said he had failed his attempts to infect the mosquitoes by making mosquitoes sting people and monkeys that had been inoculated with the vaccine;

• - In March 1937, the Laboratory of the Yellow Fever Prophylaxis Special Service was opened, being in charge of national immunisation programmes against yellow fever (sample 17D). Hugo Smith and Henrique de Azevedo Penna made important changes to the vaccine production technique to increase yielding in different phases of the production process;

• - Studies conducted in 1939 by Soper, Smith and Penna estimated in 255 the maximum number of passages in a biological system for anti-yellow fever vaccine preparation, solving an issue of severe adverse reactions in the vaccinated population (Benchimol, 2001);

• - In 1940, in Pouso Alegre (State of Minas Gerais), researchers started a study to check the duration of the immunisation provided by the anti-yellow fever vaccine (cooperation between Rockfeller Foundation and the National Yellow Fever Service), where it was possible to follow vaccinated people for over 20 years, showing that 85% of the people vaccinated at Soper time still had antibodies against yellow fever (Benchimol, 2001).