CONFERENCE PORT SURGEONS AND TROOP MOVEMENT OFFICERS 12, 13, 14 October 1943 OFFICE OF THE CHIEF OF TRANSPORTATION Brig. Gen. Robert H. Wylie A, U. S. Col. E. V. Heiskell T. C. Lt. Col, Donald E. Farr T. C. Maj, Jerry A. Griffin T. C. SURGEOR GENERAL TS OFFICE Brig, Gen. Raymond W, Bliss A. U. S. Col, Arthur B. Welsh M, C. Col. A, H. Schwichtenberg M. C, Lt. Col. Paul A. fadan M. C, Lt, Col. John C. Fitzpatrick M. C. Col. William A. Boyle M. C. NEW YORK P.O.E. Col, George E. Fingarson G. S. C. Col. Harry R, Melton M. C. Lt, Col, Harold J. Feistel T. C. Lt, Col. Henry F. Branstater T. C. Lt, Col. George N. Schuhmann M. C. Maj, William W, Scheremeta M. C, Maj. Herman Axelrod T, C. SAN FRANCISCO P.O.E. Brig, Gen, Wallace DeWitt M, C. Col. Melvin L, Craig G, S, C. Maj. William J, Quinn M. C, Capt. D. E. Bonnell Lt„ Dahlgren BOSTON P.O.E. Col. Guy C. Rexroad T. C. Maj, Robert B. Gorman M. C, Capt. Alexander J, Young __ M. C. CONFERENCE, Port Surgeons and Troop Movement Officers, Contfd, 12, 13, 14 October 1943. SEATTLE P.O.E. Col,* Louis Brechemin M, C. Lt* Col, Anthony F, Stecher G, S* C. Maj, Emil S, Danishek M, C. LOS ANGELES P.O.E. Lt, Col. J, L. Searles Lt, Col, Marcus D. White M. C, Maj, Sam G, Christian Capt. Fred B, Laughlin HAMPTON ROADS P.O.E. Col. Thos, M, Lowry M, C, Lt, Col, Ernest H. Hawkwood G, S, C. Maj. Maynard C, Nicholl G, S, C* Maj, William A, Kenna M, C. M ORLEANS P.O.E. Col. Robert F, Bradish Lt. Col. Merrill W, Everhart Maj. Albert J, Treigle CHARLESTOII P.O.E. Lt, Col, Ernest M, Nielson M« C. Lt, Col, Richard D, Roquemore T. C. Maj, Otis F, Gay M. C. SECOND SERVICE COMMAND Col, Charles M, Walson M, C. U. S. PUBLIC HEALTH SERVICE Dr. R. E. Bodet - Senior Surgeon (Lt.Col.) Dr, Robert Olesen - Chief Quarrentine Officer, New York Port. Dr. Thomas Parran, Surgeon General (14th only) CONFERENCE, Port Surgeons and Troop Movement Officers, Cont’d. 12, 13, 14 October 1943 WAR SHIPPING ADMINISTRATION Dr, Justin K. Fuller - Medical Director (Col.) U.S, Public Health Service (13th only) Comdr, W, G. Terwilleger, U.S.H.R.- Deputy Medical Director SURGEON GENERAL’S OFFICE (To attend a part of Conference only) DATE Col. Stanhope Bayne-Jones M# C. 13 Col, William A, Hardonbergh Sn. C, 13 Lt. Col. Anthony J. Lanza M, C. 13 & 14 Lt. Col. Karl R, Lundeberg M. C. 13 Lt, Col, Arnold L. Ahnfoldt M. C. 13 Lt, Col. Thomas B, Turner M, C. 13 Maj, Lloyd K, Clark Sn. C. 13 Ist Lt. Franklin S. Blanton Sn, C. 13 Mr. Randall Latta - Civilian Employee, Bureau of Entomology U.S.Dopt.of Agriculture. 13 NSW YORK P.O.E, (To attend a part of Conference only) Maj. Gen, Homer M, Groningor U.S.A, Opening Session CONFERENCE OF PORT SURGEONS AND TROOP MOVEMENTS OFFICERS Fort Hamilton, 12-14 October 1943 AGENDA Tuesday, 12 October 1943 0900-0915 Wolooming address Major General Homer M. Groninger, Commanding General, H.Y.P.E. 0915-0945 Introductory address Brigadier General Robert H. Wylie, acting Chief of Transportation 0945-1015 Orientation discussion of outbound movements as re- lated to personnel, with special emphasis on those phases of outbound movements of interest to Port Surgeons Lt. Colonel Donald E. Farr, TC, Chief Overseas Troops Branch, Movements Division, Office of the Chief of Transportation 1015-1030 Break 1030-1100 Orientation discussion of inbound movements of pers- onnel, with special reference to over-all view as seen at Office of the Chief of Trans- portation Major Jerry A. Griffin, Chief, Debarkation Section, Movements Division, Office of the Chief of Transportation 1100-1130 Troop movements through ports Colonel George E. Fingarson, Director, Troop Movements Division, H.Y.P.E. 1130-1200 Open period for general dis- cussion and questions refer- ence subjects presented dur- ing morning 1200-1330 Lunch 1330-1930 Inspection of certain port installations and of a transport ALL TIMES SHOI'TN AFTER 1330 ARE APPROXIMATE 1330 Depart Fort Hamilton by boat 1400 Inspect Staton Island Termin- al Disinfestation Plant Colonel Harry R, Melton, port Surgeon, H.Y.P.E. 1530 Inspect Disinfestation Plant at Piers 83 and 84 Colonel Harry R. Melton, Port Surgeon, H.Y.P.E. Conference of Port Surgeons and Troop Movements Onicers, rort Hamilton, 12-14 October 1243, Agenda Cont’d. 1930 Depart for Fort Hamilton Wednesday, 13 October 1945 0900-0945 Medical Responsibilities of The Chief of Transportation Colonel A0 Ha Schwichtenberg, MC, Chief, Hospital Administration Division, Surgeon General's Office; * and Lt. Colonel Donald E, Farr, TC, Chief, Overseas Troop Branch, Movements Division, Office of the Chief of Transportation. 0945-1045 Medical Transport Regulations; Instructions to Transport Surgeons Lt. Colonel George M. Schuhmann, MC, Asst. Port Surgeon, M.Y.P.E. 1045-1100 Break 1100-1200 Sea evacuation operations Lt. Colonel John C, Fitzpatrick,MC, Liaison to Office of the Chief of Transportation 1200-1320 Lunch 1330-1400 Prevention of air-borne disease on transports Colonel Stanhope Bayne-Jones, MC, Asst. Director, Preventive Medicine Division, Surgeon General’s Office 1400-1430 Venereal disease problems in staging areas and on trans- ports. Lt. Colonel Thomas B. Turner, MC, Chief, Venereal Disease Control Branch, Preventive Medicine Division, Surgeon General's Office. Conference of Port Surgeons and Troop Movements Officers, Fort Hamilton, 12-14 October 1943, Agenda Cont’d. 1430-1515 Water Purification as re- lated to ships transporting troops Captain Daniel E, Bonne11, SC, Asst, to Port Surgeon, S.F.P.E. and Colonel William A, Hardenbergh, SC, Chief, Sanitary Engineers Branch, Preventive hedicine Division, Surgeon General’s Office. 1515-1545 Amy industrial medical program as related to ports of embarkation Lt. Colonel Anthony 3, Lanza, MC, Chief, Occupational Hygienne Branch, Preventive Medicine Division, Surgeon General’s Office. 1545-1600 Break 1600-1715 a. Status of methyl bromide facilities at present for the delousing at ports 1st Lt. Franklin S. Blanton, SC, Asst, Sanitation Branch, Preventive Medicine Division, Surgeon General’s Office. b. Discussion of the gen- eral problem of the importation of disease by returning troops Lt. Colonel Karl R. Lundeberg, Chief, Epidemiology Branch, Preventive Medicine Division, Surgeon General’s Office 1715-1800 Open period for discussion of foregoing problems Thursday, 14 October 1943 0900-1200 Open period Discussion of prevention of entry of communicable diseases into the United States by co- ordination of agencies in- volved Dr, Robert Olesen, Medical Director, U. S. Public Health Service, Chief, Quarantine Office, Port of New York. Remainder of period will be available for discussion of previous problems, presentation of specific questions by Port Representatives, etc. BRIG. GENERAL WYLIE: I ask you to take your seats. The Transportation Corps and its rather far flung activities has become of age over night. A year and a half ago we were struggling with a tremendous task. We were merely trying to move men find materials some place, somewhere, with the most inadequate facilities and with very little organization. 7/e have begun to refine our activities somewhat now. V7e had a port Commander1s conference at Boston sometime ago. At that time the Port Commanders and officers from the Chief of Trans- portation wore able to got together and discuss our mutual problems. Wo found it most helpful. We followed that 'with a Zone of Transportation conference, and we found it was ex- tremely beneficial in improving that organization. The duties of the Port Surgeons arc such that we feel it essential to got together we can discuss various responsibilities of medi- cine and of transportation in dealing with this huge problem of moving ixn. General Groninger has very kindly made this facil- ity available for holding this confcrenoc. It requires a groat deal of preparation and a great deal of work, and wo are truly appreciative of the fact that he has done this. I might state that in 1940, sometime in September, the Chief of Staff was concerned about our Ports of Embarkation. We had two primary ports. They were getting on their way slowly, and they selected from the Army at large, two officers who had spunk, drive, and experience to get the things done. One of those officers has since left and gone to a position of considerable importance overseas. The other one who had a big port and a big job is still in here' pitching. It is a pleasure to introduce to you I/lajor General Groninger, Commanding General, Hew York Port of Embarkation. MAJOR GENERAL GRONINGER: We welcome you to the New York Port of Embarkation. We work hard and we make mistakes. I hope your conference brings out some of the mistakes that wo have made. I made mistakes in the selection of personnel. It seems that my job primarily is to find out what ought to be done and then to get the right man to do it. Now that is a problem, to get the right man to do the job, even with this small erew. On these transports wc have got to have good men. That Includes the Transport Commanders and the Surgeons, especially. I was just telling General Wylie at breakfact, "Of course, we have got to put on those men that i;e have with us, but I think we can get tougher men.” I think wo can do the job. I think the importance of it is such that if they are not good, we must not hesitate; wo have got to move. Now in the last week or two, wc have had difficulties on our ships, all about the same thing--diarrhea. Then the reports came in. I would just like to road about two sentences of one report. The reports are 0.1 l the same with conclusions and recommendations. Of course we people who are here at the Fort are posed with a problem, to which we have to give some consideration. He geos 1 on here to conclusions, "This is because of unsanitary'condi- tions in-the galley.11 That is what I got right along--"Unsan- itary conditions-iri the galley."- "Principal cont'ributary cause, over loading." I knew people say that isn’t so. 'Tfell, I can go on hero, ho use-reading more. I will summarize it for you. .He comes out with overloading. That is one problem. 111-disciplined units, that*is two. I mean, poorly dis- ciplined- units on board, especially the officers. There is no under-estimate of that, a little twang of seasickness or something like- that. I don’t think an officer should get sea- sick. I have gone out as Senior Commander of Troops four times and I have been performing police officer’s.business on about ■eight voyages, and I don’t believe there is any excuse for it. Oh, there might be one or two who can’t walk. They 'may be sick, you fellows know more about that; but I think there 'is a good deal of bunk in seasickness with officers. I don’t think they should got seasick. Certainly they should hot got sick ■enough that they cannot walk and go down to do their job. I ■think that is one of our principal contributory causes. Over- loading was, but that is over now for awhile. I think that poorly disciplined officers is another. Out of the last two or throe shifts, it happened to be bunches of casuals go- ing over from-Hampton Roads on a ship sent down from hero. They were good ships, too. Well, wu’fixed up a crew accord- ing to- our charts, etc., I an the staff, but when, they got down to Hampton Roads, they shoved on board a lot of colored soldiers, colored detachments and all that stuff, and they had no medical officers with them so that tho poor Transport Sur- geon had no one to help him. There ’ho was all by himself. Then the same old story-thoy ran out of medicine--that is in every report. Tnafc is queer business. I know you are going to say now muon medicine should tiiey have? I don’t know. But they have to have a lot. It is grim business. Corning back once- I had a boat load of 2,100 wounded bed cases strap- ped to their bunks and we got in a storm, and we lost one hundred miles in' three" days of travel. Wo had to push meals over the floor on hands and knees, and I have a great deal ol sympathy for those who wore in charge of that. I have boon -through it- now several times and we have got to get good officers ior tnat, so lets think about that in the prepara- tion 01 this work. I know wo could writo, about regulations here and of all this, down from old' George Washington him- soli, somewhere, but this Transport Commander is*tho boss on and when you get this' good enough, lets have it sort of lit in through tho usual channel. Wilile we are doing that it might be a good plan. I don’t know any authority who knows these regulations. •• I-assume it isn’t in the book. Maybe it could be put in the book. We have b. on doing it right along. 2 It would bo. a good thing to put it in. That would be a little more power to make these people do what we want. Now if I can give any help here in this, any time in a dis- cussion, if I could be of help to you, I will come up here. I know a lot of you have had more experience than I. I want to make you feel you can come here. I will do everything I can to further this conference, which I feel is bound to result in good. Any questions you would like me to answer now? (No answer from the floor) Thanks very much. BRIG. GENERAL LYLIE; Before we go further I should like to ask the Commanding Officer of Fort Hamilton to give you some ground rules. COLONEL LlAab > Good morning, gentlemen. Could I have about four minutes? Answer: You could have four and a half-as much as you want. COLONEL IlAiiS; Thank you. Hill you gentlemen be- lieve it - you might become lost on this post. Folks do.• So will you please take this out of your envelope. (Audience takes papers'out of envelopes) There is no north nor south on this map. Place the Officers Club next to you, the end of it to' you, with headquarters away from you. North is from the lower right hand corner to the upper left hand corner. That’s north. You can see the Officers Club is near you and you go directly up this road (pointing) right up in this direction ’til you cone to the-- gate... Then you go up to the first car line and turn to the right for the subway. If you can just place this in your mind, get this in your mind, then you won’t become lost. And then those of you who live in 600 and 249 can see where your building is right from here. Your map will bo pretty nearly oriented. I would like to say a word about the meals at this club. Of course you all have a membership card. The portions served are not too large, but don’t be embarrassed if you feel you want some- thing more to eat. Don’t be embarrassed to ask for another help- ing. k'o' have, had to cut the helpings in order to prevent waste. He have had a hard time getting our ration points. However, please don’t fail to ask for more here, at the meals, if you desire it. Now we haven’t provided any entertainment here at the post, because I believe tnat there is a better place in New York for entertainment, and you will find a list of activities in New York on another sheet that you have. And I want you to feel free- don’t try to remember telephone numbers - to call the Commanding Officer, Executive Officer or any .adjutant in case you want some- thing, anything. And Lieut. Dowdy at the desk down there will be 3 on duty 24 hours a day. Ho will leave a number where ho or one of his representatives will be able to answer anything or any question you might ask within reason. You will find out here that we are unable to supply Government cars for you. However, transportation - the civilian organization hero has the cars, and by seeing Lt. Dowdy, you will bo able to get transportation. Thank you very much. COLONEL MELTON: May I suggest to you to make some re- marks about tho 7th .avenue entrance, I see some of them came in by taxicabs. Can they cone in there, or do you expect them all to come in the main gate? COLONEL MAIS: There is a 7th Avenue gate. If you come in taxicabs, tho driver will say "The main gate or tho 7th Avenue gate?" I suggest you use the main gate. However, if he does take the 7th avenue gate - that is near to 249, whore many of you live - just use that gate, that’s all. Nothing wrong about that. They can come in any gate they want. Just say the main gate. It doesn’t cost any more. More pleasant driving in anyway. BRIG. GENERAL WYLIE: In order that everyone here may know everyone else, I am'going to ask th it each officer in turn stand up, announce his name, his job, and his stati n. I will start it off, and then ask the officer sitting hero, and then go*around these tables to the left, and then around (pointing). I am General Wylie, Acting Chief of Transportation from Washington. LT COLONEL FITZPATRICK, is our officer from the Surgeon General's Office, who is in the office of the Chief of Transportation. LT COLONEL FARR, Overseas Troop Movement, Chief of Trfinsportation. COLONEL SCHWICHTEWBERG, Chief of the Hospital Administration, of tho Surgeon General's Office. MAJOR SCHEREMETn, Assistant to tho Port Surgeon, NYPE. COLONEL FINGARSON, Troop Movement Officer of New York Port. COLONEL MELTON, Port Surgeon, New York Port. LT COLONEL SGHUHMANN, Assistant Port Surgeon, New York Port. FLUOR GORMAN, Surgeon, Boston Port. 4 COLONEL REXROAD, In Charge of Troop Control Division, Boston Port. CAPTAIN ALEXANDER J. YOUNG, Executive Officer, Boston Port. COLONEL LOWRY, Port Surgeon, Hampton Roads Port. MAJOR KENNA, Hampton Roads Port. MAJOR NICHOLL, In Charge of Operations, Hampton Roads Port. MAJOR GAY, Executive Officer, Charleston Port. LT. COLONEL ROQUEMORE, Troop Movement, Charleston Port LT. COLONEL NIELSON, Port Surgeon, Charleston Port. COLONEL HEISHELL, Assistant Chief, Office of the Chief of Trans- portation. MAJOR AXELROD, Port Supply, New York Port. SENIOR SURGEON BODET, Lt. Colonel Bodet, U.S. Public Health Ser- vice, Was hingto n. COMMANDER TERWILLEGER, U.S.N.R., Deputy Medical Director, Division of Operations, War Shipping Administration. LT. COLONEL PADAN, Surgeon General’s Office. LT. COLONEL BRANSTATER, Officer in Charge, Officers Transport Detachment, New York Port \' LT. COLONEL FEISTEL, Officer in Charge of Operation, Water Div- ision, New York Port. MAJOR GRIFFIN, Office of the Chief of Transportation. CAPTAIN BONNELL, San Francisco Port. COLONEL CRAIG, Director of Operations, San Francisco Port. BRIGADIER GENERAL DE WITT., Port Surgeon, San Francisco Port, MAJOR QUINN, Assistant Port Surgeon, San Francisco Port. LT. D/HLGREN,.Assistant Executive Officer, Port Surgeon’s Office, San Francisco Port, LT. COLONEL STECHER, Chief of Operations, Seattle port, COLONEL BRECHEMLN, Port Surgeon, Seattle Port. COLONEL BOYLE, Awaiting assignment at Seattle Port. 5 MAJOR DANISHEK, Assistant port Surbeon, Seattle Port. COLONEL WALSON, Second Service Command. CAPTAIN LAUGHLIN, Water Division, Los Angeles Port. LT, COLONEL SEARLES, Director of Operation, Los Angeles port. LT. COLONEL WHITE, Port Surgeon, Los Angeles Port. MAJOR CHRISTIAN, Executive Officer, Los Angeles port, MAJOR TREIGLS, Troop Movement Officer. New Orleans port. COLONEL BHADISII, Port Surgeon, New Orleans Port. LT, COLONEL EVERHART, Executive port Surgeon, New Orleans port. LT. COLONEL DORSKI, Director of Administration, New York Port. MAJOR BUSH, Port Surgeon Office, New York Port. BRIGADIER GENERAL WYLIE: You might understand, gentlemen, that’s one way I get my time taken up on the platform -- it saves wear and tear on your nerves, and it saves words from me. I want to announce two or three ground rules so far as the conduct of the conference is concerned. First of all I wish to apologize for being unable to stay with you throughout the conference. As it happens, a good many of our officers from Washington are away, and I am, after a fashion, attempting to do two or three jobs and it makes some demands on my time, which will not permit my remaining here. I would like to stay here, not that I think I can contribute a great deal to the conference, but in order that I might learn a little something about your problems for only by knowing these problems may we be in a position to take the necessary action - insofar as it is within our province --to help you solve these problems, I recall that not more than three or four years ago at one of our primary ports, port Surgeon was a part-time job. The officer who held that job was Station Surgeon at a rather large post, and ho ”doubled in brass” by coming down to the port and board- ing transports when they arrived. Now when I sou this assembly of distinguished Medical Officers and wo have been most fort- unate in the calibre of officers that the 'Surgeon General has made available to our ports -- I realize that wo are dealing with something quite largo in comparison with that small-time operation. 6 There is no question but what you each have problems, suggestions, ideas, and Undoubtedly criticisms, not only of some of the operat- ions in the field, but of orders and regulations that are issued in Washington, In your discussions here, I ask that you be frank, very frank. I ask also, because of the time element, that you be briefi If you have a gripe, give it to us, but be specific; and if you are specific, you will be brief. However, I think we must remember to keep a sense of balance, I am just, reminded of a story that I told to some Transport- ation Officers the other day in illustrating that same point. I beliqve the drift of it was--The General received a telegram stat- ing that one section of his Army had been surrounded and they had lost three Brig Generals and one hundred mules, and he said *By God our mules are expensive*. So keep a sense of value. Remember to be brief, and above all, if this conference is to mean any- thing to you at all, and anything to us, be frank. If the things we do in the office of the Chief are -objectionable, say so. lie don’t guarantee to agree with you and accept your criticism with- out some protest, He may have arguments of our o\m and ask our own officers to do the same thing. And I feel sure that I speak for the Surgeon General when I say that he, too, welcomes crit- icism. I had an opportunity to go up to Chicago with him last Wed- nesday and we discussed this conference; and at that time he ex- pressed his regret at being unable to be present. However, I believe his office is well represented here. General Groninger was discussing some of the difficulties of Transport Commanders and Transport Surbeons. I thought he was going to read a part of a letter which we received in our office just recently. It was addressed to General Gross per- sonally and says, ’’Dear Charlie: I am enclosing this ’jewel’ for your amusement. It is -a copy of a memorandum sent by a Transport Commander to a Transport Surgeon, It is a history of a ship that arrived with a real epidemic of diarrhea, which in- volved some three thousand out of six thousand colored troops. The Transport Surgeon had been making s mitary reports which app- arently irritated the Transport Commander and provoked this jam, I am most sympathetic with the poor Transport Commander' and his aversion to bails of paper, but really, Charlie, I. am surprised at you for sponsoring the idea that three thousand c ises of di- arrhea is a minor matter. I remember your concern over one dirty kitchen that we saw; so, my lad, here’s to our Transportation Corps to take the broader outlook and save paper". He incloses the memorandum which was written by the Transport Commander to his Transport Surgeon. Apparently, the Transport Surgeon had felt it necessary to write a number of' memoranda to ships’ officers and others, and those memoranda were qiiite critical and they were so written that the doctor might have it in the record because he thought it would produce results, I don’t know. But the Transport Commander took exception and wrote to 7 the Surgeon; "This type of paper work is disapproved. All inter- office notifications can be by conversation. These memos are often misunderstood and cause annoyances between ships’ and military personnel. We are all working for one purpose - the transporta- tion of troops safely and in good health. There is no necessity for anyone of us to go on record as to any faults or difficiences of other heads as we are not without fault ourselves. Instead of wasting time in writing, it can be better used in supervision. We, that is, the Transport Officer, and the Medical Officer, are not numerous enough to supervise sixty-five hundred men of this breed and we must rely on their officers. The troops officers are neither experienced nor capable of handling their men. That is the basic trouble, and wo brought them down so far without riot or serious trouble. 'Whether or not our mess table is perfectly white is a minor matter in comparison. The sickness and its present extent is a minor matter. It is my advice to take a broad- er outlook and try to get at the particular trouble, not at every- one else’s, and then have a talk with the personnel. Save the paper, you may need it also." I hope that does not of necessity represent ideas of all Trans- port Commanders dealing with surgeons who are trying to cope with an epidemic at sea, but I must agree with him to this extent, that wo often write far too many memoranda. Me often feel it necessary to get ourselves on .record so that when something-is being investi- gated-the next year or the next’month-you can prove that it was the other fellow’s fault. I have some notes that-were prepared, and although I find that I have already'used up a good deal of my., .time, I would like to cover just a portion of those, as far as the Transportation Corps is concerned with the movement of both men and’material. Insofar as our discussions hero are concerned, wo should consider the movement of men, bocause the common tasks between the Surgeon General and the Chiof of Transportation is primarily the movement of men. The techniques involved in the two branches have little in common. The daily activities of the Surgeon and the Transportation Officer are quite different, but, there are great basic things which wo share in common. In a Very little way, both the Medical Corps and the Transportation Corps serve in a guardianship capacity for the rest of the Array. Medical Corps responsibility is everlasting. It goes on from the time a man is first inducted.until ho is discharged or roaches the grade. In the case of the Transportation Corps, our r sponsibility is somewhat sporadic. Me move them by rail or by highway carrier • 7fd then bring them .into a Staging Ary a where we accept command responsibility. Then from the Staging Area they go aboard ship and it is our responsibility.to get them to their destination-safe- ly and in good health. Me may.state that transportation is most important in this war effort. Me cannot say that by our means of transportation, the war can bo won but wo cap state definitely without adequate transportation, the war can lost. By the same token. 8 no one can say that tho Medical Corps could of itself win the war.- But if tho Medical Corps fails to maintain the health of the xormy,- they will definitely contribute to defeat. Jointly, wo must ’face the music’ or take the credit. Jointly, therefore, it behooves us to talk of cur problems. V/e can touch only upon the principle of these problems for the individual problems are almost infinite in operations of this scope th t we are carry- ing on. In tho fiscal year 1943, we jointly safeguarded the well- being of ******************* passengers going to oversea des- tinations and we shared the headaches of *** troop ships, not counting cargo vessels which carry troops, Daring the fiscal year, we saw the average burden increase ***% and taking the last month in comparison with the first, we saw Staging area capacity rise from ******* to ******* and most of us recall that just a very few years ago, the total strength of the army was *******. i/e have seen the volume of troops overseas go up and up, and that meant for us an increase of 100% in the burden of moving cargo. For the Medical Corps, this must have meant a tremendous increase in problems for our men coming into action with all that it implies from a medical standpoint. For both of us that last fact brought tasks relating to the evacuation of the wounded, the tr msportatien and disinfestation of prisoners and a host of other problems. I mention all t iis merely to say that the variety of problems we have experienced interest you as a prelude as to wh -t is to come as to the volume and scope of operations in both of our establishments. 1/e will continue to encounter problems We never dreamed of before. Both the Medical Corps and the Transportation Corps will face tho chal- lenge of circumstances that seem beyond our power to cope with. Over and over again wo will find ourselves in Situations that press with an infinite number of reasons ‘by which to excuse ourselves for tho non-performance of the things wo are charged to perform. It will be up to us to remember th it a war is not won by men who find perfectly valid reasons for-not doing something. Rother, they ire won by men who'seek out the one possible way to do what seemed impossible. They are not won by prudence but by "fighting will" above all. T/e must remem- ber that men must be moved. 1/e may take the utmost precaution in ho*-.lth and security. T/e must stop it length to insure their being and safety, those things are indispensable. Yot they are also secondary. TJe must at best compromise with circumstances. There is no time for "prossurism". By keeping in mind the primary purpose of our actions, by keeping .n appreciation in mind of our respective responsibilities, we can wipe out our mutual problems. That brings us to the matter of technical, -.s against com- mand channels. I imagine that some officers will discuss some phases of this question, but this problem of channels is difficult in 9 the Army and in war time, because wo have two typos of officers; those who are normally civilians and are now serving .in the mil- itary service, and those who are old soldiers accustomed to the ways of tho poaeg-time army. The peace time civilian who finds himself in the uniform often finds it hard to got used to the which characterizes the Army,, and tho old soldier finds it hard to get out of the rut of habits formed in the Army when the scope and urgency of command were only a fraction as great as they are now. in war time. Your experience will toll you what I mean by command and technical responsibility. There are many details which are purely technical. Occasionally, something that appears, to bo a .technical matter, howeverJ at the outset, becomes a command function,. . Whon you discuss the policy of evacuation of patients from overseas, you must assume that primarily it is a technical medical matter, but you realize that the whole conduct of tho war has been placed by tho ability of ships to move men and materials. You realize that the command sido of that question is a most important one. If ships are tied up to move convalescents, to evacuate patients, they arc not carrying fighting troops to the front, so that the commander in the field and those on the general staff charged with the strategy hav>..- a very real interest in this problem of evacuation and in determining what the policy may be. I would like to reiterate one tiling I covered there, that is, you have a job to do. Tie have always a conflict between the necessity for action, speedy action, safety and security. Certain calculated risks must be taken, We In.ve the responsib - ilitios of tho public health service, We have the responsibilities of the Medical Corps. We have the steamboat inspection service, tho various laws and rules covering navigation; the various res- ponsibilities regarding safety of life ; t sea. We could, if wo wore so minded, find sufficient reason to practically stop our operation. However, our record has been one, I believe, of accomp- lishment, Wo have boon able to move far more troops and far more material than was over contemplated with the limited facilities available. It is only by facing our problems squarely with the intent to do, and do our utmost, that wo may hope to.contribute our part to a speedy victory. How as regards the conduct of this con- ference, I should like to ask th .t those officers who are presenting a paper or a subject come to tho platform, I believe that you can hear better from up here. Am I correct? FROM THE FLOOR: Yus, Sir, BRIGADIER GENERAL WYLIE; And there is ...Iso a tendency on the part of some of us if wo get doim on the floor, we walk b -.cl: and forth, and angage in a lot of unnecessary "bull", T[e haven’t time for that as much as it may bo appreciated. I am.going to ask that 10 those officers who hive subjects to present cone to the platform. If following any t .Ik, yen hove quest! ns, you will hive a chance to present then. I don't propose that these questions will be answered in full at that tine. It nay require some research or cooperation with others. But ask the questions so that they nay be made of record, and if they cannot be answered immediately, they will be taken care of at the latter part of the conference. As I told you, one of our most important jobs is the move- ment of troops, and it happens that wo hove an officer here who has spent a great deal of time in the last three years doing just that thing. He started the job long before Pearl Harbor in G-4, and although he has h .d a variety of titles since, he still is the one officer in Washington who puts his weight behind the movement of troops and gets then out, in spite of shortages of transports and red-tape--Lt. Colonel D. F. Farr. LT COLONFL FARR; General Wylie and gentlemen. The Gen- eral refused to let me introduce him when he came up on the platform. I admit that probably he doesn't need any introduction, because I suspect that nearly everyone here knows him. It is just possible th .t there are s .-me who have not cone in contact with him before. It might be of interest to know that General Wylie came to the Transport it ion Corps shortly after Pearl Harbor, after a very careful survey had been made in the field of which officers c.uld come in who knew something about the Transportation business. General Wylie was selected by General Gross because of the fact that ho knew more about how to handle transports, people on transports, ports of embarkation and their accompanying work, than anyone else ho could place his hands on, so General Wylie became a part of the Corps and I think he will probably stay part of the Corps for a long time. This conference is ■ very fine opportunity to meet many of you gentlemen to whom I have talked in the past two years and from whom I received lots ef letters but h vo never had the opportunity to meet, I think it will bo an opportunity for all f you to get together on some of these problems, also. Now, the part that I have at this time is largely an orientation and background of many of the things which happen in Washington th .t make you do some of the things which sound rather peculiar'at times, but there is, in many instances at least, a fairly good background for them. j.xt the beginning of the W-.r, as many of you remember, the'pro- blem of troop movements was quite simple• Somebody in the General Staff would call up a unit at its home station and say, “Three days from now”, or maybe five—if they were generous, “you will bo ready to leave—go to the San Francisco Pert of Hnbarkatibn for overseas duty". In the meantime, G-3 was writing a very nice detailed order on i few of the things they were to take with them. Training status didn’t particularly 11 bother anybody. Equipment v/as, of course, of some importance, but not too much. The units arrived in the staging areas with vory little preparation in many cases. Our ports rose to_the occasion admirably. They went through final type physical examinations in many cases. The matter of equipping was taken care of, and even in those early days our troops went out very well equipped and in as good health us could be expected, con- sidering the amount of time that was available to take care of thorn. But immediately we all became aware of the fact that wo must do something a little sounder than that in order to get troops overseas in good fighting trim and in large quantities. New regulations wore written by the General Staff to cover these things. Nobody paid tiny attention to the peace-time reg- ulations then in effect anyway, so there might as well be some new ones. New training requirements were established and the problem of equipping was given a great deal of thought. This evolution continued to take place for quite some little time find at the present time we are now in such a position that if pers- onnel arriving in the port areas do not come as they are supposed to, we have the right to send them back to the last station from which they came and let them fix them up there. This is the proper set-up after all for a port of embe.rk .tion, Tfe should not find it necessary to be the inspector, to do the complete job. Wo have no place to put these people when we reject them, tfe must send them back to some other place in any event; there- fore, they should never come in unless they are properly equipped or properly examined. Now" troop movements have changed in complex somewhat from those days when we very hurriedly called up an A.A.F. outfit in Tennessee and told it to move to San Francisco in a. hurry, and officially wo arc now tied up in a great deal of red-tape. The way it starts is, the overseas commander puts in what is known as a six months’ list. He keeps the Operations Division of the War Department General Staff informed as to his requirements in the way of troop units six months in advance. He makes all kinds of changes in those things and is never apparently quite satisfied with wh ,t he sends in, but he keeps it fairly well up-to-date. After the Overseas Commander does put in his requirements, the General Staff then has to take those requirements, 'work them over a little bit -- because troops are not always available of the types the Overseas Com raider asks for and puts out the War Department’s six months’ list. Now the purposes of this list after it is published by the War Department are several, the princi- pal one of which is that the requirements for the unit may bo ready at the time the unit is scheduled to go overseas. Because now, in this list, each unit is nominated by design tion to go overseas during a certain monthly period. Therefore, you have a target for the equipment people to shoot at; you have a target for the training people to shoot at, so that if they follow tho schedules that arc set up, material cones off the production line and you will have your unit completely trained and completely equipped at tlx proper times so that it may be 'moved overseas. Now there are a few other things that enter into this six monthsT list that ure not quite so simple as one would like "bo have them. First, tiie, requirement of the Overseas Commander, That starts the list’. However, there is another tiling which is quite important and that is the availability of transportation to move the personnel overseas that has been', requested. There are other matters that occasionally come in; the Overseas Theater Commander frequently wants more than the celling that his garrison is auth- orized to take. That has to be given some consideration in the command echelon, of course. But in general, there is every effort made to give him what he needs. Now then, in determining capabilities, we generally go buck to one of the major conferences. They carry very peculiar names such as "Trident”, "Quadrant” and, General Wylie suggested, when they have their fifth conference wo might call iu the "Dionne". They nevertheless get together very, very high echelons and decide what the strategy of the liar is. But very peculiarly that strategy always comes down to "how many can we move?". At the last conference they, made their deployment of troops that were necessary strategi- cally to win the war, turned that over to the gentlemen of the transports of the Uhited Nations to figure out "can it be done?". The boys went into a’ deep conference and came out a coutjlc of days later, maybe a' day later or the next morning after an all-night session, having shuffled their bonus all over the world, they found "Yes", they could approximately meet that, but in order to do it there wore certain tilings that were quite essential. We hud long distance phone conversations Y/ith the conferees up there discussing the matter of overloading in the wintertime, carrying more troops on the ships than we carried before. The use of those prisoner-of-war freighters for the movement of outbound troops, and the difficulties we encountered were dis- cussed fully. It was pointed out that morale might not be too high in many of these cases. These matters were carefully consid- ered at the Quadrant Conference, and when trie final result came out regarding the employment of troops all over the world, it was decided that it was necessary to carry more troops on vessels than had been our custom in the past. The shipping people gave up rules that they had been going under the last three years on the safety of vessel's, by that I mean the safety of vessels from enemy attacks. They had to bive in somewhat on that. All the calculated "risks on getting the proper number of personnel into the area at the right time to do the job that had to be done. Now after these high-level over-all policies of strategy and move- ments are decided, wc come back to the more commonplace—and if 13 I nay say so—a more practical part of the troop novenont, that is tho monthly or convoy priority list. Tho six months’ list, as provided by tho General Staff and the Overseas Commanders, covers many units that are net available. They are supposed to be available but for some reason they d n’t materialize, so each month, or prior to each convoy sailing, there is a revision of tint list as to the availability of units and also on tho needs of those units overseas in the priority in which they arc needed. Again tho overseas theater commander comes in and status, "I need tho following units in the following priority". This list is made up by tho General Staff, again being correlated with the availability and again with the possibilities of movement of vessels between ports in order to accomplish this. It is a refined version of.the six months’ list rather than any radical change, from it. Now as tho process has boon going on, tho day to day statements are made as to shipping capabilities. I think those of you who are working intimately with the.vessels know what I moan when I speak of day to day changes in availability. We had a few vessels that got . out and had to. ceric-.back, so the thing changes very, very rapidly. During this period troops are placed under movement orders for the overseas destination. We now try to got these directives issued about 45 days ahead of tho actual movement and avoid the red tape wo f ;rmerly had. Based 'on these directives and pri -rity lists, the job is turned over to the- Port ,f Embarkation for execution, and our office in Washing- ton merely serves as a servicing agency to iron out such, difficul- ties as may arise duo to faulty directives or duo to tberthings that happen boy ;nd anyone’s c ,ntr .1 and unforeseen at the.tine tho job was set up. In the handling of tr op movements, both inbound or outbound, we tried to make it a basic rule th .t the pert of embarkation is tho operating agency and does its own job., he merely attempt to set up tho mans f.r that job and to f ,-llow tpr ugh with such assistance as may bo necessary from the standpoint of operating difficulties that come up. Now basically that routine which is a fairly simple routine, covers the fundamental part of troop movements. Very simply, you have the six months’ list, you have a priority list, and you hove a troop movement order. Fundamentally, that is all there is to it. However, troop movements go farther than just tho paper work and tho directives. There arc also innumerable obstacles in the way of discuss,! ,n of those movements according t.. tho papers that are written, for instance, units th.it don’t meet tho requirements. They got ready t. move .to ■the staging area and General McNair says, "No, they haven't completed their training". Some tines we- got then in. tho staging area- and the Port Surgeon says, "No, they*have scarlet fever", or there may be other things that cone up. Occasionally our men dovol p stomach-aches before they got out. 14 There is always a largo number of unforesec i- things which happen that you can’t ovon name until they do hapj on. - Thor ofore, the movement of troops, becomes a bit on the poj sonalizod side. The actual movement depends more on the cooperrtion of individuals concerned than it does on the paperwork involved. In our own port set-up wg can say that the successful set-up we have had is based on the attitude of everyone concerned. I don’t mean just the troop movement people; th t covers not only the Water Division, but also the Port burgeon’s offj.ee, the Supply Office, Troop Movement Office, etc. The port has so act as a whole on the movement of troops, and we have the rinest bit of team work when it comes to moving troops that can bo imagined. We know that we are skating on very thin ice occasionally, and occasionally wc are told in no uncertain terms what iho thin ice wo are skating on, is. But it is all part of a calculi tod risk of getting troops to the place they should be at the time they should bo there. It is not our intention to lose any tree os on their way overseas. They may bo a little bit uncomfortable, lay snooze a little bit; if they don’t do any more than that, the/ will get over there and in a few days be as good as new. Anyway, the amount'of discom- fort that they may have to go through is going to be very small in comparison to the discomfort they are going through after they get over there. Now obviously the novem nit )f troops is not a simple, straight-forward job. It is one that involves the personal- itibs of your overseas commanders. It involves strategic policies and the policies of implementation.placed on'us by higher echelons, and it is a problem whose accomplishment depends entirely on over- all cooperation. Now arc there any questions which you would like to ask? FROM THE FLOOR: (No .response) BRIGADIER GENERAL WYLIE: : I presume in the absence of ques- tions that Colonel Farr has covered the subject very, very completely. COLONEL CRAIG: I have one question. Would it be possible to got these priority lists to us a little bit sooner? LT COLONEL FARR; • .: -■ ■ • That is a very touchy point. .It is nut possible. . Wo would like to get those lists’out sooner. . You have a particular problem there. ..I night say that San Francisco’s problem is a little bit different from others in that' wc have a joint priority list for the San Francisco, area, Wc have, I think, three committees that have to meet before the priority list comes out. Wc have the South Pacific Army, Southwest Pacific Army and the joint committees of the Army and Navy that have to get 15 together and decide on the priority list for the South-and South- west Pacific which is a joint list.. That is one of the reasons that your list is b10w.,. Vie arc attempting to speed that up, Next month’s list will not be any faster because this is the 12th and it is being finished today and,will be in your hands Thursday morning I mean in the port’s hands Thursday morning, which is the 14th, which is q. little better than it has boon. I think the last one you got was on the 20th. These priority lists are subject to change very rapidly due to the change in military situa- tions and they are very difficult to get at. In your particular case we will get them out faster, I am sure, next month, Tfo arc- picking up a little bit. LT COLONEL SEARLES: On the priority list for the Los Angelos Port of Embarkation, they come out with that list relatively late too, and wo usually just get one list there. As a consequence, the distribution is generally delayed for a day or two. If wo could got throe copies, we could take care of the distribution. LT COLONEL FARR: You will get distribution, LT COLONEL SEARLES: One other point. At present, the equip- ment going through Los Angelos is shipped on freighters and takes about twice as long as on passenger vessels and the troops get over there without their equipment, is anything being done about that? Wo could move the readiness dates up so that we can get the equip- ment over there with the troops. LT COLONEL FARR; Ho have a difficult situation in the matter of readiness for your particular area, which is India. The trip from Los Angeles to India by troop vessels is approximately six weeks. The trip by freighter is anywhere from ton to fourteen weeks. Now you have your choice of one of two evils. Either you take your equipment away from the unit a month before it leaves so that the- unit and its equipment may assemble together on the other side, or you take it from the unit when it and it gets over there a month or two months after the unit, You have your choice of those two. Our General Staff unfortunately can't make up its mind which it wants to do. Sometimes it does one -‘ind some- times it does the other, I think wo should ship the equipment first and wo are making some headway in that direction. 16 BRIGADIER GENERAL WYLIEs’ - • * v - • • - Aliy -other questions? (Pause) I see we f schedule* TiTe will recess until 10:25. - '; • (The conference recessed at 10:15 and reconvened at 10:25) BRIGADIER GENERAL VJYLIE: I would like to announce for all concerned that v/e are taking minutes }f this meeting and v/e hope that the minutes of today's session v/ill bo‘available tomorrow morning. This may save you the trouble of taking notes. I, would also like to announce now that since I am un- able to stay here. Colonel Farr-will take )ver the rather pleasant function of conducting the conference during the next two days. Also, prior to our break at noon1I believe Colonel Fingarson v/ould like to know definitely whether all of you will accompany him on the tour of inspection this afternoon. I would suggest that you all go. Our big problem hero ’str'far has been moving troops overseas, but some four or five months ago v/e first began to feel the effects of the- re- turning troops, whether they wore prisoners-of-war, patients, casuals, or what have you. In fact, the in-bound troop move- ments now each month are **** t whrif our **** troop *rtdVcrionts were a few months before Pearl Harbor. - There are ceftrfin h ro- bloins that are peculiar'to the inbound tr oop movements. You might shy it was directly in reverse of our outbound movements, but such is not always the case* Ft has: been'necessary to es- tablish within the Office of the Chief of Transportation "a sec- tion concerned primarily with that. The orientation discussion of inbound movements of personnel with special reference to over- fall view, as seen by the Office of-the Chief of Transportation, will be given by Major J. A- Griffin. ■ ■ MAJOR GRIFF IN i - r ' General'Wyiio, 'Gentlemen, There is an old adage -that all that-goes Up is bound to come down. That is ■applicable to our -movement of troops-.- Tie-’have concerned our- selves almost 100$ with sending out troops--in the past year or 18 months, and we have progressed to where it isn’t the problem if was- -past. vTo nov/ are bringing back troops in suffi- cient numbers to create a- problem. Let me give you a brief hist dry-or resume of-the past year I - A-year ago troops v/e re be- ing returned under the old procedure, or under the procedure set up by the old regulations, and it was of no concern parti- cularly. There has boon a gradual increase in these numbers to show and indicate that there is a need at this 17 time for advanced planning to insure the safe return of these troops. January of this year we returned **** personnel. For the sake of this discussion, let us break them down into Army for duty, patients, prisoners-of-war, miscollanobus. **** Total; **** Army for duty; **** patients; **** prisoners-of-war; **** miscellaneous personnel. In September of this year wo had **** Army for duty; **** patients, ***** prisoners of war , **** miscellaneous or a total for September of ****** , In order that you may better understand what we are trying to do with returning troops or how they should be handled, let’s take each group briefly. The Army for duty returned as units or organizations. Orders wore issued by the War Department for their return. The Overseas Commander gives them the shipment assignment number. Wc follow then and provide the transportation for their return. The patients - the second group: This group has had more work done on it to set up a procedure than any of the others. You have your various directives, you require the Overseas Commander to report what he has on hand, and Aiat ho expects in order that you at the ports may advise all concerned to get the hospitals to which they are going, in readiness; prepare to rccoivo them and provide the necessary transportation, whether it be hospital trains or ambulances. The third group: prisoner-of-war. There is an interesting subject. January - *****, February *****, March *****, April *****, in May wo hit the jackpot - ***** came in. That presented a problem that none of us knew a great deal about. We had to experiment, to sot up an SOP - Standard Operating Procedure for handling this. *****# s*:****, and ***** received the experience; *********** ****** received a little experience on this particular problem. I believe we now have the prisoner-of-war procedure fairly well in hand. Each port receiving its first shipment of prisoners-of-war make a bad start or two, but then when they get going, things go off very nicely. The Overseas Commander can and wl 11 in the near future have to provide us wl th a projection of what they expect to return, thon wo will bo able to provide the transportation# That projection as I anticipate it, is for units, organizations, odds and ends such as - leave or furlough, OCS, Aviation C' dot - that, I think, is going to bo our problem. I do not minimize the return of patients. We are having con- verted hospital ships which will, of course, relieve the situation somewhat but mil not cause transports or troop transports not to be used. You will continuously use thorn# Your troop transports will have to bo used to return your patients if y_ur patient accumulation is on ywhero near what we anticipate. On prisoner j—of-wr , the Over- sea Commander of the Uohth-African Theater estimated some throe weeks before the fall of Africa that wo would get between ***** and ******** 18 prisoners of uar. In Hay, we brought back ***** and the figures continue to go up. The figure was much higher than his *****, therefore, you can see that there is no nay to project or make plans as to the return of personnel when you don’t know how much personnel will be returned. That will, in my opinion, be our main unknown factor. Under miscellaneous personnel, you have your Navy, civilians, and Allied personnel. The Allied personnel is b-dng moved from coast to coast or from port of entry to a*port of departure. Most of our movements of Allied personnel have been *****. He are doing it under *****. Again the precision of ***** had to be worked up. There are many points that had to be experimented' with in order to find out just how it was to bo handled. You will note that the miscellaneous personnel for January was ***♦*,' September, *****; you can see that it stayed fairly-constant. ’1 will* come back to that type of personnel a little later. "Very recently, the War Department issued a directive or unnumbered circular for the returjg o.f; rotation personnel. I can’t give you all the fine points However, I have studied it. Again wo are "going to'.have to experiment with the details. Each Overseas Commander is going to interpret that unnumbered circular differently. I have 'discussed it 'with Headquarters-, ASF, Their idea is that the Overseas. Comm- ander will return that personnel which he considers have.boon there long enough, or that circumstances’require a man have a change of scenery, and it is thought that such men will bo included on the rotation groups, which, by,the way, arc called Reception Station Groups. Very likely, that will be shortened to RS Groups. No one seems to know or to be able to give us any figures as to how many of those groups will be returned, I think that this is going to bo quite a problem, not only from a rail transportation point, but from a medical point of view. Whereas, when units wenij out, they came.from stations within the United States where there was very ‘good control over their health. Now they are returning from areas whero the control was not as good as it was,- or is’, in the United States, The port Surgeons are going' to have *a problem that will require the utmost in cooperation between your lino officers at the port and your medic .1 officers to prevent diseases coming in, and yet not staging this pur staging area and having determined the Staging Area that each unit should go to, confer with him and let him work :>ut the specific details as to the tine of arrival. There is considerable saving t ) rail transportation if they are able tc work their rail assignments so as to minimize tho waste if transportation. Included also, then, in our instruct! Ms to the agencies to issue the orders arc our certain supply and equipment instructions. Those arc prepared at this Port by tho Initial Troop Equipment Div- ision. We also place reminders in ;ur instructions on the subject of training requirements; that is, firing with tho appropriate weapon to be completed before arrival at the Staging Areas; and re- minders concerning secrecy. As I'said before, wo hope that tho movement of troops into staging areas and out of them, will permit then to stay there for ***** days. During that period, there is a continuation, of course, of tho medical processing. In connection with the movement of replacements, casuals, and smaller two-letter shipments, we. have developed at this Port a code of medical processing with respect t. immunizati m which is specific!! in the movement order, which also goes through the staging proa. In other words, we hwo four different code specifications: Code A inyolves the immunizati m against small pox, paratyph -id, and tetanus; and 3 includes in addition, typhus; A, B and C, in addition, typhus, and yellow f ver; and A and C of. course, the basic immunizati .11 plus yellow fever. This is done so a.s to obviate-an offset spreading tho code, translating the number into the geographical locoti n, int ) too many hands. It is retained in the Troop Movement Division and passed on to the staging areas so that then, by a pre-arranged code, just, that immunization is affected with any particular shipment. 27 So far as tho four numberod shipments arc coneomod, the move- ment order itself, of course, indicates what tho requirements are. With the troops on hand then, and the ships available, or known to become available for any particular shipment, tho overseas theater commanders wishes having boon transmitted to us, were able to go ahead with our planning for the actual embarkation. That begins with the issuance of a unit assignment to ships, A study of tho ships* characteristics is important. Some ships have considerable first-class spo.ee, which is especially suitable for ‘carrying certain types of units, such as hospital units whore you have a large number of nurses, and many of the ships1 character- istics arc taken into consideration before the units are assigned to that particular .ship. The wishes of commanders .of large units, that is divisions, arc also taken into consideration. Considerable leeway is given to tho division commandor*s wishes in dividing his unit among two, three or four ships during shipment. Medical per- sonnel included in any particular shipment is as nearly as possible, equally divided among all ships. That is s.tandard operating pro- cedure with us, to try to have medical personnel dispersed on all ships. From the operating division, when a ship is sot up to be included in a convoy, there is .assigned a liaison officer who goes aboard the ship and works together with tho Transport Commander, determines first, what troops can best be carried; secondly, the exact plan for billeting the troops aboard the ship, to include the order in which the troops would be brought to tho ship for loading, so .as to minimize confusion incidental to loading tho ship. In this connection, it is our problem, to work out tho plans when overloading, is involved. Overloading varies among all the ships being overloaded according to its characteristics. Such matters as deck space for off-sleeping relief, sanitary facilities, mossing facilitcs, among all others, must be considered for a definite figure before overloading can bo determined. In that connection, of course, most of the liaison must be had with tho Water Division so that a sensible overloading figure can bo arrived at. Also, wo find hero that the Port Surgeon is very definitely involved in the selection of the, permanent medical personnel assigned to those transports, Wg have here, aside from our own Army, and Wavy transports, a considerable number of ******* transports. Some of then cone in for only the one voyage. We' consider that it is just as im- portant to assign a complete staff to a ship - a ***** ship , that* s in for a single voyage - as it is for those which have been on several runs, or on our own ship. in preparing - still speaking of ***** ships. - for the actual embarkation, it has become, .a common practice here at.this Port to have conferences with Mr, Borer, of the ****** Ministry and the ship,l s, staff and his own staff to perfect plans for the embarkation. 28 The plans for the actual embarkation - of course - plans for the movement, initially, are advanced details. The ship’s senior officer together with his assistant, go over the mess details, guard details, gunner details with tho loading officers. When I say loading officers, I mean those officers from the traveling troops that are brought in to assist in the embarkation*• They might bo called compartm: nt officers as they ■ re stationed in trio comp* rtnonts and actual- ly assist in the filling of tne compartments as the troops are brought down by the guards which of course > re furnished by the ships. I got a little aherd of myself on that, but that does explain the necessity of bringing in loading offic rs ahead of time. Other details are determined by th. execu- tive officer or Transport Commander, In the case of ***** ships, that is determined at the conference to which I have just referred, having prepared and published tho units as- signed to shipment, which is simply a statement as to what troops are going to be billotted on what ship, the port notifies tho Overseas Commander in a forecast cable of that particular information. The next step is that of preparing tho actual transportation and embarkation movement order and table causing the troops to move from the Staging /.rews to the V'rious terminals in the Port of Embarkation* It is, of course, predicated on the time and order in which it is desired to ha ve the troops arrive, a.t certain piers and at certain ships, and further at certain gangways. The mechanics of working such a schedule which in tho past invol- ved troop movements involving as many as we had at one timo which was about ***** trains, and others from **=••* up to **** trains, requires considerable planning, in order tlw-t con- fusion at the pier and on the ship during loading, is minimized. So far as we have boon quite fortunate not having any consider- able delays, but the problems are quite severe. We can readily understand tlr t hen you appreciate the fact that troops are moved to several different terminals and from several different staging ■ ror.s, the Port Transportation Officer, of course, en- joys the full responsibility of th movem ait. My planning Branch sets up the order in which we would like to hive the troops come. Wo know by now what tr nsportation can do* Having our plan in hand, it is presented to the port Trans- portation Officer who works the plan out in detail to match the requirements as nearly as possible, i„s tho troops arrive at the pier, in the usual manner, the movement is by from C'-mp Kilmer, or Cwnp Shanks to the Jersey Terminals, sent by ferry boat to the various terminals and piers, where the embarkation from tho ferry-boat to the various terminals and piers, where the embarkation from tho ferry- boat or the train is supervised and the units conducted to the specified gangwayst 29 I iijctgino that all ports- employ a Rod Cross; Service, and bands have recently-boon ordered* It adds conaidurably to the* morale of,the■troops. I an'certain that all troop movement officers in'-tho ports -arc■-.conversant. with_ the- pr .-codureat tho gangplank; the actual chocking aboard by name of ev>..ry individual; tho prompt preparation of tho passenger list to tho extent of indicating tho reason for tho dropping off of men who have booh unable to conpl to tho shipment; .the removal of service records for such non; all are a part of the. gangplank- procedureP >1 lowing- the completion >f tho actual loading; [thdt i.s,_ getting the 1.19n aboard, ship and locating their compartments, .there remains the. c.l -sing oat of the deal by computing and. submitting a recapitulati n- o£ the, shipment and pro- paration.-.by tho Reports Branch on thy,- basis of that inform tion of the- sailing cable. ... ."•■•ln connection with dobarkation, this division enjoys the super- vision and control of all debarkations; is respons iblc* for the receipt of all information and the.dissemination of all information pertaining to the arrival of ships; and is responsible far the planning and supervision'of the .actual debarkation. It means th t this division must lay iiew’ plans with nearly all other agencies in -the port. In connection with the Water Division, c ncerning tho berthing plan .and the specific requirements for th.o emptying out ,pf one ship as compared with the others, and so on. Further, it notifies the Immigration'and Customs Officials so that the appropriate panels may-be present if tho incoming passengers-require it. m Port Transportation is ijiyclved arrangements for the trans- portation-of troops. and casuals to the .staging- areas or to new .stations.,- or ini the case of prisoners-of.-irir in that connection, the Second Service Command works, in close c 00per ti in with our officers in acting on instructions from the Provost Marshal move- ment with the Port Transportation; Officer. . In connect?! cm with debarkation,■ the P -rt Surgeon must bo consulted concerning the .patients,. Our standard operating pro- cedure at' this Part do legated to the Surgeon.tho direct super- vision ■of the debarkation of all ■■ patients, working, in close liaison with the Second Service ;Cqm.nnd, Surgeon who determines where tho. patients-are to be sent. ■ -Normally, they are s girt, to the Hallo ran General Hospital not far distant-from our Staton-Island Terminal. t He makes specific arr- angements for tile, transportation of- the. patients-and 0x..-raises close supervision over the entire movement. Upon tho arrived at the pier, the'usual procedure is-for the liaison officer to board the ship together with tho representative of-the Port Surgeon’s office and others, and to acquaint thg Transport Commander with tho proposed scheme of debarkation. It is usually predicated on commencing tho action within a given period of tine after tho 30 arrival of the ship or on the-, following day if that day has boon designated f's tho date for tho debarkation# During tho debarkation/ tho. Port Surgeon, of course, exorcises technical supervision of the operation of disinfestation plans* He, at the time of tho arrival of tho ship, makes a' survey of the health condition aboard and.determines what disinfestation must be accomplished. It is our practice hero to disinfest all prisoners-of-war and in .some instances, tho escort guard# •Further than that, vre have not been disinfesting incoming personnel. Gentlemen, that is all th t I have time for. ’ I have covered the operation ->f this division in this Port very sketchily Ire th ire any questions? I know that ufiat I have said is peculiar undoubtedly to this particular Port. There is considerable variance in the methods used -t tho various Ports on account of the organization and on account of tho peculiarities of uld not be re- corded. Wylie reads schedule) I might add, the conference tomorrow and the next day will be predominantly on the medical side, although the gentlemen this morning have been discussing operation from the Troop Movement or Transportation Officers* side, the balance of the program is almost entirely medical. I want to call attention also to the fact that all of these detailed arrangements here, and it is quite a job to make such arrangements, have been handled by Lt. Colonel j/orski, who is .assistant Chief of the administrative Division. I don’t believe Colonel Dor ski wl 11 be present at the succeeding conferences, but he certainly is entitled to a vote of thanks for the arrangements he has made. ' During this morning's conference we have mentioned several phases of troop.movements• We brought out one question which I don't believe was completely answered regarding the issuance of orders for returning patients. If my. understanding is correct, there are existing adequate instructions to cover the issuance of such orders. The difficulty seems to that even if the orders are not issued at all Ports, or if they are issued, there is some delay or some failure in distribution, I would like to oho;ok wi th the several Ports and see what their procedure is. General DeWitt, dooypu issue such orders? BRIGADIER GENERAL DEWITT: No, only in the case of officers from the Replacement Pool. No other orders arc issued. They are taken directly from ship and transferred to a General Hospital, BRIGid)IER GENERAL WYLIE: Do you know if those orders are copies of those sent to the Surgeon General? 32 , A • •• •. • ; BRIGADIER GENERAL DISJ WITT; I do £ot know. Distribution is made from Port Headquarters. . / BRIGADIER GENERAL '7YLXB: Dr ye u ]:n n-, Col mol, if you receive such orders from Sun Francisc A BRIGADIER GENERAL DE 'ITT: Wo r-.c ivu such orders■ from . all ports. I an suro the Adjutant General receives then .the same way. Wo are faced with the embarrassing fact that wo don’t receive oven a majority of all orders and we’d like to get them all. BRIGADIER GENERAL WYLIE: In fact wo are embarrassed at the same thing. JJo can’t get orders from our officers applying to enlisted men. BRIGADIER GENERAL DE WITT: > Primarily, wo are worried about officers. The enlisted men, of course, cone up, but are usually traced. But if some Colonel or other high ranking officer comes back, everyone comes to the last place. Everyone doesn’t know where he is. Ho was a patient and wo don’t know his whereabouts. BRIGADIER GENERAL -WYLIE: Colonel Padan? LT COLONEL PADiJT; They call us. The Surgeon Gen- eral -and Thg Adjutant General they usually make the rounds, and they don’t know, either. Officers, primarily. BRIGADIER GENERAL ATLIE: Too brid these Gono rale caus os o much trouble. Clomcnceau said, ”1 think that the war was too impart ant a function to be entrusted to Generals'’. How about Seattle? 33 COLONEL BRECHEMIN; Wo issue the ore ors, they are taken from the hospitals, and the officer, in additic i, to tne Replacement Pool. At this time they are recovered when a big. heavy load cones in* BRIGADIER GENERAL WYLIE: How about Los An; eles? LT COLONEL WHITE: We come under San Francisco and wo render no reports except to San Francisco. Orders are issued on officers, not on enlisted men. BRIGADIER GENERAL WYLIE; You are on your own now. LT COLONEL WHITE; That’s right. BRIGADIER GENERAL WYLIE: New Orleans? COLONEL BRADISH: Issue orders on officers. There are no orders on enlisted men. On all patients arriving, the list is furnished the Surgeon General of the source of the patient and the disposition of patient. If lan not mistaken there was a recent discussion to the effect that general hospitals would report to the Surgeon of the Port of the source, and receipt of all overseas patients. It seems to me too, it would take slight augomontation of that report to indicate the Pool assigned, and not bother with the reports where additional recording functions. BRIGIDIER GENERAL WYLIE; I am going to ask Colonel Fitzpatrick to go into that. 34 COLONEL BRADISH: Bo for o I close, I want to syy there appears to bo some leak in our ar'ja, that is, in reference to the technique in reporting the- cases that cone in from over- seas, by air, through airports of ntry. I think that has boon worked on and discussed - direct evacuation iron Gen are 1 Hos- pitals, direct to the Commanding Officers of airports of entry. But wo don't know in many ins banc ;s when they come in, whore they cone from, and it is very difficult for us to koop proper bookkeeping and accounting on their presence overseas and in our area when we don’t have that information. BRIG GENERAL 17YLIE: Boston? MAJOR GORMAN; Boston issues orders on both enlisted men and officers. BRIG GENERAL iJYLXE : Hampton Roads ? COLONEL LORRY: Since tho start, wo have issued orders on enlisted men and officers from the Comnandcr. Copies of those orders go along with the report of the patients to tho Surgeon General’s Office and bo tho Office of tho Chief of Transportation, and a-copy of tho records to The Adjutant General*of tho Army. Since tho issuance of Section 82, in addition all officers are, on tho same order, assigned to the nearest pool of their Service. BRIG GENERAL RYLISr Charleston? ; LT COLONEL NIELSON: • • Charleston hasn’t had a patient. BRIG GENERAL TILLS: Wd tried to ;et you some, but nearly all stole off the ship. Any further on the orders. Colonel Melton? COLONEL MELTON; No, Sir. I think our orders ..re tho sane us Hojnpton Roads. As Tor the distribution of the se orders, that’s up to the personnel. If-we sent then out from our office, as Hampton Roads, it seems to no that personnel is responsible* BRIGADIER GENERAL NYLIN; I afree with you completely* IT COLONEL PA DAN; I an reasonably sure that what wo put on the record is complete. LT COLONEL DORSKIs From our Port, our orders arc sent to the Surgeon General and also to the Chief of Transportati m. There is a possibility they got to yjur distributing branches up there and roach the waste-paper basket or some other place, and do not go where intended. BRIGADIER GENERAL NYLIE: They all go to the 201 file. Now are there any other questions on anything covered this n ruingV BRIGADIER GENERAL DE NITTr , I would like te hrin :up the question of time-chartered vessels. Most of our trouble at my Port comes from that source. These ships cone back not under military control. The Transport Commander, Transport Surgeon and many f thorn arc absolutely helpless; in some instances are not even allowed to inspect refrigerators. Furthermore, there is not on uii personnel on board to feed the sick personnel coming back. In one instance, with ***** patients on a liberty ship, they had to nick up the galley crow to.treat the malaria patients.. One person after another fortunately had some naval personnel on board, but not enough on board to feed the patients. Men actually suffered from deprivation, but they had complete control of one of those vessels and each ship had sufficient galley crow to take care of it. They had c mtrol )f putting food on the ship. It is really a serious situation in the San Francisco Port. 36 BRIGiiDIiSR GUNiSRii VjYLIEs That entiro subject of the use of allocated vessels which our agencies operate on- our re- turn voyages has been tlx; cause of nuch difficulty and the sub- ject of many discussions between ourselves on bar Shipping strati on. Several actions have boon taken which wo hope will improve it,, he feel., although the bar Shipping Adminis- tration dues not,agree with us, that the ideal solution would be round trip allocation for all vessels' which are going to carry troops or which are equipped to carry troops or patients on the return voyage. Some improvement has been• made• Only yesterday wo sent a letter to, San Francisco, really .as an outgrowth 3i* that one ship you were tolling about, asking that you make a survey of all the vessels which are equipped to carry any number of patients, and advise the overseas theater commander that ;nly those vessels will bo used for patients so th.it you will not have an overload placed on s me one ship, when possibly shortly thereafter a bettor equipped vessel will bo available. Now I wonder if Commander Torwilieger has anything at all to. say on that. COII ANDER, TERWILLEGER,: • * X would be very glad to* li/e had tr üblo and we arc very cognizant f this tr ublo• As a matter of fact Colonel Molten and I have been working for the past ton days, just dong the linos suggested now, namely, we might call it the so-called resentment by members of the crew on ships operating under Mar Shipping Administration, their resentment to be examined and inspected by Medical Officers of the ii.rr.iy. This :was taken up in Washington after a talk with Colonel Molten, and the Division of Operations in Washington sees no reason-why any member f the crew sh uld not submit himself to a Medical inspection at any time th it a nodical array officer deems it necessary, especially food handlers ..r any other member of the galley crew. It is nice to be here this.morning, as it is, to hear -about "rod tape" and headaches, because wo being of the belief that we wore going to have it written in the .arti- cles (off the record)-- BRIGaDIDR GiiiiidßtiL WILIE; Thank you very much, sir* Any o'ther quo sti. ns ? 37 COLONEL MELTON s I should like to ask Commander Ter- willeger when he is going to be abl-e to get that paragraph in the Artides, regarding physical examination. Have they ac- cepted that? COMMANDER TERV/ILLEGER: I'd like to answer .that again off the record, (we are..working on that at the present.) BRIGADIER GENERAL WYLIE; Any other questions? LT COLONEL FARR: About casual officers, particularly Hampton Roads, there is a new directive coming out which will probably be in your bands by the end of the week, establishing pools of officers at the Rep It. cement Depots who are being order- ed to accompany casual units overseas and to return to this coun- try and take out another casual group. It is an objectionable practice from the standpoint that it means an additional "dead- headeriing" of personnel. But these officers are going to com- plete whole trips and their efficiency is Ooing to be based part- ly on their ability to keep under discipline these groups of enlisted men and casual officers all the way to overseas destina- tion. BRIGADIER GENERAL WYLIE: Any other questions? COMDR.TERWILLENGER: I would like to take up a couple of points regarding-the Army Transport, The Navy and War Shipping Administra- tion. The main tiling is a carry over from peace days and it has al- ways been the habit of shipping companies-I don’t say this in condem- nation of any shipping companies-!t just seems that at all times it’s been a plan to assign to any ship a space for a hospital or a sick bay Jtau couldn’t be used ior any other purpose. You couldn’t even use it for cargo. Then the nice- timn0 would be to give it to the medical Oflicer, In peace time I was enroute to Europe on a lux- ury liner, ihe Senior Medical Officer ’said; lrJ’d like to have You visit my Medical Department. I’d like to have you see it o8 because I an ashamed of the arr mgomont11. And it brought back the sane problons carrying over to tho present tino. A week ago. in Washington wo w- re discussing a ho spital md sick bay, I was askod not to bo elaborate. 1 was wondering' if any of us will bo lucky to live long enough to sco an elaborate hospital on any ship. I had tho privilege of visiting some of tho trans- ports and I was very much pleased and impressed with what the Army has done in converting all space into hospital space. Tho problon brought up here this morning and the health of the troops when they arrive overseas, I feel, are a reflec- tion dirjctly of two things; Humber one, overcrowding; and num- ber two, the amount of available hospital space that is aboard a ship to take care of an emergency. Di irrhea which broke out, as reported this morning by tho men, would bo directly the out- growth of overcrowding and lack of hospital space. I know War Shipping is guilty; I know Shipping Companies are guilty; the ITavy is guilty-.-- but I know the .Army isn't guilty of putting persons in hospital space ’while transports are onroute. It is a very dangerous procedure. It wasn’t stopped in peace time,' and it is still going on in war time; and ‘when asked not to dq it, they said: "We wanted to put the gun crew in." Alright, we put the gun crew in. It doesn’t holp it. I would like to ask today if we’d all think seriously about stopping transports carry- ing persons other than patients in hospital space "aboard transports, at any time.-. Also another point I would like to ask information on that’s the return of tho hospital ships carrying prisoners. Recently quite a number of War Shipping ships have been trans- porting prisoners. It was quoted here this morning, there is no need for rush in a port; why -overcrowd a prison ship to tho oxtjnt that they have been overcrowded lately. Overcrowding breaks down all sanitation. It is very important to have the troops,-when they arrive overseas, healthy, • because that has a direct bearing on victory. It is important to have our prisoners clean on their arrival hero, that has a direct bearing on the health of this country, not only tho prisoners but t.iis country. ]Jg are,now coneornod in Washington with Colonel Melton’s division, handling more ships that are carrying prisoners. Wo cannot make a success of,this unless number one, they- stop overcrowding prisoners ■on those hospital ships; and number two, wo have tho Cooperation which to date wo have had of the Public Health and the Army. But there is.no reason for rushing in ports. Then I certainly believe wo could got some workable plans whereby they wouldn’t overcrowd thq prison ships. 39 BRIG GENERAL WYLIE: I think I can state that already something has been done along that line, I might add that we have been a little bit helpless on the crowding of war ships, as the decisions on how many are to go aboard had usually been made by the overseas theater commander, and he in turn has had to make his decision based upon his local situation, he have had large battle ships come out with no ■ risoners on and in ten days later on *** comes out with *** prisoners on it. There is another angle from which we may attack that problem that we are now doing, becanse we are now going to use those ships to go overseas. That is, we are going to provide additional galley facilities and make them more acceptable as troop carriers. I find our time is almost gone* I have just two suggestions I would like to make and I will state that the other question will be brought up at a later period of the con- ference, on the last day. You may take as much time as you need then. The one suggestion is that if it is not being done now, very definitely the Port Surgeon together with the Chief of the Water Division should be brought into consultation with the Troop Move- ment people in discussing overloading. I realize we require and demand overloading because the need for certain of the overseas theaters is beyond our capacity to transport troops, during certain seasons we arc required to provide the last possible troop aboard those ships. However, there are certain limits beyond which wo may not go. It is absolutely useless to carry troops overseas if they arrive there in no fit condition to fight. So I feel if it is not now being done that they certainly should get the assistance of the Port Surgeon in determining what that overload capacity is. I will agree that after you hvo determined you can put only **** on a certain ship and Colonel Farr says ***********, it is; but we would at least like to have the benefit of export opinion; also that the Port Surgeon in coordination with the others prepare some special instructions for the transport commanders on these overloaded ships, I would oven differ just a little on the state- ment of the one ship with the diarrhea, in'which it was reported that the primary reason was ov.r-crowding. ' I take exception to this extent. It was a contributing cause, no doubt, but I feel the primary’reason is sanitary discipline, and effective sanitary dis- cipline is much more difficult after you have overloaded and has an over-crowded ship, but still I rather hesitate to give the over- loading as a primary cause; a very strong contributing factor, yes. Have you anything further? (No reply from tiio floor) We will assenble at 1:15, I want to thank you all. 40 LT COLONEL FARR: This session today is going to prin- cipally cover the medical aspects of the meeting. Before we start, however, I have an announcement here that was handed to me. We want to be certain that all officers sign the register downstairs both in and out. Now to start the discussion today. There is a little subject that has caused a great many ques- tions in everyone’s mind from time to time, as to just exactly what the medical responsibilities of the Transportation Corps were. We had some indication at yesterday's session of the com- mand responsibilities and that of technical supervision. The Surgeon General’s Office, which acts as the Surgeon for the Transportation Corps, furnished for this conference an officer who has had no small amount of experience with various and sun- dry arms of the services. Having spent a great deal of time in the Air Corps, he should know the problems we face very much on command and technical channels. Colonel Schwichtenberg is going to discuss this problem. COLONEL SCHWICHTENBERG: You have heard from General Wylie, Colonel Farr and Major Griffin who have presented you with the background of activities and responsibilities of the Transporta- tion Corps, with some emphasis on responsibilities of special interest to the Medical Department. It is my purpose to dis- cuss briefly the relationship of the Medical Department to those activities and responsibilities, and to present to’yon some concept of the Medical Department cooperation necessary in order to accomplish and facilitate those Transportation Corps responsibilities. Nov; after all, I believe the responsibilities, that is, the Medical responsibilities to the Chief of the’ Trans- portation are really fundamentally quite simple. There are those that arc common to any Command;. measures for the control and prevention of diseases, for the care and treatment of sick and wounded, and, of course, the provision of dental and veterinary service for the command. In the case of the of Transportation, thepe- responsi- bilities are materially modified by the character of his organi- zation,, in the same sense as. Colonel Farr intimated that the same general concept involved in Medical responsibilities in aviation. ■ They may well be divided here according to the mobil- ity and non-mobility of the elements concerned. Now the fixed installations are - we might call it static. Here we have the usual medical services in- ports and other station field installa- tions of the Transportation Corps, and those, of course, of all res- ponsibilities common to any fixed command, such as the provision of hospitalization, insurance of sanitation, and in general, the 41 maintenance of health in the Ports. Also, of course, we must provide for civilian employees the medical services that any employer is required by good industrial practice to make avail- able to his employees. There, is a special responsibility of the Chief of Transporta- tion, which is in regard to the Veterinary service 'at Ports, and that has to do with food inspection service. This service in- sures that food products purchased locally, or in many instances merely passing through Ports, destined for the use of overseas troops comply with the requirements. The, medical responsibility for mobile outbound units .includes of course, you all know, tho screening out of individuals enroute overseas who arc not physical- ly fit for such service, who have been overlooked by home station pf origin, or have fallen victim to some in-curront or tenp- ary disease. . ’ We had some discussion about this thing with -General Do Witt yesterday, and it is something that is very close to mo personally. I feel - and this is only my personal belief but T share it with quite a number - that when a man arrives at a Port or staging area, has disability such as hernias, pernicious, sinuses, tonsils, and what not this represents in each instance a failure of tho medical department, which I believe is attributable directly to tho surgeon in command of the stations from which these individuals originate. I beliovc that it is fundamentally sound to say that all]of these individuals receive a thorough physical examination, if pos- sible, prior to the beginning of this period of training which culminates at the port. This to my mind is a groat waste', and there is still another angle to it which I think is important. The Surgeon General does not beliovo that in tho event that a soldier, seen at a port who has a hernia or pernicious sinus, should be ODD* 'He believes that man should receive corrective surgery. Now where that corrective surgery should bo done is a very real problem, and I don’t believe that tho port facilities in many instances will be able to accomplish all o-f that. I think that there is organization available for such individuals to bo returned to their posts. They certainly can bo returned to some nearby station or general hospital. Anytime that any difficulties along that line are encountered in regard to bod credits,, it is only necessary to call my Evacuation Division, and wo. *ll arrange for the necessary bed credits, as necessary. Now in addition, we have medical responsibilities in these outbound units to ‘prevent the embarkation of individuals, who because of communicable diseases might be dangerous to the health of others who- are "embarked on tho ship. Aboard each ship must be placed sufficient‘medical supplies, personnel, and equipment. 42 in accordance with roeommendations o£ the Surgeon General, to seo that these medical responsibilities can bo properly carried out. The transportation necessary for the proper employment of supplemental personnel required for the care, treatment and safety of patients expected to require evacuation from over- seas is also one of the medical responsibilities. Now on ship board which of course is another phase of this responsibility, it is required that essentially the same medical service be made available as to a fixed command on land. This includes the care of the sick and the wounded developed in transit as well .as those being evacuated later on when the ship is in- bound; in that latter instance, when they roach this side, to have insured that these individuals who are possibly potential carriers of infectious and communicable diseases are properly cared for, and also insurance of proper facilities for care of patients evacuated from overseas, and their care until turned over to service commands. We have had considerable difficulties in this particular problem in regard to officers returning from overseas, who have lost their papers, and who are without funds. .That’s a condition which occurred sometimes in the last war and certainly has already occurred now. It can be expected to recur in this one to an increasing extent as the war progresses. After all many of those officer patients have to be transported by hospital train, particularly if they arrive at a port such as Boston, to the nearest general hospital which is some distance away. There are meals to be furnished these individuals, or they have to bo fed I should say. The question as to how that should bo done has arisen. It is a particularly difficult question when you stop to think of complications involved. These officers have been overseas where they could always arrange to be fed at some mess. When'they get here they feel, after all is said and done, they have been wounded overseas, they should receive meals and other necessities without further arrangements. Yet the only way they -can be fed is from the dining car which is the same source of food as the rest have. And of course the enlisted men are issued meal tickets. In the case.of officers, however, you can’t issue meal tickets and the result is that hours after they have gotten on the train, meal time comes around and they have no funds. There seems to bo no way to feed them. That has not been solved yet. There are several possible solutions to make arrangements so that these officers can be issued meal tickets for that pur- pose. That is, as you all realize, quite a departure in policy. ■The Quartermaster is not interestod in making that departure in policy,'though it may be necessary to do just that. Another temporary solution, which I don’t believe should be our final • 43 solution, but one that should help, will be to have the Port Surgeon insure that the Red Cross is cable to contact those of- ficers and make suitable loans. I don’t like that system at all, but it will enable them to bqy a pack of cigarettes, or to got a meal, in the interval between the time they arrive in this country and the time they have been able to get their finances arranged, .when they reach the general hospital. At least it will prevent some.suffering. There are tremendous implications to the command responsi- bilities of the Chief of Transportation. The lack of ...suffici- ent attention to these command responsibilities in their ports, and of the Port Commanders, would undoubtedly result again in wide spread epidemics in the staging area with the troop move- ments outward. In addition there would have been shipped over- seas large numbers of men who have boon namifestly unfit for service, and their immediate return to the United States, of course would put additional burden on our transportation faci- lities. As I mentioned before, it.is not the policy of the Surgeon General to have those individuals, who are unfit, re- ceived a CDD. I can’t stress that enough, because it was one of the things he was very emphatic about at one of the recent conferences. Frequent outbreaks aboard ships of air, water, and food bourne communicable diseases with resultant comparative incapa- citation of troops as they arrive overseas would have been prevented. Also, lack of facilities for the care of the sick and wounded arising enroute., and lack of facilities for the care of the sick and wounded arriving from overseas. The proper utilization of ship platoons might be considered at this point. There has been a good deal of "grousing" I sup- pose that' would be as good a word as any - on the* part of many of these individuals on these ship platoons, particularly nurses and doctors, that they were not doing anything, they were sitting.around. At.the same time there was a groat shortage of doctors and nurses. So we’have here a paradoxical- ly situation. I believe that some arrangement will have to bo made to utilizo theso more fully. However, I also realize, well realize, that recently this condition has more or less corrected itself because of the .fact that they arc being ship- ped out and now more nearly completely utilized-. It was the plan that ship platoons- in ports should be utilized by the Port Surgeon in the various installations as far as possible. With returning personnel (civilian, military and pris- oner s- of -war) the importation of communicable diseases into the United States represents a serious problem, and failure on the part of the Port Surgeon to combat.this, dr cope with this sit- uatioh, would have resulted and still can, if it has failed, in the importation serious nww diseases into this country. The fact that there has- not been by fa'r and largo a!ny note- 44 worthy failure in any of these respects, indicated that these command responsibilities have been discharged in a complete manner; and this would not have been possible had there not been a real- ization of, and a great deal of effort to take care of these responsibilities by all concerned. COLONEL SCHWICTENBERGs These Command responsibilities have been discharged in an excellent manner. This would not have been possible had there not been a realization, and a great deal of effort from all concerned to take care of these responsibilities. Now in considering lfall concerned”, I don’t limit myself to Port Commanders and their Surgeons alone, but almost every officer associated with the. Port. The cooperation of everyone of these individuals is the thing that has been responsible for the excel- lent results that we. have had so far. We have had good coord- ination and cooperation among all of these individuals, but as the tempo of the war increases and particularly as the move- ment of personnel is increasingly inbound, there will be even greater need of cooperation and coordination between all of these individuals charged with those responsibilities. This has been in vision by the Chief of Transportation and the Surg- eon General and to provide for it, it has been mutually agreed that the Surgeon General will act as the do facto Surgeon for the Chief of Transportation. The Chief of the Hospital Administration Division will coordinate all Transportation Corps matters referred to the Surgeon General’s office, and will generally supervise all Trans- portation Corps matters of interest to the Surgeon General. Under the Chief of the Hospital Administration Division, the Surgeon will be represented by a liaison officer -at present- Colonel Fitzpatrick detailed to the-Office of the Chief of Transportation. He will, as a representative of the Surgeon General, directly advise the Chief of Transportation on his responsibility where these recommend it ions are given in accord- ance with known policies or procedures which have boon prescribed by the Surgeon General. He advises the Chief of Transporta- tion after consultation with the proper agency in the Surg- eon General’s Office when the recommendation involves a change in policy-or in approved procedure. On tho inauguration- of new- policies or procedures where-coordinated action by the Surgeon General’s office is required, he keeps the Chief of Transportation informed as to the status of his comriu«nd • medical responsibilities, and tnis is necessarily based on information that he receives from the various Ports. He.assists in the necessary coordination with those concerned on medical matters referred through channels to the Chief of Transport- ation when the decision reached must be based both on technical 45 medical consideration and command considora't-ions . ■ T;ho ulr. timato purpose of this arrangement is to effect a uniformity, of medical policy in the several ports to provide -a properly coordinated channel which port officers may utilize to secure medical decisions and generally effect proper technical medi- cal supervision for the Chief of Transportation. If this :>r any other administrative arrangement- is to func- tion efficiently as it is intended, it is essential that, cogni- zance be taken of proper channels of communication. These- were touched, on very briefly by General Wylie- yesterday. '.That.-.con- stitutes proper channels under this setup is not often easy to define since the arrangement is somewhat unusual. It is, of:course, not desired that purely routine medical matter of no command inter- estobe forwarded to the Chief of Transportation, but' it is essential that matters of any command interest be -forwarded through channels so that proper dissemination of infer:lati n and coordination of decision may be effected. The best guide for making a decision as to the way it sh mid bo forwarded to the Chief )f Transporta- tion and What may bo properly sent directly "to -the Surgeon Gen- eral’s Office, is contained in Paragraph 11, AR 340-15 which states: ”C oraduni cat ions relating to the initiation of new or changes in existing policies and regulations, or those roquir-- ing decision or action affecting the command as a whole, will be routed through normal military channels of command. Commun- ications )ther than the above, routine in nature, whether from a subordinate to a superior or vico versa, may bypass inter- mediate headquarters whenever it is apparent that intermed- iate headquarters arc not interested and no action by them is required. Com unications will not bo routed through a head- quarters which has no interest in the nutter and which is not expected to intervene therein.'’ The only addition to the above statement >f principle - to base decisions regarding the routing of communications - is that matters of command interest whether inquiring decisions or not’should bo routed through command channels, and command channels will always include the office of the Chief of Transportation where medical matters are concerned. Now this is very in the arrangement of mat- ters in the office of the Chief of Transportation there is very close liaison between him and Colonel Fitzpatrick so that he will certainly receive- these right away. It is only through adherence to these apparently unimportant administrative details that one can obtain the proper coordination of action and dissemination of information, and avoid needless conflict of interests through misunderstanding. Often times it appears that people are fight- ing each other almost as much „s we are fighting the war. In the last analysis each Port is a separate Corarru nd - in effect that is a separate service command having under its control several stag- ing areas, sub-ports, and transports assigned or attached to them. Under the Port Commander the Surgeon has the usual functions of any Surgeon of a command. In addition to such functions as arc 46 prescribed for the Surgeon of the Corps Area or the Service Command now suitably modified in accordance with the existing organizational policy, inasmuch as each port surgeon has avail- able only a small technical staff - it is believed by the Surg- eon General that he call upon a surgical, medical and sanitary consultant of the Service Command in which he is located. That has not often been done, as a matter of fact, but it is the Surgeon General’s wishes that the Port Surgeons take advantage of those technical staffs that the Service Commands have available. All technical matters should be processed through the ordinary technical channels and these of coarse will include the Port Surgeon. He is therefor responsible for direct, general, tech- nical supervision of medical activities and of all Port echelons. Of course, proper attention must always be paid to the command. It is believed adherence by the Port Surgeons to the broad gen- eral principles outlined will enable the continuation of excel- lent results under the more severe conditions which will certainly obtain as the war progresses. The current arrangements between the Office of the Chief of Transportation and the Surgeon General and the arrangements now in process for technical, medical, surgical and sanitary consultants as required from Service Commands will, I believe, enhance the uniformity of medical policy, and the soundness of scientific medical procedure in all command echelons of the Chief of Transportation. There has been a considerable discuss- ion of the matter of personnel. I believe that too few of the officers in the field realize how serious the situation is insofar as medical officers and nurses are concerned. We don’t have it scheduled on our program. I have tried to hurry through .this part so that I could give Colonel Padan who heads the Personnel Section in the Surgeon General’s office a chance to talk to you yery briefly to give you his slant on his personnel problem which, of course, is one that all of us have. Will you come up here, phase? LT COLONEL PADAN: Gentlemen. I think that most of the Port Surgeons 'realize that we have a shortage of medical per- sonnel* By that I mean Medical Corps Officers and Nurses. I don’t believe that all of you know the seriousness of the sit- uation and what we will face in the future. To put it bluntly, we have been "on gravy" up to now. To orient you briefly; in our former scheme, where we thought that wo could.give .the old- time medical service the way we started out in the -war, we need- ed approximately 6,500 doctors. Beginning in December of last year and continuing through January of this year, the War Man 47 Power Commission began to enter into the question. It went up through the Chief of Staff and the General Staff and along in March, there' was handed down to us a figure ’’out of the hat” so to speak, that there would be only ***** doctors available if the Army went into ***** men. We have gone on that assumption and as you will remember, along in May and June, allotments to all installations were revised. In our station hospital of a thousand beds, we went down from an idoal of *** doctors to ***. That applied to all Service Commands and to the Chief of Transportation, and also to the same extent in the Army Air Forces. In allotting the ***** when we made that reduction, there wore still a thousand more positions allotted in the Army Serivo Forces than wo had. We hope to make that up by the natural process of attrition. We have closed two Medical Replacement Training Centers and a few things of that nature, and the Army Ground Forces program did not get as big as was expected. The Army Air Forces had a little cut back and wo thought that wc could make that here within the last few weeks. The General Staff has been considering - this should not be publicized after you leave this room ********fc****(off the record) As you know, wo actually have approximately ***** doctors. Some ***** are overseas. Therefore, how are wo going to get doctors and h'w many are wo going to get for the hospitals? How many are you going to* get for the transports? We arc now present- ed with the problem of rendering a maximum medical service with a minimum of personnel. It will probably bo a medical service that will be often of vital interest to you. Up comes the question of how many doctors are we- going to put on transports. What is the policy going to -be? It has ‘not been definitely decided* but it is doubtful if it would bo a desirable policy to carry a non- commissioned officer and no doctor. Up to now it was supposed that we would get doctors at the rate of ***** a month* In addi- tion to that, we wore supposed to have gotten all interns that were commissioned. Actual procurement has run around **** a month average for the past year. Last month alone wo had sepa- rations from death, sickness, and other causes totaling ***** so we have ******, i do' not know but I would like to get the reaction from the floor. I can assure Colonel Schwichtcriberg and Colonel Fitzpatrick as.to what the Port Surgeon thinks is the biggest vessel that can be safely run carrying troops with- out a doctor. We have a lot of things to consider. The Navy uses a destroyer. As I understand it they have no doctor. They have no doctor on the submarine. We do not want to use an offi- cer that is too ’’green”, but. it has gotten down to this point. Wo are seriously considering taking the second doctor out of the combat battalion. This means sending that battalion into the front line to actual combat with one doctor. Now another thing about the nurses, wo still have hope for nurses. We shall be limited. We have been limited to a certain extent as 4a to the number wo might h >pe to procure. The nurse situation is improving slowly and with Army Cadet Corps or whatever this Nurse Cadet Corps is, it will probably pick up in due' course of time. IVo have definit hopes by the early part of next year of meeting our procurement objective from there. That is all I have. I would like to hear an opinion from anyone who might like to voice one on the transport pro- blem. COLONEL SCHUHNLNN: Colonel Padan, I would like to ask a question. You asked an opinion from the floor as to what the smallest transport is that should carry a doctor - the biggest one that can get by without one. You gave some figures. That would be roughly about one doctor to every **** men, wouldn’t it? COLONEL PADAN: Noll, they want us to reduce it. It runs down now to one to **** men. COLONEL SCHUHMANN: V,:hy can’t y u use that as a guide? On the transports, if you arc going to put on ***** men you are going to have a crow that is going to be more than ****** COLONEL PADAN; You can’t use that for a guide because **************** COLONEL WHITE; One thing I would like to point out. The largest transports operating actually have only **** doctors. COLONEL LOPPY: V m We should iaup in mind the use of those Liberty Ships and set the policy so that it will boar a definite relation te these, which we are using for our trans- ports. In other words, they are going to bo somewhere in the capacity of those ships. GENERAL DS WITT; I think the capacity of the trans- port is the factor, which, when you asked the question, what would be the maximum capacity wo could put m an enlisted man. GENERAL PADAN: Yes, sir. 49 GENERAL DS WITT: That depends entirely upon the type of enlisted non you put on the ship. We can't go out and put a technician on a ship and expect hin to do the work. Now if we arc going to be required to put enlisted men on these ships as wo probably will - up to *** or *** non - wo have got to get them in the Medical Department in number of quantities. Now if you are going to do that we should plan ahead, establish a school, one or more schools, utilize our technician schools and require a course of training to properly select men that we could trust there, with that proper training. You could send a ship from our port with up to 3 or 4 or 500 patients providing they ship troops in a convoy, and they have available a doctor from that convoy, but the main thing is to get the proper type of men* We pick out a man he is classified as a technician. I don't think he can handle that business. If we can establish a tech- nician school at **********,• pick the men carefully with educa- tional background, if possible, some training in biology and give them a course of instruction. COLONEL FITZPATRICK: I think wo can got by with less doctors with respect to the medical point that it might be pos- sible to reduce your requirements if you put inly one doctor in a convoy. I do not think that the average convoy is going to stop particularly if it is in dangerous waters for the trans- fer of patients from one ship to another. To put the people on the ship whore the doctor is. You cannot risk the life or lives of others or individuals for the life of one individual no matter how much you want to. GENERAL DE WITT: I did not mean to infer the trans- fer of patients in a convoy, but I do moan, use the same system as the Navy uses. Bo able to transfer a doctor and bo able to take care of patients on various ships. MAJOR QUINN: I ■ I hoard-some of our convoys do that. LT COLONEL FITZPATRICK: You have a convoy of 20 ships. If you want to transfer your doctor from ship to ship that would mean 20 stops. I don't think they could■establish that. COLONEL PADAN: One other thing I would like to bring up for consideration and leave open. I do not want to take any more time. The opinion of the TMD as to the possibility of disbursing outbound doctors has got to bo reconsidered no matter how much leeway you have. Ikn .w they are all going to the same 50 place that is one tning that is probably going to be manda- tory to use all casuals that you can within your limitations to provide nodical services on these outbound boats. LT COLONEL FaRR: Did yju have any further ques- tion? Colonel Schwichtenbcrg got out from this thing very lightly. COLONEL SCH.,ICHTENBERG s Let me also make a statement here that in making up this program Colonel Farr, frm the Office of the Chief of Transportation and who I believe knows a groat deal, I know he knows a great deal more than I do and I believe who knows more than anyone else does a- bout this general problem. He has not included himself in this thing. LT COLONEL FARR: Any discussion on these respon- sibilities. COLONEL ’HELTON; May I ask a questionl I think there is one. thing that needs a little more clarification* Now Colonel Schwichtenberg mentioned the staging areas reu ceiving patients, be would like to know exactly how we ate going to handle these if you get a hernia and they have facil- ities in the staging area to operate. Shall we operate? COLONEL 3CH7ICHTENBERG: Yes. COLONEL BELTON; Now in our staging area we have two large hospitals, and we can operate, and in the natural course of events we expect them to bo back to duty within 90 days* Nov; shall we utilize our surgeons, and we have excel- lent surgeons and facilities in these staging areas, shall wo do that or shall we transfer all of those cut to a general hospital? COLONEL SCHbICHTENBERG: Certainly I do not believe that comes under this term surgical procedure which we have in the bar Department and do I know that after all is said and done that hernias are being operated on in these station hospitals all over the country why then shouldn’t the same thing be done at the Staging Areas’ hospital. Provided only one thing. That you don’t get tied up to the point that you can’t take care of situations that recur in your station. That in my mind that’s 51 the only tiling that will hold you up. LT COLONEL FARR: well, gentlemen, there is one thing to mention to you. Tomorrow morning we have an opportunity for the discussion of all problems. Nov/ in'order that the session will be a fast moving one and also one with good answers, I would like to have you keep such notes on questions as you may have down on this session, write those questions out and give them to us at the close of the day. Vic will refer them to the proper officers this evening and they will do a■little work this even- ing, I hope, and come up with the answers that are necessary so that in our discussions tomorrow we will have the best answers possible on these questions. There are some things that have not been covered fully this morning that I want to know. You will want to ask further questions so keep records of these things and turn them into the desk hero this evening covering any subjects that have been talked about >r if you'have got some things that have not been discussed that y;u want answers 3n or want to bring up for discussion tomorrow,_let us have those. If we do not have time for them or we arc unable to got An answer, wo will take them back to 'Washington, work out some answers there and publish them t~ all concerned. It would be a good idea to put down on paper, right now, some answers to the question- that Colonel Padan propounded, and that is doctors on ships. \io should have the opinions of all ports on that and now is a good time to start getting them. Nov/ the next phase of our mornings session is the result of the Port Commanders conference at Boston. At this confer- ence there v/as considerable discussion about Transport Surgeons. The Port Commanders decided that they wanted a uniform regula- tion for transport commanders• It wa.s so written in the minutes of their meeting and General Gross directed that wo have a con- ference for the purpose of working up such a regulation. That was the primary cause for this conference, the motivating force that brought it about, although we have been discussing having such a conference for the past six months. Now to discuss the medical transport regulations, you can go into hours and days, if we take it piece by piece. - There- fore, v/e have picked on the regulation that is most voluminous and the 52 most detailed, and whether it shows the most work, I don’t know, hut it certainly shows a great” deal of work. V/e picked on that regulation and wo sent it out to all of you for study prior to the conference. We assume you got it and had a chance to go through it at least hurriedly. We are now going to have the presentation of that regulation in rather brief form this morn- ing, having about an hour allocated to discussing it. Following that, we will h ve open discussion tomorrow, and at that time we will have further discussion on the regulation. Now in order to got the thing covered, it is going to be necessary to select a small group for a little special duty to actually sit down and ‘.gather all of the comments that v/e get out of tnis meeting with such decisions as v/e reach, and come out with the finished regulation. Making up one of these things is no simple job. It takes a groat deal of research and ex- perience, both experience of the individuals who write it and the usuablc experience of the personnel under his control, and with whom he is associated. We are going to have for this presentation. Colonel Schuhmann, from New York Port of Embark- ation. LT COLONEL SCHUHMANN: Colonel Farr, General DeWitt, and follow officers. I think Colonel Farr has made a pretty good introduction here. We have several of our regulations here - - - regulations, as Colonel Farr called them - - - I prefer to call them instruction. If anybody desires to have one, we can hve them distributed. I don’t know if each officer brought one with him. The greater part of this next hour v/ill be taken by dis- cussion. It is my intention only to make a few pertinent remarks merely as an introduction. As General Groninger men- tioned yesterday, we are going to accomplish in 2/g- days what ordinarily would require 2 weeks. Because of the enormous vol- ume of material to be discussed regarding instructions for Trans- port Surgeons, an attempt will bo made this morning to direct this discussion to the proper channels, so that the primary mis- sion of this hour may be attained. The object is to decide the type of material which lends itself to becoming standardized instructions for Transport Surg- eons. For the past few days I have been hurriedly reviewing the various instructions for Transport Surgeons from the diff- erent Ports of Embarkation. I have been struck by their similarity and their tendency towards uniformity. Further, I have noticed that with each change published at the various ports, there has been more and. more tendency for all of these instructions to become 'similar. : 53 In reviewing jjny instructions from .the various ports you will find that each contains some instructions which ".re taken word for word from, the other ports. Yesterday, General V7ylie re- marked that it is the* desire, iof the ASF to standardize proced- ures throughout all of its agencies, and he remarked that the Transportation Corps is making every effort to attain this end without actual interference with operations. In view of this, I believe", it appears appropriate at this tine f >r Port Surgeons to select standard instruction to cover all Transport Surgeons and to have these instructions published by the Chief of Transport ation. In addition to reviewing the.instructions for Transport Surgeons published at the various ports, I have also reviewed current 'Tar Department directives and pertinent Army Regulations, and it is my opinion that in these Army Regulations and War Department instructions, only minor changes are needed. These directives and Army Regulationstoll what the duties of the Transport Surgeons are. It is believed that this should bo augmented by instructions which toll hoi/ te accomplish these duties, and that is all that we intended our instructions at the How York Port of Embarkation to attain. Wo wanted to tell how to do what has te be done. Later on you will see why curs are more or less voluminous. They aren’t directives; they merely tell how. As Colonel Farr t )ld you earlier the Commanding General, New Y >rk Port of Embarkation, recently forwarded to each Port of the-United States, to each Port Surgeon of the United..States rather, a copy of the instructions for Transport Surgeons as published at this headquarters. It was published with a view to having each Port Surgeon become familiar with itsccohtonts so that it might be discussed at this meeting. It;was not furnished, I might remark with the intention that it be adopted at each P )rt nor with the intent that its contents be accepted as an ideal to follow. •' It is merely to bo used as a guide because we have to have some standard from which to work. Because wo are using the Now York p..rt of. Embarkation instructions as a guide, it is believed desirable at this tine to briefly review the history concerning these instructions with a view to showing the need for such. I will go back to peacetime. It was customary at the How York Port of Embarkation for the port Surgeon to give oral instructions to Transport Surgeons prior to an assignment to a vessel. However -- and I believe the most, important fact was that wo had an experienced medical detachment aboard each ship, the first sergeant of which was thoroughly familiar with routine administration. It was merely a matter of time before the Surgeon in turn became familiar with this administration. Following the declaration of war, however, it became necessary 54 for the Port Surgeon to continue his orr.l instructions, but the large number of Transport Surgeons assigned, node it necessary to supplement these oral instructions by information in writing. Before long we noted that we had a I*rge number of written in- structions. As they became more and more numberous it was finally decided to compile them into booklet form and this was first accomplished in New York in May 1942. As the Port Surgeons Office in turn increased in size and became more and more spec- ialized, it was divided into sections such as. Supply, Transport Inspectors, Personnel Section, Evacuation Section, and the need for special information in each of these sections became evident. Now items were added to these instructions until repeat- ed mistakes on the part of the Transport Surgeons, or, in part- icular, oramissions on their part necessitated the publishing of specific instructions, .as a result it ctn safely be said that at the New York Port of Embarkation there is, or has been, an absolute need for each item present in this booklet. Un- doubtedly the same conditicns have existed at other ports, and the interchange of information between ports brought about by the visits of Surgeons has resulted in a uniformity of these instructions to which I cl luded earlier. It is suggested that this now instruction contain overall information for Transport Surgeons operating out of every Port. It is believed that supple- ments containing information peculiar to the various ports may be added as tho necessity arises at the individual ports. In all probability it will be possible to incorporate the good points of the present instructions that are published at the various ports in the United States as it becomes evident that the material con- tained within these instructions should be permanent in nature. Now, Yvhen I say permanent in nature - I don’t mean it won’t be subject to change maybe in one month, or six months or one year - I mean it should be an all-year instruction. We made one mistake at the New York Port in our instructions, f.or example: on the use of atabrine - - atabrine is to bo used in our in- structions between the months of May and October; that should not have been made part of tho permanent instructions. The instruct- ions should be applicable to any transport carrying troops from our smallest frieghter to our largest transport. It should be an elaboration on how to accomplish the requirements of the cur- rent War Department directives and amy Regulations; it should be concise, and have a degre.e of elasticity. This degree of elasticity should allow for tho addition of instructions peculiar to various ports. Now I think it is most important that it should be logical in sequence, and it should be well indexed. By making continous additions which become very numerous in a short tine, and are not included in the index, we lose the whole point of tho instructions and we have found that Transport Surgeons can not find or do not refer to the written instruction. 55 A As to tho reasons for the publishing of a standard: in- . , .struction, it is believed tho following is sufficient; first, it is the :desire of the Commanding Ueneral of tho Army Service Forces and-second, it is the desire of tho Chief of Transportat- ion; and I think tnese are reasons enough. If they desire uni- form instructions I can see no reason why we should say, or any- body say, wo can’t have then. If we do have uniform instructions, it is believed that the following advantages will be obtained, therefrom; One, it will facilitate the training of personnel prior to assignment to transport, personnel will have, something to work on when they arrive in the port, and we can make up a standard training program which will include all these instruct- ions. It will facilitate tho exchange of personnel between port. At the present time, the way our transports are operating, personnel is permanently transferred to the port at which the vessel is assigned. Certainly if the Transport Surgeon runs into uniformity in handling his material at one port, he will fit into the other port much better. It will help him overcome the administrative difficulties when he is a to these other ports or upon his return to a port other than his home port. Now, in the event a large number of Transport Surgeons are suddenly needed, there will be a standard guide for reference. Along that line we might remember that Colonel Lowry menticned a little earlier the fact that they are "blowing up" a lot of freighters to carry personnel and in much larger number than formerly. That means that we may suddenly have to put a large number of transport surgeons aboard these vessels, and we will not have time to train them in our own offices, where we do not have a pool nor the authority to carry those people as overhead. I believe further, a standard instruction would tend to make uniform reports, so that these reports would be much more under- standable at central agencies - such as. the Office of the. Chief of Transportation - when they arrive. It would facilitate the ability of each Surgeon to accomplish repair, secure supplies, raid change personnel, etc, when they arrive at strange ports. Lastly, I believe it would tend to standardize medical care aboard trans- ports, Now, that may sound rather odd. But Ido believe, and we have seen it here at the 'New York Port of Embarkation, that some Transport Surgeons are performing work that is not necessary performing elective surgery. In particular, I believe they are not handling mental cases to the best advantage of the case, themselves or tho Service. Every Transport Surgeon has a tend- ency to bring his mental cases on deck raid give them a little air, and we have a case where on one convoy, throe of them decided to go over tho rail. Open ward cases cannot be treated on transports the same as they are treated in a hospital. I believe we should give thorn specific instructions on how to handle these cases. It should be based on the experiences of the various Port Surgeons, 56 because they are certainly in a positi m to see what hap- pens n're than the individual Transport Surgeon, T'7e have found in New Y ;rk, when•assigning temporary Transport Sur- geons to vessels - which we have done recently - that there is a very narked improvement in the work performed by these officers when they are given instructions prior to sailing. They cone into our office, if only for one day, to receive oral instructions. Keeping all of those pbove points in mind, I believe it desirable at this time to discuss the contents of the manual which we have at New York, because it was forwarded to each port Surgeon and discuss some of its c mtents as to its applicability at Ports. Those arc all the remark I intend to make on the subject because, as we said before, it is too large a subject and would require too much time. Nov; you will note at the New York Port of Embarkation we have published a bound copy. It is bound, which may not be t m good a policy. It is indexed, and it is divided into certain sections 90 that it will be easy for the Transport Surgeon to refer to these sections. In ether words, wo want to mako this inf ;ramtion 'available to him. *Jo have tried giving him the Army Regulation, War Department Circulars, and Surgeon General Circulars, but he does net refer to them. If we can give him in one compact form an instruction that will cover most any problem that might arise for him, I believe wc will attain our end. New if each )f you has one of those in- structions from the New York Port wc will go through it. I would like to have any comments, and as Colonel parr mentioned if there are any comments, they can be made in writing, to be turned in, so that we might study totight with a view to making further remarks tomorrow. In Section I of this instruction, wo have provided merely general provisions. 17e have tried to tell the Surgeon in these general provisions what his hospital is, how many patients he should have in it, how many bods ho should keep open, and we have referred to the pertinent _rny Regulation. I think you will find that same instruction in almost any instruction pub- lished at the various ports. Mg have tried to cover secrecy. Large .reports come in stating each port that the vessel has touched, and it is believed desirable to have these documents clasaifiod. LT COLONEL FARR: Wc ran into some difficulties, I recall, at our last conference, due to somo new regulation put out by the Administrative people of the ASF or somebody, stating that you can’t publish types of regulations, instructions. 57 or something ot that nature. Will that apply to the publish- ing of something along this lino? Colonel Hoiskoll will have to modify the title of it, or what exactly is the standing of this particular .thing? COLONEL HE IS KELL: I think that is just a technicality and I don’t think it will apply to this'. LT COLOITEL FARR; The question I have in mind is whe- ther this should-bo issued as a 'Jar Department Circular, an' Army Regulation, a Transportation Corps directive, or a guide? I am wondering if our administrative problems in ASF would have any bearing on that or whether we can decide ourselves what would be the most useful. COLONEL HEISKELL; I think we might have to get some administrative advice before \;e finally decide, but from the standpoint of distribution, I think it would be better to got it issued as.a War Department Circular, or as a guide put out by the War Department that would-.give it distribution abroad to all the ports >f debarkation. I think it should be dissem- inated that far. We ran into that recently in the salvage matter' aboard-vessels. We had authority to issue it as a circular, but I was convinced it would get better distribution as a War Depart- ment, Circular. C 0 LOIIEL SCE 71CHTENBERG; As a 'Jar Department Circular, how- ever, you don’t want this thing.to go to everybody, but just to a small group, so why is it necessary,for it to go all over? LT COLONEL FARR: . .• I think Colonel Bradish might have something on that. Quito .frequently 'mr vessels get down to some of these other places, and they completely disregard any instructions over given.by the port insofar as what can be put on. A wide distribution would help, would it.not. Colonel? 58. COLONEL BRADISH: The only reason I see basically for publication of this typo of guide or memorandum or directive —whatever we choose to call it, is that it is going to be subject presumably to such frequent revision and correction that, that would argue the validity of publishing it as a circular# Presumably, also, each port will have an appended or attender or supplement to this directive to cover certain local minor ad- ministrative requirements for that port. For that reason, I would be inclined to think that as a Transportation Corps direct- ive, it could.be handled with a little more facility and your changes could be made, and I think it still could probably get in the appropriate hands overseas. However, you may feel that it should come fr ,m the War Department to those overseas com- manders, and of course, the only way that could be done is by having it a War Department Circular. LT COLONEL FARR: Possibly we can take care of that in a little different manner. I am inclined to think. Colonel Heiskull, that we are going to have frequent changes in this, although the changes are going to depend on what form we decide to put it in. If we decide to keep it general, we won’t hive as many changes. However, I believe wo might be able to get the General Staff to put out a War Department Circular or an amendment to present instructions directing the Chief of Trans- portation to publish such a thing and th.t this will bo the valid regulations for the job. It will be up to us to keep it up to date, su that wo have in the Oversea Theater the directive, to the effect that a set of instructions will be published by the Chief of Transportation which will bo suffipiont authority for thorn to stick, and it is then up to us to publish them. Wo may. bp able to do that. Put I believe. General DeWitt you sire hiving difficulty with personnel coming back from overseas, hot in accordance with the way you think they should. BRIG GENERAL DE WITT: That is correct. LT COL FARR: : . Are there any instructions which you put out that perhaps are not given the credence in the Pacific you would like them given. We should have some weight behind this to enforce the regulations we put out. Do you have any further questions or comments on this matter now? 59 COLONEL LOWRY: it not bo very simple to handle changes regarding local conditions, authorization for which will bo in the instructions themselves - for local changes to be made by each local commander? LT COLONEL FARR: That is opening the way up, I am afraid, for too many changes that are not entirely orthodox. COLONEL LOWRY: That would be authorized by the Chief of Transport a t i on • LT COLONEL FARR: I wonder if that will be necessary? MLJOR QUINN: I am sure it will. There is so much variance in looking over the .memoranda they have and the one wo have, there is no similarity at all and there can’t holp but be a tremendous variance of opinion. LT COLONEL FARR; Are those basic variances or MAJOR QUINN: I bolievu a good deal of it is basic. LT COLONEL FARR; Such as? MANOR QUINN: . Well, for one thing, we include no professional instruction in ours. LT'COLONEL FARR: Is it objectionable to put profess- ional instructi ~>n in? MAJOR QUINN: We believe sc, yes. 60 BRIG GENERAL DS WITT: : Professional instructions vary fron time to tine with professional procedures# They could be carried in a separate memorandum fron each office and not in- cluded in this. One day you treat malaria cases one way, and another day the Surgeon General comes up with a circular and changes the method. It is always subject to variance fron day to day. I personally feel that the regulati ns themselves should be purely administrative and the professitnal instruct- ions are something that could be changed from time to time. LT COLONEL SGHUffiANN; I commented a little earlier here that we mto mistakes in curs. I do think though that it should include treatment of mental cases, that is, the actual handling of these cases. BRIG CENERaL DE WITT: But not the drug treatment or how much sodium amytal you give. LT COLONEL SCiIUHHaNN: Th.xt brings up the whole sub- ject again, he h.ve attempted to tell those people how to "dot their i’s". he have gone into detail, ~e have told them exactly how they will do things, and tno reason for that is because they did net do them or did not perform them properly. Tnereforo this is merely an instruction. MAJOR qUINN: You may want them to "dot their i's" a little differently than we do. Our whole supple problem differs. In yours, you ask them to make out a requisition, he isk them to make out a list-; the requisition is made out in o'ur office. LT COLONEL SCHUHMANN: It is the desire of the Command- ing General, Army Service Forces to standardize this, MAJOR q'JINN: Then we will h ve to standardize it. 61 LT COLONEL SCHUHFANN: The only answer to that as I can see is that wo will all have to give a little bit. The advantages of it, as I pointed out, were some eight or nine in number. No- body his criticized those. Now, I will repeat some of then. It will facilitate the training of this personnel, so that there can be an interchange of this personnel between ports. It will overcome'administrative difficulty for the Transport Surgeon upon return to ports other than the home port. In the event we get a call for a large number of Transport Surgeons suddenly, there will be a need for standard guide. It will tend to make this report to be received by the Chief of Transportation uniform so that he can properly interpret it. It will facilitate the ability of each Surgeon to accomplish repairs, secure supplies, and return personnel in the pert. It is done differently in every port at the present time. BRIG GENERAL DE TiITT; I think there can be no question about the value of standardization. It is just a question of the type of instruction we get out, The only point I raised is the question of including in a liar Department publication of that kind, things that wore not standard -- like medical treatment and various things like the handling of mental cases you can lay down certain principles. I am not criticizing yours at all, but just tho general makeup of those regulations. I don’t think we should go so far as to say what treatment they should give under any conditions except the general handling. Remember the fact that our Transport Surgeons are graduates in medicine and have -been practicing medicine. Vie can say a mental patient should be.kept below deck; at certain times restraints will be used, and at certain times restraints will not be used, Lhetin r we should give them p .cks or contin us soconal or sodium amytal, is a medical matter, .that I think, you should leave to the judge- ment of the Surgeon. Based on procedures: outlined by the Surg- eon General’s‘Office, this is not a criticism of your or anyone elses. Just geiioro.l principals, I think, should be considered when we get up tiiose standardized regulations. I don’t think anybody can doubt the value of them. Every port varies in certain things. Every port has good things and every port his bad things, —not bad things, but things not as good as at other ports. If we can get tho best fr ,m all of these, it would be a big step forward. COLONEL. BRiJDISH: I think it is wise to have a general standard operating procedure from an administrative standpoint, as those vessels end the Surgeons go from port to port and from 62 area to area, throughout the world. I do feel, however, from my standpoint, that these directives or these instructions, should be reasonably general. I think we. are treading on a little bit of delicate territory here perhaps, r nd superseding the local commanders’ problems. I think wo should be careful. I do think that certain jurisdictional discretions should be left to the Port Commanders, .and I think also the Port Surgeons should have some discreti nary jurisdiction in their local problems and policies. I don’t chink there are any two theorists that have precisely analogous professional problems. I think a g3od many of those policies should be handled locally as General De’iitt says. After all, we are dealing with doctors and r. variety of surgeons whose policies are a little different. I don't think wo can standardize the practice all over the world with such a direct- ive as wo hid in mind here. IV at is whore 1 think the supple- ment to the general pattern laid down should be used. i itJOR GORLxtH: I have a suggestion to make. I think tile general instruction if it’s going to be issued should be limited to 'che basic administrative problems and should de- finitely not contain the profossi .rial subject. But I .Iso think tn t in acc »r dance with what Colonel Schuhmann has said there are many surgeons who although they are fundamentally doc- tors, have not had experience v.n transports. I think there could be an addendum put in the back, not is a directive, but as a sum:, ry of the experiences other transport surgeons havo hid; if Certain procedures h vo worked .ut very well with some surge., ns they could well be adopted by ethers. A lot of things happen on transports that do nt happen in general practice with which they are not familiar. I think they can 'well take the advice jf other surge:ns, but I d ’n’t think such advice should be issued as a directive. BRIG GSN3EAL DR WITT: Th t was the very point I made. It isn’t a quest! n of putting these things out to people, but puttii then in aV ir Department regul iti m which would necossit to publishing any change, make that a sop rate bulletin, or memorandum, and take those pr ;fessi nal matters up in that way. COLONAL oCHUHin.NNs General DeWitt, in i way I H..ink you made a very good point. Those .re the typos of points, I think we will need if there is going t j be a committee to rewrite these suggestions. C ;lmiel Farr suggested th -t they be written and 63 so that they nay be discussed tomorrow, I think it was a very good suggestion, as Major Gorman mentioned, we don’t like to tell a doctor ’’You will have to give aomebody an aspirin tablet or paint something with iodine, instead of morthiolato"• A lot of doctors we have had on transports may be good general practictioners, but they are certainly not psychiatrists. They do not know how to handle a lot of mental cases, and especially aboard transports. That was the reason for our instruct! ns at New York. Whether this should be included in general instructions covered by the War Department of the Chief of Transportation is what should be brought out at this meeting, and I think it has been brought out. LT COLONEL FARR: I Would like to hoar something from Seattle. COLONEL DREG 1IEMIN: You have a point there. The only thing I ever thought of putting in the instructions to the Transport Surgeons was something that they could use aboard the transport about certain procedures, in order to show the practice aboard ship. Outside of that wo loft everything to the practictioner« We have had quite a number of nice young fellows vim took to the sea and used excellent judgement and weren’t governed by very many regulations* Wo wroto very little, as little as wo could. We wrote the professional things adaptable to the boat that were a little different from the general practice. But we had very little professional instruction, LT COLONEL FARR; Charleston, have you any comments? LT COLONEL NIELSoN: I think there arc certain general administrative matters included in the general roc >rd but there are still some administrative matters that arc peculiar to the port, and va vi 11 either have to standardize cur procedure, or else take 'chose peculiar port! ns away from the instructions to the Pert Srigoonsc LT COLONEL FaRR; Wo are, I believe, approaching some sort jf an organizational stondardizati.n within the whole group of port structures. Our control divisions are apparently working toward that end, so I suspect that administrative procedures 64 submitted will roach seine type of standardization. 1/hat it will be is a little hard to say. I would like to ask one question on the matter of these regulations. Does San Francisco have a pub- lished set of instruction, bound or otherwise? iIIJOR QUINN: Yes. LT COLONEL PARR: Does Seattle have a published set? COLONEL BRECHEMINi L'e have a small published set, much smaller than anyone else. LT COLONEL FARR: Does Los Angeles have a published set? LT COLONEL ’ .HITE: Yes sir, we have recently written a revision within the last two weeks* LT COLONEL FARR: Does New Orleans have a published sot? COLONEL BRADISLE Yos, administrative regulations* LT COLONEL FARR: Does Charleston have a published set? LT COLONEL NIELSON: No do not have a published set* LT COLONEL dARR* , • Docs Hampton Reads have a published set? COLON;:;! LEAR!' vyo had two set? - mimeographed sets of instructions me is our standard sos for r gular trans- ports and she other is for the small boats - LT COLONEL FAEtR: Does Boston have a published set? 65 major gorim* l'/e just bound ours before we curie to the meeting. LT COLONEL F..JdR; I know New Yjrk has. I would like to suggest that we get copies of regulati ns from each of the ports. I don't imagine you have sufficient copies to leave at this tine. I think they would be valuable in w rking up a revision of these Regulations which we are going to put out. I think the group established to do that would do well to have complete sets of these regulations which have been compiled by each Port. Do you have any further discussi. n? Vie still have a few minutes to talk about this subject. Apparently we are coming to the idea that these are not t,. be extremely specific. Is there any discussi f xhe supplies needed. Le have an equipment list that goes on aVI the various sized transports. If he presents a list to the porn Surgeon of rny port, it should be the duty of that office to supply him with whatever is necessary. Therefore, I think you can take quite a burden from him by eliminating all of the Supply Sect! n from these regulations. In the matter of keep- ing stock rec rd accounts, I d. n't know that it will be necessary. It seems to mo if you take a certain amount of supplies and use them at sea, r in a -cheater, the Transport Surgeon should not bo bur- dened with keeping a detailed stock record account. I think the whole trend or this should bo towards simplicity and to get it down in eight or ten, or twelve pages -- r ther than a large booklet. COLONEL BRVI-VSI '.iho matter of stock accounting n transports apparently differs in different ports J know that Colonel Melton wanted his surgeons tu keep after his property, and he fowls that that procedure, considering the 'V eal problem, is the sr.luti r. for his situation. However, there is nothing that requires Transport Surgeons to account for pr pertya The question came up in New Orleans and we had the Fin.-rce Section 66 and idie .auditing Section give us an opinion and they stated that it was not required for any property accounting. We carried that a little bit further however, and shipped the supplies to the transportation agent who does maintain a stock record account hnd in turn issues the amount of expendable supplies to the surgeon on a regular memorandum issued slip. Therefore, he has a certain' amount of responsibility which keeps him aware at least of his responsibility for the property. That keeps his adminis- trative burdens down to a minimum and doesn’t go quite so far as simply shipping the material to him with no further account- ability. Now, there is one more point I would like to bring up, and that Is this. These regulation or this directive covers two phases of activity. One of them is the general standard operating procedure of an administrative nature, which affects many other agencies in the Port and must be worked out on a staff conference - type basis as it affects each port, in turn, and between themselves, and as it affects the Office of the Chief of Transportation. NoW, the other feature we are dealing with hero, it seems to me, CDmes from an entirely different angle, and that is the one of technical supervision of medical service itself, which is basically the responsibility of the Surgeon General, and in turn his representatives from the various commands. This being a technical service, therefore, I feel that these directives, with reference to profossi >nal policies, should probably come out of the Office,of the Surgeon General primarily, or at‘le'ast out of the various offices of the staff surgeons on the staff of the Port Commander, and those■policies, insofar as necessary, can and will be integrated for the Chief of Transportation through Colonel Fitzpatrick’s office. I think we are dealing with two different proceduresi one, technical service, and one general administrative service, and, we should differentiate between them. COLONEL SCHUHMhNNi Colonel Bradish, if I may say some- thing on that, I believe it has been brought out very well this morning, as far as the professional service or the technical ser- vice goes, it should be at a minimum in those instructions. There are seven sections to this -- one of which covers the technical care of patients. I believe it has been decided that the people who work on this new instruction should elimin- ate detailed instructions on professional care. 67 I would like to say something on that supply natter which you nenti ;ned. It is our opinion -- when I say "our" I mean the Port Surgeon’s opinion -- that the men on transports are not accountable for property. War Department Circular No. 18, this year, is the one that first cane out on it. It has been modified recently, this past September, I think. It covers all supplies on transports except medical. Those words are always in there "except medical". We interpret that to mean, when the transport leaves here, there is no accountability* Vile got an opinion from our own Judge advocate. Water Division, and the Chief of Staff. It was decided the Surgeon would be accountable. Therefore, in this instruction, if it isn’t applicable at ports in the United States, this interpretation shouldn’t be in the general instruction. Vue have .covered two sections in my opinion. I don’t know if anyone else has any remarks on these sections which should be changed. Certainly this professional care and supply has been covered and there are seven suggestions in all. there any further remarks or recommendations concerning the others? MhJOR , In the evacuation of patients, -Section 111, we have a different procedure than you seem to follow here.- The General explained to me, you have a tie-up with the Second Service Command, which doesn’t exist in our Port. How do we standardize that? LT COLONEL SCHUHHLNN: Maybe that will be corrected. COLONEL SCHWICHTENBERG: I see no reason why some more or less stand- ard procedure couldn't be adopted. In each instance, it ms funda- mentally the same thing. It will standardize'the Now War Depart- ment Circular to include hospitalization and evacuation policies, I ti ink in that case, whatever anyone does he will have to more or less follow the same general plan, and therefore; this will also bring.it to. both. C OLOi lijly Lo> VRY-j The instructions that the Transport receives about evacuati m can bo standardized. New York carries it beyond where the Transport Surgeon has to go but up to a certain point the Transport Surgeon can do the same thing. . • 68 COLONEL SCHI7ICTENBER6» : I think you are entirely correct on that but I think the reason that the organization here did that, revolved around the fact that Transport Surgeons bring patients into the port and in reading over the instructions know just exactly what is going to happen to then, and can plan their activities so that it will dove-tail in with what is going to happen ashore* I grant that maybe that isn’t desirable or the general practice, but there are going to be differences. After all you don’t have a Hallorai Hospital down in place or in San Francisco. And they have still a different problem in Boston compared to the one they have at San Francisco or here in Nov/ York. They have to put men on trains, you have to do the same thing. It is not possible to formulate an exact statement, but I think you hit it quite accurately when you said certain general things apply to all. COLONEL LOWRY: Among the general things parti- cularly, those of us who have to evacuate ship-trains, prefer to have our rosters prepared differently. Mq prefer to have them prepared by classification. In other words, we prefer the mental in one class. Somewhere in there I think we could get a standardized procedure to please everyone, LT COLONEL SCHUHMaNN: Colonel Lowry, nay I make a re- mark along that line? T/e have done that at New York. Vie had to line them up according to classification at one time. Tie had evacuation by train at New York of course, and we have gotten away from that lately. Hie have devised a form when we have this, so they don’t have to submit numerous reports; they can have on one report everything that is required. That was the intention of this and it was put in alphabetical order so that we could locate a nan by name. Now, of course, we have a system of tab- bing and marking our ambulances going to the hospital, which tells what type of case it is. That is done by our own person- nel here at the port. But this general form that comes in and is really a transmittal of all records -- that is what it really is -- we found very satisfactory hero at New York. ;*s you say, it night not work at another place and will have to be modified to apply to all places. COLONEL LOWRY: It is definitely unsatisfactory for us. We have to make it all over again if a roster is sub- mitted in that form. 69 LT COLONEL SCHUHMANNi Why do you have to make it over? COLONEL LOWRYj Because we frequently send one classification to one hospital and another classification to a- nother hospital. LT COLONEL SCHUHMANN; From one ship you snnd patients to different hospitals? COLONEL LOWRY; That’s right; from the one ship we send patients to different hospitals. LT COLONEL SCHUHMANN: Of course, the answer tq that, I do believe, and the ideal -- I am expressing my personal opinion -- is to have a debarkation hospital where all patients are processed and then shipped. LT COLONEL FiJIR: We are getting close to our time , on this. I an sorry wo couldn't have gotten a little more done on it. It is a subject that is going to take quite a bit longer . to finish up than that which we have allotted this morning. The only way that I see to'come out with a definite answer, which incidentally will not be agreeable in fill respects to the majority concerned, is to set up a small committee to do the work. I think Colonel Schuhmann, if Colonel Milton is agreeable, should do a portion of the work as he has a very good background on the subject. COLONEL MELTON: (indicates his reply affirmatively) LT COLONEL FARR: / I should like General De Witt to nominate some one from his port. GENERAL DE WITT; I nominate Major Quinn. 70 LT COLONEL RJRR: May Major Quinn have about a week’s duty in Washington to work with Colonel Schuhnann on this ? GENERAL DE WITT: Yes. LT COLONEL FARR; Colonol Melton, can you spare Colonel Schuhnann for a week? COLONEL MELTON: Yes, LT COLONEL FARR: In order to give these two officers the maximum anount of help I would like to see copies of each of your port regulations turned over to then, and in addition we should give some further discussion to this natter tomorrow. Therefore, I want each port to submit a written list of .either questions or recommendations, or, if you want to submit an out- line of ideas which differ from your own set of instructions, submit these tonight-, so that we can use them as the foundation for al5 or 30 minute discussion. In peacetime, we used to write up a regulation and circulate it throughout all the ports to get their comments before it was published, I recall one regulation in G-4 which took 4 months to get out on that basis and it was a relatively simple one compared to this. Therefore, we will not have time to follow such a procedure. The committee appoint- ed will come out with a regulation that is concurred in by the Chief of Transportation and the Surgeon General, It mil be based on your recommendation and will be published subject to revision within a period of, shall wo say, six months. So if you have onything that you wnat to get into it, the thing to do is to set it up today and be sure that it is covered, IVo will now have a break of about 13 or 14 minutes, recon- vening at 11:00 o’clock. (a recess was called at 10:50 A.M.) 71 LT COLONEL FARR: Gentlenon. The return of the sick and wounded from overseas has been one of our largest jobs* The plans for handling that came at a tine when there was very little actual activity in the Army insofar as anybody shoot- ing anybody else. When the aSF was first organized there was set up within it an organization known as Hospitalization and Evacuation, .it that tine it was decided th.it the aSF would be responsible, of course, for the return of personnel fron overseas. It was decided that there was needed in the organi- zation an officer who could fron experience handle many of the problems that cone up in the movement of personnel by transport, particularly those who got sick enroute, but later the more important job of bringing back many of the sick. The field of officers was carefully surveyed and it was decided that Colonel Fitzpatrick, who had considerable experience as Transport Surgeon and who had more or less specialized in that type of medical work, was selected to cone in to the ASF Headquarters to do the work. Subsequently, it was decided the evacuation operations were becoming so important in the eyes of the Chief of the aSF, and as they were principally centered in the office of the Chief of Transportation where the actual ship movements took place, that there would be a liaison officer fron the Office of the Surgeon General to the Chief of Transportation. The principal part of the work w uld be to h- Id down that particular job. The development of the sea evacuation procedures has been a very difficult one because of the overseas commanders’ problems in- volved. Colonel Fitzpatrick has worked on that job fron the beginning,, and he will have to give you the 11 hows and wherefores” • COLONEL FITZPATRICK* SEA EVACUATION OPEPATIONS 1. General DeWitt and Brother Officers. One of the inevit- able by-products of this or any war has been and will be production of sick and wounded not only the sick and .wounded resulting from disease and non-battle injuries resulting fron causes similar to those that obtain in tines of peaoe -- but also those resulting fron battle injuries. 2. Of the sick and wounded occuring in our overseas forces, some recover quickly; some recover and are restorable to full duty after comparatively prolonged periods of hospitalizations; some are permanently disabled; some die. A basic question which required an answer early in the war, was, Where to treat what type of casualty. Is it better to treat sick and wounded in the theater or to bring them back to the continental United States for treatment? 3. The answer to this question -- and this is the case with many apparently purely nodical questions -- has an inportant effect on mili- tary operations in general. Based on the decision as to where to treat 72 sick and wounded and this decision is known as an "evacuation policy" will bo results affecting: a. Availability of experienced personnel in the theater; b. Requirements for replacements -- which requirements of course affect requirements for outbound shipping; c. Shipping requirements for the maintenance of numbers of individuals who are not, for certain periods, product- ive in the military sense; d. Requirements for fixed hospitalization within the theater, and for the personnel and supplies required for its operation which also affects requirements for out- bound personnel and cargo shipping; e. Requirements for facilities for the evacuation of sick and wounded from the Tsheator to the continental United States. 4. iifter a considerable study, and based on previous exper- ience, The Surgeon General’s Office has concluded that the optimum evacuation policy, taking aLI factors into consideration, would be a so-called 120-day policy. Under such.a policy, all individuals likely to be permanently disabled, likely to require hospitali- zati 3n in excess of 120 days, or requiring, special treatment faci- lities not available within the theater, are evacuated to the continental United States as soon as their physical condition permits; others are retained within the theater for-treatment and restorat; or to full duty. Most overseas theaters today are operating under a 120-day evacuation policy; a few, because of special circumstances, are operating under policies ranging from 90 to 180 or m re days. 5. whatever the evacuation policy, however, it was certain tb.it there would be sick and wounded requiring evacuation to the continental United States; and the war Department under date of 18 June 1942; charged the Commanding General, army Service Forces with responsibility for providing for the evacuation of sick and wounded delivered to his control. The implication was that overseas commanders would provide for evacuati. n re- quirements within their commands, and for delivering.evacuees to the control of the Commanding General, Service Forces. 6. Responsibilities for evacuation having been fixed, the question arose: what would be the requirements. This was not an easy question to answer, since the army was then operating in many areas concerning which no previous experience was avail- able; present-day combat methods differ from World liar I methods, so that casualty results couU be- expected to be different; and the results of any action in terms of casualties are never susceptible of precise prediction. However, based on the com- prehensive studies of General Love of the Medical-Department, (World War I battle casualty statistics), and estimates from The Surgeon General’s Office as to the incidence of disease and non-battle injuries that might be expected within the several physical and climatic environments where pur troops are stat- ioned today, anticipated evacuation rates (factors) were 73 arrived at. These factors wore then applied against projected troop deployments throughout the world. It was estimated that as of Decern her 31, 1943, we would be evacuating sick and wounded to the contin- ental U. S. at a-rate of ***** per month; that as of 31 December 1944, we would' be evacuating sick and wounded to the continental U. S. at a rate of a little more than ****** per'month. 7. These estimates apparently are proving conservative, burn- ing September 1943, there wore debarked at United States ports, approximately ****** sick and wounded evacuated by sea. It seems apparent that, assuming a realization of current plans, the ates both for 31 December 1943 and for 31 December 1944, may be exceeded. Perhaps by the end of 1944 wo will be'evacuating some ****** sick and wounded per month. 8. To return to the development of current operating pro- cedures for the evacuati m of sick and wounded to the continental U. S., the responsibility, except for intra-theater evacuations and concentrations, had been pin cod upon the Commanding General, .army Service. Forces; the requirements had been estimated as a- bout ***** per month by the end of this year; about ****** nor month by the end of 1944. There remained the problem of pro- viding, or designating the means: a. Shipping, with adequate hospital facilities provided thereon; : b. Medical personnel adequate for the proper care, treat- ment, and safety of the sick and wounded being trans- ported; and c. Medical equipment and supplies necessary to enable the personnel properly to perform their functions. 9. iit this time (December 1942) shipping was critical. ******** ******** ****** Medical equipment aid supplies were not too abundant, especially in oversea theaters; medical per- sonnel in certain areas did not exceed needs; and the inbound movement of personnel was negligible, and the Commanding Gen- eral, Army Service Forces, not the overseas commanders, had placed upon, him responsibility for the care of sick and wounded once they were delivered to his control. r 10. The Joint Chiefs of Staff had promulgated a policy pro- viding that in the interest of economy of shipping, the primary means-of sea evacuation would be by regularly-scheduled, returning troop transports; that eventually three c nvonti n-protected hospital ships would bo made available to provi.de for overseas areas not served by regularly-scheduled troop transports, and to supplement troop transports in areas for which they wuro regularly .scheduled, when necessary. .The Chief of Transportation was directed to provide hospital facilities on .1 1 troop transports under his dontrol, and it was envisioned that by fir the greater part of the shipping requirement would be- met by the utilization of transports. 74 11 • Tho question of nodical supplies was net by providing that port commanders would maintain aboard each troop transport medical supplies sufficient for the care and treatment of sick and wounded arising on route during the outbound voyage and for the care and treatment of a number of sick and wounded equal to one-fourth the troop capacity of tho ship during tho inbound voyage. 12. Tho provision of medical personnel to care for patients evacuated to tho continental US presented a problem more difficult of solution. The goal was to provide adequate personnel for the care of tho sick and wounded and at the sane time c inverse ship- ping space. Because shipping schedules wore unpredictable, it was never certain that a given ship would or would not bring back patients. Not more than one-third of returning transports brought back any considerable number of patients. Therefore, if personnel adequate for the care of a number of patients equal to one-fourth the troop capacity of the transport were permanently stati nod aboard all transports, there would have resulted a con- siderable loss of personnel shipping space. 13. Nor was it possible to depend on medical personnel re- turning from overseas to the continental United States. At that time the numbers of such pers jnnel was wholly inadequate to pro- vide the personnel required for the care of such sick and wounded. 14. It was therefore considered desirable to establish in each overseas theater pools of organizations under the ultimate control of the Commanding General, .ormy Service Forces (thnough the Chief of Transportati m) and available to the overseas com- mander, to be embarked on returning transports when needed. It was decided to use regularly organized units rather than in- dividuals in order to provide ease of administrative control. 15. The foregoing is essentially the system of sea evacuation operations under which requirements are being met today. The system is not perfect; it is certainly not the only method that could be employed to do the job satisfactorily. But this system is working satisfactorily. It is 'not considered desirable to materially modify it until by actual experimentation and trial another system can bo demonstrated to be adequate. Recent develop- ments however have made minor modifications of this present standard operating procedure inevitable; 16. In the spring of 'this- year, the shipping situation be- came more favorable; it became more apparent that the enemy would respect convention-protected hospital ships. A recommendation "originating with The Surgeon General that convent! .n-protected hospital ships bo considered the normal means of evacuating the helpless fracti ,n of the sick and wfunded, was presented to the Joint Chiefs of Staff; ano there lave been authorized a total of 24 hospltdl ships of which there are now 3 in operation, and 11 under Construction; It is anticipated that in the near future the remaining 10 ships will be selected for conversion, so that the whole program will have been completed well ahead of schedule. 75 17. For various reasons, it is contemplated that the numbers of duty personnel returning for various reasons will materially increase; included in this returning personnel will be the usual proportion of medical personnel. It is imperative that full use bo made of their services while enroute back to the continental United States, both because of the increasingly critical shortage of medical officers (doctors) and also in order to avoid unnecessary was tape of outbound personnel shipping; space. 18. For the ferepoinp reasons, there will be shortly processed a new directive for sea evacuation operations. It is difficult to predict tho details of this directive but in general it will provide; a. That convention-protected hospital ships will norm- ally be utilized for the evacuation of the so-called "helpless fraction" of the sick and wounded to the continental United States,; b. That hospital ships will be under the control of the Chief of Transportation, will not be assipned to a theater, are meant primarily for the evacuation of of patients from overseas to the continental U. S.; that they nay be concentrated temporarily for the support of an amphibious operation; that they nay be utilized for intra-theater evacuation on a temporary attachment basis; that they nay be so routed as to assist in intra-theater evacuati n without seriously interfering with their primary function of returning patients to the continental United States; c. That the remainder of patients (approximately 60% will continue to be returned on troop transports, to be cared for preferably by medical personnel returning for other reasons if available; otherwise by ships1 pie toons; or, if other means are not- available, by personnel furnished by the overseas commander for this specific purpose. d. That because of the fact that convention-protected hospital ships may require to be concentrated for the support of an amphibious operation, or maiy suddenly cease being used because of enemy action (Pacific especially) it will bo necessary to bo prepared for a sudden return to full utiliz obi m of regularly-scheduled troop transports, with returning personnel and/or platoons provided for care en route; e. That the reserve of platoons necessitated by the considers tion that convention-protected hospital ships cannot be wholly and continuously relied upon, will be utilized: (1) In part, to man some of the large number of new troop transports that will be available in the near future; and (2) By attachment to port installations, and nearby service command installations (particularly to cover rail movements of p itients). This is already being done by some ports, with mutual satisfaction. 76 f* In recognition of the fact that the composition of any group of patients being evacuated by troop trans- port may vary within wide limits, there will be attached to the new directive a table to serve -as a guide ±o overseas commanders in the use of platoons or other personnel for covering return of patients; and it is thought th it this will enhance efficient use of such personnel, and delay or perhaps elimin- ate any necessity for a material augmentation of the requirement for platoons; that it may permit a reducti ,n in platoons even in the face of increasing requirements for evacuation. 19. A directive to ports will modify current responsibilities. One thinks particularly of the anomaly that presently attempts to hold certain ports resp nsiblc fur evacuation from given areas when they‘have no knowledge and certainly no control over tho means for discharging tht responsibility. 20. In'general it is thought that the cu rront procedure for the return ef sick and wounded to tho continental U.S., with such minor modific itions as changing conditions require, will not only meet requirements during the war, but will also meet post-armistice requirements when, for a few months, it can bo anticipated that requirements for such evacuations will double or triple. 21.. One possibility upon which I have not touched, is that of an increasing utilization of air transport for tho evacuation of patients, not only within theaters, but also for the evacuation of sick and wounded from overseas to tho continental U. 3. Just what part this facility will play in tho future operations, just how extensive the use of air transport will bo, is not predictable except that it is likely to be quite extensive. Tho army Air Forces are working on this problem, and Colonel Schwichtcnberg may have some remarks to make about tho possibilities, are there any questions? (No questions were asked). LT COLONEL FARR: Now, this was a very thorough discussion, but I don’t think that it was so thorough that wo can’t ask ques- tions on it. COLONEL BRECHEMINs TVhat is tho:capacity of tho 24 hospital ships authorized? LT COLONEL FITZPATRICK: Each of the 24 ships has an average capa- city of five hundred patients and an average speed ef approximately 12 knots; the ship’s capacity applied to th .t average speed gives you a certain probably patient lift which is sufficient to meet 40/o of the total requirements -as previously estimated,, and as they are estimated today. 77 BRIG GENERAL ,DE WITT: Jo are training now in the staping area in Camp Stonenan four hospital ship companies. Gone tine ago, when those units were activated, the activating order stated that the Commanding Officers would be furnished by the Surgeon General. Up to the present time s’a.ie of those units have been there for two months without any Commanding Officers.. It seems to me, it is rather important that those men pet there in time to familiarize themselves with their units. I would like to ask Colonel Padan if he can givo any information relative to that. LT COLONEL PhDAN: General, these men have been select- ed in accordance with the directive that came out. It said that these hospital platoons would be activated on a certain day - we’ll say it was the 10th of the month, and we got the direct- ive about twenty days after the activation date; that very frequently happens. These Commanding Officers have been selected and nil of them have been placed on orders. I understand that one. nan was granted leave somewhere. I don't know where it was .granted, but he never showed up. The first two individuals we selected for that were Regular Army men. Upon selection for that duty, they cane in with a pitiful howl - they didn’t like a boat - they would, get seasick. One of them said he had noth- ing but a fishing trip that cane close to any sea experience and he has been seasick, and evorytimo he had gone overseas, he had been sick - he didn’t want any part of it. Le didn’t want a nan with that kind of attitude, so we got a couple of ether non and one of then gave the s:vae story. Le have to got these men clear- ,edo There are still four men ordered to go and one of then, the last one, states that he despises and hates ships and is going to got sick, lie had told him that after he had been at the port a reasonable length of time and submitted a request through chan- nels, we would try*to replace him. we fuel that wo should be very careful in selecting Commanding Officers for those ships. Everytime we got a man that would fit the bill he comes in with this story, are you going to put a nan wifh that attitude aboard ship? You nay just as well not put him on. They are under orders and'l know one of then-has been granted a rather extensive leave. BRIG GENERAL DE WITT: One reason why I ask the question is that I have one officer, a Captain now, who desires to reach tho grade of Lieutenant Colonel. LT COLONEL PjJDANs We can't make him a Lt. Colonel, but wo would rather see that ho is well qualified for this assignmont. ‘do would like to know the names of any non that you have who are fit for this job. he have people who have requested this duty. We have one man who is exceptionally well qualified for this detail# It so happens that I would like him, can ideal nan fron call aspects, but the Military Intelligence Division says that he must remain in a certain spot, so that eliminates him. It seems \ like all the others we select, for some reason don't want to go on there. 78 BRIGADIER GENERAL DE WITT; I have one nan who is not worried at all and who wants to go on that particular duty, ‘so it’s a hard proposition. LT. COLONEL PADAN: Colonel Fitzpatrick has a plan, I think to revise downward the reorganization of some of the larger hospital ship platoons - anyhow, the first ori- ginal of the company ship platoon - some of those will be re- organized to provide personnel for hospital ships. BRIGADIER GENERAL DE WITT: One other question I would like to ask is about the equipment of these ships. Will they be equipped at the port at which the conversion is made or at the first port of call so far as that port is concerned? LT. .COLONEL FITZPATRICK: I think that will depend upon whether the conversion is made t a port under the Chief of Transporation or at a port not under the control of the Chief of Transportation. LT. COLONEL FARR; The fixed equipment will be part of the conversion contract. You are referring to the supplies. They have fixed equipment hero and ship equipment which is sterilized and ready to go. BRIGADIER GENERAL DE WITT; I suppose it is converted here in New York and then transferred to the Pacific. Will the equipment be put on here or at the port of departure? LT COLONEL FARR: It mil be put on at the Port of Departure. (To Colonel Schwichtonberg) Would you like to say something about air evacuation? COLONEL SCHWICHTENBERG; Just a few words on air evacuation. We know that it is a good dead, faster than the rest, but it has one advantage entirely apart from its speed and relatively speaking from the number of pa.tionts we move. 79 you require far fewer medical personnel to handle them* Medical personnel is getting scarce and that is another desirable way of conserving them*' Many of you know and some of you have heard rumors of large equipment that is coming out. I am not at liber- ty to tell what some of the larger equipment will hold, but it may be that some of our evacuation problems may be materially modified by air evacuation. That, of course, will only change some of our problems because while new we have our patients coming into the ports, in that event they will come into air fields somewhere. As I look over our facilities at the air force stations> very few of them are equipped to handle patients in the numbers that may well be brought back in routes of transport pianos and there arc modi- fications of levy equipment that is being made available. The problems that you have as Port Surgeon will then be spread from thu ports to a large number of places, and as I say, it will not diminish the 'overall problem. It will probably change its com- plexion horo and there and that's about all that I can tell you* LT COLONEL FARR: Have you any further questions on this matter of evacuation organizations and hospital ships and what not? COLONEL MELTON: I think the suggestion that the Port Surgeons could present the name of a specially qualified medical officer who had experience on our ordinary transports should be given a groat deal of consideration. Je can furnish you some excellent men that we know have been excellent on board the ships, but we want them replaced. Remember that* ('Laughter) Our liberality does not go that far. (Laughter). LT COLONEL PhDAN: V/e will replace them numeri- cally. COLONEL MELTON: I have the statistics of some of our ships that arc already converted and several others that arc being converted. Are there any objections about telling them the approximate capacity of those? LT COLONEL FARR; That’s all right.' 80 COLONEL MELTON! ' Well the Acadia, is already con- verted, and has 604 and the Seminole has 442, and the Sham- rack 547 capacity, They arc the. three ships in operation at Now York.- Nov; we have in -process for reconditioning hospital ships one with ,406, and ono approximately with 640, and one 500, one 250, one 700, ..and one 800. Those are the ships in process of being reconditioned as hospital ships. LT. COLONEL FARR: : , ■ j This manner of submitting names, do you want the ports to submit directly to you the names of personnel that would be capable to command hospital ships? Would you have each Port Surgeon submit such a list? i LT. COLONEL PADANs I would and then we would take it up and consider the clearance. Wo would take it up with the COT and then let it go back to the port. Wc would just like to have a few who .re exceptionally qualified. LT. COLONEL- FARR: It will be done. Now on this movement of hospital ships from the east coast that wc are going to effect this month, I have hopes of our hospital ships making their port of call Charleston. Wo had a little diffi- culty getting one of them to go in there, but maybe with a little bit more training wo could-get them to find the- harbor, (Laughter) Are there any. further questions on harbor ships' and evacuations? Well, we are about ten minutes -ahead.of schedule which is not serious or critical, but if there is any further discussion, let’s have it, LT. COLONEL FITZPATRICK: I ’would like to make just ono sug- gestion on the matter of those names of officers to be turned in to Colonel Padan as recommended for being C.O.s of hospital ships and that is this; Inasmuch as those officers are going to function in a duel capacity, as doctor and transport commander, extreme care must be taken to insure th-' t the officers so selected arc not only efficient as medical men, but also that they are capable of exercising command functions in -a creditable manner. LT COLONEL FARR: That is a very important point. We have had some not too fortunate experiences with some of our very capable surgeons in the matter of administration, and 81 speaking of hospital ships too - administratively - they did not come up to standards and very nearly got us into some rather scriour trouble, because of that. Another thing on those com- manding officers. General De Jitt has indicated that he thinks they should assemble with their unit from a purely transportation standpoint as soon as possible because as soon as that outfit is assigned to a specific vessel, either the C.O. or some one designa- ted by him will be ordered to the port at which the vessel is being converted to help on the details of the conversion. As the drawings that are made up arc only general, and the many minor changes that have to bo made are r.r, de on the spot, the C.O. or someone else of equal ability in his organization should work ahead with the conversion of that ship. He should have a chance to be with his unit before ho goes ahead and therefore I would like to urge that they get him out of there and get him out fast, leave or no leave. LT COLONEL PA DAM; ; \ ! How'is our table on hospital ship complement c ming along? Do you know what it is Colonel Fitz- patrick? LT COLONEL FITZPATRICK; That will be the subject of a con- ference. Uhen the conference will be held, I don’t know. . LT COLONEL PADAN: You should know that a now table for hospital ships is being proposed and a radically changed and revised table will result. I don’t know how.it will end up or when, but it is coming* MAJOR A. P. FULTON; 1/Jhat is the .percentage of mental patients expected to be returned? Bringing back any shipload, what is the maximum percentage of mental cases to be expected? LT COLONEL FARR: ' You mean the percentage that can be placed on board? MAJOR A. P. FULTON: V" Yes, the percentage of accommoda- tions you could have on board. 82 LT COLONEL FITZPATRICK: There is a now instruction which has recently gone out from the ‘'ater Division of the COT office, which provides minimum accommodations for mental patients - the so-called security accommodation type equal I think, to 4y% of tho total trip capacity of the ship in question, MAJOR FULTON: That isn’t exactly what I have in mind - say a hospital ship with a capacity of 500, what is tho maximum percentage which wo might expect to have available for evacuating mental cases, LT COLONEL FITZPATRICK; Approximately 50%. MAJOR FULTON; Our present conversion has boon at least 30% or in that region. In other words, we are about 20% short on existing ships. LT COLONEL FITZPATRICK;- That’s right and in tho last few days, a recommendation has been sent from Colonel Farr’s office to the S.G.’s office recommending that a change bo made to provide for a maximum of 50% of this basis - that between 20 and. 25% of the total patients arriving from overseas are mental patients requiring aboard ship, not on land, security accommo- dations. Wow since all that type of patients is included in the 40% which is supposed to have bean taken care of by hospi- tal ships, th it is equal then to f~ of the 40% which would require about 50% of your accommodations on hospital ships to be suitable for mental patients, * It is still nccess; ry, however, to pro- vide spaces on troop transports because of a question of tho possibility that hospital ships may be withdrawn either tempor- arily or permanently for various reasons from a iven area. BRIGADIER GENERAL DE AITT; In connection with the- evacua- tion of mental patients, it might be of. interest .to know that shortly before leaving. Urn "Fr .noised, I had v long conference with officers' who had spent a long period' of time in tho South- west Pacific and' a shorter time in the South Pacific. I was told that the Surgeons' in the various theaters out there were very much concerned over tho accommod Vtions of ment"-.! patients and■ that they were accumulating a much larger-.number then wo could evacuate without existing facilities,* This particular officer who.--was 83 pretty thoroughly familiar with the whole system of sea evacua- tion, has gone so far as to devise some scheme by which they would have portable accommodations. He brought back a sample of a airplane mat, on which to have these things so that they can fix them into the hulls of a ship, and bring back these patients in very large numbers. I think that thing is coming up shortly - why we should not provide a great many more accommodations than are provided at the present time, LT COLONEL FITZPATRICK: That very same question did come up in Washington. It was received from the Southwest Pacific area and as a result of their request, a directive has gone out from the Water Division of the C of T which increases facilities aboard troop transports for the return of mental patients by an amount equal to three percent*of the troop capacity of each • ship. It is for that same reason, that the medical capacity on hospital ahips is being increased, BRIG GENERAL DE WITT: It is Those directives have been cut for some time, LT COLONEL FARR: L think you are thinking of the total hospital capacity. This is to be mental capacity, BRIG GENERAL DE WITT: Of course, mental, CAPTAIN YOUNG: Speaking about the estimate of the percentage of mental cases which we may expect in the future, do you think in the opinion of the Surgeon General’s office, that this percentage will be maintained or increased/ I mean maintained at its present level or increased? It was my under- standing in talking with various people concerning the classi- fication of mental cases, that many of these boys were sent overseas in the first part of war who had not been thoroughly understood, shall we say, as to their mental capacities or mental or moral fibre so that this particular subject then has been tajcen up in greater detail, with the men whom we are sending over in our present group of troops. What I really want to bring out is that the examination of those going over today is carried out more thoroughly so that we may expect that the number of mental cases will not be as great in the future. 84 LT COLONEL FITZPATRICK; • ' That question as far as I know per- sonally is rather unpredictable, the neuropsyhiaric branch cf S» G’s office will perhaps bo able to give a more precise answer. I would guess that any decrease in the incidence of mental cases among overseas trmps which results from a better screening of troops outbound, will bo neutralized by an increase in the incid- ence of mental cases resulting from the factors of combat activity and other unpleasantness overseas. COLONEL MELTON: I wanted te ask Colonel Fitzpatrick, he brought out in-his paper that we should have on our transports, supplies sufficient to evacuate one-fourth f the troop carrying capacity in additi ;n to what wo put on for the outgoing voyage.- Now, we have done that, a 1 thou h we had an investiga- tion a short time ago, in which it was said there were net enough supplicssaboard ship - and I think that is not borne out by the facts in the case. Now we just recently got a wire that we put a four month supply on each ship. Does that four month supply include the extra supplies that we already have on these ships? 77c find we have a great deal of trouble in getting space to store these supplies, b'o have an argument every time with the ATS that they donTt have enough space. Now, if we put four month supply on board and wo have been putting approximately four months supply aboard in addition to that, is that to be continued - are we to continue with that? LT COLONEL FITZPATRICK; • That requirement of four months supplies applies only to a specific theater. It is temporary at the specific request of the overseas theatre .commander• I would suggest that the supplies necessary for the■care of the nu- mber of patients be limited to of the-troop capacity in ques- tion and to be included in the four month supplies, and that the four month supplies not bo in addition to the supplies required for patients equal to of the troop carrying capacity of the vessel. LT COLONEL FARR: ' ' ' I believe that is the intent of the overseas commander in his request, be will adjourn for a little lunch and will return this afternoon at 1:30. 85 LT COLONEL FARR:• Our discussions so far have been on facts rather than on anything that we are trying to un- cover that is new. We are by requirement, as we have discussed before, going to have to load transports rather heavily. They are crowded, uncomfortably crowded, in many cases. But it is part of the risk that we have to go through. Now it is sur- prising sometimes what small things change the trend of the war. It may be that some of the advanced things that the Surgeon General has done and will do, will further change the trend or the picture of the War* We have as a speaker this afternoon an officer who is going to bhing up something that is quite new to all of us* He is Colonel Bayne-Jones, from the Surgeon Gen- erals Office) who is Assistant Director of the Preventive Medicine Division* COLONEL BAYNE-JONES; Gentlemen, Being the first speaker in the group who came up from the Preventive Medicine Division of the Surgeon General’s Office, I want to say for all of us how much wo appreciate the invitation to be here, and also to express the real fooling, the groat satisfaction and sense of privilege we have in being close to Port Surgeons and Ship Surgeons, and the men who arc handling epidomilogical problems at a focus. You get it on the ships, in the staging areas, at the ports and often in a very concentrated form when things have to be handled quickly and expertly. From our talks last year there has developed an epidcmilogical point of view and mutual understanding of most kinds of theater problems. We take things more or less as they have to be taken in dealing with crowded conditions that can't be relieved by separating people into more space, and as I say, trying to revise means of focus. What I have to tell you about today is in the nature of progress reports. I have not a practical apparatus to propose to put on all ships on a movement to sterilize the air in troop quarters at least, but a commission in airborne infections under the Epidcmilogical'Board, a large civilian board. The commission has been working constantly at Chanute Field and other places to try to devise means of steril- izing the air; thereby, cut down or remove the agent which produces the acute respiratory diseases with which you are mostly concerned. The chief of the diseases that you have to deal with in these troops on ships, as we saw it last year, was really acute infection of the upper respiratory tract, notably common cold, possibly influenza if it comes on, streptococcal infec- 86 .tipns, tonsillitis, nd we cm include in this group of res- piratory infections, meningococcal infections. * Those infec- tions give us most 'trouble in cert in seasons of the year ' 1- though they are prevalent in various tines of 'the 'year. But the season of greatest ■nxicty nd difficulty, I should say, would be from December until into April, These diseases occur more 'frequently under conditions in which troops re crowded, and occur under the living conditions th t men have on the transports th .t yqu are handling. The modes of spread of tluse diseases 're f mill r to us. By knowing those nodes of spread, nd I think by thinking about them again we can got on to devising some me .ns of control. Infections are spread by contact and by droplets from coughing and sneezing; I would say by air and very fine p: rticles that may be in the air carrying virus ;nd bacteria, ho fe.l quite sure that they may be spread by dust, but studies indicate that pathogenic organisms cm be gotten up off the floors and out of dusty air; aid lately a greet deal of attention from our commission has been focused on the content of blankets end covering of end things, in terns of the pathogenic organ- isms, notably streptococci. Last ye r alien this problem ans studied it seemed pretty clem that you had tiro phases of it to deal with , One th t concernod the Ship Surgeon was the outbreak of acute respiratory diseases on a ship a feu days after it left the port, Llow the men bringing that infection aboard which was pro- bably incubated in the staging areas, and in incubation periods '.men they came on ship. There is not . great do 1 that you can do as a Port Surgeon, at least as a Ship Surgeon, to control the non that cornu aboard infected in that.manner, he heard from General Hrwloy 1 ,st year, particularly th t './ hat troubled him vas the acute respiratory infections rrising in troops after they landed. The figures have shown that there would be an outbreak on ship and then .a subsidence, nd then an outbreak of respiratory diseases among them, after they were ashore on the other side, undoubtedly indicating tiia.t they had infections spread to them on the.ship. Those are two main troubles, and focusing the fact to what may bo done on bo'ard ship will pro- bably load to relief to some extent of the early st .ges of in- fection, nd perhaps load to control and prevention of infec- tion to men on the ship. There .are two main methods of approach to this problem, granted tin t wc have a crowded condition tht.wo can’t correct by separating the men: one is by giving the men drugs that were supposedly anti-bacterial or help then to get over this bacteria; and the other is to do things to the air that they breath and the articles that they are most intimately in contact with, to reduce the virus nd bacteria of those fine 87 particles. The use, of drugs to. control the respiratory infec- tions means the use of sulfanilamides, notably a sulfathiazole. There is still a debate going on as to whether you can control the ordinary respiratory diseases by giving doses of sulfadiazine to soldiers when we got interested last year with the reports that came from the Navy Doctor Rivers and his group. He found that by giving as little as a half gram of sulfadiazine at various intervals sometimes he had some periods of one a day, ‘sometimes once a week, to men in his pier where the Navy were quartered the incidence of tonsillitis:and scarlet fever dropped quite substantially. At the same time, however, his latest paper showed that the incidence of a streptococcus carrier was not produced. However, I believe that might come out in the discussion. There have been actual trials at some of the ports in which sulfadazine had been used, and the incidence of scarlet fever and some of the sore throats have been reduced. I think more experimentation might well be done along .that line, keeping good record and knowing that this small dose will not provide any troublesome reaction. The most notable result of last year’.s studies in camps was the destroying effect of sulfathiazole on the reduction of meningococcus carriers end the stopping of outbreaks of meningitis. We have on the basis of those studies - Circular No. 170, dated September 30, issued by the Inspector General, which only came out a couple of days ago. I thought L-would mention it to add a little more to the background. It is recommended in this Circular letter that a. single dose of only two drams of sulfadiazine be administored, by mouth to new recruits,, say within the first six weeks of their entry into Service. It seems perfectly phenomenal that so small a dose of sulfadiazine would do anything, but in camps where carrier rates of meningococcus wore 30 percent and even higher and in some cases up to 70 percent, these cases were reduced to carrier rate of zero. Thereafter, it stayed down for some' reason,not yet understood. It stayed very low for throe weeks, rose slightly in the next three weeks, and Colonel Kuhn has recently reported that somewhere more than two months after doses were given, and such a small dosage, few cases developed. Moreover, where it was possible to divide a division in half and free to keep the other half in control, practically no cases occurred in the treated group and cases continued in the other. Some of this work was done in the meningococcal infections last year, and there are some questions perhaps that may have been on the downslopc when some of this work was done. But the mass of evidence is thoroughly in back of this recommendation that comes out in Circular letter No, 170 that sulfathiazole bo used for the control of meningococcus. 88 I should think it would bo used ns we say it in hero in small groups of soldiers under crowded conditions, as on a troop transport. This now work takes away practically all the terror that wo have had meningococcal infections in the pact, ond gives you a moans of control that is For the blankets and the floor covering on floors, some extremely in- teresting non: work is coming long indicating th-t you can treat those new materials with one of theso glycols plus other wotting agents with some urea in the mixture,. It is amusing to soo some of the bacterial counts that have boon used in some of the posts in the Army last winter. During the next winter it is extraordinary how th t count has boon greatly reduced by application of some of those now methods by the storilizati xn of the .air. As I say I havo boon making progress reports of many of these now methods. For the sterilization of the air, I ,m quite sure in due time the use of ultraviolet light and the use of glycol vapors will swing to the side of the glycol vapor action. Experimentation is going to the extent of both those agents. It has always seemed to mo that the difficulty of those ultra- violet lights is that you are bound to eliminate a groat space. It is not likely that you want to sterilize by the use )f ultra- violet light. In addition it may not be free from irritating effects; on the other hand glycol, whoso vapors arc extraordin- arily bactericidal, may kill bacteria and they kill virus in the- air with substantial rapidity. And those two substances, propylene glycol and triethylone glycol, when conccntr- tod one part of two hundred million triothylone nd one part of five hundred million propylene will sterilize the air very quickly,. Last year wo talked. Colonel Melton and others, about the use of propylene glycol on ships. VJo found that propylene glycol had a slight fire hazard. In vapors it is not inflammable but whore running down the window pane it c :>uld bo lighted by a match or a spark. Trial showed on the other hand that it is not so inflammable and a relatively little fire hazard. Last year the apparatus for vaporizing propylene glycol and tricthy- lono glycol was tank heated by electrical heaters, and vapor blown off by tanks with the intention of introducing it into the ventilating system of the ship. Lliat wo are loading to know and what wo havo designed here I :m sorry I can’t pass around, or show to you in' any detail. It is really a tank (holding up book from stage) of triethylone glycol surrounded by a steam jacket that can bo used on a ship. Even with a pressure of 30 lbs in this lino triethyl ,no glycol is heated by that and steam is bubbled through an inn>-r compartment and the intention is to introduce that vapor into the ventilating system of a ship, Tiw problem y-t to be solved is on actual trial. This has been put under conditions in which the rocking and swinging of a ship 89 do not upset and splash tho material all around, so that it is lost or mixed up in improper ways. It has no moving parts, it hasn’t any sparks or any motors. By the way, the concentration of glycol coming out can bo so adjusted that you can got anything from almost any amount vaporized that you wanted, according to the size of the amount, in handling the apparatus* The other part wo all need to understand is the factor of concentration of tho vapor. • It acts only in the range of humidities between about 30 and 60 percents, best in the region of 35, humidity of 35* Therefore, it*is necessary to control humidity in the ship as well as to control the concentration of vapor. One of the things I hoped might come out in the discussion- is whether you have humidifier things on ships on the northern trip in winter; and if not would it be possible for us to supply surgeons with Gycrometers, a thin: that begins pretty soon to take readings, so that wo might know what the northern run in the winter time may be and what humidities there might be on different parts of the ship. The other thing this might lead to would be a trial installation of this apparatus on a ship permanently in port, grad- ually working it up to a time when one might feel relatively certain where it would go and work practically on a voyage. At that time wo would like to ask if some of our civilian consultants, who are ex- perts after years of study, might join up with a team of ship per- sonnel and get the trials that would be necessary to put this be- fore you in a convincing way. I am bringing you, as I say, some definite progress on the use of sulphadiazine, particularly on the control of meningitis, and a fairly definite statement that wo feel we may be on the way; that we have an apparatus for glycol vaporization that may be worth your consideration, on ship. LT COLONEL FARR; Any questions you would like to ask? Colonel Bayne-Jones brought up some very interesting points there. How soon would you want to do some installing? COLONEL BAYNE-JONES: V/ell, I should say within the next month or month and one-half. LT COLONEL FARR: , •* . . ■ ... i-.,.:- ■ ■ n Any further comments on this ? 90 LT COLONEL FARRi i/hat are the -possibilities ,of such a procedure? LT COLONEL FEISTEL: ‘ You probably would need a dozen of those machines on a ship. If an apparatus like that could bo used with an electric squirt gun, I think this apparatus might bo a little more practicable for the ship. Now on most of those ships the vessels themselves are rather old .nd the ducts through which the spray would have to come are numerous. You would need quite a few of those things before you would bo :blc to effectively work it. COLONEL BAYNE - .JONES; I am wondering whether or not wo could use the ventilating system. LT'COLONEL FEISTEL; The nower typo ships can, but in some of those old ones it would b>. difficult to rig one of these things up, COLONEL BAYNE -NONES s The Colonel expresses a conception which is interesting to me but is turned down by experts. That is the conception of spraying a ship ar nmd as you w ..uld from a bomb in compartments. That w uld solve tho_ problem somewhat. On the other hand, we ought to be able to keep . concentration in a super-saturated atmosphere .-right, along. I am not sure, I doubt whether just a periodic spraying would do the job. The air would soon bo filled gain with the bacterial viruses from the men who are in the room," ; LT COLONEL FARR: ■ ‘ I think wh t Colonel Feistol had in mind is some kind of spraying system in the ducts that could be spraying constantly. Now I gather that is a liquid that has to bo heated and vaporizes from the liquid, COLONEL BAYNE-JONES: One successful - experiment was done in Philadelphia in a ward, and in a school, whore they let the glycol vapor drop down on a hot soldering iron .nd-then it was blown around the room with, an electric f n.■ 91 LT COLONEL NEILSON: I think it would be a great thing to put this method if it were perfected, in a staging area because all staging areas have now ************ square feet per man, CGLONEL BAYNE-JONES; Trying to use the glycol vapor in the staging areas is difficult on account of the ' atmosphere. The barracks don’t lend themselves to air condi- tioning. You have open windows, open doors, and the heating system all makes it extremely difficult to get the actual conditions you would have to have in a staging area, COLONEL LOWRY: Have these electric humidifiers been on the market many years? I am thinking of a little pot- like arrangement with an electric heating element, COLONEL BAYNE-JONES: For humidifying the room they may be used. COLONEL LOWRY: You arc normally supposed to use- water in these things. They have a fan in them. They operate nicely, COLONEL BAYNE-JONES; I don’t know whether they have actually used one of those things. The electric heated vapor- izer which was devised last year was on the same principle, only you have to have a separate humidifying system. The relation be tycoon the glycol in the water vapor is something like one part of glycol in three thousand parts of water, so that they don’t go from the electric humidifier very well, COLONEL FARR: Who is here from the Water Division? MR. MURPHY: I have just come in, sir, and I think we can supply you with information on the humidity condi- tion on the Atlantic. We have ships at present with air condi- tioning with spaces such as mess rooms in which experiments might be carried out. 92 COLONEL BAYNE“JONES: You have tho data ready? MR. MURPHY: T7e have the data in humidity and temperature and wo have what we call a thermo system. COLONEL BAYNE-JONES: As a matter of fact triettylene glycol has been used satisfactorily. It is part of the air conditioning system. You can actually use it to take some of the vapor out. 1 MR. MURPHY: C • • I think probably the problem is to keep the balance between the two. LT COLONEL FARR: Would it be possible for your to give those figures to Colonel Bayne-Jones on humidities? MR. MURPHY: Yes, sir. LT COLONEL FARR: Major Fulton, do you have any in- formation on humidities? MAJOR FULTON: No I have none in mind. There are no two ships alike. The heating is a mixture of direct radiation and cold air passing through coils and then on into the various compartments as heated air. In addition wo are constantly installing cold air ventilation so that each ship would have to be a subject of study for that particular instal- lation, but as far as humidity goes, I have no figures on that. CCLONE'L MELTON: I* would like to ‘make a remark on sulfadiazine. Late last winter I found out that Dr. Rivers had been doing this experiment we are talking about in tho control of scarlet fever. At that tiirre we were having quite- a number of cases of scarlet fever in' the task force units in our staging 93 areas. I came back and we issued directives to our staging area surgeons in all units in which scarlet lever occurred* They were immediately to give each raemberof their units five tenths gram of sulfadiazine* They ■'./ ere to follow this up day and night. They were to make the Dick Test. They wore to discontinue at the end of twelve (bays, n the ones that were negative, be got excel kit results’ in every case. Very few cases of scarlet fever developed and it disappeared as though by irr gic. I am telling you what our experience has been here. I think it is worth trying,. MAJOR GORMAN; I would like to ask Colonel Bayne-Jones what his experience has been in influenza with sulfa drugs. COLONEL BAYNE-JONES: I haven’t had any experience with sulpha drugs in influenza. There haven't been enough influenza in troops this year to make a trial. The general impression is it is of no value on the influenza virus. wo haven’t had a chance to try it this year. LT COLONEL IbJdR: I think the subjects taat Colonel Bayne-Jones brought up are some of the most importatnt things we can be thinking about. In other words, prevention of some of these air-borne diseases. I believe tnat it would be very well if we could have some of our port personnel work with you,. Colonel,.on the practical aspect of putting then on board ship. Nov/, for your convenience, should wo use an East .Coast port as a ,'guinea pig or would* you like to have an East Coast and a West. Coast port working on it. COLONEL BAYNE-JONES: I would say on East Coast port be- cause the center of apparatus manufacture is in the East. The main .groups‘ of people are most accessible in the East, be are mostly interested in the eastern run. LT . COLONEL VARR: be are coming into vi ntor and it is tine that if we are going to do something, we should be doing it. Colonel Feistel, I would like to have the facilities of your place; I would like to have the facilities of the New York Port. I would like to have the Eater Division at Washington 94 get in on this, and wo will put everything behind it to give you a start on this thing with a view towards getting, an experimental ship out soon as possible. XT COLONEL FEISTEL: I can take Colonel Baync-Jones with.-ijio and start on it. COLONEL BAYNE“JONES: I have to go back tonight# LT COLONEL FaRR: V/e will arrange to have you start at the first opportunity convenient to you which may bo some timo this week# COLONEL BAYNE-JONES; This comes pretty fast, but I would like to have the means to go ahead with it* LT COLONEL FARR: Colonel Fitzpatrick will be the local correlator in the Chief of Transportation and will see to it that you started on it promptly and will see that you get something done. I believe wo should have a representa- tive of Colonel Melton himself in on this, not only from the standpoint of glycol distribution, but also on these other medi- cal practices which you and he have been working on. Does anyone have anything else that ho would like to ask Colonel Baync-Jones? COLONEL MELTON: I would like to ask Colonel Bayno- Jones when Dr. Robinson was here when wo were trying this experi- ment last year, he spoke then of soaking sheets in this solution and hanging them up. that time ho hadn’t developed fully what the effect was going to bo m upright individuals- like man# Ho was trying experiments then on monkeys and rats doing autopsies on them. Do you know what the latest results on that have been? COLONEL BAYNE-JONES: Triottiyleno glycol -vapor-’d-besn’t hurt monkeys and rats. /e know its use in. air conditioning some large buildings in New Y .nk, particularly when used it and no- body knew it was there. 95 LT COLONEL FARR; Thank you. Colonel, Our ports whether far or near are located near large cities which have rather high venereal rates. For reasons psychological or otherwise there breaks out on transports cases somewhat heavier than you may find in normal well-policed camps. The problem which results is quite a headache not only to the Transport Surgeon but to the < surgeon on the other side after their arrival. It causes concern to the Surgeon General and to the Chief of Transportation. We have Lt Colonel T, B. Turner, Chief of the Venereal Disease Control Branch of the Preventive Medicine Division of the Surgeon General1s Office here this afternoon who will discuss this problem. LT COLONEL TURNER: Colonel Farr and gentlemen. During the past six months the venereal disease rates have showed a favorable trend with between 25 and 30 cases per thousand. Wo have administrative problems really out of proportion to the actual number of cases. It has even gotten mixed up in the question of Anglo-American relationships during the past few weeks so that there is a continuous problem. Some months ago we became excited about the higher rates at the port of embarka- tion and began to look into the problem. It was immediately apparent that these high rates do not actually reflect conditions at the ports. It was simply a reflection of what was going on in other areas of the country - the large number of troops tun- neling through these ports. Our survey did reveal that there wore problems involved, I would like to sketch very briefly what we regard as some of the problems and then ask a few specific questions that I hope can be further discussed by this group. This will help us or help this group in developing an overall policy. There are two major aspects. One is the preventive problem - that is the protection of troops while they are in the staging areas and ports. When these troops arrive it is presumed that they have been indoctrinated and sufficiently educated and instructed in methods of protecting themselves, so I think there is not much that we can do about-that. It comes down in our opinion largely to a question of providing prophylac- tics. It seems that station prophylactics will always have a very limited usefulness. For example, men who come in here for a short time in New York, it is almost impossible to instruct them adequate- ly where stations are here and see that those stations are accessible to them. It is almost impossible to do that. So the first ques- tion I would like to put to the conference group is with respeot to the practicability or the advisability of making individual pro- phylactic packages available free to soldiers in staging areas. As you know. 96 in this country we have individu; 1 packets which are supposed to be' kept -in unit day rooms. They aro supposed to bo sold or bought with-the unit funds and resold to the soldiers or given away, '-As I understand it, wo have been going -over this whole thing with Colonel Melton and some of the other Port Sur- geons. Most of these units, as I understand it, don't have funds and the system now in effect abroad is th.t if a unit does not have unit funds tie medical officers are authorized to issue them without cost. How the question is, should that policy bo put into effect in staging areas* I am of the opin- ion that it. should. Secondly, there is the question of sul- fathiazolo prophylactics. I don’t believe th .t that has been developed at those staging areas to the extent that it might bo. Sulfathiazolo in doses of two gr.ms, either divided into two doses o.f one gram or one single dose appears to prevent gonorrhea and the problem comes then to an administr tive one. Can sulfathiazolo bo administered to those soldiers that need it rather than as a mass process. 170 don’t believe it is justi- fiable to give it too freely but if there is some administrative mechanism whereby the man coming in can be picked out, that is the man that needs the prophylactics, we believe that it is an important aspect of the program. Now the second feature of the problem is the management of patients already infected, I think it is hard for rarny of us to realize the revolutionary changes that have occurred in the treatment of venereal diseases in the past few years, you .11 know, a fairly high proportion of 50, 60, 70%, the figures vary - respond to sulfathiazolo in cases of gonorrhea. The rest of them respond to penicillin if is any penicillin to bo had, ij.ll our efforts should bo designed to discover the patient as quickly ,s possible and to bring him under medical care. Anything th .t keeps hims from medical care is against the best interest of the soldier, and the unit to which he belongs, and certainly punitive measures do not help out much. They outlive their usefulness, I gather that there are opposing influences-with regard to shipping people overseas; On the one hand there is the pressure to ship individuals with venereal diseas because of military necessity, manpower, and win it not. Secondly* the unit com- manders want then to be shipped. ihey don’t like them to bo taken out of their units. thirdly, is the question of purpose- ful infection with a view to bo taken out of a unit. Personal- ly, I think we are inclined to over-omphasize that but never- theless it is one of the factors and then I assume that Port Surgeons do not wish casuals hanging around more than :access' ry. On the other-hand, there is certain pressure to withhold cases from transports. That comes principally from, the theater commanders, --t the moment considerable -pressure from the BTO not to send infected men over or at least not to-have-them ar- rive there in an infectious stage, .nd :as I indicated - some foreign governments have done the same. Secondly, I assume transport surgeons aro very busy and they djn’t want to bo loaded down with any more sick people than arc necessary. Now then, what aro the problems? In the various steps and first in the staging areas? 97 The first problem is one of early detection, lihat mechanism are v;e uoing to set up to discover these people as quickly as possible after they arrive at thestabbibnb areas? As I understand it, there is a physical inspection which is supposed to be made within the first forty-eight hours, I gather that everyone is extremely busy during this period and there is some question as Vo whether it is practicable to do a good physical inspection, I think we have to do more advertising to the soldier selling him the idea that if he is infected to report to the medical officer, and as I indicated before, you have to divorce from punitive measures. You can’t say to a man, ’’please report if you have any infection” and then turn around and punish him. I ■’would be interested in hearing some comments on how we can pick up these cases early so that he can be cured before the time comes to uo on transport. How secondly, with regard to the method of treatment, should the men be treated on duty status or should they be hospitalised immediat oly? I am speaking now of gonorrhea because the syphillis and shankroid cases have to be hospitalized until they are non-infectious. That was another question that I would like to hear some comments on. If patients can be hospitalized without interrupting their regular duties, perhaps it is better to do so. Perhaps the results are a little better in the hospital because we can give hibher doses. On the other hand, treatment on a duty status is entirely practi- cable. The results appear to be almost as good. Their complica- tions are no higher in frequency. Thirdly, it is the question of penicillin. Should penicillin be used in the staging areas and I think ce tainly the answer is yes to that if the pencillin is available but that puts a real responsibility on the staging area because there is very little pencillin and it must be used only in those cases that are truly sulfanamide-resistant. Secondly, what should be the policy with reference to shipping venereals, I think that we u,re all agreed that early syphilis, primarily secondary, should be hospitalized until they are non-in- fectious which should be Gto 10 weeks. All newly discovered cases that appear to be respondent should be shipped if pencillin is available, be believe that all cases, regardless of their stage, unless they have complications, could probably be shipped provided the medical services are sufficiently adequate to t.dce care of them on board ship. Lastly is the question of specialized personnel. If there is one thing wo have learned in the last two years it is that many of these administrative problems c;in be much bet- ter handled by specially trained individuals, he realize that there is a. tremendous shortage, of doctors, that all of you don’t have adequate allocations. On the other hand, if there is a large problem as there is at some of the larger ports, we believe that it will save .manpower in the end by having’a veneral disease special- ist who lias nothing else to do except to carry through this program. 98 LT COLONEL FuRRs The meeting is open for discussion# BRIG GENERAL DS MITT; In your opinion, would it be a proper policy for the Comnaixing Officers of hor.ie stations to ship all gonorrheas uncomplicated to staging areas and there should they be held before being shipped oversea's? LT COLONEL TuRNER; It is exactly the sfvne problem in the homo station that you meet in tho st;p ing area. The unit commanders .e net want to take these men out# I believe that we coul I handle them better by cencentr -tine our efforts at the stamina areas# I thing it is largely a questi.n of not detecting those people that are sent# LT COLONEL FARR: Any fu rthe r discuss! on ? COLONEL MELTONj p - - g a- : me I.don’t want to bo hopping all the tine but when I was out in Colonel bhite’s iron I hoard ■no thing tht I think could bo adopted very beneficially in nil of our areas. For instance, the mechanical sale of contraceptives, that is the rubbers and tho chemical contraceptives. He has out thcpo in one of these areas where you can insert in one side and a dime in tho other and tho non can get it without having to purchase' it from some female dork in the PX or some man. th t is selling bo’or in the boor-pardon# He has got stuff back in a drawer there, and he has to open it up- and pet it out. Some of t use follows will hesitate to got th .t if they are net furnished them. Now, these mechanical dispensers .re made some- where on thc-hest Cotast, and I think they tiro a (,o ,d idea. It is a'-'.slut' machine'. I am going to try to adopt it if I can get it. That is so much for the purchase. New our method of handling our venereals here• .to have just got out a new directive and Major Schwartz, my venereal disease c.-ntrol officer and I. would, like’ to have hii state something on- just what wo want to do and get- sotd’suggestions from the rest of you. 99 MIJ OR SCHAaRTZ; Our plans arc fairly complete, though wo believe wo have some hookers to work out of the plan but in respect to movement and t roatment of venereal cases at staging areas and then their handling from the staging areas to the transports. In the first place, we are trying to put in measures v;hich will pick up those cases at the staging areas. Ac then plan to alter our present plan which is now a test of a plan at task force units at the staging areas, he believe wo can handle them bettor if we are given them at the hospital and give thorn intensive tost treatment. This Circular No. 129, permits us to give 4 grams in one dose and after that every 24 hours# At the present time with treatment on a duty status, the men are treated .at the staging area and from there put on the ship and it may mean a day or two, sometimes longer, before those men are looked at by the Transport Surgeon. Usually the staging area gives the man himself his medication depend- ing on him to take it. Now we know that many of these men will have a temporary response to one or two days medication and may not report to the Transport Surgeon for#continuation of treatment until throe or four days out and by that time they have relapsed and then the results of treatment are not so good. So wo do feel that the continuity of treatment is the important thing in getting away from too many sulfanamide-resistant cases, gnat we plan to do is to hospitalize all of those men at the staging areas, then when the time for shipment comes to group them in who are going to each individual ship regardless of the unit to which they belong, and send them as units under supervision to the ship on which they are embarking. Our report will come into the Port Surgeon and Transport Surgeon listing the venereals that are coming on each ship. The Transport Surgeon-then will either place them in the ship’s hospital im- mediately or, if the number is too large and they cannot be admitted to the ship’s hospital, he will then designate a section of the ship as an additional part of the hospital area. In other words, these men do not have to be in the hospital but they do have to be some place whore they can be restricted, where they can be watched, and where the medication can be given on time. In addition to that by having this report come through the Port Surgeon’s office telling us how many venereals are going on each ship, particularly in regard to gonorrhea wo can estimate a little better how to make the best use )f a small supply of penicillin which we have for placing on trans- ports. Our attempt then, further, is that when they get on ship that this intensive treatment will be continued. That is one gram every 24 hours for 5 days and the further treatment will bo the same. That is, if they fail to respond and there is still time after the second or third day interval following failure on one course, a second similar course 100 will bo begun. Wo then further plan to place on the ship a supply of penicillin to cover the cases, or* to,put, in another way, so as to reduce in every way possible the nuf.ibor of cases reaching a debarkation in a symptomatic stage t.o be accomplished .somewhat this way. Say 72 hours before reaching the port of debarkation, those patients who are still symptomatic"will be given penicillin. In other words, those that need it the most will be given it first. Those that soon more likely to respond without it will be skipped if the penicillin is not available, ho feci then if wo can give. continuity of treatment, cover it with penicillin as much as we can, th t we will reduce the number of cases of gonorrhea reaching the port of embarkation in a symptomatic stage, further, we ask the Tr nsport Surgeon to submit at the port of debarkation a report of all men with venereal disease in a symptom-'.tic stage so th .t the surgeon of the port can dispose of them, we hope, by hospitalizing them until thoy arc all right so th t they can travel with their units rather than sending cages from the ship in a symptomatic stage on with their units with the potential spread to that area, That in brief is our plan for trying to ship these ven- ereal s and we know th .t there will be a good many problems all •..long the lino but unless the tiling can bo accomplished with this continuity, we are going to have too many venereals reaching the other side. I would like to put in a couple of t lings while I am here. Tho men :.t the staging area, after completing their processing during which time they do not have any passes and up. to the time of the ; lert for movement to the. ship,,have only 12 hour passes which makes .it an ideal spot if wo can work it to put in this prophylactics for treatment, for gonorrhea at least. Now the problem, of course, simmers down to how to handle units' who in the past have had high rates, .According to burgeon’s General Circular, this treatment can bo given only to units who have had a gonorrhea rate of 50 or more per annum. This boils dorm to units, colored groups, because there probably aren’t more than a handful of white units in this country whose rates for 6 months period have been anything near 50, while colored troops in the groat majority will have a rate in excess of that. So, wh .t wo hope to do then is put in a plan like this that all units having high rates, members, of those units 'when returning from a pass at the staging area whether or not they have b.-.n exposed, they will bo given prophylactics, "ho ,hqve received permission as well to allot some pencillin to the staging areas. lib intend, of course,: to use it only for task force personnel and the problem there h-as. boon .something like this, A man in task force docs not respond to sulfanamide. He must be sent to a general hospit' 1 which takes 2 or 3 weeks before ho gets back to the staging area. By th t.time the neces- sity of withdrawing him from his unit etc - we fool then that if that man can be given his penicillin at the staging area, there is no reason why he cannot stay with his unit, plan to allot that carefully though, on individual requests of that kind. 101 LT COLONEL WHITE; I would like to say one thing on the machine dispensing prophylactics. We found cur rates dropped considerably after using these machines. However, an ordinary cigarette vending machine can be converted into this use. We just about had the rate down when we began to get. colored troops and our rate jumped up. COLONEL LOWRY: The problem is difficult at Hampton Roads because we are drawing from casual units largely and that is to reach back to’t-he home depots and get them to initiate a complete venereal register, Syphilic rates have come down very wello Frequently, we do not get the information on these people until they make their 48 hour visits. If we can get these lists of all venereals of all types, we can initiate the treatment on the same day, I believe this will add a great deal to this continuity and we are in the process of working on that at the present time and I think it is going to be a help to us, LT COLONEL FARR: Any further comments? MAJOR FHI TON-; Speaking from the experience of a battalion commander of colored troops I might answer two ques- tions that were brought up. This particular battalion had an almost-.aJtroncmical rate and it was made up partially of troops who had avoided overseas shipment by becoming infected and being kept in the hospital and at the approach of a shipment again, became reinfected hoping to go back‘to the hospital* Apparently, they are going to do that over and over* They instituted duty treatment of this intensity type and to insure that they actually got the treatment, the fihst does was given at the dispensary and at such times as the men Were near the dispensary. If the troops moved out into the field, the tablets were given to the platoon leader or a reliable section sergeant who, at the correct time, saw the man swallow a pill and there was no question about getting it. The rate’fell into, the limits of white troops very quickly. As for the contraceptive side, it is rather helpful giving them to colored troops. Suppose they leave early in the evening and stay away all night, they simply don't use them. We broke that up by requiring every- one who came in for a pass to take a prophylactic. That and the discomfort and the having to get up every 4 hours to take a pill brought the rate down very abruptly. 102 COLONEL BRE.DISH: You .think you popple hnve trouble. I an fron New Orleans .- T/e have approximately colored strength and we have al l the blue ribbons, that could bo award- ed for the last two years for high rates and the problem is everlasting. I hate to-even start going into the details as they exist. Colonel■ Turner has been very helpful to us and we are batting away at the problem, i*.s you all know, the 4th sth and Bth Service Commands have, and always have had, the highest prevailing venereal rites and t.e Ist, '2nd and 3rd Commands have had Hie; lowest venereal rates. Tie think nothing of a rite of 600 per 'thousand of a unit down there and that rate has prevailed, application of effort over a period of many months has resulted in an overall reduction of that rate down to round 250 per thousand. Th t is colored rate. The white rate is below 30 per thousand. Our roblen is net alone for shipments averse is, but due as well t- the fact that there are a large number of units activated and trained in and around the New Orleans Port of Embarkation, he have tried overy way known to influence the rate, he experimented with several battalions - colored battalions, we gave then a gran of sulfathiozole when they went gut: on pass and gave them another gram when they returned, he reduced the rate to zero in those units during those periods. Now it is practical to go ahead and pat out mass sulfhthiozole therapy and control this in a staging are .. he ran many thousands of urin analysis and blood checks, he don’t think we have hurt any of those people, he limited their passes to twice weekly, it so happens, however, approximately 50 to 75% of the cases occurring made their contact in and around- the city of New Orleans. T/e can’t reach the man who is on furlough at home. This seems to account for about 50% of our cases. The only way ho-can bo reached is by education and by-furnishing him the technical materials necessary and having"- his- cooperation in the use of them. The matter of prophylactics, •sulfathiozole to the unknown exposed cases on return frdmdpass' work well with white troops but not with colored..You can’t get anything out of them as to whether they had an exposure or not- I/O’ have had fair success with the ambulatory treatments of colored persons but we have had to resort to a procedure the Major has outlined. You can’t give that colored man 40 ‘tablets with a, routine and have him report daily to the dispensary for his progress study. Ho simply won’t tako it. You have to kite h him take it pers.onally. There- fore, you hive to delegate that back into the unit. If you have a good cooperative unit commander and first sergeant, charge 103 of quarters, etc., who will see this thing through you can get excellent results. There is one thing that I would like to point out at this tine and that is that I think it was in the month of May a directive came out with reference to furnishing at ports of embarkation a trained, well-qualified venereal disease control officer. That came out just prior to the turnover in the management of personnel allotments. We were to requisition officers if we had available vacancies at that time. We didn’t havb any, At least, I didn’t have one and I certainly haven’t hdd any available vacancies since that time for the requisition- ing of that officer. I am wondering if steps can’t be taken to provide the Chief of Transportation with the necessary allot- ment increase to actually furnish us with the skilled, well- trained venereal officer, LT COLONEL FARR: Colonel Heiskoll, can you answer that last question? COLONEL HEISKELL: Colonel Turner and I discussed that subject at the time the directive was published in May. There has boon a considerable development in personnel technique since that time. We felt that New York and San Fran- cisco and possibly New Orleans wore looking at it from the stand- point of /orsea shipments which "would justify an officer W'ho could deveto his full time to this important matter. Wo felt that in the other ports duo to the scarcity of personnel that a part-time officer who specializes in that subject could handle it. That was just our general feeling which was a quick decision. After all, one officer so far as the allotment is concerned, I think can bo worked out. lam not from the Personnel Division. Wo have an officer here, but ho is from the civilian outfit. The Surgeon General will concur that it is needed as a full-time proposition. If not, you will have to fall back on part-time. I would be very glad to take that up with our personnel (military) when we return to Washington. BRIG GENERAL DE WITT; I took this up with the port Commander or Chief of Staff, I said we needed this man very much and the thing went back, as I remember it, to my office with an indorsement. Wo needed this man but we had to have an increase in the overall allotment for that officer in that grade, LT COLONEL FARR: In other words, there arc too many in the port but they are not in the port Surgeon’s Office. 104 BRIGADIER GENERAL DH bITTs’ I‘say there are not enough in the port anywhere. LT COLONEL FARR: ■Je have had a very fine discussion. Thank you very much. Colonel Tumor. In those times when the sources of water supply arc very well controlled the problem of coordination and control of pbt- ability was very simple. To have now reached the stage where transports may pick up water at nearly any place they touch. The results are that very frequently water is in bad shape and requires a proat deal of work on it. be have two speakers to cover this. Captain Bonnell who has done a proat deal of work ‘in his specific area and later Colonel the Surgeon.’General* s Office will pive a further discussion. CAPTAIII DONNELL;' Perhaps no one noticed at our charming dinner aboard this British transport last night what the water tasted like - but I drank the water. I will admit we did have'liquid'refreshments beforehand. I have been in ■the habit in the past year ofnot drinking water aboard trans- port. . About a year ago out in San Francisco wo were presented with a rather‘bad‘prob]em.' be had to do something about drink- ing-water nihe transports and at the sane tine in order to justify our results, or lack of results, wo had to Conduct a certain amount of research. Now the disease organisms which we were attempting to combat are taken into the'human system through infection primarily, through food, and'through water, but you can’t draw a lino down the middle and put food on one side and water on the thor and always say that the' disease •which is being produced aboard transports or'with the troops when they get to the other side are occasioned by either being picked up by food'or water. As long as we don*t have the nec- essary data there is no proof of that. There food is concern- ed, we can run laboratory tests occasionally aboard the vessel. You have your food examination. Sanitation Corps, inspecting the food analysis. ' Sanitation•conditions in the galleys - as far as water is concerned has never up to this time made any specific progress. Perhaps you can account for Franco being a nation of wine drinkers and England being a nation of tea drinkers by saying that England hasn’t the' water that Franch has. Yot at the same ’time we are ’attempting the greatest mass transport of troops in all history and wo"are definitely not giving them the necessary precautions as far as water conditioning is 105 concerned. When Sir Francis Drake took his ships off - oven as late as our brcat clipper ships - even as late as 1940 - v;e were not conditioning h;’at or. Sir Francis Drake carried his drinking ■water in hogs heads usually coated with pitch. Later on, we be- gan to install steel tanks in steel vessels. Tic lined them with cement because of the reaction of water against iron and steel, causing rust and sediment. But still we wore just dumping water in the tanks and assuming that because the source of the water, that is the city water which we loaded, was pure or relatively pure, that that water was going to remain in a pure state. Such, of course, is absolutely contrary to the facts. In the Pacific., we have been faced with a problem of ships travelling slow ci coultous convoy routes picking up water at stations widen end not have approved sources of water.. Using ships to co) ry a greatly increased operating personnel and having a tremendous increase in the number of passengers, that is military personnel, and yet for their drinking water you only had tanks which were in those vessels' for normal personnel and normal jperating personnel and normal passenger lists during peace time. That meant that certain;tanks had to be constructed aboard the vessel, or, as is more often the case, there had to be a certain number of tank conversions. Tanks which might formerly have carried gasoline, fuel, oil, or in the case of some of the Dutch ships., cocoa.,, oil, things of that shape had to b. cor-:, true tod. ’am very fortunate, I might say blessed nd also cum ed by having an old time Army Sergeant on my post. After he gets through ray hard head exactly what I should do then I am all right*. One Sunday while at work he was trudging through the rain. He works on Sundays because his wife wants him to go to church. He was passing by a street where a water main had broken and he saw a strange contraption out there. A trailer, two wheels had"flasks of some kind or cylinders and they had pipes sticking down into the main and there were a couple of nun fooling around so his natural curiosity got the best of him and he found out they wore using a sterilizer. They were applying chlorine gas to a broken water main or one which had been broken and they’were attempting to cleanse the broken main, the pollution that had been picked up at the tine it had been broken, as I mentioned before he had to dp something about our water supply aboard transports and at the same time justify our results or lack of results by-research and by statistics. In that connection, during the past 11 months we have taken more than 4,000 water samples from aboard ships carrying United States military personnel. Taking a water sample is not as simple as it sounds because first you have to have sterile bottles. Second you can’t merely go aboard a ship, turn ui tap, and take a sample and when that sample is analyzed consider that you have an adequate representation of the potability,of the entire mass of the ship’s water aboard. You have to take samples from a number 106 of tanks and a number of taps from the various parts of the ship. Wo attempt to'take ton. Wo still don’t fool wo have a truo picture but in view of our limited personnel, time, and other things of that sort, we consider that number sufficient. Until recently, wo have been taking samples on Navy ships-and War Shipping Administration ships. We handle on the water sample up to 10 or 12 ships a day. Wo take water samples upon their arrival. Wo take them while they are in port and we take them just prior to their departure. To got back to the machine the sergeant saw, as I say, ho told me about'it- and I went to investigate. We made certain connections so that ho could begin using these (pointing, to diagram). Assume this is a cross section. A lino is dropped into that tank. A certain amount of chlorine gas is injected into the filling line which might range all the way from 100 parts per million to extreme cases of 300 parts per million. In other words, you havo a heavy saturated Water-chlorine-' solution pouring into that tank. As that tank slowly fills up, organic matter which might be deposited on the side or on the bottom is affected by action of the chlorine. When that tank getd filled 4, 6 or 8 hours later, the other tanks arc filled; that chlorine water is pumped through the circulating system of the ship. There arc sometimes millions of pipes in that connoctioh. The machines are then disconnected and the whole mass of that water is dumped overboard and the tanks are as we consider them sterilized. In other words, we receive potable water at the port so that if you put pasteurized milk in a dirty milk bottle you are not doing any good. We arc attempting to sterilize our containers, We took 20 test ships and kep figures on the potability of the water samples, before and after this sterilizing which more specifically is known as super-chlorinating, prior to super-chlorinating the first timo our potability was about That is an astonishing figure. Wo got that to jump up to 88%.potability water samples by super- chlorinating once. It wouldn’t stay there. It dropped back doim to* about 72%, We super-chlorinated again. It got up to 94% potability. The vessel went out on a long trip and came back. Wo had 20 vessels .hero. The vessels came back. The results were a little better - 75%. Wo super-chlorinated and got them up to 96% potability. In-other words, wo have been able by super-chlor- inating to climb fr0m.35% potability on ships water on the pacific runs to 96% but along in hero beginning about 6 months ago other factors began to enter in and I want to describe those to you briefly. First, I would like to point out and some of you know this much better than I who are more familiar with ships, that a ship will have several drinking water tanks. You have a tank in the immediate nose of the vessel which is called the foropeak. You have the counter part in the stem - the aftpeak. Somewhere in the base in one or more sections you will ha‘e water tanks kno\m as the domestic tanks. And finally, although certainly 107 their use is not approved, there arc certain double'bottom tanks lying immediately above the keel and the dcadwood. You have a great number of sources of contamination of ships water. For instance, on a vessel which we will merely call "X" - a very dirty vessel by the way, in fact, coffee comes in a better c inn than "Z” - the engine plates and the bed bolts wore very loose over the tanks which were used for water• Y )U had fuel oil seeping in there. These-tanks have pipes running to the surface called vents. There is a certain amount of contamination through there. You have constructed on a good nunbeo of vessels a little wood chenise we call do, houses, he oven have deck latrines so that you have contamination for the deck into the tanks. You have plugs rusted up and also through some of these water tanks some of the sanitary linesjpass. The sewage passes through there and duo to the corrosive acti m of water on stool and iron, you always havo leaks. You hive double connect! .ns, therefore, in spite of super-chlorinating, wo find wo are not getting at the root of the problem, lie still had s>. urces ;f contaninati n aboard the ship and wo had to do something about it. wo began to buy and install small machines. The essential p rts of the machines were about the size of a typewriter and are called a hypo chi orinator. There is a mechanism which will inject a certain amount of chlorine solution into two water manifold aboard ships. They do net con- dition the ships water in tanks out they do condition that water passing through the boiler manifold prix to its consumption by troops either indirectly by galleys or through fountains. Those arc mechanical hypochlorinators. ho sot thorn at first at about two tenths part per million. Th it is that tuore would bo two tenths per million Chlorine left in that water after a certain retention of time. Actually, we put much more in there than that but it was being oxidized. The machines vary- ing in different ships were so sot that wc still had two or throe or four parts per mill! m of chlorine loft over, ho still weren’t getting at one important organism however* Th vt is the cost of amoeba dysentery. They, ordinarily,■are -not susceptible to chlorine in that c moontrati ;n. Yet, if more chlorine-is injected into the water, you h vo such a high residue that it just isn’t palatable any more. You can’t oven drink the stuff. To get up to 10 or 12 parts per million with a sufficient period to ill the cyst of noetic dysentery you will hove to find some way to make the water palatable. Because of that wo used an activated carbon filter and began passing the drinking water through th it after’ the water had boon highly chlorinated, he figured the cyst -h id boon killed by-the 10 or 12 parts of chlorine. The water was dochiorinatod by passing it - through the filter and it cane out the other end free of chlorine, was do ox, s dt, and ab out as good drinking water as you can find. There is still one snail object! n to our system and that is there is nj chlorine residue in the water after it passes the filter and still has to pass through con- 108 sidorable pipinb before it is finally consumed. That can be overcome by one of two ways, possibly more, either by putting a little sifter valve on the side of the machine.or you might back-track your water through the chlorinator again, a dual chlorinator or through another one. On our tablethere are a certain number of sketches, some showinb the set-up. Tliere is a sketch or picture and then there are a certain number of others ..which an engineer would have very little difficulty in following. I think practically all of the tables have this large sheet showing the picture. This is a picture and not an engineer’s drawing* You will note in the upper left hand comet that there are water tanks* The water passes out from those tanks to the mechanical hyserchlorinator where a certain mount of chlohine is injected into it. Finally, it goes to a retention tank idlere the chlorine has sufficient time to o±ide bacteria or protozoa before passing through the filter or the chlorinator. A good number of vessels already have a gravity tank or pressure tank installed which can be used for that purpose, I don’t care to go into -any more technical engineering details because I am sure you are not interested in those things right now. Tie have tried to raise the potabil- ity of ship water to about the neighborhood of 95't - that is our result. I would like you to keep these drawings and make any use of them that you can. I would like to turn the balance of the discussion to Colonel Hardenbergh,Chief of the Sanitary Engineer Branch, who will have something to say to you on the subject. COLONEL HARDENBERGH; Captain Bonnell has gone over this situation and showed you braphica and with the aid of that excellent drawin0 very nicely how these things can work. Now it really doesn’t take very nuoh data to be sure that some work needs to be done along this line. Our o\m experience in sani- tary and public health engineering in civilitm life and over many years has shown us by ctual experience what may happen under the conditions that we have in supplying water to the ships. There are a number of .records in the Surgeon General’s Office which pretty clearly and perhaps not completely incriminate water supply. Tic have records of one or more outbreaks.on docks where the water has been contaminated in a way that X will explain a little later. I believe that in the records of the San Francisco Port of Embarkation there is very .strong evi- dence of the incrimination of water in intestinal- outbreaks on ships. However, as I said, it isn’t necessary to go into those records. Our own experience in civil life, ’.in hotels and other structures are somewhat comparable and have given us oppor- tunities for the decontamination of wnter. The conditions are 109 much more favorable for accidents to happen on ships than they are in hotels and other places. Now when we go to carrying out any program of this type we run across a great many complications. First, we want to regard the structural features of the ships and the conditions in which they are operated these days. First, we have two or three or four or sometimes more water supply piping systems within the ship and we have drinking water, bathing water, salt water, and I don’t know what else. Wc had those things come up in our hotels in Atlantic City and some of us almost got gray hair. When the troops went in there, and packed into rooms as they were, they were using three systems of water supply - private wells, city, and salt. In ships they have esentially the same condition. Now as Captain Bonnoll pointed out, when your troop ships were converted to carriers, they had much more water carrying space and as he showed here, double bottom bilging tanks, converted liquid cargo tanks, etc., all used for water supply. Now aside from the difficulty of keeping those tanks clean and sterile there are many opportunities for contamination through manholes, through sounding line holes and vents and opportunities of that sort so that unless we have quite a degree of perfection through reconstruction, rebuilding of these things, we are going to have trouble. It didn’t make much difference if a little oil leaked down here, or a little contamination leaked down into these tanks when they carried oil or something of that sort. It docs make a difference when they are carrying drinking water. Then we want to remember that these ships are a maze of types inside. It is almost impossible to follow up any individual pipe line and the opportunity for a hurried plumber in making an error and connect- ing to the wrong line is sc great that I don’t doubt that it is do., j more frequently than it has been done. We. expect it to occur and it will occur. Then, beyond that, in our ships we have many additional chances for contamination. In some cases sewers pass through some of these tanks that have been converted for carrying water. We must remember that a good many of cur ships have been in use for 10, 20 or more years and during that time they have had what you might call a local plumber working on them, their own ship’s plumber and’sometimes a groat pressure to reduce repair costs has been effccted--a thing that happened in the hotels during the past years. Many of our hotels have been on the verge of bankruptcy or up to their necks in it and in repairing and in maintaining their plumbing systems, they have gone to extremes that are really fascinating from a crying view- point. Then we have also many additional chances for con- tamination - cross sections, possibility of leakage into the tanks - the use of water of tanks as ballast on return trips, sc perhaps you might be inclined to agree with Captain Bonnell when he said he didn’t drink water on ships any more. Our ships are very com- plicated structures. Sometimes at the... last minute a ship's engineer will come" on board who has never been that ship before dr it may 110 be during that re-finishing process of a ship tint erne off the ways over r. year ago. Such a ship hms-. lost a good deal of rosenblanco to its sister ships as far as piping is concerned. The refer a, we can say the nor engineer is pretty nuch ignorant of what is going on inside th ~t ship. As natter if fact. Captain Bonnell informed me in the case of one ship the engin- eer was si unfr.milinr with the linos th t ho dumped all the drinking water in theniddle of the Pacific and they had to get along with whit the distilleries could produce on board. Our ships are carrying personnel to ports where the water supplies are not without a gro-t deal of question, so we must consider that the ships .are likely to pick up cent min ted water and bring th t water back on their voyage, cent nin-ting the pass- enger lines and pipes usod fir water supply. It would seen that wo can meet one condition by preparing c-refully and ar- ranging c .rcfully rather simple instructions for the ship’s personnel> both the Transport Surgeon nd the ship’s personnel who has charge of water supply, 'ih:.t probably should tell about the common types of hazards and wh. t they c uld personally do. Of course, in addition to that, an adequate treatment method has boon devised as in most Army installations. 'Vo have cer- tain essential factors such as reliability - it must work. Simplicity - even some of our 1 nor IQ employees must be -able to run it satisfactorily. It must be positive in rcti m. You turn the wheel nd smothing happens and it should be fairly reasonable in cost. The process of r-dding hypo into tanks is not very satisfactory. Mmy of those tanks shown hero.arc baf- fling. It seems to us th t chlorine must be used for our puri- fication agent. Due to this multiplicity of pipe lines and the possibility of intor-c mnecti ms end contonin .tien from outside, it seems necess ry th ,t a chi mine residual bo nr do throughout the ship, -Qv. t chlorine residual would afford a certain zone of protection against after decent-nin.etion. You can put in enough chi mine to provide m with some degree of protection against what wo might call normal or chance minor contaninati m, How the use of hyperchi orides scons preferable to liquid chlorine, for several reasons. I don’t think we want to mess with our liquid chlorine machines round, -the ship. Ilyporchlorite has many advantages over that liquid chlorine. It seems necessary also as Captain Bonnell pointed out to add a pretty heavy dose of chlorine, th t is, to rely on super- chlorination. If that is done, we then must bo dechlorin ted. Thr.t is, lae must take" on ugh chlorine out of the wt ter so th.-.t the water is drinkable, Ta,t can be done in one of two ways - by aiding dechlorin.ating .gent or by passing the water through a carbon filter. Wo must control our dechloriir tion process so s to 1c vo an appreciable residual in the -w- tor, T_ probably c n best be. accomplished by use of ,a c rbon filter such as shown on Capt in Bonnell’.s drawing ; nd by providing by paths so th- t vo can nix in r certain prop orti on the chi orin ted water nd thereby maintain '• residu 1 throughout 111 the ship, A vury skilled routi. o inspectien seens necessary at the different ports to detect and clii inato the hazards due to structual features such as these I have nonti ;nedj or in the case of ships which have already been inspected, to see that there has jeon no dangerous changes in pipin.; by the ship’s plumber. Also, to provide our sterilizing service f .r the mains and tanks as reported by Captain Bonne 11 and as shown in one of his other drawings where he added 100 or more p irts per million and finally managed to sterilize the pipelines or tanks in the ship. I think th.t is a very important routine procedure to carry on whenever our water samples or our examinati ms indicate the need of it In addition to our ship’s inspection, we have another problem connected with water supplies at ports of embarkation and that is the safeguarding of the pier water supply, as you know the ships are now connected to the pier linos fur fire protection as soon as they .re connected at the docks. g,uite uften the fire pumps are started and as a result in a number of cities where ports of embarkation are located, we have had. complaints that the water is tasting mighty salty, umat’s- happening? -c also had at Hew Orleans on one of trie municipal piers a ship parked, tied up to the dock, and started to use the pumps draw- ing up the water from the waterfront and wo had some 300 or more cases of intestinal diseases at the docks down'there so we must, make an attempt to sec that contaminated harbor water is not pumped back into the shore linos. This whole program may be criticized as fighting ghosts. It does seem, that ,/e are fully justified and required in ny opinion to initiate a program of control which it seems to me shourM‘includej a. The development of adequate' and satisfactory means of purifying ships water using basic equipment now available on the market. The San Francisco Port of Ambarko.ti m has gone a long way in accomplishing that although I think if we got a com- mittee of engineers on it, we might add a few little improve- ments to that program that you h .ve laid out there. b. A provision for the installation of such equipment ,n ships. Now this- means working the Transport tion Corps, the bar Shipping administration, the Havy, the U .ritime Commission .and the Public Health Commission. c. The institution of adequate inspect! nl service at all ports of embarkation by qualified engineer personnel and I might offer you the services of some of our sanifary engineers who. are members of State Boards of Health in ]_ re-war days and who have had a Oroat de A of experience in this general m .ttor of wat6r, protect! in under the most difficult conditions. •Another step which we might label "d" would be the necessary instruction of ship personnel and tr .nsport protection and. 112 facilities for the protection for pure water supply. I believe if wo can lay out a program, of that type wo Can ac complish a great deal in safeguarding our water supply. You folks know probably better than I hoi; serious a matter this is. I am not thoroughly acquainted with the problems involved in ports of embarkation. I am familiar with similar problems that have arisen and have existed for many.years in State and Muni- cipal Health Services and I donft think they arc any different. Thank you gentlemen. LT COLONEL FARR* A few minutes now for discussion. Does anyone have questions? LT COLONEL STECHER: ' 1 I would like to ask you if you know anything about the condition that broke out at tho Hotel Congress during tho Worlds Fair, This hotel has had Army personnel quartered there. COLONEL HARDENBERG: From conversations I had hoard, I almost got heart failure when the Air Corps moved in. The Air Corps cooperated remarkably i/o 11 and limited tho number of troops going into that hotel to a number somewhat smaller than the number of guests who lived there when the epidemic occurred during the World’s Fair. Since that epidemic, wo had checked over all tho pipes in that hotel and approximately 80% of the piping in that hotel had boon replaced since that trouble started during the World’s Fair, Nevertheless, wo wont over it and noth- ing was taken for granted. Of the largo number of hotel taken ovor by the Army, we have found some very good hotels and some very bad ones, and wo consider ourselves mighty lucky that wo got out without a single epidemic - it really was luck. It was also tho fact that the Office of The Surgeon General realized the importance of tho situation and wo went to work on it right away. It seems that these hotels parallel ship conditions considerably. LT COLONEL FARR: Are there any further questions? If not, thank you very much. Colonel Hardenberg, We will change our schedule slightly as wo have had quite a- long session this after- noon, We will take a fifteen minute break and reconvene at a quarter to four. ( RECESS) 113 LT COLONEL FARR:: Tho United. States Govern- inont is one of the largest enployers of civilian personnel at the present tine, and there are two aspects' in the taking care of this largo group of civilians. One is.frcm tho humanitarian standpoint and the other from tho purely plain business viewpoint of having fewer liabilities and laterw Maj or IT. L. Cook of the Surgeon General’s -office will discuss tho Army Industrial Modi cal Program as relates; to Ports of Embarkation. MAJOR COOK: I would like in the first place apologize' for the absence of Colonel Lanza, Chief of >ur Branch, who was unable to be here today, and: from whom I think you would get a much bettor talk and opinion of what we think a Medical Industrial Program should bo. . Mar Department .Circular No. 59 of -24 February 1943, relates to the Industrial Medid.li 1 JP.rogram of tho,United States i4my for tho treatment of military and civilian pens>nnel at Army owned and operated industrial plants, arsenals and depots. ’’The .nrmy owns and operates a large number of arsenals, depots and other ’industrial.plants' the employees of which number several hundred thousand. As an employer, tho Army:is obligated to furnish safe and hygienic working conditions and to,maintain an adequate industrial medical*service. The extent to which women are being employed in Army plants make this doubly important. Tho purpose of this circular is to clarify the functions and scope of tho industrial medical program of the United States Army” That was not our statement. That is the statement of the Ad- jutant General, who.charged the Surgeon General with that re- sponsibility. It has been, enlarged to.include industrial plants •arsenals, and or depots and we’re very glad to see that tho Chief of Transportation decided that Ports of Embarkation can be con- sidered- as- industrial plants.- I understand that he has recently issued a directive that' the ports will follow, AD, Cir, No. 59. I would Mike to tell, you about the Industrial Medical Pro- gram, what it has accomplished and perhaps questions from tho floor will settle the problem you people might have built up in your mind since' receiving that recent directive from tho Chiuf of Transportation.' I am glad that' Col mol Farr introduced the • sub jojot as he did. I would not have liked to have him' ask me to, talk about the occupational hazards of dock-workers and stevedores, because I don’t know much about that; I have had very little opportunity to go down to the docks.- I do think that wo have people in our 114 outfit who are acquainted with that problem. It is very difficult in one respect to detail what the Surgeon General's Office has done with respect to the Industrial Medical program in the line of directives for the field, but I think I can explain that to you a little bit. In our latest count, there are some 610 Army owned and operated industrial plants, arsenals and/or depots in the Continental United States; that includes anything from a sub-depot in the Air Corps to a large arsenal, munitions depot or chemical warfare installation, and in that particular group, there arc some 850,000 to 900,000 civilian employees, 30/ to 35/ of whom, arc women. Those figures definitely make tho War Department the largest em- ployer of civilian labor in any industry in Africa today. Wo haven’t written many directives for tho field to tell them how to do this and that, as an explanation of the lack of written direct- ives; lot us take tho example of throe chemical warfare plants all manufacturing the same thing. One is a military plant. This is a small plant, but it has had a fen; people working there since the last war and they are putting out a little bit of their particular item. They’re working in an old 1918 plant which has been remod- eled to a certain extent. We will go to another plant making tho same thing whore each particular part is made in various parts of the plant, each part about throe miles from tho other. They all have their little nucleus and know how to work this- plant; everyone of tho three buildings in the throe parts of the second plant are all manufacturing the same brand now thing. Then we have another plant where.they have a similar organ- ization that is really on a production scale turning out mass quantities of the same item. The hazards that occur in manufac- turing this item very frequently in each plant. If there is a spill of a toxic product in tho old plant, it gets on to tho wooden floor and scops in creating constant hazards. Some of tho newer plants have floor covering where the stuff can be cleaned up within a period of several hours and the hazard is eliminated 100/. In a pla.ee where they are manufacturing chlorine in one particular plant and piping it to all the other places, -with each individual plant manufacturing items of chlorine, I think you have an example of the problem facing chemical warfare service and arsenals in issuing directives on health pro- cedures and industrial hygiene procedures 'that will cover all three plants. Therefore, tho Surgeon General’s Office, ’when it started this rather .prodigious task less then two■ years ago with perhaps 459,000 employees which figui-e is now at least doubled, thought that the bostihing to do was to put qualified men into a position ’where they could write their own personal directives on the spot. We have had very satisfactory results in,that respect. Hot long ago. we had two industrial hygiene manuals sent in to us from two Army branches both 100 to 150 pages long, covering the hazards and prevention and care of people affected with occupational hazards as they wore found in just those particular Army branches - so that we could sit 115 down in Washington and write an industrial hygiene manual and sont it out to you people. I think that the Port of Embarkation probably very well could have a separate industrial hygiene manual made up by people at the Port knowing what the problems are. T7e could not look back into literature and find out much about those particular situations today. One of the biblos of industrial hygiene stated that very little has been written on dock workers. Yes, undoubtedly, there is much to bo desired in the industry regarding the hygienic aspects of their work. It wont on for a few pages talking about upper respiratory and infectious diseases. That is a big problem in Ports of Embarkation because men are working under all, kinds of weather conditions, frequently going in and out of ships and up and down the docks. What, then, can wo do for these employees that are working at the Ports of Embarkation? Tip appreciate the problem only too well, being only three floors above them in the Military Personnel Surgeon General’s Office. In fact TJD Circular No. 59 states: "Increase in allotment of medical officers to ser- vice commands will not be made for radical service in Army in- dustrial plants, except under unusual circumstances and for specific assignments. Requests for medical officers designated as required for unusual circumstances and for specific assign- ments will be approved by the Surgeon General’s Office before being forwarded to the Military Personnel Division, Headquarters, Army Service Forces. Medical Department personnel may be se- cured for the Industrial Medical Program as outlined in Section 11, Circular Ho, 2, TJD, 1943". That makes it hard to outline an ideal situation at the Ports of Embarkation, but I think I ought to toll you what wo would like to have done and I can tell you that Colonel Lanza will do everything that he can to help out. There is a reason from a humanitarian standpoint for having an,industrial medical program. If the civilian employees in your Ports of Embarkation or any of the big’air fields walk out on you, you won’t get your ships out. If y>u make those people feel that thoy are part of tho war and they’re getting just as good service as the follows that we’re trying to ship out; that they’re not being passed over and are just as much in uniform as anyone else, I think perhaps this morale point of view will pull up production a little bit more. That this is' a fact has been proved in industry, and I am sure that it can be proven in any agency in the Army at tho present time. The industrial medical doctor or medical officer has to have a different point of view than that of the regular doctor. In the first place, he is putting a well man into work and he wants to keep him well. He doesn’t want sick people on the 116 job. He wants to prevent him. from putting sick. It is the old Chinese method. It is just as different as pediatriocs is from adult medicine. The industrial medical man, there- fore, should be a full-time man, and he has to know what the employee does and what happens to him when he does it and if he doesn’t know that, ho isn’t much good. The industrial medical man, therefore, should not spend his time in the dis- pensary. He shoul*d get out and see what is going on; see what these people are going through and improve conditions without holding up production and without causing trouble in his plant. We hope that the general industrial medical picture in the Army will result in the correction of mistakes when we see the causes of absenteeism. After all, that is what the Industrial Medical Program is for, to cut down absenteeism. Long experience lias shoiwi in private industry that labor did things because they had to. Labor got mad and went to the extent of having laws passed - statutes - and then you had to have a doctor around to take care of the fellow who got sick or injured on the job. At the present time, the roster of industrial medical men in the country shows fewer surgeons than medical men. In other \/ords, they are properly placed in the Surgeon General’s Office because we believe industrial medicine is preventive medicine, I think from that standpoint that you can see why the industrial medical men should be a full time man, that he shouldn’t have to be bothered or have part of or most of his time taken up with other duties. You can't expect when you get one officer, as an industrial medical officer, to got additional medical officers to help run your show; the man you do get must be an organizer. To give you on example of that, we recently went over the figures as to how many doctors were working in Army industry by percentage of people employed. Forty percent of our plants which figure covers sixty percent of the population - these are the larger ones wliore we have a better setup at the present time - we have roughly one doctor to every three tiiousand employees, and we have one nurse for every seven hundred and fify employees. Contractor-operated, government-owned plants have one doctor for every 2,000 employees and one nurse for every 500 employees. One of the best medic.d services in private industry in the country, proved to a company of 45,000 employees that in one year they saved from infection and lost time over a million m;m. hours. That particular company has one doctor for ever 8,000 civilian employees and one nurse for every 800 civilian employees. Now we don't do timet well in the Army, because we don’t have- -45,000 people concentrated in one place often enough. If you will divide 640 into 850,000 you will see why. What should the industrial medical service consist of? It should consist, in the first place, of properly placing the man in his job in order to complete that job. We have to have co- operation. We know there is a man who hires the individual. 117 and there is a nan who finds out if he is fit to go to work, and wo acinit in the arny, we are not able to have cur own non examine the employees as often as we should like, although that situation is improving all of the tine. The usual practice has been for the civili m employee to obtain a medical certificate from his faniiy doctor tli t he was in'pood condition for the performance of the job, for which he was applying. Because of the fact that this doctor night have boon t "iking care of Joe for s-v. no time without pet- n- ting' paid for it; when Joe cones in and applies for a job to *? work at the New York Port of Embarkation, the doctor will be very glad to fill out the form th .t was given to Joe*, .nd won’t care too much what he puts down. Not only th t, you have the Civilian Personnel people sayin. : "be want this fellow to work in a certain place", and on the basis of the form the doctor has filled out, you should be able t. decide whetner or not he is physically fit to work tnere. Then you have to be able to take care of this follow when he gets to work. Tin .t do wo mean by that? bo don’t mean you hive to have a doctor for every 400 people working. You can have one medical man in charge of four or five first ..id rooms in the dis- pensary. Many times, by having api ce who re the nan can ro when he gets hurt or fools ill, he can be discouraged from staying out longer th.in is necessary, be also fool that it is important to take care of anyone who gets sick on the job, whether or net it is service so long' -as you can keep him on the job that particular day. It may be some sort of illness that requires him to go home then, certainly he should go hone. I’m talking about headaches, hangover's* sinus attacks and things of a temp- orary nature, bhen we talk about what the Surgeon' General and other people can doj as 'far as the Medical Industrial Program, is concerned, there is, 1 think, a sufficient number of non in the Surgeon General's Office who could be used as an advis- ing and. consulting group,. I'll say this much, if we don't know the answer, wo'will find" it out. be also have some other help for you and that is with regard to' the n.my Industrial Hygiene Laboratory. Now, this is a laboratory in' Baltimore, 11 aryl find that is staffed by train- ed medical officers and industrial hygiene engineers commissioned in the Sanitary Corps who can tell you whether any of your em- ployees are working; under hazardous conditions. They can sample the air - the dust in "the' air, or anything that is chemically in the 'air. They can tell you whether your lighting and ventila- tion is correct. They can tell you how it can bo improved, .any- one of the ports can 118 have what wo call a complete industrial hygiene survey at any time upon request, I think, the problems th t.will come up in the instituting )f an Industrial Hygiene program or an Industrial Medical Program at the Ports of Smbarliation can be bettor solved by answering questions. I have 'tried to outline what wo have done to a cert in extent. • As far. as. accomplishments go, wo have some 120 medi- cal officers and roughly 80 civilian physicians working for the Industrial Medical Program for the army at the present time, I carlt give you the total.number of nurses off hand, life have erected and equipnped adequate industrial medical dispensaries at some 178 plants throughout the United States. You can get any surgical or medical equipment from the list of the Industrial Medical Dispensary (97256*03) and I think you wild find that that will handle most of the situations that you will come ..cross. If there is anything wo can do for you in Washington, we will be only too glad to cooperate. Colonel Lm za has b-on at the New Ymk Port and has submitted a survey of what he thought needed to be done in the Port, I am sure that if similar surveys are needed, they can be made at the other Ports of the United States, LT COL FARR: We are fortunate in having with us this afternoon, Lt Colonel Corey* Would you like to say anything in this connection? LT COLONEL COREY; I would like to ask one or two questions which occurred to me before the survey was made, m you know Colonel Lanza came over and talked to us ab >ut the original directive of Headquarters, Army Service Forces, shortly after the reorganization. The Civilian Personnel Sections in each installation were charged with what has been designated as a health program. The question of the relations lip of responsi- bility for that health progr m, and the Industrial Hygiene Program which is now the responsibility of the Surgeon General’s Office, I think, needs some clarification which would probably help in instituting such a program in the Ports of Embarkation and other installations of the Transportati m Corps. In years gone by, there was a good deal of question as to how far the Army could go under the various appropriation acts in providing pre-employment examination or post-employment medical assistance or examination for civilian employees. With arrangements that have been made through the Surgeon General’s Office recently in connection with the modicrl appropriation which provides that that fund cm bo spent wherever it is obligatory -- ’'arising by reason of regular contract", or one other term there - - 119 I ferget what it is its a pretty broad term which we used ' recently in working with ysur office intaking care of medical expenses; it seems to me these arrangements eliminate much of the difficulty which has arisen in the past in connection with the expenditure of funds for civilian and seaman, I believe that the Civilian Personnel Sections in the Ports can be help- ed, if, under the responsibility of the Surgeon General, we make it a rule tohavc the medical certificate to which you re- fer, completed?:.at tho Port by the Industrial Hygiene Medical Officer, prior to employment. Of course the questions that come up are practical ones * assuming that it can be done legally - the questions that comes on that is whether or not there would bo sufficient personnel for this suprise and I believe Colonel Lanza in talking to us about it indicated that, while there might be some difficulty in extending it to its maximum extent, it might bo done by contract medical care, I know that it is being done in some degree; the degree varying from one installation to another. In general, a civilian employee will, at his own expense, take themedical form or certificate that has been given to him to a doctor for the required examination, I believe that the discussion that wer had about seaman, inconn- oction with the appropriation acts, opens the way to establish- ing a definite policy that the medical form shall in all cases be filled out by a medical officer at the exponso of the Govern- ment perhaps through this Industrial Hygiene Program, I vrauld like some comment on that point. The second point that I had in mind is that I would liko to ask about how far the Civilian Personnel organization can lean upon such an organization; when, as and if it is established in combatting cas ;s of absenteeism* There is now operating in all Civilian Personnel Divisions or Civilian Units in the vasious installations what is known as the Employee Relations Program, That program has been directed to us in some detail, requiring thata certain amount of preventive non-technical health education andhealth matter be taken up or handled by such employoee relation units. Typically, a man stays out. He may of may not call saying that he is all. The Employee Relations Unit which is set up is supposed to attempt, insofar as their personnel will permit, to go to tho man’s homo to find out that is wrong with him; normally, if the man is not ill for more that 2 or 3 days, his statement can be accepted as to his having been ill. If it runs beyond throe days, he is required to have a medical certificate. However, to close tho gaps of that 3-day period in successive groups of one or two days, the Employee Relations Groups would refer all such cases to an Industrial Hygiene unit operating on the policies laid down by the Surgeon General, It '’would seen to mo that some such line of demarkation might be the proper one if that is within .the concept of tho Industrial Hygiene Group. I take that as a typical case where the relationship may vome to- gether. There are other cases. Those two questions are the ones I think your comments upon which would be appreciated. 120 LT COLONEL COOK: In answering the first question Colonel, The Surgeon General's Circular of a year ago which has not been rescinded states that Medical °fficers of the United States Army do pre-employment exams of Industrial War Department employees. Roughly, those are the words. LT COLONEL COREY: It is "may”, however, rather than "will”, LT COLONEL COOK: That is entirely a question of personnel at the post. For instance, we realize that at many places we can’t make medical officers do pre-employment physical examinations. The reason that the circular was put out was that about throe weeks prior to the circular, there came out from the Adjutant General a statement that medical officers would not do pre-employment Civil Service examination s; wo had it changed to the extent that medical officers may do pro-employment physical examinations on industrial employees of the United States - of the War Department - and it was done that way, written from our office, in order to enable us to use medical officers for the examinations. Nov;, as to getting examinations done at the expense of the War Department; as I under- stand it, you cannot give Johnnie Jones $3,00 and tell him to go and get his physical examination, but you can hire civilian physicians or contrzct surgeons and put them to work doing pre-employment ex- aminations or some such other work in the industrial program that you think they should do. War Department Circular No, 2, I think the date of it is January 1, 1943 states that civilian civil service physicians may be hired and used in the industrial medical program of the Army, It was'our intention at that time that Grades of P-4, 5, and 6 would be used. We have found, since, that some civilian personnel classification sections, using a 22 year old classification of doctors, feel that most doctors are first aid men anyway and don’t rate more than a P-3. Contract surgeons want more money than is allotted in the Circular or they would quit. We couldn’t even get anyone that we could put in charge of a few dogs and cats with a contract surgeon’s compensation. After all if a man isn’t good enough to earn a good living today in medicine and is willing to accept a contract surgeon’s job where there is no promotion and where there is not any way of advancing his salary, he probably isn’t going to be of too much good to you as an industrial medical doctor. However, we do have seme very patriotic individuals and retired Army Officers and other people who want to be in this war, to be in a uniform, who can’t get into the Medical Corps. They are willing to take a contract surgeon's salary, which is that of a first lieutenant, even though they know they can’t get a raise in rank or in pay, and work for us on that basis. We wanted to pay people more so that wo would have more to 121 offer. At the present, cost-plus contracts of the Aray which pay 6 to 10 thousand dollars for industrial nodical doctors are a little too tough for us. We had to pay then a little more than we wore, anyway, and I think, in a very short tine wo will have Job Classification Sheets for industrial civilian physicians which will be accepted by the Civil Service Commission Civilian Personnel, ASF, and others allow- ing us to put doctors in those particular grades. As to the question of absenteeisn in industry, it has not proved feasible to have visiting nurses go around and check up on Johnnie Jones when he does not come to work . That has been the experience of a lot of insurance companies and other companies. We have heard that in the Army,’tind-we have, asked those who have used that system to send us the‘figures proving it ana wo never received the figures. Wo think that’s pretty much a waste of personnel. We do think that you will clear up your absentee cases through Industrial Dispensary before they go back to work. You will find that will have almost the same effect and that it can be done. As. far as employees of the Transportation Corps or other Corps that do not fall within the Adjutant General’s definitions of an industrial worker in Army owned and operated industrial plants, arsenals, and/or depots, we are very sorry wo can’t give you more information, LT COLONEL COREY: That has answered my question very well. I would like to come back to the first one again a little more dir- [ cctly. Would it be sufficient if a directive were to be issued from the Office of the Chief of Transportation saying that in the future, all pro-employment medical examinations would bo done by the Industrial Hygiene organization? In other words that the Civilian Service Medical certification form is within the scope of what you fool is the industrial hygiene ideal. LT COLONEL COOK: Yes, I could say in many of the arsenals and plants throughout the United States they do their oivn physical examination of every civilian employee that is hired and they do not follow particularly the Civil Service form because many of the doctors feel that it is inadequate and doesn’t give them enough information; for example you take only blood pressure, you don’t do urinalysis of those'women over forty or forty-five. They don't have to have certain examinations for urinalysis *or blood pressure taken just because they happen to be females. We believe both females and males can be sick. The extent of your program depends entirely on the man doing it and how much authority you will- give him and how much help he has, I can show, you excellent programs and poor•programs probably right within a very few hundred miles of New. York City 122 LT COLONEL FARRs Thank you Major. Are there -my other questions? '-ho-will continue with our schedule new. bith the prospects of increasing the number of inbound personnel vh ich includes not only military personnel but also civilian personnel, the problem of preventing'the import vti ;n of diseases becomes one of our major- problems . be liave with us this afternoon two officers' from the Surgeon General’s Office who are quite competent to speak on this subject. The first one will be Lieutenant Blanton of the Sanitation Branch of preventive medicine, who will discuss the status methyl bromide facilities. Lt Colonel Lundoberg, Chief of the Epidemiology Branch of the Sur:.eon General’s Office will give a further• discuss! on on the problem, be also hive with us today a Mr. Latta from the U. S. Department of agriculture. Bureau of Entomology, who I believe has i root deal to de with working on some of those projects, ana Mr. John * * -If of the Office of the Chief of Engineers who has a-oreat deal to do with the do si; n of these disinfestation units so if you hive any quest! -ns at the close of this period, I think tint wj ire in very eod shape to get then ans*- wered. LT BLuhJ'TON: By way ef introducti n, lot me say that M.B. (note: hereinafter indicates methyl bromide) is really the answer to the entomologist’s prayer. It his an uncanny anility of pene- tration and many of the ether fumigants fall short of some of the characteristics of M.B. I would like te mention just“one example where it has proven its worth. It happened to bo my pleasure to be workiii; out a control of a serpentine leaf minor, whe was minim; in between the two byors of tain loaf of a very expensive grocn-houso plant, be tried everything we c uld, but fund tiiat the plant-was just a little less to tolerate than the insect. Finally, I hit upon M.B. and through its quick penetrating quality, we were aole t eliminate this post from a Lino eastern green- house ranch. / u long list of a great many ins -cts that other controls wore incapable of curbing succumb to M.8., which did the job in good order.' -Poout a year and half ago, represent itives of the Surgeon General’s office called in the Bureau of Entem. logy PI mt quarantine of the United States Department of riculture tc conduct some experiments with various funig'ints hg in/ to fin1, somethin;; that would replace steam, bell, after try in, _ chlor,g icrin am: a number of things like cyanide, they hit upon M.B. Tney thou; ht it that time that it would be equally as efficient .s .ny of the other fumi. pints. Th t was*' chief ly developed for field use. but then as you Port Surgeon’s know, with the mcomin. prisoners, it had to: be used, mu they hid hopes ef using it for that purpose• But then weeks a, e, I was called inte the Sur eon oeneral’s Office to join a malarial survey unit with prospects 123 of going to Now Guinea., and was told at the tine that some of the •Ports were having a little problem with their M.B, Fumigation Chambers. I visited four ports in the hast and I also visited factories at Haguestown which made some of the prefabricated chambers and also Camp Lee, Va, which has some of the plywood and prefabricated chambers in use there, hell, the only time I visited Boston, they had a nice set of blue prints. They do have plans for 450 or 500 man per hour disinfestation plants and they’re going to use concret chambers, I believe. Every port you might say, presents a different problem. Some ports have too little space to carry out the regular plan that was draT,m for disinfesting plants. At Boston, they will have to use two floors. They’re going to have to use chutes to send the clothes down to the fumigation ch:imbers. Also by the use of concret which is quite heavy, they can’t put the clumber on the second floor and naturally, it had to go on the first floor. New York had its headaches as Colonel Melton and all of you know there.is a beautiful plant on pier 34 mostly steam, but it is built so that the fumigation chambers, when satis- factory chambers are available, can be installed in place of the steam, I have seen plywood chambers and concret clumbers, submarine net buoys converted and also prefabricated clumbers. I am glad to say that I never saw the plans of those original things because at least wc might be able to accuse some poor carpenter for turning that out and not placing the responsibil- ity on the designer, I might say that the biggest fault with them was the felt gaskets. Unfortunately M.B, does not know any- thing about the shortage of rubber and it goes right through felt. No matter wh-.it kind of chambers you build or buy, the size of the door depends on whether y-u want to use trucks or not. Smaller doors - you can’t get small trucks into them, but with large doors like you see on this model here (indicating) you can get a truck in that carries from 60 to 80 bags - push it all the way in - the trucks being loaded prior to the treatment, I c:me to New York once and say very small trucks that had 16 bags on them, I saw three men work 7 minutes to get one of these trucks into the chamber. That was the longest time it took I will admit, but there was something wrong with the design of that truck, I didn’t know at that time, but I thought it was the fault of the trucks and I was ready to condemn every truck until I went to Charleston and there they had one which was much larger and differently designed, and held 81 bags. Two men were pushing it around and they pushed it into the chamber within two minutes. One of the most important features about any fumigati n chamber, is the d-.'or oi-d ’the.' important feature about the. dlor' is the gasket, -and how it should be installed. Xt. seams that it is very* hard to, got gaskets particularly the kind of gaskets that should be used. There should be always two gaskets. Han’t ..let .inyne to Ik you. differently. And those gaskets should be cut on the square. 124 they should ho beveled and should never be cut on the corners; notch then and bend then around. Then the next thing is hinges, lot of the places hove hinges upon which they depend to hold that side of the door against the gr.sleet. That never works. It may work fa* a week, but it is no good. It should bo a loading hinge and should have separate fasteners to clomp the door to the gasket after the hinge has pulled it around in place. Fasteners for the door have always been too few at most places and in nariy cases too light. It does not take too much pressure though, just so that the pressure is oven on the gasket, Nov; I will mention s jnc of the hazards. H. 8., like any other fumigant that is worth anything, creates hazards if it is left around the operating personnel who will breathe it in over a long period. It is just as dangerous to have a low concentration over a long period as it is to have a high concentration over a short period. Host of these hazards have boon due to leakage from the poor gaskets on nal-fittcd doors, and to leakage around the applicators, that is, the measuring devices. These devices are an easy thing to check and the people who install then are glad to give instructions or, at places near them, will be gird t) check them far you and install then. Another serious hazard is gas in the dressing r )on. This is caused by pulling the bags before the gas is taken out, and I assure you it is pretty hard t. got them mt of the bag. N;w wo arc working on a plan that under preliminary tests enabled us to got out 80/4 of the surplus gas at the uiid of the fumi- gation according to >ur leak detector measurements which arc qus.ntita.tive in nature, 1/c hope t■> do some additional ex- periments and .‘use qualitative measurements, but oven so, in those tests after we had taken the major part of the free gas out, wo took some )f the clothes out end put them on the hood of an automobile where wo loft then for 58 minutes, Xlc put them back into another bag and we still had some gas coming off - not much, but a little, Th t ..shows that woolens hold on to the gas for a long time and that wo *re going to have to have adequate ventilation in the dressing room. At one place, the ventilation was poor and there was a considerable amount of gas in the air, A test of the blower which was supposed to bo talcing the air out of the dressing room and changing the air - was not able to affect my hand- kerchief when I hung in front, *'c wore told that the reason for that was that the window was loft open. Personally, I can't sec that, I found that whore two blowers were being used on six vaults of 265 cubic feot-tj_get the gas out of the vault, one of those sane blowers wasb.ing used in a dress- ing room of 28,000 cubic fee.t, ‘ It'is up to the ventilation experts to put adequate ventilation in the dressing room. 125 Another thing I would like to mention here is the way exposure periods are set up based on treatment in the vault. Circular No. 99, Section 2 on Pago 3 of that Circular, there is a schedule of exposure depending on the temperature. I should like to call to your attention at this time the fact that the temperature should not be based on the temperature of the clothing or of the woolens. The insulators should be good and if you put cold woolens into your chambers be sure that you place your dosage in the exposure end accord- ing to the temperature of those woolens, otherwise we will have lice escaping. At this time I would like to introduce Mr, Randall Latta, who was one of the original workers on the list of the Surgeon General’s Office and had a great deal of experience with methyl promide in this country, in Puerto Rico and Havana, Cuba in experimental stages and also with large commercial treatments. MR. LATTA; This problem of fumigation was turned over to the Bureau of Entomology because of the experience we have had in the application of fumigation methods for the control of insects. Our Bureau instigated the original work of developing fumigation at atmospheric pressure. At the request of the Surgeon General’s Office we have developed not only the method of fumigation, but the equipment with which to apply this method. The desire was for equipment that was simple, light in weight and made of non-critical material and that would efficiently do the work. We developed two things, a fumigation vault, a model of which we have here, and the individual fumigation bath. The Vault after it was turned over to the Surgeon General’s Office for testing on a large scale has passed through many hands, many innovations and ideas have been added to it. In fact, so many that little Abner would say ”It’s getting a bit confoosin’'. So today I thought I would take this opportunity to show you the original model and the-basic simplicity of it in a discussion of the basic fact of fumi- gation, so that when these problems of equipment come to you, you can evaluate the merits of the changes that are made in the equipment on the basis of what you know to be neces- sary in the first place. The original vault was made of half inch plywood with two-by-two supporting frame which was designated for a field unit and which was demountable to be taken apart and trans- ported in trucks. It consists of six panels--button, top, two sides, front and back. The front was used as a- door and the gaskets seated on the face of these panels-and the doer fitted in this manner (demonstrating on the model). It can 126 bo hinged with the li ;ht type of hinge if y>u wish, or it can be sot in by hand which is the method now used in the model built by the QMG. Tho type of fasteners is also a cause for quite a bit of discussion. That is really a place for a field day with man's inventive mind, because you can figure as many types as there are men working on the problem. But the basic thing is that you want to fasten the door against tho body of the vault so that the gaskets seat evenly. It is not necessary to have a heavy, rigid doer. If you have very few fasteners, such as refrigerator hinges on one side and refrigerator type clamps on the other it is necessary, of course, to have a very rigid .door so that it will n't bulge between this point and that point (indicating tho frame of tho box where the door is situated >n hinges). But if y m use a light type door and put in enough fasteners, it is just as good. It is between this point and that me (indicating frmt end of the model) that the rigidity of the door matters, '/o have advocated all of the time a double row of gaskets around all of tho openings. Tho primary factor in a fumigation vault is that it must be gas-tight. In this case you have-rapid circulation jf tho gas within a vault. You have only a short time period so that a leak factor can upset your calculations. One gasket will work for a while, but two gaskets can do six times a bettor job. One seems to protect the other - they last much longer. They have on commercial installations - - lasted 3 or 4 years. If there is-an uneven place on tho seating of mie gasket, the second gasket tends to protect it. ’/e have tested that in many ways and have come to the conclusion that the double row of gaskets is necessary on all openings, especially the small ones and that is the point often overlooked. You sec tho small vent in the front door has this double gasket (indicating). The vent inside here - those are tho gaskets. This simple arrangement has worked out whereby one blower can be used f’or the.circulation within the vault and tho venting of the gas afterwards. In this method if you can see inside of here (indicatin' inside of tho box) there is a directional duct up the back wall at which end you just blow through the vent. V/hon the vault is in operation, the exhaust vent is closed so. that tho air circulates within the vault. Vihen it is desired to operate it, the operator without any hazard to himself, at tho rear of the vault pushes in the rod hero ~ that has a fastener and that closes the-damper directly over the top of the duct diverting tho air up through tho exhaust duct so that it can be piped out. You see how the rod actu- ates the damper (demonstrating operation of the rod). As I have said, there have boon many ideas a dded to this equipment. 127 The Quartermaster Corps with a field unit has designed, I think, about six typos. They have g -no around in a cc. nplete cycle and ha vc come back to a typo basically like this; (indica- ing). There has been considerable comment on the use of plywood; it would be easily injured; the setting surfaces between the panels would be injured, so that you couldn’t make a ti;,ht seal, bell, the answer is, the funipation vault is not apt to be of rigid structure, be have then ande out of the fr nod, covered with a pas-tight cloth material which has worked very we .11. In this case, your plywood contains gas enough’to do a rood job. The setting surfaces arc se.aled--each set is sealed up by a con- pound and seals up the panels all round 'with his fingers. He shuts the door and tests it by looking ..11 around. Ho c:n see whore he has done his work and he therefore can do a very good job. The type vault designed by the mmy dug moors has all the basic ideas of this, except it is a bit he .vy. It is male out of concrete and it has a heavy stool door. It h..s a circulation inside the vault and a gas typo chamber, which are all cent .inod in those plans. I have samples of the dispenser, but I think all you gentlemen are familiar with it, at this tine. (At this point Mr. Latta produced the dis- penser and demonstrated its operati>n) j w You tighten this clam; and it releases the gas into the vault, I also have samples of the type of rubber gas fitting which we have used very successfully if you would like to sue that, arid I am quite willing to answer any questions that I can fol- lowing tliis, I thank you. LH COLONEL PARR: Thank you very nuch Hr. L At a. Colonel Lunderberg, do you wnA to go ahead? LT COLONEL LUNDERoERO: It is getting late and I will try not to detain you gentlemen longer tnan the appointed hour. 'The problem of what to do about the returning soldiers uf course is now upon us, and it will be increased when the rotation plan gets into full operation, be in the our eon General’s Office have just recently heard about the rotation plan. I believe it was mentioned in this conference yesterday. The problems will b’e multiplied enormously during the demobilization period. No one’knows as yot what the temp of demobilization will be. It 128 nay bo reasonably slow and orderly, or it nay bo spoodod up by public donand for the rapid return of tired troops, anxious to resume civil life. No natter what the official spuod set by the ]Yar Department, I think it is reasonable to expect that the processing of troops through ports and through demobilization centers will also be attended by cries for greater speed. This is certainly the experience of the last war. The rotation plan proposed by the War Department fortunately offered us the opportunity of a training period in demobiliz- ation, It is true that the demobilization is only partial and consequently many corners can be cut to save time. This is very fortunate. We hope to see the present plan of handling returning troops evolve gradually into an officiant and work- able scheme for mass demobilization, which will inevitably come. The present plan contemplates a rather rapid passage of troops through the port areas with a stay of two to four days, in so called reception stations. From one to .three stations will bo designated in each Service Command, utilizing the facilities of well-established posts. ' From the information now available to us, it appears that the bulk of the processing, both nodical and otherwise, will be done at those reception stations. Before going on 'with the discussion of the present tent- ative plans, I would like to consider briefly some of the nodical and public health implications of the problem of the returning soldier. There has been a groat deal written about this. They have written about it in the public press and largo numbers of dire predictions have been made about it. The prob- lem presents two important aspects. One, the protection of the individual soldier, who is returning. At the moment I would like to confine my remarks to the period of the next few months when this rotation plan is going to be in effect.,.'; In considering that, wo should boar in mind the following facts, ■'which boar on this aspect of tho problem, and which really must bo given careful consider- ation, First, wo have to acknowledge that troops from some areas will have been heavily exposed to malaria, dysentery, and other tropical diseases, mid high infection rates may be expected. I think there is no denying that. That' is a hard fact that you will have to face. Secondly, the troops returned on-;rotation aro returned because they aro fatigued by long residence in war areas. Many soldiers will definitely be under par, physically. There will be many sick cases.. Thirdly, all will bo eager for furlough and the time for examine.ti on will be short. You can-, imagine the pressure that will be brought on you to let the fellow's get by. They are going to want to get home quickly. Next, some tropical dis- eases resist treatment 'and are prone to relapse. This is true of malaria, filariasis, schistosomiasis, chronic bacillary and amebic dysentery. Five, some civilian physicians may not be 129 acquainted with the exotic tropic diseases, and failure to dia- gnose end properly treat cases may be, expected. Lastly, fcr the present, troops will return to military control after a furlough and will again come under medical surveillance. That is the saving aspect of the problem at the present time. This fact sim- plifies our medical problem enormously. We will not have- to chock and record the present physical conditions against the condition at the time of induction. For the majority of troops, our chief concern will be to see to it that the individual will be sufficiently fit to be turned in his home community for a few weeks furlough. The other side of this problem is the protection of the public health. That is the thing that agitates people more than anything else. There you have to consider the many ar- guments brought up on this subject one way or the other. Some Jeremiah has predicted catastrophe - the country over-run by malaria and dysentery and all sorts of dreadful tropical dis- eases. One of the things always mentioned is the possibility of the establishment of endemic foci of diseases not new present at a given area, and of course, malaria, is the main one, which people arc worried about, Filariasis -- have had some filari- asis among our troops. Then we can speculate about schistosom- iasis and onchocerciasis, trypanosomiasis and leishmaniasis. These typical tropical diseases occur frequently in Central Africa and down throughout South America and the Far East. Pec pie are worried in addition to that about the introd- uction of new and virulent strains of diseases, that we may have at the present time, but are held under control. An ex- ample of that would be the introduction of a very dangerou-s type of malaria. Next, there is worry about the introduction of new and more efficient vesters of diseases, such as anopheles gambiae. Our friends interested in the agricultural aspect of this are worried about the introduction of new agricultural pests, such as the Japanese beetle, and this thing that eats up the cotton down South, I don’t know much about those. All this is very important also from the economic point of view. The possibility of yellow fever exists and our old friend the louse the typhus louse, A louse gets loose from a prisoner and gets on to one of our Americans. Another worry is the introduction into the community of a large number of infected individuals who, by mere might of numbers, might be capable of initiating and propagating epidemics; that is the thing people arc worried about. In this group, you might place such diseases as amebic and bacillary dysentery, trachoma, hookworm disease, and possibly relapsing fever. 130 In tlio face of nil that the* bad predictions that have boon published and spoken of in public--those questions arise, IJhat is the burgeon General’s Office going t) do about it? what is the “ar department going to do about it? '"‘hat is going to be our attitude tow .rds this thing? It vrould bo Very nice if there wore some men wise Enough who could see into the future and who were really wise •‘•chough to know what to do about it. Certainly there is nobody in the burgeon General’s Office >r in the »'ar Department who is that,wise, wo have done the best wc can, Iwc have consulted all the wise men in the country. For the past yo-r this thing has boon mulled over end discussed, and thrashed out by the wisest men in the medical profession .md the field of public health, ex- ports in the burgeon General’s Office, *.nd the exports in the National Research C ouncil have had repeated meetings and the thing has been thrashed iut from every possible find con- ceivable angle, Tw'o do have •; cert- in tentative plan which lias been worked out. In other words, wo have taken some sort of a stand. How wise that st .nd is (going to be wo don’t kriow yet. It 7ri.1l s jon show v/hother it is adequate, I want to give ym a .rough idee. >f what the point of view, of the war Department and of the Public Health Service, and of the National Research Council is on this problem. In July of this year at the numerous meetings raid at the request of the burgeon General,of the armed services, the National Re- search Council gave us their considered opinion. They told us what they thought wo should do in the case of cert.in diseases, they also gave us their explanation -of what the magnitude of the problem was raid the seriousness of it, I would just like to read from the-official minutes of that meeting, I will go to the back of the thing first and pick out the real post the plagues* It mentions plague, cholera, yellow fever, typhus, smallpox, leprosy, anthrax, psittacosis, those diseases-arc the so-called quarantineablc diseases, officially declared so by the Public Health Service, they arc really bad diseases. Ships coming into this country from ports where those diseases are present have to have Bills of Health, I think it, is called, and inspectors and quarantine. Our advisors have told us that-it is their considered opinion that present quarantine regulations, if maticulously carried out, fire considered adequate for the protection of the country from those diseases. There isn’t time to go into th it any fur- ther, The next group of diseases arc not quarantineablc in the some sense; Bacillary dysentery and amoebic dysentery, A lot of people are worried about that, I don’t know why because we have plenty of dysentery in our own country. Tra- choma, Loa-loa, relapsing fever louse-borne raid tick-borne -■ and oroya fever have been put in a separate category, and it seems to bo the fueling of the wisest men in the country that the chance of 131 establishing through debarkation andemic foci of these diseases in this country were negligible, or that no preventive measures were feasible. Now then, Leishaniasis and Trypanosomiasis it was rec- ommended that men diagnosed as having Leishaniasis and Trypan- osomiasis be hospitalized and treated until cured and rendered non-infectious, if practicable, and this is not a very difficult job. Ondhocerciaeie -- we may have a few people with this disease coming back and it has been recommended that no further attention be paid them, except to remove the nodules* Schistosomiasis -- there is a considerable amount of concern about that. The National Research Council advise that all known cases be hospitalized and treated until cured and rendered non- inf ectious if that is practicable; that studies be undertaken to determine whether local species of snails can act as vestors and to develop more satisfactory drugs for treatment. That is being carried on now by experts of the Public Health Service and others. They recommended also that the Surgeons General of the Army and the Navy make available from their records upon request of the United States Public Health Service, the names and home addresses of all military personnel discharged to civil life who have a diagnosis of Schistosomiasis. We are not going to set up an elaborate system of reporting the diseases which will probably be as rare' as that. From the available records -- from the Form 52 that comes into the office, it will be possible to know at all times the names and ad- dresses of those -individuals, which can be turned over the Public Health Service for surveyance. How then for Filariasis the following -recommendations were adopted: a. That men with symptoms of filariasis bo hospitalized until clinically free of the disease, Filariasis really is a Chronic disease and we have no specific cure for it. It lasts for years and the only good thing you can say about it is that it’.doesn’t increase -- The■diesease doesn’t progress -- once the man is removed from the danger of infection, but it is going to be impossible to hospitalize every man until he is cured. It may take years, b. That when feasible men diagnosed as having filariasis, be evacuated from end-.mic areas, c. That infected men are not to Sent again into endemic areas. 132 d. The presence of microfilariae in the blood in the absence of clinical symptoms shall not vje.rr.ait restriction on the movements of the infested individual except as noted in recor.inend.ition c. above, e. Th.ob the Surgeons General of the nri.iy -nd llavy Make available to the United States Public Health Service fror.i their records, upon request, the names and home addresses of ..11 military personnel disch.a'ued to civil life who la.ve a diagnosis of filariasis, f. That further studies be undertaken to determine the ability of local species of mosquitoes to ..ct is vectors of filariasis -aid to discover effective drugs for treatment. Now for Malaria, which is the tho most important of all, and is really a problem. Tho re c oilmen nations we have on that are as follows; One, that military personnel not be discharged to civil life until sufficient treatment has been given to render them clinically free of the disease. Tv/o, that encouragement be given to programs for the control of the mosquito vectors in known and potentially endemic areas in the United States as the most practicable solution to the problem of preventing postwar malaria epidemics. Three, that every effort be made to provide the quantities of antimalarial drugs necessary for civil use. In general the consensus of opinion was that tho rigorous enforcement >f present quarantine regulations .and the efficient application of measures now in f.>rco to prevent the importation of new disease vectors w.uld afford adequate protection against the introduction of the majority of tropical diseases. General recommendations regarding the introduction of tropical diseases into the United States were ..s follows; One, that the efficacy c f measures now in force to prevent the introduction of disease vectors into "the United States be investigated by the Interdepartmental Quarantine Commission.of the Army, llavy and Public Health Service and that changes be recommended as indicated, Tv/o, that- through the medium of medical journals physicians and health officers be repeatedly admonished to consider the various tropical diseases, particularly malaria, in any discharged military personnel coming under their care. Txiree, that measures be taken to instruct medical technicians and personnel of public and private diagnostic laboratories in the United States in the diagnosis of tropic diseases particularly malaria. How we have hero the opinions of experts which might tend to lull one into a sense of security and I think that would be entirely wrong. The problem is going to bo grave, there is no doubt abeut that. I don’t believe there is time to go into --(turning to Lt. Colonel Farr) how much time do I have? 133 LT COLONIAL FhRR: Twenty minute s. COLORED LUHDEBERG: I would* like to toko ten minutes to abstract from a paper read this morning by Colonel Russel McCoy, dealing with this very problem. I think it reflects pretty well the official view of the bar Department -at the present time. Colonel McCoy summarizes the three important points of the Public Health aspects of diseases as follows; One, the -possibility of establishing now endemic foci of the disease in areas now free from ml aria. Two , the introduction of now strains of the parasite in regions where* malaria is al- ready present, and a resultant increase in the amount of malaria in those areas. Three, prompt recognition and proper treatment of relapses in soldiers after they have returned home on sick leave or furlough or have been discharged-from the army. The first of these problems, that of the possibility of establishment of new endemic foci has attr icted the most atten- tion. Exaggerated statements predicting dire consequences have occasionally been published in the public press. Suggestions have been c ffered th t. Troops returned from malarious areas should be segregated. In the north'the point of view is that such troops should not bo sent 'to northern states because these so-cti :;ns - malarious 100 years ago - are now freoe from malaria and the disease should net be intro- duced again. In the south the opinion prevails th „t infected troops should not lie brought to southern stubes because in this part of the country conditions are most favorable for the spread of the disease. There is seme merit in both paints of view, but questions may be raised as to whether either of them is really valid. It does illustrate human nature a little bit though. The idea of nlet somebody else look at it". The practical difficulties of segregation -are, of course, obvious, present there are no certain criteria ■ by which a case-, of malaria may be pronounced completely cured. Relapses may occur after many months of latency. It would certainly be impractical to attempt to’deny, furlough to returned soldiers for any such length of time. Since the discovery of the * mosquito transmission of malaria at the turn of the century, it'has been demonstrated repeatedly that the most fruitful methods of malaria control are those directed against the mosquito vector. Methods designed to c .ntrol the human reservoir of the disease * are of decidedly lessor importance. In this country the 154 accepted line of attack against malaria has been that against the mosquito vector. No attempt has been made to control the movement of human carriers of the disease. I believe a little reflection on that will show it to be the case. Up until the last decade'thousands of infected'immigrants from southern Europe were allowed- to enter this country and to settle at will. Seasonal migration of southern agricultural workers of northern states has boon encouraged in the last 20 years. No untoward consequences in the malaria situation have resulted from this policy. There seems no good reason to take a different attitude toward soldiers who may be carriers. As long as a soldier remains under military c ontrol, there should be sli lit chance of spread of malaria to civilain communities. The men live in well- sanitated camps. Ah on sick, they receive prompt medical attention. Proper screening of hospitals should prevent them from being bitten by mosquitoes during periods when gamctocytes are most numerous in the blood* The chief problem arises after soldiers have been discharged from the Army or return h .me on sick loavo or on furlough. Alien relapse cases occur in communities where there are anopheline mosquitoes, these individuals may he a source of spread to others* It is well,to con- sider how serious this danger is apt to be. Outbreaks of malaria havo occurred from time to time in onc-cndonic areas in the northern United States. In rocont years thcro havo boon such outbreaks in southern Minnesota, east- ern lowa, northern Ohio, and in Camden, Now Jersey. In the summer of 1942, a small outbreak, involving ton cases, occurred at A’appinger Falls in tho lower Hudson Valley of New York. This past summer, a somewhat larger outbreak of 53 cases-occurred at a small town in Illinois. The char- acteristics of those outbreaks are much the same. They have involved comparatively few cases, they have not tended to spread, and often have subsided without anti-mosquito measures. Unlike dengue, malaria does not tend .to occur as an explosive epidemic. Even in localities whore- condi- tions arc favorable for spread, the warning given by prompt recognition of early cases ought to allow the institution of control measures to prevent an extensive epidemic. It would appear reasonably certain that prompt action to control Anopheles mosquitos will be sufficient to prevent serious trouble fr.n any new foci of malaria which may occur. There local authorities do not have the personnel, supplies or equipment to conduct anti-mosquito work, the United States Public Health Service, with its special organization for malaria control, is prepared t) 'give immediate help when asked to do so by the state department of health 135 Another aspect of general problem is the possibility that new strains cf malaria introduced might be more viru- lent than those already present in this country. Although differences in virulence may occur, they apparently are not of sufficient magnitude to be of great significance. In recorded epidemics of malaria, it has always been some change in the mosquito population that has been responsible. For example, in Brazil some years ago it was the introduction of a new vector. Anopheles gambiae, which is a more potent carrier than the species of anophelines normally present. In the Ceylon epidemic ten years ago it was the exceptionally great increase in the number of anophelines already endemic. Over 90 percent of the relapsing cases of malaria among re- turned troops are of the vivax or tertian type. This species of parasite is much less apt to produce malignant infec- tions than is Plasmodium falciparum, the subtertian or estivo- autumnal parasite which predominates in the tropics. Although it is more difficult to effect a permanent cure cf Plasmodium, vivax infections, this species can be considered less danger- ous than Plasmodium falciparum as far as introduction into this country is concerned. In the past the most serious epidemics of malaria have always been caused by the falciparum parasite, Probably the most important problem concerned with the return of infected troops has to do with the individual soldier himself. Mill there always be prompt recognition of malaria relapses in soldiers after they have returned to their home communities? In many sections of the north, physicians are not familiar with malaria, especially the estivo-autumnal type caused by Plasmodium falciparum. Failure to make a promnt diagnosis may be a serious matter in cases of malignant malaria. Prompt diagnosis cf malaria cases is not only important to the patient, but is also important for the timely institution of control measures if outbreaks of malaria should occur, Nov; I have taken the time to read that abstract cf that paper, which I think will probably be published somewhere soon, because I believe it summarizes the point of view of those of us in the Surgeon General’s Office and of our advisors.‘ How I think I should mention at thie time a little bit to give you some idea of what the present plan is or the- ten- tative plan for the handling of these returning troops, troops coming back on a rotation status. That is the thing I spoke of a short time ago. At the present time there is a form in development, a War Department Circular, which will direct in a broad way what the functions of the Medical Department will be in handling these returning troops, and secondly, there will shortly be published a technical circular 136 letter from the Office of the Surgeon Gunor .1, giving in some more dotoil, on outline of what is conceded to bo an adequate program for the handling of those- returning troops. You all think immediately, of course, of the question - how elaborate an ox-mination do we have to moke? Is it necessary to do laboratory tests on all those troops for.all those diseases? I have indicated from the abstracts from the National Research Council program there, wo don’t feel that it is necessary. Tentatively, t.iis is what the Surgeon General proposes. Uc arc going to attempt by some moans or other to got a gen- eral history back of the troops. That doesn’t a medi- cal history or a long detailed statement, but we must hawe- some information as to where themen c me from and a little bit about the typos of diseases to which they Iv vc boon ex- posed, and if possible, the amount of tropical diseases end other communicable diseases they have had in the,past few months. In other words, anything about what troops have boon exposed t) will forewarn uur nodical examiners what to look for. Just how this information will bo obtained isn’t known yet. However, some sort of medical history will come along with these people. It is pl umed that at .these reception stations, as I think they arc called, of which there will bo some 12 or 14 scattered throughout the country, the men will be sent in groups for procossossing before going on furlough. A chock 7d.1l be made on the history of the infection in the group- or the individual, bach individual will be examined medically as expeditiously as possible. I might road this and toon I would like to have your comment on it. ,fGeneral Medical examination. Each indivi- dual will be examined medically as expecitiously s possible, not following routinely a plan for complete physical exam- in tion, but giving special attention to manifestations of conditions considered wst likely to bo present as the result of his foreign service. ,J-he licenses considered to bo if particularly importance at tiiis time include those mentioned in pr. 5, below. In.addition, careful consideration will bo given to the possible presence of unrecognized nouropsych- iatric disorders. 5. Special Medical in. If the available his- tory or the general examination indicates the possible presence of one of the diseases listed below, the indie .tod special exai.lira.ti ms should bo pvrf ormed: " I have hero a half a dizen diseases which I will mention. Amebic Dysentery, -It has been proposed that if the man had a history or suggested symptoms or -physical findings of 137 anobic dysentery, a curtain amount of laboratory work will have to be done. In the case of amebic dysentery, it will be the examination of fresh stool smear. In the case of bacillary dysentery, an examination of the stool culture and smears, Filariasis should bo easy to diagnose because most of the troops will not come from where it is. Careful examination of the lymphatic system and scrotal contents. Blood smear for parasites. You never recover many parasites on these early cases, ( Hook ‘worm. In some places in the South Pacific, there has been more hook worn than was anticipated. It might be well to check into that a bit by use of the stool smear. IJow then, malaria. There must be a physical examination, sufficiently detailed to determine the presence of significant effects of chronic malaria a thin blood smear -- this should be done routinely in men who have discontinued the taking of suppressive anti-malarial drugs within 30 days. You can’t turn men loose for three or four weeks, or however long the furlough is going to be, without trying to estimate whether or not he is going to have a relapse when ho is home. There must be a detailed exam- ination to really determine his condition, pulminary tubercul- osis - chest X-ray examination in all suspected cases. Schistoso- miasis -- stool and urine examinations for ova. Trachoma careful inspection of conjunctival surfaces. Venereal diseases-- inspection for eviuenco of infectious cases - dark fieli examination, blood serology, smear and culture for gonococci, when indicated. Hospitalization should be provided for men in whom the following conditions are shown to bo present: Amebic' and Bacillary Dysentery, Hookworm Infestation, Schistosomiasis; Treatment until the pationt is cured or rendered, non-infoctious. Filariasis with Symptoms• Hospitalization until the patient is free of symptoms. Clinical Malaria or Malarial parasitemia; Treatment until the patient has been free of symptoms for two weeks and/or two negative blood smears have boon secured, probably something should be done or will have to .bo done about warning the man who may come down with malaria. Give' him some warning. You can’t turn them loose without some warning about what they might possibly expect. In all other diseases - no mention is made of all the thousand and one other diseases these people may have because they arc pretty well covered in other existing regulations. I wanted to road this draft of the proposed Surgeon General’s Office Circular letter. It will give you an idea of what is being thought of in the Surgeon General’s office, and it will inform 138 you of something that will probably cone out eventually. It will take a lot of coordination with other ayencios; transportation and personnel and the other ones. LT COLONEL Fhß* are there tany quest! ;ns you • would like to ask on this particular subject at this tine. ► (No Response) It not, thank you very nuch Colonel Lund ebon . he now have-a few ninutes schcdulod for open discussion on subjects that have cone before us. However, before wo enter into this discuss! m. Commander Terwilleyer has indi- cated ho would like to* add a few remarks f ,-r the record. CCMInNDER TERbTLLEGERs ’ • I enjoyed the roputati m of beiny a nan who spoke off the record; I will n.;»■/ speak on the record. Colonel Melton, about a month ayo , nenti nod tiiat members of the crow aboard the ships were not willing; to- sub- mit to physical examination by medical officers of the nruy, and that question was brought up ayain yesterday by General De l/itto This no min: I chocked with the division f Operations and they are working ,n that, oe c• ;n hurry it up if we can pet ?c formal request fr m this meeting askiny th t a directive be issued alon. these linos.' Send that to the Deputy, .dninis- t rat or of oar Shipping, addressed to the attention of Hr. ll.'/. Jackson. The second point raised yestord .y was ships operating under 17 a r Shippiny administration, that they mily wore allo- cated one Way. On the return voyaye it was decided that those ships would carry patients. One criticism of the ships was that they were not’ adequately stocked with food, nor did they have proper personnel in the palleys. ; / If we 'review' the royulati ns in reyards to th t, al 1 ships al- located under bar Shipping n are »; iven a sufficiient •supply of food for a return voyaye plus- 30 days. ‘lhen the ship is in .a foreiyn port it takes on rati ns for the crow, for the stevedores, and for the people operating in that.foreiyn port so .that 'there should bo no need for the waste of food. In reyard to the personnel of the yalley, it is the obliyation of bar Shipping t: staff that yalley with people in key positions like the storekeeper, the chiefs, etc., bus boys, scullery men, etc. If the staff is inadequate then that would bo supplied by the Amy Transportation. I just want to clear up th. so throe points of ye starday. 139 LT COLONEL FARR: 'We have here, as I mentioned before, Mr. Wolfe, from the Corps of Engineers. I wonder if you would like to say a word about the progress that is being made on the design and construction of our disinfestation plants. MR. JOHN ID LEE ? The concrete chamber which we have developed incorporates all the features which Mr. Randall Latta pointed out, in his pre-fabricatcd model here, with the exception that we have made it out of concrete. I have been up to the manufacturers of the d,)ors to t'lk vmr whether or nit the contractors can secure them when these particular boxes are made. This outfit is perfectly willing to make doors providing a sufficient number- of them are needed. I gave the name of the President of that company to the Division and area Engineer Officers, whereby they can contact them in the event that they wish to use pre~-fabricated doors. LT COLONEL FARR: Thank you Mr. Wolfe. Arc there any further questions now? We have got to start on some one point on those questions. Lot’s take this last one we just discussed - the one Mr, Wolfe just discussed. D os anyone have any questions he wants to raise on disinfestation plants? Their progress or design? COLONEL LUNDERBERG-? I would like to ask Mr. Latta about the time it requires to kill a louse in the ordinary delousing processing with B.M . What should we toll people who sec a louse is still alive when ho comes out of the bag? MR. LATTA: That will depend on the amount of .over-dosage. However. they should all die, I would judge in from two to six hourso It is possible that there might be some activity after -24 hours but that is rather rare. They do not feed and if the eggs are removed from the female, they are not viable. About the direct ratio to the temperature -of the increase of the dosage,-that is., tho more cur plus dosage-you have the quicker they will die -■> that is variable and will depend on conditions. I have examined a good many hundreds of men - and I have; yet to see any visible symptoms, I don-*t believe there would be much chance to see anything. The activity immediate- ly following the fumigation ceases very soon. When we talk about death, we mean no activity, even when the insect is disturbed. 140 LT. COLONEL FARR; It is possible, is it not, that some of these dead lice 1/ill full off the clothes and what not into the trains when they are moved, and saneone is boing to raise the question* he say a louse is dead, what can we tel], the railroad people if they have occasion to say ’’You fumigated these people, but wo found sOl.lO lice". \Jq would be assured they are all in-the proper state? MR* LATTE? I think the chances of that happening are very slight. The lice do not stay on the body, they stay on the ole tiling. Even though they have been killed, they tend to cling; to-the clothing. They are practically al- ways on the inside >f the underwear, or in the inside of the shirt, next to the body where it is warn, personally, I don’t .think there is much chance that one will, fall off after it has been fumigated., as long as there is.any activity, tne. one that did fall of would be a dead louse.. COLONEL LOWRY- • I would like t) ask a question on that. Is there a practical point to which you c. . I might add. Colonel Melton, you arc going to get the speed of those vaults at Eri» Port, and they arc also going.to be developed by the Lindsey people. These will be com- pared wlbh each other,, 1 was told by the Quartermaster that that was an improvement ovci the one that I had severely criticized which I had seen at Crmp Leo. I got up to Hagerstorm and found the new box being buill If we could get the good features of the two together, werd have a pretty good box, but there are enough bad features from each place to condemn the box. I don’t know who is responsible. I got it somewhere that it costs SBOO to have some improvements h ''here. ho could see to it that such improve- ments are made in v,raring, and that the manufacturer produces the goods. COLONEL MELTON; I should like to make one other remark. In the event we try that in our commercial type and you get excel- lent results - for in some way they have got to be airtight and gastight - you can put the factory on then. Colonel Lowry is at Hampton Roads. I’d like him to explain. COLONEL LOITRY; This plant improved down there in many ways - a synthetic plant. he had the same trouble Colonel Melton had. Wo managed to obtain from the Navy some submarine net buoys, about 200 cubic feet capacity, he had the welders cut doors in the end of the buoys and mount rubbergasketed doors obtained from the ship- yard. he had a whole series of six hooked up on a vacuum, ho could pull .a vacuum on any one of those tanks in 45 seconds, ho have run through two prisoner movements with this equipment so far, and they worked very nicely, with little leaks; I would say in the chambers.themselves, no leak; a little bit at times around the applicator, that’s.all, he have run through rather a long set of experimental work on various arrangements to show what we can kill, and we killed 100% of eggs in 10 minutes or less. Now, we have doubled that tine for safety and we worked on a 20 minute schedule. One thing about the vaoumm, it enables you to wash gas effectively, ho had the same trouble Colonel Melton had, gas es- caping in the dressing room. For that, we have sustained suction ducts all across one side )f the dressing room and four.spans on the far side, ho keep that going constantly during the dressing. 146 Jo think the plan is working nicoly- It is of course entirely dopendont on material which happened to bo over- loaded, but it has worked nicely. If anyone is interested I have pictures. If interested,- I will have tine tomorrow ar I I wou,ldbc plnd to show thorn. LT COLOII2L FARR: Our tine is about up for today. I winder if there are any questions on the industrial medi- cine program before wo close this mooting. Do you have a clear understanding of everythin; involved on that? I have a couple of thins to bring up. I want to remind you again of the questions that we'd like to have given us this evening for further study and particularly those points you wish to raise on the Transport Surgeon Manual, as this is one of the last chances you have to get it • I’d like to take this -opportunity to thank the Surgeon General’s Office, particularly the Preventive Medicine Divi sion, for the' extremely interesting program they put on this afternoon. L’d also like to thank the Department of agriculture and: the Chief of Engineers who have c ontributed a great deal to this discussion. The matter of keeping infectious diseases out of the country insofar as the is concerned is medically the responsibility of the Surgeon General. It is up to us to give every bit of cooperation that wo can to aid then in that job. 'Jo have covered very many different points today and I hope that the questions we have will be such that we can continue^our discussion tomorrow. I believe that to- morrow ,we will have ss me representatives' from the Public Health who will give a little.,talk. Doctor Fuller, are you goint to bo present tomorrow? DOCTOR FULLER; I’m sorry I’ll not bo able to be here tomorrow-* LT COLONEL FARR: I would like to introduce this evening Doctor Fuller of the .gar Shipping Administration. I wonder if there is anyt ing you would like to say?. 147 DOCTOR FULLER': I have nothing to say'except to express my appreciation that I have been invited here, I have enjoyed the day very mue] and wish I could have been here yesterday and tomorrow but ci' .uniotances over which I have no control won’t permit me to be here.: LT COLONEL FARR; * Thank you very much, I hope that you gain from this our feeling of trying to protect all concerned. Occasion- ally we .have to call on the War Shipping Administration to got some help in putting these gadgets the boys were taMng about on the ships. DOCTOR FULLER; Incidentally, I might say the Public Health is establishing a sanitary code on War Shipping that will apply part- icularly to the War Shipping Administration, that is boats under charter operated by them. Part of that code calls for the mechanical chlor- ination of all water. About 6 months ago the engineers engaged on ships were requested by the War Shipping Administration to inspect the plans; that is, the type of plans for different types of ships, not the individual plans for each ship not completed, but plans particularly for proper intaking of water and adjoining, unnecess- ary cross connecting in the pumping systems of the ship, and so on. Ships are now and will be inspected by sanitary engineers as they come through. The influx of ships in one convoy was so great that it was not possible to inspect all the ships. The water problem is a little different in merchant ships. It does not carry prisoners aboard as on transports. Many ships on short runs carrying enough water will be able to make the round trip, nevertheless, we feel it is necessary to Chlorinate all of the-.water in all the tanks - waste water and drinking water, I hope at any rate that the question of security of water will be pretty well in control in a short time, LT COLONEL FARR: Thank you very much, sir. We will re- convene tomorrow morning at 'nine o’clock. 148 LT COLOIIEL FARR: Dr. Farran has not arrived. I want to take this opportunity to go briefly over part of the organi- zation of the Chief of Transportation, that portion which may be of interest to you. This is more on orientation so that you knew who is where. The Chief of Transportation, as you all know, is General Gross. He has two assistant Chiefs; an Assistant Chief of Transportation for Operations, General Wylie, who is now Acting Chief of Transportation, and an Assistant Chief of ■ Supply, Colonel Toolman, whom you haven’t met. The Assistant Chief of Transportation for Operations, which is a staff job and not a direct line job is on the staff of the Chief of Trans- portation. It has functional control over the Operating Divisions which are directly under the Chief of Transportation in command channels or command line. Under the Assistant Chief of Trans- portation for Operations, we have the Movements Division, Port and Field Agency Division, the Planning Division, and the Intelligence Division which is concerned with Internal Security plus some other G-2 functions. The Planning Division deals entirely with plans for the utilization of transportation facili- ties based on strategic policies, and are the representatives of the Chief of Transportation on sub-committees of the joint and combined Chiefs of Staff. Port and Field Agency Divisions are actually rear echelons in the Ports for all tho nasty jobs that no one else seems to want to do. If you need additional personnel and you can’t got it through Personnel Division, tho Port and Field Agency Division will try to analyse the job from an operating standpoint to see if the personnel is needed. It also acts to improve methods of operation and to aid along with the Control Division, which sets up here to aid in standardi- zation of port procedures. I want to emphasize tho detailed Movements Division more than the.others because that is the one that most of you will deal with. Colonel Maclntyre is.Chief of the Movements Division. In it are three main branches. I list my own branch first, of course, the Overseas Troop Branch. The other branches arc the International Aid Branch, the Overseas Supply Branch and then there is a Communication and Security Branch which operates the secret teletype net of tho Transportation Corps. That Branch is very important and some day will come out with a little bit of Mhell" with the Adjutants of the various ports because they got the operation of the teletype stuck down in regular Message Center Channels. The thing was.sot up for tho purpose of being an operational teletype and to take the place of tho telephone and still be secret, but that is going to bo another argument. 149 Overseas Troop Branch is the one that most of you will have more of your dealings with. We have the Medical liaison officers from the Surgeon General attached to this Branch because in here is the principal part of Troop Movements in and out. The Branch is made up of a Pacific Section, an Atlantic Section, and an Indian Ocean Section, for outbound movements. The officers operating in those sections are responsible for the areas cover- ed by their sections and to see that the troops get through that area. - We also have the Organizational Equipment Section which is responsible for such headquarters work as has to be done in correlating the movement of equipment with the troops. Our theory is that you cannot separate troops and their equipment if you are going to have them equipped when they got to the other end. We have the Debarkation Section which takes care of the return of all sick and wounded, the return of all healthy individuals whether they come in' organizations or otherwise, and the return of prisoners of war. All of this takes ships which must bo at correct places at the right time. Therefore, we have a Ship Utilization Branch.• That Branch is responsible for the scheduling of all troop transports or maintaining schedules on all transports all over the world for a period of six months in advance of the present time. It is used for planning purposes. This brmien and the Planning Division -are the two planning agencies operating with the combined chiefs and the joint chiefs in an attempt, I should say, to keep abreast of the changes of mind th t every- body sooms to hive, as to whore they are going to fight the war and when. Colonel Stokes is Chief of the Planning Branch. Ho and I handle between our two organizations, the majority of that ad- vanced planning and also the current planning. Wo consider planning in throe phases: Shorth nd Planning, which is immed- iate planning) Immediate Planning, that pi .nning for the next month; and then our Longhand Planning, th it goes out to the end of 1945* Wo also have a small section. Statistical Section, for working up data on vessels that have gone, utilization of those vessels, to make charts that go into the utilization re- ports,-, and all that sort of eyewash. Wo find this puts in one compact spot the principle elements of the movement of troops both in and out, and their well-being. There are some of the medical policies that of course have no interest in the actual movement of troops. Although very rarely you do como up with .. now disease or come up with some 150 ohange in tho medical policy, and yet you don’t change the picture of troop movements. Colonel Hoiskell, who has boon here in tho Field Division, is tho other individual officer in’ the office of the Chief of Transportation who is particu- larly concerned with medical problems. Our liaison officer works with him on those problems. I am giving you that more as a 'sideview than anything else. I think it may be of help to you. Most of you know who the officers are that operate many of these divisions. In the Army, you arc supposed to be interested only in tho organization and not tho personal- ity, although, peculiarly, most troop movements depend on personality. So unless you would like to raise some ques- tions, we will pass this one for what it is worth. We are now entering our closing session of tho conference, one that I found to be particularly interesting. It was Very clear to me v;hat we wore talking about until yesterday after- noon when Colonel Hardonbcrgh kind of floored me, but it was still interesting as far as lam concerned. I have learned a great deal from the presentations'. However, presentations at the conference are principally setting up the means for further discussion and in these discussions we can raise many questions that have been bothering us and the operation of our ports * We do have another subject or the continuation, shall we say, of one of our principle subjects to be discussed before wo enter into the free for all of question and answer. We are vary fortunate in having Dr. Oleson a Medical Director of the United States Public Health Service, Chief Quarantine Officer, Port of Mew York with us this morning to discuss the prevention of communicable diseases in the United States by coordination of agencies involved. As tho Public Health Service is charged by law with this function I am sure that Dr. Olesen will give us an extremely interesting discus- sion. DR. OLESEN; Mr. Chairman and gentlemen: Within tho past few weeks there has boo-n considerable space devoted in the newspapers to a discussion of the topic which somewhat interests us. The sub-committee and mobilization of the Senate Committee on Military Affairs pointed out the fact that in the Port of New York there is a lack of centralization and pooling of resources so that things were not going well. There has been some editorial comment upholding tho fact-finding of this sub- committee and it occurs to me that it touches us rather closely because of the sanitary resources of the Port of New York which are somewhat scattered and not coordinated to the extent that tho best results could be achieved. We have a precedent for estab- lishing a coordinating coramitte in the security efforts that have been put forth in New York, .and I well remember some con- versation that occurred between General Phillipson, who I be- lieve was the Corps Commander at the; time, and some one who posed a question to him. 151 It was somewhat on this order. We were looking, incidentally, rather roughly at a- pile of reports on the desk of the Collector of Customs at- the time this meeting was held. There were sixty- eight fires on docks in the metropolitan area of New York, he were 'non-plussed as to what could be done about this particular aggravating occurrence. So someone asked General Phillipson, Mls it possible for the Army to- stop this sort of thing? Could you so pose your forces that this sort of thing will not occur?" General Phillipson with a little twinkle in his eye said, "Yes, we could do it but," he said, "no ships would sail in the Port of New York. Everything would be completely stopped". ' And I think that that should be recalled in connection with what I have to propose too and what I may have to say on the subject. It is simply this; Yes, we can prevent disease from entering the Port of Now lork; and yes, we can prevent dis- ease from entering any of the Ports in which you are statioied, but there would be no commerce so that wo must take chances, he must liberalize our procedure, we must take such measures as will be within reason. I thought that that was a very inter- esting point that the General raised at that time and I thought that that might well servo for the theme of what wo may discuss today’. We can stop it, yes. Eut there will bo no goods brought in or out. Everything will si ply be stopped in the Port of Mew York. In the Port of New York wo have a number of agencies de- voting their attention in one way or another to the subject of sanitation. 'We have some of course that are devoting their attention to medica 1 care, I am not going to discuss the subject of medical care because that is entirely separate, but I shall propose today the desirability at least of sotting up a small organization, possibly a very flexible one. It need not be a rigid formal organization or grouping, but it is possible in some of the larger ports. It would be advisable to have a well-equipped public her.lth officer, an officer with a public health view-point. Not a diet -.tor, but someone to db the lay work of telephoning to accumulate the material that is needed for"making a success of a small organization devoted to san.lt at ion. Within the last ■’week we h ve had such a conference here in New York and it has been most helpful. Possibly if we had the organization presided over by not ... diet .tor, but a person who could have regulated the affairs of this group, it might not have been necessary to hve had 'toils p .rticular meeting. The meeting was held for the purpose of ironing out some of the perplexing problems that occasionally arise here. Heretofore, we have always gone to each other in the kindly, friendly spirit and have .solved our difficulties by private conversation. 152 I just want to review for a moment, if you will, the organi- zations which ontur into this picture, and I refer briefly to the principle activities which they perform, leaving the public health service until last, possibly not because it is least,' but simply because of convonionco and probably a little longer discussion for the purpose of sotting forth in rather clear terms the functions that are described to the public health service, its jurisdiction, .the things it can do, the things it can’t do, and the things it is not equipped to do. No one is more cons- cious of the difficulties under which wo have been laboring than I have been because we have boon requested to perform certain functions that wo simply were not prepared to undertake. X' I might first mention the Army Air Forces because it has a very largo share in this activity of safeguarding the health of the poor by efforts of sanitation, in preventing the influx of communicable diseases from the outside; and I wish to pay a very small tribute, but well deserved, to Colonel Melton, the Port. Surgeon at Now York, to his assistant. Major Schuhraann, and also to Major Buzzard on his staff. All those gentleman, I think, have maintained their equipment under very trying circumstances 9 They have done this at times, I am sure, they would have boon willing to throw a brick through a plate-glass window. They have always been kind and considerate and ivo have reached con- clusions that have been helpful. You all know pretty well’ what the Port Surgeon does from your experience in other communities.. I am not going to dwell on that very much except to say that they are bearing a very large and important share of the responsi- bility of getting these diseases stopped at the gate. In other words, wo would like very much to pool the sanitary facilities ovf this Port. I think that the sanitary' facilities of other ports should also be pooled. It is a good "catch" expression - - "pooling the port". That is a subject I am particularly devoting myself to this morning. Tho Navy also has a very strong interest in this, but not to the ex- tent that the Army has, for tho reason that the Army has set.up its own delousing facilities. It also has its facilities for dis- infestation and fumigation. There has been excellent coordination and cooperation with Colonel Hayden, who is tho Advisor to the Commandant of the Third Naval District. There,have been inspectors who made the inspections on these vessels and then reported to us, but they haven’t been very good,. because they have been lay in- spectors who have nob idea of what was needed in tho way of sanitary 153 inspection and have thrown into our laps many problems that pro- bably never should have arisen and should never have been referred to us. The W.S.A. has a very large share in this by reason of the large number of vessels which have come under their jurisdiction, for the purpose of transporting supplies and troops. Many times these W.S.A. vessels are not equipped to carry troops. It has been a sort of great annoyance to all of those in contact with vessels that they have not had adequate sanitary facilities; that they have not had adequate sleeping facilities, as the regular Army transports and Navy transports have had. There is a problem to be settled there as to who is responsible'for sending out vessels that are not equipped to handle prisoners of war. That should be considered. I am just scurrying over this lightly. You will recognize in your own communities the counterparts of the organizations I have mentioned. I want to mention to you some of the organi- zations that wo come in contact with here in York City, particularly some rather odd and rare groups. We have public health services of some of the allied nations. For instance, the Norwegians have their own’Public Health Service here in Now York. They have a competent man at its head, and another man to supervise affairs in Washington. The British have the British Ministry of War Transport. Those people are immensely cooperative in anything you ask them to do. We have had some problems with venereal cases venereal diseases which have come into the port on Norwegian and British ships, and owing to the rapidity of movements, owing to the necessity for them to depart as quickly as possible, those venereal cases are carried on them without any treatment. We have had some correspondence with Directors of Public Health Services of foreign nations and they are very responsible. The longer I stay in the Public Health Service the longer I believe much can be accomplished by consultation end persuasion, rather than by opening a book. Wo have settled many prime problems by going to the people themselves who arc involved and reason- ing with them in a friendly way. I believe there is a feeling in Now York probably that many of the things that come up con be settled that way. As• far as I* am concerned, they always can, and certainly we can always roach a point of departure where it is favorable to both groups and where there will be no quarrel. One of the initial organizations in York is the little organization known as the Medical Directors and Steam- ship Companies under Commander Terwilligor, representing the Grace Lino formerly, and I believe he is still a member of the organization. Dr. Gatlor, of the United Fruit, has for years 154 done all of his own fumigating with hydro-cyanic acid with as groat an efficiency as we have ever undertaken. Dr. Hewitt, of Standard Oil, has also boon very helpful. You will find men of that typo always ready for consultation t such con- ferences as may be desired affecting their vessels. One of the groups that should probably be considered is tho Post Control Group. By reason of the lack of Federal facilities for fumigation and disinfest ition, we have to rely very heavily upon this group, he know the 'secretary of tho association very •'..e1l - he lives over here in Brooklyn. Hr. Butner is a fine . speaker, and I think a very honest gentleman, but; he can’t be honest for the whole crowd he represents and, I fool at times \/e are being "gyped”, to use the colloquial expression, by reason of making contracts with these pooplo on a cost-plus basis. I think wo are paying too much. I am sure if we could have the facilities at .our disposal for taking over this work, wo could save a great deal of money. They are short-handed too by reason of induction and other drains on personnel, so that they are not in tho same position anymore for undertaking large jobs th it they formo rly wore in. Those are some of the groups I should like to mention parti- cularly as being members of a little flexible org nization such as we might easily set up. In tho 1 rgo communities, possibly, it would be wise to have a competent public health official with an officer with a public he-,lth view-point to do the 1 y i/ork and make the suggestions. X would like to suggest particularly in a little conference group of this kind, it would be desirable to have a little mimeographed statement of what each organiza- tion included therein, does for sanitation in the port. There should be telephone numbers of the Chiefs of tho units involved. It would not bo an expensive thing. I have seen this done in other communities. My particular reason for ..dvocating such an • organ! aat ion, is that it has dways worked well in public health organizations. I came in cunt .ct with the Public Health Federa- tion in Cincinnati riuiy years ago aid found they had two re- presentatives fr jn every org nization in tho City of Cincinnati, who were in any way interested in public health. T.i.t is one of the most powerful organizations there. It has a dynamic secretary and it is one of tho. most dynamic organizations in tho City of Cincinnati because it h ,s political power as well as persuasive power. They have achieved and simplified this cohesion. I tnink wo -.re too loosely knit together at the present time to achieve the best possible results. Tuun, coming to a brief discussion of what the Public Ho-alth Service duties are in this community. We have taken stock recently because of the various problems that have arisen and we find wo are not as well equipped 155 to undertake work as wo should like to bo. We wore caught rather flat-footed ‘by the unexpected and sudden demand made upon our resources, and by reason of losses of personnel due to induction and resignations by poorly paid men who went into ship yards, which is a chronic state with every organization. I am not be- moaning the fact. I know it occurs with every other organisa- tion. Just now wo are much bettor off than we were for a long time by reason of the acquisition of 25 enlisted men at this port, and those of you at other ports know, too, that the Coast Guard has also loaned or detailed enlisted men for duty with quarantine stations. We aro fortunate in having 25 very good enlisted men who were detailed to us and help us in our disinfestation and inspections, and some of thorn arc showing marked versatility in their field, so that we can roly upon them. Before long we ex- pect to expand greatly. The Coast Guard derives its surgeons and physicians from the Public Health Service. So that when a submarine is sighted and the "same is sunk" it usually means there is a Public Health Service officer on board to do the work. We have at our station at the present time, a young man who just came off the **********, the Coast Guard ship which sighted a sub and did away with it. Some of his accomplishments worked so well I should like to boast about them a wee bit, because he had some serious injuries due to shell fire from the sub **************, tjg had one nice case which I should like to mention briefly it was a hemorrhage of the liver, which lie stopped by transplanting a piece of nusclo and knitting it in so that the hemorrhage was somewhat subdued. He is a very young fellow and I think he did an excellent job, I just mentioned this to impress upon you the Coast Guard atten- tion from-the Public Health Service and I think they're doing a first class job. The Coast Guard, of course, has a very strong interest in pest extermination. Heretofore, we refused to do anything for them on the grounds that cockroaches and water bugs and lice, and other things, wore a nuisance rather than a public health menace. We have in the past consistently found fumigation for the extermina- tion of rats, that being one of our chief functions which we have studied for many years. It was 20 years before wo encountered a single case of bubonic plague. It was last January 1943, when a French vessel came from Casablanca with rats and fleas on board, which were undoubtedly infective. Due to some very poor laboratory "work, not in our own station, confirmation was entirely sour, which is the quickest and best way to express our feelings upon this p.ar- ticular case, but there wasn’t any question about the authenticity of the diagnosis as far as we. were concerned. Every victim was killed and we feel that 20 years of constant endeavor which we 15C were just about to give up, Ims repaid us for that long experi- ence. Vic are now going at it with redoubled energy. The public Health Service has some things it can do with these 25 Coast guardsmen. Tile are now able to disinfect and to fumigate, small craft of the Coast Guard, which arc vermin infested. Tie never did that before, but wo feel now that in return for the help given us, we should make some adequate return to the Coast Guard for this work. Admiral Clark has cooperated admirably in this work. Ho simply said that if any of the non did not cone up to expectations wc will supplant then. Colonel Molten has sent several of his men to us for training in tho inspection work, which they like to lenow about too -- and I think they know tho job pretty well as it is already, but they thought wo might exchange some ideas on the subject, he are constantly getting men from other parts of the world who come in here for training or to see what we are doing. \7e are training men fr in Bermuda and Haiti, and if we can use influence just a little bit, we mil make for more uniformity of procedure and do a better job. Our principal work then is to fumigate cargo vessels -- not the vessels belonging to the services, although wo are planning to undertake that on behalf of the. Army and Navy. 'Jo fool that is not tho mission wo have to our follow services. 'Jo can at the present time do a reasonably good job. Fumigation of the "Bermuda", one of the two crafts which ran regularly between Now York and Bermuda, before the War. I think the *********** Tho ******* is still afloat. It is a **** stacker v/ith one painted a different color. That is a big job and when a ship,like that came in, it Leant wo had to, in the past, divert )ur entire personnel, which is relatively small anyway, to this single task of fumigating a largo vessel. How without augmented personnel, our augmented group of workers, we are able to undertake some fairly decent sized jobs and we are very proud of that fact. The Public Health Service still hasn’t any arbitrary auth- ority to do this, that, or tho other thing. 'Jo can’t hold vessels in quarantine unless it has an actual or expectant case of quar- antinable disease and, unfortunately, quarantinable.diseases are those wc seldom see. You are all familiar with quqqntiliable diseases, cholera, plague, smallpox, yellow fever, typhus fever, anthraz and psittacosis. Those are the ones we seldom ever see. They are certainly not very large. Personally, I think I would rather encounter a case of I would be much more afraid of a case of poliomyelitis, or meningitus on a, ship. I should men- tion the fact thdt tho Department of Health of the City .of New York, has an active picture of the problem and they have been very help- ful. They take care .>f minor diseases, such as measles, mumps, chicken pox, scarlet fever, poliomyelitis. Poliomyelitis is certain- ly not in my estimation a minor disease. How it is communicated 157 and how it is conveyed I would like very much to know, and how to stop it would interest me still more. But the Department of Health takes these cases on .fter they pass us a quarantine. Yje let them know what we have. But that is the mly absolute jurisdiction that we have at the present time, and I hope in the prospective that changes that may occur and I should like to be around to p rticipato in making any changes, because I think quarantine as it stands is inaccurate and is a hit and miss affair which * should bo radically changed. We have under c nisiderati>n with the burgeon General's approval, at the present time - his tentative approval - because the plans are not definitely laid out, to let certain vessels pass quarantining without inspection, that would be an innovation which would bo much appreciated by the shipping interest and especially the tanker people involved. The rapidity with which tankers must be in and out of the port is startling. The personnel there will toll you to.at they don't get ashore for months at a time. They get alongside a dock, load their oil, discharge, it, and don't have a chance to get off the shipat all before they are on their way again, he 'would like very much to let tankers and lot certain cargo vessels from certain key ports in tne world, go in and out of the New York Port without stopping them for quarantine. Quarantine is an outmoded word. I wish that we could find a better ■'word for it. Vie in New York roly on the expression "ship sanitation". We think th t if you have a clean ship, half your problem is solved. If we can clean ships here adequately before they go abroad, we think we have done a good piece of work. If wo can get them free fromrats, for instance, it will be a real achievement, and that has been our -aim for a groat many years. One of the interesting tilings that came up some 15 to 20 years ago was the f act that when wo fumigated a ship we seldom recovered any rats. There wasn't any tiling on there as a result of the fumigation. On taking stock we found fumigated, vessels that didn't have rat’s on them .and that was the reason wo didn't recover them. Some bright mind on the quarantine thought of the very pleasant ta.sk of going out on the ship and making an inspecti n to see just what there was on the vessel. And at the present time, .3 Lt. Grayson, of Col Helton's staff will toll you, wo have inspectors who n ke an inspection on the ship and they come home and say they have three rats or fifteen rats, or twenty rats whatever the estimate may be and as a result of trapping and fumigation we are. able to chock upon our esti- mates as to the extent of knowing hew far off wo are. It is rather amazing to sec. 158 As a result of-trapping and fumigation wo art able to check upon'.the results and derive estimates on the number of rats destroyed. It is amazing hov; closely those men with their long experience and training are able to estimate the number of rats on a ship, so I think that is a fair summary of what the Public Health Service -is able to do at the pr ese nt time . l/o have no authority to stop the ship and hoist a yellow flag on it because wo think there is something on board. 'Wo have to kn-w and be definit about it. We do have authority to suggest, pursuade and consult with the people c ncerned that it would be a good thing to do so and so. In that way we exert a little pressure on them. With respect to the Grace Line ships we would go' around and try to soil the idea that such and such a thing would be helpful. This was dune by way of suggestion and, of c arse, we would be very well pleased in having coopera- tion and living them agreee. If there were /ejection 0.K., but if they agreed we wore pleased with the cooperation. I’d rather deal with the person who is not so complacent in ’whatever wc have to offer rather than with one who accepts every suggestion set before him We always had the problem of continuous outbreaks of diarrhea on the Old Rotterdam which never loft a Port without having un- usual cases of diarrhea on board. We tried just as hard as we could on the Swedish vessel, Kungsholm, which was a very clean vessel, to prevent the outbreak of diarrhea; and although it was a very clean ship it always had these outbreaks. We participated in inspections and always made suggestions, but outbreaks of diarrhea still occurred and people would bo afflicted even for several days after they had left the ship. Our efforts on the Kungsholm were utterly ineffective in attempting to stamp cut this particular infection. It was a very annoying thing, because the company was losing a great deal of money. People just simply knew that they would get diarrhea' on that boat and that they would suffer for a day or so after leaving it. We tried everything without any results, even down to the exa- mination of the food, the food handlers, the galleysand the kitchen utensils. It was just one of those things and our suggestion didn’t seen to eliminate outbreaks. , In the case of the Grace Line Ships, wo .consulted with Doctor Terwillegor, and we would go through the ships Very carefully. He agreed that there was something to correct and he did correct them. And that is the best result. It is all right to make a promise but the real changes are brought about through cooperative effort's and "they are the most pleasing be- cause they help out. 159 I wish to lay special emphasis on the fact of having a clean ship taking o.n clean people at the Port of Embark,ation. That boat has a bettor chance of escaping all of those maladies that beset a ship, than just dumping them on any ship at a foreign port. Hi at happens to come along. I have been very much impressed with this for a very long time, ever since my childhood days, and especially since I was in the Philippines. No army trans- port ever loft Manila without first going through the process of steaming all of the effects of the personnel on board. Incidentally, when I was in 1110-1110 I had dinner with Colonel Brechenin one evening and in addition to a wonderful dinner that was placed before us, upon the ceiling there was painted a complete table with all tho beautiful food that the Spaniards can provide; so if you weren't satisfied with what was placed before you, you could always look at the ceiling and get something different there. Now at Marivalous, we had a quarantine station where the ships were processed for cleanliness. Tho Marivalous station is at that point, as you know, on Bataan where all of the dread- ful fighting occurcd before General Wainright and his men suffered heavy losses and before they could got back over to Corrigedor. I have boon very much upset by the thought which has been in my mind for a long time that the Japs arc now occupying my quarters in Marivalous. The transports used to stop there very often where they wore taken over and the mon were bathed and their clothing and effects steamed in the steam chambers, and the d±ip was washed down, and a disinfectant used, which I don’t approve of at all at tho present time. I think that is getting back to the dark ages. A good old scrubbing and washing with soap and water always seems to bo more effective. Y/ithin tho past few days wo ha.ve had some discussion as to what should be done after a mechanical cleansing of these boats which bring back prisoners-of-v/ar. Tho suggestion x»ras made that we use a one or two percent solution of cresole, or crcolinc or lysol or something of that kind, and I rejected tho suggestion which I hope will meet tho approval of the participating agen- cies. I don t think that they do any particular good by just substituting one odor for another, gives a feeling to some folks of freshness and cleanliness but as far as tho actual worth of it is.-concerned I think we can roly on the good old scrubbing soap and water and a little soda if you want to use it. Mechanical cleansing means just.that and it does not include a return to the old days. I am not going to go back to those dark ages again but you will be surprised if you took a cruise around tho country at how many Departments of Health, including the one in Washington, DtC., were still relying upon disinfectants for tho prevention of communicable diseases. 160 In concluding those desultory remarks which I hope will bo the object of some discussion and some criticism if you care to indulge in it. My hide is fairly thick from long experience in the quarantine service and I am used to being kicked around. In fact all of the delays which occur in the Port of NoV/ York are always due to quarantine and that is reason enough for being subjected to much criticism for any delay regardless of whether there Is illness aboard, whether, the quarantine doctor is delayed, whether, there is a 1 ck of diesel oil in the Coast Guard cutter or whether it is due to a faulty cylinder or some other defect-, or somebody falls d wn and breaks a log. 'No matter what Hie cause for "the delay its due to quarantine-. In Manila all the newspaper stories usually started with the phrase; "After the customary quarantine delay", no matter what. Of course th it is a fair criticism bee...use we h .vo not always been prompt to re- vise our procedures and there is a need at the present time for all of us to re-examine all of our procedures in the light of recent events and developments to see whether or net we c.n shorten and curtail and eliminate worthless procedures that we have been engaging in. As far as I am concerned, I n willing to t-lce the word of the master of the vessel .s to the ho .Ith of his crew, upon entering the Port of New York. NMw that is a daring statement to make, but long experience has taught no that you can roly protty well on the statement of a lay person, if you will place that re- sponsibility upon him and let him hAd the bag. : Host of the men who operate vessels arc very jealous of their certificates• They would go so far as to cut off a right 1 )g or lose -a arm rather than lose thoir certificate of ability t navigate and command a vessel. I find in my own experience by asking a m ster or the first mate or the chief steward whether he has voneral disease on board, ho will bo very prompt and thorough in telling y u just what ho has because the men on board usually come to these fellows for treat- ment. as far as I am c ncernod it would not be a difficult thing ■to take thoir word for it, as regards health cenditi ns. As long as a man is able testand up -and muster I believe, ho has a good chance of living, for then he mil fall into tho hands of his medical men of the company and they will take good c to of him, or the case will be reported to the Co ast Guard who wl 11 sand out a cutter to remove him to a hospital. To recapitulte briefly, I ’would like to suggest a desira- bility of having an elastic organization in the Port, one that is not necessarily tea- rigid, that -may be used for such a venture so that we may gather together and know who they are, what each is preparing to do, and if possible, in-seme of the- larger Ports, t have a responsible officer who can coordinate these different 161 agencies just as this Port .Security Agency has built up quite a little organization in New York. They have placed under Mr. Flynn experienced customs officers'who frequently call me up. I want to mention, I am constantly in receipt of tele- phone calls from physicians, from laymen, who want to known why it is that some vessels no longer have rat guards on their lines. Such individuals living in a beautiful apartment house on the river shore look out,of the window and see no rat guards on the lines and call up and ask why this neglect is permitted to go along. Our reply is a very simple one, and I believe, a legitimate one. It is that we prefer to spread our small force of inspectors and others on the more essential features of ship sanitation and not to expend the time of hundred of inspectors cruising around the docks to pee whether there are rat guards on the lines. be inspect these vessels very carefully when they come in. Vie know their rat condition and we do not feel that rat guards are essential although they are often effective, he have actual photographs of rats climbing right over these rat guards and we don’t feel that will take the place of a competent and thorough inspection and fumigation when it is needed. COLONEL FARR: Thank you very much. Gentlemen, do you have any questions that you would like answered? (No questions) DOCTOR OLESON; Probably many of you just have some things you would like to bring up. I suspect there .are. I don’t think you are very content at all with what I have said. COLONEL MELTON: I would like to take -this occasion to thank Doctor Oleson for his remarks and thank him for the hearty cooperation we have had with the Public Health Service. There is one tiling I would like to recom lend to all of the Port Surgeons and that is the assignment of a certain number of bright young men to your Public Health Service to get train- ing in. ship inspections, lie found it very beneficial. Ho has boon kind enough to train a number of those young men and we find that they can do an excellent job of inspect .on of snips. Furthermore it relievos the oAfic.-r personnel as we do(not nave enough officer personnel to do that. Is it in order. Doctor Oleson, would it be all right for you to outline something in the nature of a plan to clean up those prisoner-of-war ships? 162 DOCTOR OLESEN: I would depend upon Colonel Farr be- cause he has a schedule. COLONEL BELTON: Perhaps you can mention it briefly for the benefit of the others. DOCTOR OLESEN: I think the thing may be summed up brief- ly by saying that at the present time wo believe that prisoners - • of-war should bo deloused under the direction of the Army for the reason that the Public Health Service lids- no facilities in this Pert although it may have in other ones. Feeling that ship san- itation was one of the rising features of future quarantine, and feeling that ship masters, agents, operators, and owners were' getting the idea that a clean ship was highly desirable, wo gave away Hoffman Island which you could see from here. It is a beautiful Island down the bay about 5 miles and is now occupied by the Maritime Training School. It is well worth see- ing those schools. They are running a first class job down there for the training of Merchant Seaman and have excellent officers there for the needs of the '‘occasion* The steam infestation plants had been dismantled and thrown to the scrape pile. Wo simply lost everything we had when we gave it away to the City of New York, and it was later taken over by the Coast Guard, and then by the Maritime Training School. We have no facilities for the School at all and no facilities for delousing. Naturally, it falls' ho the Army which was fore- sighted enough, I would say, in the development of dolousing facilities. I think they have done an admirable job. They are doing a first class job at this Port and they are doing it at the other Ports too. Wo conceded that it should bo done for the Army and Navy and I have had some conversations with Colonel Melton about it, that if a vessel came in with a case of epidemic typhus, it would bo processed for us too. Of course there is difficulty in this Port because of the several jurisdictions that exist over vessels carrying prisoners-of-war. The army has its own transports and takes care of them throughout. It is the, old' story of putting clean people on clean ships, and we wouldn’t want to put troops on a dirty ship. That is the sole.purpose for which Colonel Melton has been striving to got cleanliness, which can bo achieved by an orderly program including the mechanical clean- sing of vessels with a good thorough job of scrubbing up, which I think will take care of most )f the 163 things that are needed. If there is infestation I believe there should bo fumigation -with a lethal gas for those occasions when it can be demonstrated that it is needed. It is only through in- spection by trained people that you can determine whether this infestation exists, and that has been the, reason that we have boon so ready to help the Army in training the man that they have sent to us, who, I think, arc pretty well equipped to make inspec- tions of vessels and to make suggestions and recommendations. The T/ar Shipping Administration, is getting its vessels from private operators and owners,, which raises a serious problem because they are chartered and they arc paid for navigating the vessels in and out of the Port as quickly as possible. Tilth additional inspectors this, will enable a quick turnaround of the vessel, ¥o have no way of knowing about the arrival of vessels unless the Army and -the Navy inform us. Tic have to devise a simple form for reporting die arrival of a. vessel in port. There is, however, provision in the Quarantine Laws and Regulations for recognizing our friends in the Army, Navy and Coast Guard by filing a certificate. It will prevent and obviate the necessity of dropping anchor and waiting for our Doctors to come aboard. And we are fairly busy at the present time I assure you. Then convoys come in with fifty, seventy, or ninety ships at a time you can-readily understand that an inspection of vessels in those numbers poses a considerable problem for us. ¥o have been able to do fairly well, although wo are still the object of some criticism for downess. The fact that wo have ten doctors docs not mean much to a man who wants to got his ship in and out quickly. ¥o arc doing that fairly well at the present time and satisfying most people. To obviate the necessity of stopping a ship for quarantine in this Port or In other ports I hope this certificate may be filed by the medical officer with the quarantine station notifying us that his vessel is in. Then we can make our plans for inspecting the ship if we are asked to do so. ¥e can only inspect on request, T7o cannot barge in and take over, ¥o do not want to do that. Tic prefer to bo asked for advice,, or for consultation, or for an inspection, and then it would be necessary for us to adjust our schedule so that it can bo done. After a mechanical cleansing without the. use of a disinfectant, we will have to have a final statement that the work has been done, and wo would like to accept the statement of whoever docs the work, even down to the commercial fumigators whom we know very well as to the type of job they turn out. 110 all know them pretty well. The commercial fumigators, I an sorry to say, aro not strictly reliable but wo know most of them and know just what they can do, ¥c prefer to do it that way because we think that will cause the least delay to the ships. 164 COLONEL FARR: Colonel Lundoberg. LT COLONEL LUNDE3ERG: The Public Health Service- of course is charged with the responsibility of protecting the Public Health of this country fr on the introduction of danger us diseases. I think that went along beautifully in peace tine. , The channels of conmunication were set up and wo know when ships loft and when they arrived* All wore agreed as to what the procedure would be • There nay bo others here who do. n>t have the picture clearly in mind of the relationship between the Port Surgeon’s Office and the port Quarantine Officer. How is it possible for instance for Dr. Olosen to lain: when a certain ship is coning in from a c mtaninated port? Or is he interested in that? DOCTOR OLHSEN: V.'e are very interested in that Colonel, but somebody will have to .toll us because we have no. advanced notice. Our radio is out of c .amission and our reports are very meager at the present tine. Unless wo are told when the vessel arrives and where it cones fr n, wo have no way of knowing* Therefore, that will be a cooperative feature that should be arranged between a Port Surgeon and the Quarantine Officer so that a definite pluii i.iay be laid down whereby we may be advised and make arrangements accord- ingly. Remember of course that your real interest is only in the communicable diseases and net in the diseases that you are going to be interested in when your troops come back. LT COLONEL LUNDEBERG: Lets assume, Casablanca or one of the Algerian ports is an infected port in a real sense. DR. OLESEN: It is now. LT COLONEL LUNDEBERG: I’d like to ask Colonel Helton particularly; how do you work it out, how do you got around it, or how do you adjust the rules of inspect! Ms in this situation? You, of course, know when a ship comes from and infected port. Does that ship bring along with it a bill of health? urc you notified what the situation is, or is the public Health Service? 165 DOCTOR OLE3EIi: I’d like to say. Colonel Melton may bo holpjd by saying that tho American Consul has boon relieved in Casablanca -nd tno American Bills of Health arc being prop?.rod Army, and that each vessel from there does or should in so far as military secrecy can be conserved, carry such a bill of health when it comes in. This gives a fair picture, not too accurate, of tho quarantine diseases prevailing Casablanca at tho tine the bill of health was obtained, .nd also tho other diseases. If Colonel Melton 'rants to know just what the condi- tion was at Casablanca tho time the transport left, he can find out from tho Bill of Health. I think that its a shifty business of evicenco; I prefer tliat we lay very little emphasis on some of tho bills of health brought in for the reason that they don’t give a very clear picture as it .exists. We prefer to rely upon our inspections as to the presence of rats, trapping, of fumigation, and taking them into our laboratory and innoculating a procedure which we keep up faithfully at all times. Howev.,r we never have gone on transports unless by request, he feel it is out of our juris- diction and anyway wo haven’t sufficient force, LT COLONEL LUNDEBERG: As I understand it, the Public Health Service does not inspect very inbound ship. DOCTOR OLESEII; Correct. LT COLONEL SCHUHMA'JN: Colonel Lundoberg, I’d like to say tlir t we worked out with Doctor Ole sen a form of certificate he worked out a certificate on his suggestion - I mean he has helped us write this certificate so that it would give him sufficient information. It is addressed to The Chief of Quar- antine Office, United States Quarantine Station, Rosobank, Staten Island, N.Y. That’s in our permanent instructions. 166 COL. SCHUIMAITN; I an reading from our instructions to Transport Surgeons. It states; "THIS IS TO CERTIFY THAT; 1. The sanitary conditions of the vessel is satis- factory and there has been no quarantinable or other communi- cable diseases during the present voyage." It goes on doT-vn hore - I "won’t name the quarantinable diseases. Dr, Olesen already mentioned them. It states; "3. The vessel has not visited Foreign Ports kno'v/n or suspected of being infested with Cholera, plague. Epidemic Typhus Fever, Smallpox, or Yellow Fever". That’s one paragraph that you nay refer to, or you may use the next paragraph labeled "OR 3,": "OH 3. The vessel has visited Foreign Ports knovm or suspected of being infected with Cholera, Plague, Epidemic Typhus Fever, Smallpox or Yellow Fever, but has hold no conmunication which was liable to convey infection," Or still another; "CR 3, Communicable disease other than quarantinable has occurred during the present voyage but is under control. Active cases have been reported to the local civil health authorities upon arrival in Port. 4, The vessel is believed to be free of rats and is not in need of an infestation inspection or fumigation by the U S Public Health Service. "OR 4, Evidence of rat infestation has been noted and as inspection by the U S Public Health Service is requested with a view to instituting corrective measures. 5, Duplicate copies of United States Bills of Health are forwarded herewith. "OR 5. Unites States Bills of Health are not available," Now in the distribution of this, the original is- given to the master and two copies are presented to the Port Surgeon, one of which is to be forwarded to 'the quarantine officer. Apparently Dr," Olesen has not been receiving them, DR. "OLESEN: • - The Colonel has not been getting them, LT COL SCIIUHLIANH: Col. Helton has a note here from which it appears it is desired that our office, rather than the Transport Surgeon, notify the quarantine station when a ship has arrived. Re should also state whether or not an inspection is necessary and the ports from which it departed. 167 DR OLESEN; I might say that this certificate, which was devised locally, has no official approval. It was de- signed for the sole purpose of expediting ships. Uc fool in every fibre of our beings that is our function here above everything, we’d say, at any tine, in addition to making things safe as possible, to get these ships in and out as quickly as possible, I believe we have achieved it. Uc caused very little delay to the Army Transports and to Navy vessels* It is a now thing and I have no criticism to offer at all. It is so new we’ll have to wait for the results, COL MELTON: Vie’ll see that you get this. LT COL FARR: I think it will be very helpful. DR OLESEN; Then wo can offer to give you the benefit of our inspections, occasionally, if you desire then. Ub never want to force ourselves upon you unless something goes radically wrong and it seems necessary to stop in. I don’t think that will over occur. Uo will always be able to work amicably together, if wo just understand what is expected of each other, and I am sure that is the; solution. LT COL FARR: Regarding this matter of notification prior to arrival, I am‘not just sure how that is handled in the Ports, and I am not just sure of how much notice you want; whether you want notice before they arrive or not until they do arrive. DR OLESEN: Until they do arrive, we can’t have that over the air. That is prohibitive. U'c get from the Port an account of cargo vessels-coning in but not of the Armed Forces. I don’t think it would bo of particular advantage to hove that in advance. It would bo ample to get it when it gets to- port. By that I mean we can go to the ship Surgeon and the person who renders the certificate on an armed vessel 168 must be - I don’t say a commissioned officer - but certainly an officer of the Army, Navy, or Public Health Service. It isn’t available to Pharmacist Mates assigned, or a vessel without any documentary forms aboard, LT COLONEL FARE: Then the thing that is necessary to you is that a certificate tye promptly moved from these vessels to your quarantine stations, DR OLESEN: I think that would bo helpful. I don’t know as to how necessary it is, I shouldn’t say it was absolutely necessary but it would be helpful not only to us but to the personnel of the Amy and Navy. LT COLOWRL FARR: I assure you that our Port Surgeon will cooperate on that, lam not familiar 1 ith other Ports, An at is s'our San Francisco set-up on that? BRIG GENERAL DE ATTT: The set-up is not the same in San Francisco. Our relationship with the Public Health Service is very cordial and very cooperative, but they have not been able to give as much assistance to us probably because the'y do not have sufficient officers there as Public Health Service Officers on our ships. Every ship coming in our harbor having such a certificate as Dr. Ole sen spoke of was tranSiiLtted to Dr. .Jhite, the quarantine Officer there. He decided which ships should be fumigated; but that is the only relationship we have had upi to the present time. DR OLESSN: That was the reason for my suggesting the desirability of having this small group. GRIG GENERAL DE 'ITT: I think that is extremely important Doctor. Alien I get beck, I may contact Dr. Ulii,te - I can’t think of the other. Dr. Harrison and Dr, Gallagher, the health officers of tin City, and the other agencies and get them to form just such a committee. 169 LT COLONEL FARR; Do we have any other questions? COLONEL BRADISH: At the Port of New Orleans sone of these problems were discussed at a conference with Dr. Walsh of your Service, the City health officials and the State of- ficials. They had a variety of problems. They had the pro- position of handling quarantinable diseases, receiving and transmitting communicable disease cases occurring amongst civilian passengers. Of course, wo had the responsibility too of handling the military classifications. It was agreed that there would be no quarantine inspection of Transports or any vessel upon which we had a commissioned medical of- ficer. All cargo vessels are stopped at quarantine and are checked by Dr. Walsh of the Public Health quarantine Staff. However, he received no advance notice of these vessels; they simply come in quarantine. For purposes of security wo didn’t want to be transmitting papers around, showing the arrival of Troop Transports and so on. It was simply agreed that there would be transmitted to Dr. Walsh a simple state- ment that the Transport had arrived and had satisfactory health conditions prevailing on that vessel. The Bill of Health certificate does not go out of port for quite a while but is available for his information any time he desires to see it. He further agreed that if a case of quarantinable disease did appear in Port wo could call him into conference immediately in order that he could carry out the proper responsibilities on that type' of case. It would work very simply and very satisfactorily,- and I think that he feels that he knows what is going on. We fool that we adequately and satisfactorily cover the security requirements on a vessel and that wo have not transmitted information into channels that perhaps don’t take the same security measures we do on the information we get concerning the vessel. LT COLONEL FARR: I think that is a wry desirable set up. I suggest if you transmit the name of the vessel then you can submit everything; you might as well add everything. COLONEL BRADISH: The name of the vessel is not trans- mitted . LT COLONEL FARR: Transmitted by form number? 170 COLONEL BRADISH: Simply a statement that a vessel has arrived. As a matter of fact no kind of statement. BRIG GENERAL DE '.ITT; I’d like to supplement my remarks by saying in connection with arrival from infected ports, also Hawaii, that they are required to raise the Quarantine Flag coming in from those ports, and it is required that Quarantine Officers be aboard every one of those ships, in spite of our certificate* DOCTOR OLESEN: I wouldn’t want to delay things that long in New York; I’d be afraid, COLONEL 10 DRY: In Hampton Roads we have been able to work out a three weeks credit between the Navy, Array, and Quarantine Service. Our own officers have found it works out very well. The Navy, of course, gives us information on handling arrivals as soon as possible. We assume the responsibility for keeping the Quarantine Officer informed of the work pending. We have also worked out a method there of handling the ships ■ which we do not want to stop in Quarantine, Certain officers of the Navy arc qualified to issue practique and certain officers in my office are qualified to issue practique, althouii we can call in the Quarantine Officer for assistance at all times. The Quarantine Officer has a good mechanical arrangement. We keep the Quarantine Officer informed of all details of arrivals. He will take or he will allow to pass whatever ships we want, . He even carries his cooperation to the extent that ho will take them in order if we want them,* We found it very helpful to keep in close check with them. In addition, bringing him advance warning will enable him to get advance notice, We found that three-way, close liaison among the Navy, Army and Quarantine Service has-been very helpful to us. LT COLONEL FARR: There are no more questions? Thank you very much, Doctor, We have always heard very fine things of the set-up here in New York, and I am sure after hearing Dr, Olesen you can appreciate why it works as well as it does. He has a wonderful grasp of what is going on. 171 There is no service outside of the War Department that is so closely tied in with the operations of Transportation on in- bound troops as that of Public health Service. I have been in the job of moving troops for the past several years, and during that time we have had several emergencies. They always come up- six to twelve hours before sailing. You name any port and you will find some of them. Wo always had the finest of cooperation from Public Health Service in finding ways and means of getting around those emergencies in order that our troops may move. Any organization reflects the character of the head of that organiza- tion in its functions, and I’d like to present to you at this time the Surgeon General of the Public health Service, Dr. Parran, Would you care to gay anything. Doctor? DR. PARRAN: Colonel Farr, Gentlemen: If I may say, I should like at the outset to try to summarize and sharpen up some of the points that have boon made by Dr, Olcscn in his dis- cussion. I think you can assume the fullest wish to cooperate in dealing with these mutual problems among the Army, Navy, iviaritimo Commission and the Public health Service, Listening to the discussion thus far, I am not suro that all of you especially the operational lino officers, grasp the limita- tions and the scope of authority of the quarantine laws. 1 need to go back in time to a situation which existed in preceding generations whencommonce among the nations of the world was being blocked by arbitrary and discriminatory action on tho part of tho Health Quarantine Officers against nations with which they wore not friendly. So a series of international quarantine conferences were hold resulting in certain covenants which were entered into among all of the major nations, and, I nay say, practically all of the nations of the world, Tho theory underlying those conventions is that tho Quarantine should not be a bar to international commorco, but that measures should be like, as Dr, Ole sen has said, a siovc, a siovc which can be made more coarse or fine, depending on tho particular disease hazard. However, it was agreed that Maritime Quarantine would not operate against all communicable diseases. Tho scope of our quarantine laws and the provisions of those laws arc limited by treaty obligations, applied to certain of the more dangerous communicable diseases. Dr. Olcson has named them. The laws do not apply to any communicable disease. However, in this country and in most nations of tho world, regarding quarantinablc disease, tho power of a Public Health Service today is absolute; specifically against plague, yellow fever, typhus, psittacosis, cholera, small pox and anthrax; and all of the civil police power of the government can be brought to bear to prevent introduction of such diseases. 172 whether they be transported in military or civilian ships or pianos. The laws give to the Public Health Service complete authority of enforcement and authority to call the enforce- ment agencies of the government. In other words, under the law, the Army or the Navy has not the responsibility of pre- venting the introduction of a quarantinable disease. That resides in the Public Health Service. Nov/ in tine of war as a practical measure, very clearly the Surgeon General and Transportation Services recognized the situation, the need for secrecy in the movement' of Navy and Army ships and planes, and agreements were entered into. These agreements are some- what different, as the one between the Air Transportation and the Transportation Services. As regards air transportation, it was agreed that at each airport of entry, each Army or Navy airfield to which pianos would come from foreign lands, there would be nominated to us and appointed a medical officer of the _rmy or Navy, whose responsibility it would be to act in the enforcement of the quarantine laws• In other words, wo agrood that the Public Health Service should refer to the respective, services the responsibility for carrying out the quarantine laws. It obviously implies a knowledge on the part of.the individual medical officer concerned, of those laws and regulations. As regards the ships, the problem was mure complicated, because there has been indicated hero strictly military -and naval craft. There are craft belonging to the maritime Com- mission under the Army and Navy, some of which had a certain amount of civilian shipping. Perhaps our instructions up to' now have not bean sufficiently definite. I think a confer- ence like this is very helpful in trying to clarify cur pro- cedures. However, after listening to the discussion this morning I got the description of disinfestation as a practical method. However, I should h ;pe that bef .ro this conference breaks up, we can have some hope that before this conference breaks up, we can have some general agreement as to what are the most practicable ways of insuring against the introduction of quarantinable diseases - I emphasize that adjective - and second’ on seeing that the movements of ships are not unduly delayed. It is obvious of course that it is necessary to minimize the delay in the movement of ships in these times. The plan which has been worked out and is being worked out, here in Nov/ York seems practicable*. It is gratifying to know 173 how comparable other plans in effect at Hampton Hoads or San Francisco and other ports are. Yet since the problems are common, I should hope that r .th r uniform and standard plans can be worked out under which not only would wo' be assured of cooperation in- exchange of information, but under which plans the respective responsibility of each agency is clearly set forth, hiving pe- culiar to the Army and Navy the responsibility in connection with ships under their control. I will emphasize, especially to the operational line officers thit you, the army, one assuming thereby a very real responsibility. It is easy for us to say we wash our hands of this, and turn the responsibility over to you. That isn't quite the way of doing the job, it seems to me. Some of our quarantine measures in the past may be outmoded. We have tried to keep pace with the scientific developments in epidemiology and disease control. I thought Dr. Oleson seemed somewhat apologetic about giving up Ellis Island for detaining people. I hope in peacetime wo shall never need a type of place of detention such is that. The most economical place is aboard ship. Under modern conditions in case of quarantine disease, provisions nay be made for care at our Marine Hospital at Staton Island, and beds are always available there for that purpose. Again, having disbanded disinfestation facilities here, the Army has established disinfestation facilities, obviously not being economical to have those facilities duplicated between Army and Public Health Service. That's part of the arrangement, namely, th it your facilities should bo available for this purpose. Dr. Olosen has emphasized and I should lice to underline that our strategy against each disease, th-t is against the nt, primarily, is to fumigate every ship that comes in, and to build that fumigation on the ship; and that con be done; and a.detailed inspection made of each. That makes it impossible for rats to find a comfortable home aboard these ships. We have been able to keep constant track of the sanitary conditions of these ships that come to any of our ports, and even more, were able to keep a global map as to where each ship is, or was at any particular time. At this particular time, obviously that is not pos- sible; therefore we need to depend on other measures. So much for the quar an tillable diseases. For the non-quarantinable diseases, many of which are more serious possibly than those lisued as quarantinable, the general procedure suggested would be; One, to keep track of the conditions at foreign ports; tv , to see that the sanitary conditions at cur port of arrival and our health organizations here are adequate to prevent major outbreaks; three, to observe the presence of such communicable but non-quarantinable dis- eases and to notify the public health officers and the juris- diction concerned of this purpose* 174 It is a deliberate policy. I represent that this nation and other nations do not exercise their national authority of quarantine against any and all communicable diseases. - I know you have hod discussions of some of the problems of com- bat of anopheles, aegypti and other things. They will be coming back and will be important, but I think this is not the time to go into it. Before closing, I should like to say that early last winter three of us and the Surgeon General discussed this gen- eral problem with particular reference to the changes that have been brought about and will be brought about as a result of air transport. We agreed that there probably were some holes in cur amor - that of the possibility of carriers of yellow fev- ers coming back from West Africa or some with the diseases from the Southwest Pacific. As a result there was appointed, with the approval of the President, an inter-departmental quarantine commission composed of medical officers of the Health Service and the Army and Navy, Colonel Lundberg was the Array representative, but because of ether duties he had , it was necessary for the Army to name an alternate in his place. That Commission has boon riding the airlines north, cast, south and west to see ' what the conditions arc. The recommendations of the Commission, in effect, arc to investigate the problems of the transmission of disease, both between such foreign bases and other countries in such hemi- spheres, and between cither of such places and the United States. The Commission is charged to recommend changes of law and regulations in order to insure, as far as possible, against, the breeding of disease as a result of military operations, and especially air transport. There have been some outbreaks in our Army. The recent outbreak in Hawaii is a good illustration. Recently it appeared. Fortunately, perhaps the epidemic has had a wholesome effect in the stimulation it has given to ideas of control there, which control public health indicates all of you don’t know. The second break in our armor occurred between the west coast of Africa and the eastern side of Brazil. You wifi recall that in the early thirties, the; French established a trans-Atlantic Air Line. This Air Line is said to have in- troduced in South America the mosquito anopheles gambiac. From Natalo, the mosquito spread over large areas. This mosqui- to is a very vicious vector of malaria. 175 It just had not been known in tho Western hemisphere prior to its introduction, but it took root and spread widely. It caused severe and devastating epidemics of malaria. In one large cot- ton area there was complete loss of crops because no one in that area was on his feet to pick the cotton. As a result of this condition the Brazilian Government spent three or four million dollars. The Rockefeller foundation contributed about half as much. That joint effort accomplished a remarkable result in regard to sanitation in that area. For the first time, a species was completely exterminated over a large area, naturally, the Brazilian government is very sensitive about the introduction of that vector of malaria, especially since it has found on Army Transport Planes, on a number of occasions, anopheles gambiae. The dates and planes are a matter of record which have been re- ported to my office. They have found down there on several occasions the tsetse fly vector of Africo.n sleeping sickness. I wouldn't want to put this on the record. Perhaps they have been reluctant to have the snooping Brazilians examine their planes so meticulously, but I assure, you that this examination is necessary. Within the past two weeks a report has come which is even more disturbing, namely, that the Brazilian health authorities have found in the Navy Officers Club in NataXe a number of anopheles gambiae. The story has broken in the Brazilian press and is a serious international incident. The matter is naturally beinb taken up aggressively between the Secretary of State and the Secretaries of War and Navy, It is a matter of imminent concern on the part of our medical service. Fortunately, our Quarantine Commission at that time wasn’t in South America, I anticipate as a result of their study of that particular situation we may be able to insure against that outbreak in the Army. There is another danger- ous area in the Carribean. We have expected and looked upon the Carribean Islands as barriers against the introduction of yellow fever, yet the conditions in many of those islands are very favorable to the spread of yellow fever should it bo introduced. Yellow fever is endemic in the jungles in a largo area of South America, and for that matter is endemic in all South America, The Carribean Islands instead of being bar- riers have -become sea -beds from which we get further trouble, further impairment, delay in introduction of wartime trans- port, - Those problems -are all part of complicated field opera- tions which are of concern to you. I wish, Mr. Chairman, that I could have been more adequately prepared this morning and had not had to come in cold as I did. 176 LT COLONEL FARR: Thank you very much. Those thoughts are most interesting and fit in very well with the rest of our conference. One problem raised by Dr. Parran was the problem of control. You have your local committees. Some of you don’t have such strong committees. Dr, Parran, how would a committee in Washington, made up of the Public Health Service, the Surgeon General, the Chief of Transportation, the War Shipping Administration, the British Ministry of War Transport, Navy and Air operate if it were established to co- ordinate with committees of various ports? DOCTOR PARRAN: Mr. Chairman, my first snap judgment is that perhaps wo should await the return of our Inter-depart- mental Quarantine Commission which will be back in a few weeks and study their recommendations. Perhaps their recommenda- tions will not be made until further conferences arc hold in Washington. I think it is very possible that such a group as you suggest might be sot up under the combined Chief of Staff as a temporary group to advise in reference to certain specific problems which will be raised by the Quarantine Commission when it comes back. I am conscionciously loath to recommend additional committees in wartime unless they are to bo temporary committees charged with specific responsibili- ties so that they can get their jobs done and then disband. Colonel Lundoberg, have you any comments to maize? LT COLONEL LUNDEBERG; I agree that the Quarantine Group who will be back in a few weeks will be in a much better position to advise us on this matter. LT COLONEL FARR: The best thing to do at the present time would be for our Port Surgeons to cooperate with the local public health authorities in forming such a local group. Dr. Parran, would that not bo the best immediate step to take whore such a committee is not in effect? DOCTOR PARRAN: I think that would be a clearly in- dicated step. Each group, however, should understand its responsibility. 177 LT COLONEL FARR; I am sure that your Ports which do not have such a committee will take steps to take care of that matter when you get back. Are there any other points which you would like to raise before we go into discussion on previous present- ations? (Pause) I see there are none. We will start in with some of the questions that have been brought up and which were handed to me last evening. lam going to, leave this matter of a committee to work on the Transport Regulations until last, because wo have a committee established to work on that and unless you have some questions, we will take it last, I would like to ask those of you who are going to enter into this discussion,particularly those in the back of the room, to speak up loud enough so that the minutes may be taken be- cause the reporters have difficulty catching some of the faint whispers from the back there. Now, point number one, is the matter of how many troops we can carry on a vessel before that vessel can take a doctor on board, Hampton Roads proposes that 350 soldiers \/ould be re- quired before taking on board a medical officer. Where the num- ber of soldiers are smaller than that a trained medical tech- nician should be supplied. This technician should be supplied. This technician can bo trained in accordance with the recommend- ations by General DeWitt. Another recommendation is that all ships carrying 250 men or less have a qualified enlisted man - medical attendant in- stead of a medical officer. It is further recommended that the school proposed by General DeWitt be established. We have from two ports a recommendation that wo use enlisted personnel only on those transports, that our Transports Surgeons* manual either be supplemented or have a particular specialized section. Should wo or should we not have a seperate set of in- structions for enlisted men when no medical officer is present? COLONEL BRECHEwiIN: We have quite a number of cargo vessels enployed in Alaskan trade but we don't have many ports to stop at. We always call at the Coast Guard Installations on the inland run, and that has saved us the services of a great many medical officers. Occasionally wo have commercial liners with from 50 to 300 or 400 men. We -would like to have a general agreement of the actual number required to put a medical officer on board, I ‘was always afraid that something would break out 178 on those boats, and I would bo hold for not having a medical officer aboard. LT COLONEL RANK: I think the number is going to have to be definitely stated by the Surgeon General's office, do can make a recommendation. I think wo should make a recom- mendation at this.conference, but it will have to be*confirmed or changed by the Surgeon General. 'To have 250 and 350 recom- mended. Dogs the conference fool that wo should recommend 350 as the dividing lino? LT COLONEL FEISTEL: May I suggest that the length of the voyage also be considered. LT COLONEL*FARRs That is a very good point. It com- plicated the problem, but I think we will have to. consider it. If you have a five-day voyage, you arc not going to run into the complications that you will run into with a sixty- day voyage. LT COLONEL SEARLES: > . I might suggest also that the over- loading of a vessel bo considered. You might have 300 men on a vessel that would normally carry one hundred. Undoubtedly you would need more medload attention in that case from a layman's standpoint, whereas in a boat which was not crowded you night got by with an enlisted man. LT COLONEL FARR* I guess that is another factor that has to be considered. MAJOR GAY: Seattle has a little different pro- blem in that they use an intor-watorway. They have this problem.. These men may be out at sea, maybe 4 weeks, 6 weeks or more and out.of touch with any instruction of any kind. The emphasis should be placed on the training of those men. BRIG GENERAL DE ITITT: It seems to me that we have to approach this from the standpoint of available personnel and the problem is for somebody in the Surgeon General's office 179 to decide what the maximum number of troops is that we can put on board ship without a medical officer, and then for us to meet that problem and that problem is training personnel.- how we have in service excellent technician schools. Wo are turning out surgeon technicians, medical technicians, pharmacy technicians and laboratory technicians, but what wo need is some man with all those qualifications and wo haven’t got him. If we are going to moot this thing intelligently we’ve got to train these men. Certainly the training will have to extend much longer than it does at the present time, I think we can meet that problem, LT COLONEL FARR; May we make this recommendation from the conference to the Surgeon General - that a school be established or that qualified men be trained. The exact dividing line will have to be decided at a later time, COLONEL MELTON: I am afraid that we are giving the impression to public health that we don’t have any trained men. Commander Terwilleger has said something about the train- ing that is taking place with the Maritime Commission, and these men are likely to substitute for some of the men that we are trying to train, I am highly in favor of the school, but that is a four months course, what are we going to do in the next four months? COMMANDER TERMILLEGER; Mr. Chairman, as far back as a year ago the Public Health Department in cooperation with Mar Ship- ping established a school at Sheepshead Bay, There is a Mari- time Training Station there for the sole purpose of training what we call hospital foremen. We train from pharmacist mate to hospital foreman purposely, because pharmacist mate is a hangover from the old horse and buggy days from which we carry with us the idea that pharmacist mate is an assistant to a doctor or a man who is entirely confined to a pharmacy and dispensing medication under the, medical officers advice. Therefore, we chose the name for our graduates from that school, the’Hospital Foremen, because their training went beyond the so-called pharmacist mate. 180 The requirements for those non is rather high. 1/e sot an I.Q. test for then during their indoctrination which compares to tho IQ. required for a boy entering a radio school or any of the special training divisions of War Shipping. A lot of those non have had medical background. They have boon boys who st rted in pro-medical school and because of tho urgency of manpower or financial reasons after two or three years have had to change their course. Thy want to serve thoir country and have enrolled in our hospital course school. Briefly those are the prorequisits. The course in training is 25 weeks and during that 25 weeks they are given an introduction into the basic sciences of medi- cine, courses in anatomy, phusiilogy, chemistry. Tib keep in mind at all times that we are not training professors, that wo are not training medical men, that is physicians, but wo are training so-called medically trained technicians, a group of men which here in tho States of New York and New Jersey en- joy a license to render first aid under tho rules and regu- lations of the States of New York and Now Jersey. According to the standards of the Navy, they to recognized by tho Navy as qualified men to render advanced first aid, medication, treating of minor surgery, treating of traumatic injuries, etc. In addition to medic .tion, these men are given practical experience in actual bedside nursing, they are given practical experience in operating rooms as far as a trained attendant should go, treating wounds, dressing, giving hyperdermic, intravonus therapy and last but not least, trained to complete innoculations for immunization which should be carried on while these men are in transportation. It is our plan that everybody should bo working on it to have it in the very near future, I think by the very first of January. We have m de sep .rate rules and guide books for these men which they take aboard the ships. It is parallel to our Ships’ Medicine, but is written in turninology which these men can interpret "aid in which we also give them a guide as to just how far they can go. They are not surgeons. They are not to go beyond their range and there are limitations. Our guide book of instructions tells us whet their duties ire and what their relationships are to other officers aboard the ship. Then the second largest group, the care of sick and wounded aboard our ships. The course is 25 weeks. To date wo have graduated over 800 men and we are graduating approximately 50 a week, ae, . hope to run this number up to 4500. 181 In addition to the hospital training they take anothor month in the Sheepshead Clunk’s School, There they learn the routing of a ship’s clurk. This was done by the request of almost all of the shipping companies because a liberty ship operating in war times, has very little work for ship's clerk. He might be busy two hours per day, but on the long run, he has nothing to do in the meantime. Space in the liberty ship is scarce and we don’t want to increase the complement of the ship unnecessarily. The minute you increase the complement of a ship, you increase the demand for lifeboats and if you increase the demand for lifobouts on one side of the ship you have to duplicate it on the other side. If you put on one extra man, sometimes it means putting on two extra lifeboats. So wo have started this combined course. LT COLONEL FARR; You say you are going to put this on all id.S.A. vessels, 'That will their relationship bo to Military Personnel if and when Military Personnel are carried on that ship? Mill it be acceptable for them to replace medical personnel of the Army? COMDR. TERWILLEGER; They would replace medical personnel of the Army to the point that they would replace a trained attendant in the Army, but they won’t replace a medical officer of the Army, We would be very happy at any time to cooperate with Army personnel that needed medical or surgical care. LT COLONEL FARR; I think that is something that is going to be of immense value not only in pattern, but from the standpoint of actual health. You are primarily interested on conserving doctor personnel; you feel that this conference should go on record as recommending steps be- taken to got such typo of enlisted person- nel for you, LT COLONEL PADDEN; It boils down specifically to a personnel matter. It is a planning and operational matter, I am primarily concerned -with the non-availability of doctors. There will be no alternative. Somewhere, somehow, we have got cut. We know- it is not desirable, but we are faced with the pro- position of reducing doctors. As I mentioned yesterday, it is so serious that consideration has been given to recommending the re- moval of the second doctor from a combat battalion on the front lino, that means men in combat with one doctor. That is the 182 reason we brought it up. It is being considered by every- body in the Surgeon General’s Office to arrive at some reasonable figure as to hoi/ many doctors v/o can use. This same question has been brought up repeatedly. The medical technicians weren’t broadly trained raid that thwy couldn’t step in. We admit, all of us, that v/o have excellent medical technicians, surgeon technicians, but they arc specialists. LT COLONEL FARR: I believe that all our Port Surgeons agree that it is possible to replace doctors on these small vessels. I would like to be sure of that and see if anyone disagrees. LT COLONEL WHITE: There is one thing I would like to bring out. What would be the minimum number aboard a freighter with which v/o would have to supply a trained technician? Wo send a lot of freighters out with 5, 10, and 12 enlisted men on board. COMDR. TERW'ILLEGER; In the Navy in peacetime if you have 40 or more men on board ship or even 5 or 10 men, whether that number be military personnel or whatever, they have to carry some form of medical aid on board. To date wo have over *** men assigned to sea duty with the ******** Lino, the ******** Line, the ********, and the ********, 60% of the lines operat- ing out of the Port of New York and we are beginning to get back what v/o call ’’fan mail”, No are getting very good reports on these men to date on work that they have done. Nov/ in sotting up a school for the Army, I would like to make one suggestion. In preparing your courses, don’t try to make professors out of those men, of the men ill at sea need good nursing care. They need to be made comfortable, proper diet, if necessary, men should be given proper nursing pare until their return to their home ports. 90% of these men will make excellent recoveries, but in training the young non, and these boys arc young men, you alv/ays have to tone then down because they wont to do things dramatically. If you im- press them with the idea of passing on the milk of human kind- ness to their sick buddies, it does a groat deal on board ships to build up morale. 183 COLONEL MELTON; I know this training, has boon taking placo hero for some- ti.no. I want to suggest that we ask Commander T’orwillogor1 s training section to supply ur train- ing section with their program, which night bo a help. Of course there are more or loss specialists. I would like to go on record as asking Commander Torwillcger to send to each Port Surgeon this book of instructions that they had issued for each ship. Tic can use that in compiling our instructions for any of our technicians that we nay want to put on these ships. Now their training is 25 weeks. Ours is presumed to bo not In ss than 12. Is that right? BRIGADIER GENERAL DE VJITT: Yes. COLONEL MELTON:, . I an sure that in 25 weeks those non can bo trained to look after ordinary illness on board ship whether it be military or naval. I would like to see a number established as a solution to this particular problem. There arc too many factors involved and I’m afraid that the res- ponsibility of our Surgeon General toward protecting the lives of our troops will bo hazarded under certain circumstances-. I fool that the decision of adequately trained nodical techni- cians or a doctor on board any given ship must bo weighed out in each individual case and that responsibility can bo- settled. Probably in the port, further they are reluctant to see troops of 100, lot us say, ship anywhere over any period of tine with- out the services of a doctor. Now 500 non can be shipped from Now York to England in **** days and run no risk. 100 men from San Francisco to India may got into all sorts of trouble. I think you have to weigh the physical condition of those troops at the time of their clearance. The season of the year must be considered, a prcvilonce of respiratory diseases and all that sort of thing. Now if of the 100 men you- send out, fifty got very sick and ten die, the Surgeon General is -;oing to back to our people and he will say that he has made adequate pro- vision for the protection of their health. Tie have heard' the subject• mentioned of taking calculated risks. I think we must carefully calculate our risks. Also I would like to see some studies made with reference to the matter of taking out our calculated risks in the transportation of troops on trains into zones on interior. 184 There we have a network of -medical facilities, there the time factor is very much shorter; and there at pres- ent, judging from my own experience, we also have a large num- ber of surgeons constantly tied up traveling all.ever the country. There I think that we can take cur risk and one way or ether cave those surgeon manhours and devote them to the ports where those questionable coverages could be made to any body of troops, from 100 men up, depending again on the length of the run, the physical conditions of the troops and th: season of the year. I would again like to repeat that I am reluctant to soe troops at sea in any number without the services of a doctor. I think coverage can be made at the same time not run- ning against the requirements and the inevitable circumstances' with v;hich Col, Padan has stated on tho matter of furnishing doctors. I realize that that whole subject is complicated, but I would like tc have it go on the record and hate to see an -r- -bitary picture sot up, LT COLONEL FARR: With reference to the minimum number of men that could go cut on a boat or ship "without medical attendance of any kind, wc have ha 4 a conference with Colonel Fitzpatrick who loans on 250 as a dividing line. COMDR IWILLERGER: The only satisfactory solution would be tc put a doctor on each ship. That is impossible. The problem will have to bo met by compromise and all wc ape going to decide is the level of the ccmpr Wise. I would like to say also that the Port Surgeons have small operating services and have had made available to them the staffs of exports on service commands. I might state that these surgical, medical, and sanitary con- sul tants are there for the purpose of helping the Commanding Officers of the station hospitals tc solve their professional problems along those particular lines within that scrvic com- mand, In this particular event, after suitable arrangements have boon made between the Port Commander .and- the Surgeon and the Commanding General of the Service Command, these consultants can be made available tc the Port Commander. I believe that any report that these consultants make shei’ld bo. sent tc tho Port Commander for his information. Naturally, it can go to the Port Surgeon. LT COLONEL FARR: ' • That is the understanding that General Kirk and General Wylie had last week - that it should be made available to the port commandors. 185 I think it will be very helpful to the Ports, I know that some of them have already made some arrangements quite successful, others have not. We would like to have you go ahead locally with those arrangements. I think we ought to finish up what we were doing, that is, in the matter of personnel other than doctors on the small vessel. I think that we are all agreed now that it is practicable, not desirable, but probably will have to be done- I am wondering if there is any further' action to be taken by this conference in covering that particular point. Colonel Schwichtenberg, do you feel that we should make recommendation as to the size - should we leave that up to the Surgeon General's Office after they have explored the possibilities of furnishing capable personnel? COLONEL SCHWICHTENBERGi I believe that General Bliss’ idea was that we should get some expression of opinion of the Port Surgeon as to what should be done. I believe that you already have that in those reports that you got from most of thorn last night. Anything you have done is going to be pre- dicated upon the absolute non-availability of officers. That is something that we just cannot got around, LT COLONEL FARR: We do have from at least two Port Surgeons on record here, their recommendations, which Colonel Bradish has made. Is there anyone else who would like to make his recommendation at this time? If not we can drop this matter as having been covered, LT COLONEL LUNDEBERG: May I say as an outsider, that since 6 months training will turn out 4500 men, why can’t we use. some of those mon? LT COLONEL FARR: I have an idea that the War Shipp- ing Administration could train these men for vessel work for their own art! not lend them to the Army, COMMANDER TERWILLEGER s I think, the only way wo could help out is purely in an advisory capacity, you have a lot of technicalities involved. First of all, those men who are trained by War Shipping funds would have to be placed on War Shipping vessels operated by War Shipping Administration, X86 I’m. afraid that you night subject yourselves to severe criticism if these men were to go on boats other than those operated by the liar Shipping Administration. If wo can help in starting up your school in any way or lend any of these non as a training project, I think that would be alright. LT COLONEL FARR: He is not going to give away person- ae 1 unnecos sarily. LT COLONEL PADAN: Lhat I meant, Llr. Chairman, was if the ship was one not staffed by War Shipping personnel. Indian it is a question of a foreign crow or a ship on a charter, then assigning these night be criticized, lie are operating solely under WSA shipping, LT COLONEL KARR: That was my understanding. LT COLONEL PADAN: I would like to make another re- mark here. The thing that wo want to arrive at primarily is a policy that the Surgeon General of the Army recommend, with a statement that if doctors were available, thit would be from casuals going overseas or from rotating personnel coming back, that those should be utilized, lihat wo are talking about now is a certain fixed minimum that we know that wo would have to pro- vide taking no chance. These 50$ chances that a lot of the boats going out have a certain number, that casual doctors might bo placed on the boat - what we are talking about is the absolute fixed minimum number of doctors we must provide, the same with the number of enlisted personnel. Then another problem comes up that some of these boats don’t carry people :d 1 the time. Some- times they carry freight end some ti.ies they carry passengers, lie have to know for planning purposes the maximum number of doctors that wo will provide the COT, and ho'will have to use them in accordance with the procedure established. ,ld system which presumably goes back to the river boat days, whereby all longshore- men labor is recruited from a pool of colored laborers longshoremen. By the way, stevedores are very touch about bein>; called longshoremen* There is a difference. A .stevedore is a man 194 who contracts for the labor and furnishes the equipment for the unloading of vessels. ,Longshoremen are the laborers. That pool involves over 4,000 colored laborers -- the foreman whom the stevedore contracts for a gang, picks up his laborers end he usually has nearly the sane group. But the sane gang doesn’t necessarily work on the sane vessel a t any given installation. They nay bring different gangs to the army piers on every dif- ferent occasion, because they’re always slinging jobs all up and down the waterfront for commercial vessels and otherwise. Now the question is, is it safe to allow these longshoremen, if it is not practicable to vaccinate then, to handle the ”B" bags out of the hold? Then the question is raised why isn’t it practicable to vaccinate then, other than because of the numbers involved, which is very considerable, and we still can never bo sure we have got then all. There seems to be a peculiar psychology involved the minute you start requiring a vaccina- tion of that type of labor, which is strongly unionized. It may be considered performing extra hazardous work and the factor of time and a half cones in just as it does in the natter of loading ammunition. The stevedores feel that they will be badly handicapped in the inability to persuade the colored laborers to take the vaccination, and it nay bo that they won’t join the gangs when we need to 'go out there in the unloading operations. Probably the solution lies in attempting to im- munize a company out of a port battalion to handle this particu- lar feature. I an curious to know whether any other port has a similar problem, and I would like expressions of opinion as to how likely it is that longshoremen handling baggage would bo infested with lice. LT COLONEL FARR: Colonel Lundcbcrg, do you want to comment on that? LT COLONEL LUNDEBERGj I talked with Colonel Rradish about this last night, I am inclined to beliovc that perhaps they should bo vaccinated. Furthermore, when you consider that wc are pro- bably emphasizing this typhus hazard pretty heavily, I begin to wonder if it is not carrying things a little bet too far, I don’t know enough about the developments to know how much danger there is from those ”B,r bags. Lhat have you to say about that point, Lt, Blanton? LT BLANTON: The first question that comes to my mind is how long arc those bags in that hold before the personnel handles it? 195 LT COLONEL LUNDEBERG: „ From a week to two months, COLONEL BRADISH; On the average the period is shorter than 30 days, and I believe the lice don’t breed within 50 days, LT COLONEL LUNDEBERG; What about the temperature? COLONEL BRADISH: Die temperature is very hot in that area, LT BLANTON: Under those circumstances I ’wouldn’t want to say just what it would be, COLONEL BRADISH; In looking into this thing, there were 16 other classes cf personnel, who have access to these vessels whoc bus- iness requires going on the ships; customs officials, immigra- tion officials, FBI, military intelligence, and sc on down through the list. We can't apparently enforce immigration on those people. It may bo necessary in the end that the Public Health Service will have to set up a Federal requirement for the immunization of those people if the situation is dangerous enough to require: it. LT COLONEL LUNDEBERG; I don't think it will be dangerous enough for that, I do think that with the people in those categories you mention it might bb a voluntary thing and the sorrier btainod fre m the Army, Specifically I don't know how to answer that. Colonel Bradish. I don't knew how lusy these "B" hags arc. Docs any- body know if the "B" bags are pretty lousy? COLONEL MELTON: Gentlemen, wo are back to the louse again. In the New York Port, the hold baggage is handled by the Army Transport Baggage ..action, and all of those men wo recommended they all have typhus innoculations. Vvc also have recommended that the office give innocula.tions to all cf the civilian per- sonnel employed by the Pest Control companies. I believe that is about as far as wc have gene. 196 IJo have recommended that. He./ then, they haven’t all had it, but wo think it would bo wise if they did. I think all the personnel that works with the baggage section of the A.T.S. have boon innoculatcd, but otherwise we haven't done anything further. How our problem is a little different from some of you. Your baggage is on for 30 days, ours is on about taro weeks, which is about time for the louse eggs to hatch out and the lice to be alive when he gets back. But I don't think you have to go too far with that typo of innoculation, COLONEL bCHUILLNINj That’s right, I don’t think there is any great hazard, COLONEL HELTON: I think there is very little hazard - very little danger, LT COLONEL LUNDEBERG: Ido know this, I talked a breat deal with Dr, Dyer of the Public Health Service, and he fools pretty ■well satisfied with the program wo have now and he " ff the record” said that he was not at all worried about the future. TJo have a non-lousy popul rbion in this country and he can’t gut too excited about the introduction of typhus. It may bo simply because we have an undoubtedly excellent vaccine available in adequate quan- tities, It may be now eo are a little bit too prone to put it in everybody who happens to come within smelling distance of a louse, LT COLONEL PARR: The question I would like to raise on that - - we now have a directive out that they will do it when advisable but they won't do too much of it. How about a modification? LT COLONEL LUNDEBERG: How does that read? COLONEL BRADISH: All ,p e man ent personnel a board in con- tact with returning troops and prisoners of war. It is fairly broad. 197 LT COLONEL LUNDEBERG; Now with respect to tv sg who cone in c .mtact witn the prisoners thorns elves COLONEL BILlDIoH: But what constitutes "contact"? Contact with the baggage in the hold is a danger. On the. basis of those I feel I have some moral support at least* LT COLONEL LUNDEBERG; I don’t think that there is anybody here that is wise enough to know what the danger is. LT COLONEL FARR; I have Circular 99 here, ponding the publication of more comprehensive instructions. "The lav non measures for the prevention and control of typhus are prescribed, - a. vaccination; requirements for immunization against typhus are sot forth in Section-111, ,Jl 40-210 and applied to civilian employees of all Army owned ;r bare-beat chartered vessels to the same extent that they apply to military personnel." Then there is a little discussion of that and paragraph 2 "In ad.liti m, all port personnel who may come in contact with lice-infested prisoners-of-war, troops, and other personnel returning from wor- sens will be similarly vaccinated." Now when the more comprehen- sive instructions come out, perhaps we can modify this. LT COLONEL LUNDEBERG: I doubt if they will ever cone out. I think that is plenty broad enough. LT COLONEL F.JiR: Does that cover it? ~;e are running a little bit ever our time; we will stop at 12:30 however; in the event it is going to cause anyone any embarrassment for their future appointments, I am making this announcement• e have a very small number of questions loft, mo )f which wo can’t answer. This is the one wo can’t answer. It would be )f great value to clarify the■situation as regards trm pools of temporary transport personnel, such as that now at Hampton Reads Port of Embarkation. Can such personnel bo used rn other ships than the nies for which they wore originally designated? Can they be used on any short run ships? 198 I think the answer is that they can be, but I have got to chock’ tin t through the personnel people boforu I can give you a definite r.nswur, : LT COLONEL PADnN; . - That is all right; I can give you tho answer on that, LT COLONEL Fine. LT COLONEL R.DANj ii.s long as they are there, they won't be there very long because too much hell has been raised by tho Service Command about them being thero. It was right for the first sixty days but the last 90 was the straw that broke the camel's back. You con use them for anything you want, they wero sent there primarily to aid with the boats, Tho New York Port, as I Oot it, has seen fit to keep those men and to put them to work on the Pert, and send some of tho Port people out. You con use them for anything you want as long as it is for short runs, LT COLONEL FARR: Has a clearly defined policy boon formulated regarding the dininfostation of patients including prisoners of war and their personal and homo baggage prior to departure from the overseas port? I believe that Colonel Lundcborg answered that one yesterday, LT COLONEL LUNDE3ERG: But it did not answer it very sa- tisfactorily because I don't think I know- if there is such a clearly defined policy. LT COLONEL FARR: Can wo have such policy? LT COLONEL LUNDE3ERG: I don't sue why not, wo certainly should have one, LT COLONEL FARR: Uill you make every effort to get one? 199 LT COLONEL LUNDEBERG: Ygs, I will, LT COLONEL FARR: Thank you. Next question - if such disinfestation has boon accomplished, is it felt that it should be repeated routinely upon arrival in the U,3. or just performed in isolated instances where lice are found? There have' been several instances where the ship surgeon - in one case, on a hospital ship, certified there wore not infested individuals on board, but where inspection upon arrival at the hospital showed a few cases which had not been detected aboard ship. LT COLONEL LUNDEBERG; The policy far has been to more or loss put the burden on the poor port surgeon - the Port Com- mander - to not require him to delouse everybody, but delouse only those who need delousing. That brings up the problem, how is he to know who needs deiousing, if we didn’t have some of these in your method of delousing, I suppose a person could be more dog- matic about and say everybody gets?, deloused either aboard or here, or at both places, but it is the feeling with the louse powder and things wo have, that that is not going to be necessary. Everybody in Washington has hesitated to add that, and, of course, that puts mor responsibility on the Port Surgeons who determine who is lousy, I suppose the answer to that has to come through your ship surgeons. Is it possible tj have ship surgeons know those things? COLONEL MELTON: What personnel do you refer to? Pris- oner s-of-war or all persons? LT COLONEL LUNDEBERG: I refer to the soldiers. Prisioners- of-war are pretty well covered. COLONEL MELTON: I think that, prisoners-of-war should all be disinfected and they should all have their baggage disinfect- ed, but for the returning prisoners, when they are notIlousy, it is necessary. Recently we got over throe hundred of a British Field Artillery Regiment and they had their clean, newly pressed uniforms on. If we put their wollen uniforms in there, they would have had a- fit. We inspected then and examined them and found that they had no lice, and wo gave them a critique. We lot them go through. I think you have to use your judgement on that. 200 LT COLONEL LUNDEBERG: I would like some expressed opinion from the Port Surgeons. COLONEL MELTON: I don't see how the Port Surgeon can avoid a certain amount of responsibility* I don’t think wo should have an ironbound rule that everybody should be disinfested, because some people don’t need it. That is my opinion. COLONEL BRiJDISH: You can send the first man aboard as a representative of the Port Surgeon, and the first question that is asked of the Transport Surgeon can be "Has there been any evidence on lice on board of the returning troops?" I think the Transport Surgeon is in an excollant position to know. In the first pi .co he makes a daily inspection of the vessel. In the second place ho conducts the sick call. If you hvo very lousy passengers they are going on sick call because I don’t think an American soldier will go around lousy without trying to do something about it. We have no intention of delousing anybody who isn't lousy. LT /OLONEL LUNDEBERG: I think the attitude of the Surgeon Generali's office is that we prefer to see an occasional loufce or a half of a louse, or three lice, creep through the door, rather than add the enormous burden of dolo sing thousands and thousands of people. The situation is getting better I think. Our weapons .are improving and there is loss concern about the whole thing than there his been in the past. BRIG. GENERAL DE WITT: One other thing in that sane circular you read from (indication to Lt. Col. Farr), it directs all troops will be examined after debark ition for lice and dis- infested, which is absolutely impossible in San Francisco. You have men on the piers suffering from a cold and you can’t examine men on a pier after they hve debarked. I don’t think it is intended to imply that way, but that is the wording of it. LT COLONEL FARR s Returning troops and other personnel are to be carefully inspected, upon debarkation ant. all infested personnel and their bags promptly disinfested. The bedding, cloth- ing, and baggage of such in’ ivic.uals are to be disinfested by appropriate means. 201 BRIGADIER GENERAL DE VJTTs That should ull bo done on the ship before the men debark# LT COLONEL LUHDEB3RG: I think that is the meaning of that. COLONEL MELTON: I think that the term debark could mean while on board or immediately afterwards• LT COLONEL FARR: l/ell, the opening sentence is "upon arrival at the port of debarkation all is oners-of-war will be disinfested. Returning troops and vthcr personnel arc to be carefully inspected." It implies upon arrival, but I don’t think it needs to be taken that way. You didn’t intend it that way, did y;u Col mel Lundeberg? LT COLONEL LUNDSBERG: No sir. That ;;as intended to put the responsibility upon the Pert Surgeon. Eh other ho wants to line them up on a cold pier or to have a.Transport Surgeon on board, a man. so pod that he can take his word, why that is up to him. LT COLONEL .FARR s . T/g have one different topic now in the matter of debarkations. This has come up at Halifax too, and that is, the order )f debarkation, whether you take your / troops off first or whether you take your sick and wounded first. That is the practice of the various ports? How about San Fran- cisco? BRIGADIER GENERAL DE HITT: iit a Joint meet in other day with my medical officers and the .liter Divisi >n, they decided to take the -patients first and stated the order of the evacua- tion: ambulatory, non-mental, mental non-disturbed, litter patients, then the insane and violently insane. Before those, however, I should have said officers and nurses. E'o pet then back to the hospital first. 202 LT COLONEL F..ZR:, ; Hoi/ about Seattle? COLONEL BRECHEIIINj 'No have got the trains there and if they are late, then wo give the Navy or somebody else the right of way and let the troops clear and analyze the situation. It is according to we have got to move, LT COLONEL FARR: How about Los Angelos? LT COLONEL dUITEj [e move the patients off first. On Navy ships through courtesy of a general working agreement, the Navy takes their patients off first, and on Army ships, Amy patients come off first, in the same order as General DeWitt has described, LT COLONEL FARR: Hoi/ about New Orleans? COLONEL BRADISHj Debarkations lust, VJb have to make arrangements with the guard house which receives .all evacuations and requires rather close cooperation with the convoy, ’To have been fooled so many times and wore told the arrival tine and they were !L be- fog intervenes, and we found the personnel tied up in the operation of the convoy and we were very much embarrassed by having them ’wait around sometimes for four hours, ’Te wait until it actually arrives. Then wo give them the hour and it is worked out very nicely, I don’t believe it constitutes any great inconvenience, LT COLONEL FARR: Hoi/ about Charleston? LT COLONEL NIELSON • General debarkation last unless there is a critical case, in which case we do it first, LT COLONEL FARR: How about Hampton Roads? 203 COLONEL LOLHY; Our standard procedure is to dobark patients first according to the individual cases, with the troop movement. If there are Army patients on the sane boat wo arrange by the location of the ship and by arrangement with the Naval debarkation that in the Navy area we take our patients off too, and in an Army area, we take their patients off. LT COLONEL FARR: , How about Boston? MAJOR GORMAN: Jg have attempted to debark both the troops and the patients at the same time. That 'was the purpose of Colonel Rexroad’s question as to how many gangplanks wo could put down, where the various facilities for the ships were located, etc. If that is not possible, wo will evacuate them last, LT COLONEL F;JNRr I think that at Halifax you had a difficult problem of rail, MAJOR GORMAN: Yes, sir, that’s correct. LT COLONEL FARR: How about New York? ✓ LT COLONEL SCHUHMANN: In Now York wo schedule the patients first—that is through troop movement. They will always schedule them first. If there is any delay in the ships and the trains waiting to remove prisoners-of-war and other per- sonnel, we take them last. Ae also use two gangplanks. LT COLONEL FNRR; In other words, the general plan is to debark the patients at the most suitable means to the local, arrangements and cause them the least inconvenience. 204 We have one other question raised that we are not going to have time to discuss, because it is pratically a now subject and one that we can discuss for an hour. That is the matter of custom clearance of returning personnel. We have, working on that, two officers in the Movement Division - one of them an international aid. Major Banks, and Major Griffin also gets into it a little bit. They are trying to work out some reasonable uniform and acceptable procedure for the clearance of personnel through the customs. As our load of returning personnel increases, that possible delay is also increasing and may cause some trouble in the future. We have about reached our slightly overtime time limit and I think it is time to sum up the results of the conference. We covered troop movements and medical problems both, We invited our troop movement officers to attend and participate because of the fact that troop movements and medical responsibilities are very closely allied. We have been very fortunate to have with us Public Health Service representatives, WSA Representatives, and I think yes- terday wo had some British Ministry representatives. It is an opportunity and has been an opportunity for these various services to got together on some of their mutual problems, I am afraid wo haven’t come out with all the answers we would like to have come out with, but I do believe, we have come out with a much better understanding of what some of the problems are. The committee on regulations for Transport Surgeons has been set up. Colonel Schuhmann and Major Quinn are on the committee* I would like to have them work with Colonel Fitzpatrick on this job, and the sooner they, start the better. If you can start the job immediately and I think probably for the convenience of San Francisco, we should start it immediately, so that Major Quinn can be free to go back to work as soon as possible, N BRIG GENERAL DE WITT: Yes, LT COLONEL FARR; Wo will look for you then, shall ■wo say, tomorrow morning? LT COLONEL FITZPATRICK: I think that Colonel Schuhmann sug- gested they prefer to work in New York prior to going to Washington, 205 LT COLONEL FARR; All right, that is acceptable* LT COLONEL SCHUHIOJN: I think we can write the thing up here and then bring it do-vm there for approval. All the Port Surgeons who brought a recent issue of their latest instructions to port Surgeons night leave those with us. LT COLONEL FARR Yes, we asked that yesterday, and if between you and Ha jjr Quinn y m don’t have them. (to tin offi- cers) if have not furnished one to either Colonel Gchuhnann or Major Quinn, please do so following this session. Now y )U have had the minutes of the meeting presented to you each morning. It has been a tremendous job to pot those minutes out so quickly. The girls, as well as the enlisted men involved in this task, heave worked v-ery hard. 'Jo owe them a great deal of thanks for their prompt and efficient handling (if this job. I have been asked by Colonel Dorski that you leave the cover of your notebook here, )r your whole notebook, so that they can bring it completely up to date. The are making sene revisions inihe text and bringing it more up to date, and a complete copy will bo mailed to you. However, if you would liko to take out this part of the minutes, as you have be~n furnished thorn, in order to take them with you, you may do so. Same of the folders have already bo.ni taken hone apparently. Those who have taken them home'have only the first day’s minutes. Jo will be able to furnish additional minutes to supplement those if wo know whoso are missing. But I want to ask y..u to leave either your whole book >r the cover before you go# COLONEL SCEJCHTEN3ERG: I would like to take this -opportunity to thank, in the name of the Surgeon General, the Chief of Transportation for making it possible for representa- tives of the Surgeon General’s Office and myself to bo at this Vwry profitable mooting* 206 LT COLONEL FARR: Thank you. Colonel Scwichtcnbcrg. We ewe a great deal to the Surgeon General for his participation in this conference, without which the meeting would have fallen complete- ly flat. Lieutenant Dowdy and his group have given us very fine service in making arrangements and I am sure we all appreciate everything that they have done. However, wr can’t limit ourselves just to the particular in- dividuals, because the New York Port as a whole has done a tre- mendously fine job in setting up this conference. Hie adminis- trative details that were worked out by Colonel Dorski; the trip that Colonel Fingarson planned; and the trip through the disin- festation plant which Colonel Molten planned - all in all I would say that the New York Port, and we might go farther and say, that all the organizations here in New York, and Commander Terwilloger have all been a great help to us. Dr. Clesen's discussion this morning was cm of the best we have had, and subject he covered was one of particular interest. Dr. Bedet from the Public Health in Washington has been a great help tc us, giving his assistance behind the scones as wefl as at the meeting. I think we have a rising vote of confidence and thanks to the New York Port for the fine Job they did in setting this conference up. (Applause) COLONEL BRECHEMI Jv: Nobody said anything about thanking Colonel Farr. (Applause) COLONEI FARR: Thank you. (The conference adjourned at 12:30) 207