HISTORY OF PREVENTIVE MEDICINE IN THE WESTERN PACIFIC BASE COMMAND This monograph ie being made available in manuscript form pending the completion of the official History of the Medical Department in World War II9 and must be considered as a draft subject to final editing and revision0 Persons finding errors in facts or important omissions should communicate with the - Historical Array Medical Library9 Washington 25, Do C. It is emphasized that all statistical data in this monograph are tentative and subject to revision when tabulation of individtial sick and wounded report cards has been completed. TABLE OF CONTENTS Page Chapter I Introduction 1 Chapter II Clothing , 1 Chapter III Housing 2 Chapter IV Nutrition . 3 Chapter V Personal Hygiene 4 Chapter VI Water Supply 7 Chapter VII Disposal of Waste 17 Chapter VIII Control of Insects 19 Chapter IX Control of Rodents 39 Chapter X Immunization. . 39 Chapter XI Intestinal Infections 41 Chapter XII Infections of the Respiratory Tract and Infections Transmitted by Discharges from the Respiratory Tract 41 Chapter XIII Venereal Diseases . . 41 Chapter XIV Arthropod-Borne Infections 47 Chapter XV Miscellaneous Infections . 57 Chapter XVI Diphtheria 59 Chapter XVII Nutritional Diseases 59 Chapter XVIII Environmental Diseases 59 Chapter XIX Extra-Military Sanitation and Liaison Activities. 61 Chapter XX Civil Public Health ..... 63 List of References 67 WEifelN PACIFIC BASE COMMAND HISTORY OF PREVENTIVE MEDICINE IN THE WESTERN PACIFIC BASE COMMAND CHAPTER I Introduction Headquarters, Western Pacific Base Command, hereinafter referred to as WPBC, was formed from the element of Island Command Saipan on 25 April 1945 pursuant to General Order dated 14 April 1945, Headquarters, U, S. Army Forces, Pacific Ocean Area. WPBC in- cluded roughly the area between 130° to 155° east latitude and from the equator to 30° north longitude, the main islands being Saipan, Tinian, Guam, Iwo Jima, Palau and Peleliu. (See figure 1.) (The writer* re- ported to the Island of Saipan on 28 September 1944 and was assigned Medical Inspector Island Command, baipan and worked in that capacity until WPBC was formed.) At that time, the newly formed AGF, Saipan, did not have an assigned medical inspector and the writer continued to devote most of the time to the Island of Saipan. The following report is based on intimate, personal observation and experience as well as records at Headquarters WPBC. The supporting units assigned to WPBC and under supervision of the Medical Inspector coneisted of a Malaria Survey Detachment, Malaria Control Detachment, a numbered Medical Laboratory, and a sani- tary engineer. All of the AGFs had an assigned Medical Inspector and a sanitary unit varying in size from a platoon to a full company. *The Historical Division, SGO, was unsuccessful in finding the name of the writer of this report. CHAPTER II Clothing The clothing allowance in this area was in compliance with Basic Authorized Allowance of Outer Clothing for Enlisted Men in Central Pacific Base Command, contained in Administrative order $1, Headquarters, CPBC, dated 20 March 1945, Index CPYQM-114.20, This allowance consisted mainly of three (3) sets cotton khaki clothing, three (3) herringbone twill, six (6) pair stockings, five (5) pair shorts, five (5) undershirts, and two (2) pair shoes. This clothing proved to be adequate. Working details were allowed to work with shirts removed due to the climatic con- ditions . 1 CHAPTER III Housing Housing was generally uniform and was at all times adequate and consistent with the general development of the islands. In the early phases pup tents were used for a short time as were some of 4the remaining civilian buildings.! Following the pup tent phase, pyra- midal tents were used, housing four officers and six to eight enlisted men per tent.2 Wooden floors were provided for the pyramidal tents as lumber became available. Construction of prefabricated buildings and Quonset huts for the housing of troops was begun as soon as materials were available and the program progressed rapidly until practically all troops were in semipermanent buildings. The allocation of space in the semipermanent buildings was 48 square feet for enlisted men and 80 to 320 square feet per officer .3 Originally, all hospitals consisted of ward tents with wooden or coral floors and floored and screened operating rooms. Semipermanent construction was begun at an early date and the progress was in con- formity with general development on the islands. Messes and kitchens .—Improvised screened kitchens were used until semipermanent construction could be accomplished. All of the kitchens had concrete floors with adequate drains and some of the com- bined kitchens and mess halls had complete concrete floors . (See figure 2.) 2 A Standard Kitchen Standard Mess Hall Figure 2 CHAPTER IV Nutrition During the assault phase9 K and C rations were used and the B ration issued as soon as units were provided with fly-proof kitchens even though they were of a makeshift varietyThe amount of fresh food as a supplement to the B ration varied some but the island of Saipan generally was representative of the fresh food issued0 Saipan received its first shipment of fresh food on D plus 136 and during the period from June 1$ to December 31, 1944 had received the equiva- lent of about ten days of fresh food per man05 This fresh food supplement consisted of fruits9 meat3 vege- tables 9 butter9 and eggsQ Following this period9 fresh food was con- stantly available and at least one fresh food meal a day was servedo There was no evidence of nutritional disease but there was a uniform weight loss of the commando6 The consumption of food including dairy products9 as well as fruits and vegetables that would not necessarily be cooked before eating was prohibited until definite control could be establishedo^ The islands gradually took advantage of the fresh vegetables9 and fruits that were available from native and Foreign Economic Administration sources0 On Saipan fresh fish were accepted from native fisherman beginning in June 1945 and an average of forty tons of fish was issued per Fish available consisted of bonita and mackerel and the processing was closely supervised0 Fish were iced as soon as they were cleaned9 and re-iced upon arrival at the pier0 Fresh fruit and vegetables produced under FEA supervision were accepted for Quartermaster issue and the supply was adequate0 Ice cream manufactured from standard ice cream mixture was a welcome addi- tion to the menuo It was manufactured both by individual units and centralized ice cream plants0 On the island of Saipan a central system was in operation and the issue which began in February 1945 was grad- ually increased until it was issued once a week to general troops and four times per week to the hospital.9 The quartermaster bakery began functioning early and constantly furnished a good bread for all troops. Several moderately severe food poisonings were experiencedf but none were of particular interest0 All of these occurrences were investigated and all found to be due to the faulty handling of food fol- lowing preparation and none due to food being defective at the time of issue o 3 CHAPTER V Personal Hygiene Personal hygiene in general was very satisfactory and the health of the command was excellent, (See tables 1, and 2.) Fungus infections were rather numerous but considering the climatic conditions in the area, were not an unreasonable number. Bath- ing facilities varied considerably and gradually progressed from the use of steel helmets to standard semipermanent showers, (See figure 3«) In the early phase, many improvised showers were constructed with the use of 55 gallon drums and rain water was plentiful. As the water supply was developed, there was always an adequate amount of chlorinated, unfiltered water for shower purposes in addition to the completely pro- cessed water which included chlorination and filtration. 4 Standard Washroom & Shower Standard Latrine Figure 3 TABLE 1.—Diseases (1944) Saipan (APO E44) No, of Cases Rate per 1000 per Annum September 4,153 1393.26 October 559 215,74 November 253 86.55 December 262 65,42 TABLE 2o--Diseases (1945) W. P0 B. C, No. of Cases *Rate Saipan (APO 244) No, of Cases *Rate January 456 39.90 202 61,07 February •* 608 51.10 298 81.19 March 725 47.68 387 79.21 April 960 72018 294 78.33 May 1176 86,45 331 88,79 June 1744 101,39 548 114.84 July 1704 123,80 516 148.90 *Rate: (per thousand per annum) 5 CHAPTER VI Water Supply SAIPAN10j11#12 a0 Topography.--Saipan is roughly H l/2 miles long by 3 l/2 miles wide (See Topographic map Jo12 It is extremely hilly throughout, with a peak of 1500 feet elevation in the center0 There are flat areas at the north and south ends, and along the west coast at the Kagman Point peninsula* b* Geology*--Ground structure consists principally of a shallow earth overlay over coral, with lesser areas of red clay and volcanic rock* Cavernous ledges abound * Co Rainfallo“-Annual rainfall averages eighty (SO) inches, falling chiefly from July to November. do Sources of waters (1) The only perennial surface water on the island was Lake Susupe, too saline to be used as a source of potable water supply® There were no streams, due to the porosity of the coral ground structure. (2) The Japanese utilized springs, shallow wells, and roof run-off as sources of water® Several springs developed by them became part of the island water supply. Many of their shallow wells were used at the civilian internment camp® In areas removed from springs and wells, concrete cisterns for stor- age of rainwater were provided® Rainfall was col- lected from one of their flight strips by gutters and stored in underground reservoirs. (3) After the TJ0 S0 invasion, Japanese sources were utilized after purification, and the drilling of deep wells was begun® Distribution points were provided with elevated storage in wood-stave tanks, and the installation of mains was begun, to de- crease haulage by trucks0 Japanese reservoirs and pipe lines were used wherever possible® (4.) Excellent deep wells were drilled at Isely Field and Chacha soon after invasion, and their number was increased steadily with the development of the island9s facilities® One year after invasion, thirty (30) drilled wells were in service® They 7 varied in depth from 50 to 4.00 feet® All were equipped with turbine-type deep-well pumps, gaso- line engine driven, of 30, 60, and 200 gallons per minute (gpm) rated capacity0 Water from the deep drilled wells was generally of excellent bacteriological quality, but hard, It was struck in three different geological formations: (a) At sea level, when a layer of basal fresh water floats on salt waterc (b) In an artesian stratum considerably below sea level. (c) Perched several hundred feet above sea level. Basal water at sea level was subject to salt water intrusion if the draught was excessive; safe draught was determined by experience0 Deep wells in certain areas yielded brackish water under any appreciable draughto These were used as sources of non-potable water for washing and bathing. (5) Many former Japanese wells were used, plus several newly dug onesB They invariably yielded water of high salinity because of their proximity to the ocean, due to the mixing of the fresh water layer and the underlying salt water caused by tidal fluctuations in water level. (6) Springs.—Eight springs were developed by U. S0 troops, seven of which were used as sources of potable water; one was non-potable because of its salinity, AH springs showed appreciable bacteriological contami- nation in spite of proper construction to exclude surface water, (7) Infiltration tunnels„“-Three infiltration tunnels were started in the spring of 19450 They consist of horizontal unlined tunnels in coral at sea level, de- signed to skim the layer of fresh water floating on salt water.One was abandoned early, another did not develop any appreciable supply of water while the third was successfully completed in July 1945. It was 400 feet in length and yielded 204 million gallons per day (gpd) of excellent water, low in salin- ity, An adjustable weir was provided at the pump sump to control the depth of skimming, to prevent the in- trusion of brackish water. 8 (8) Roof catchments.--Two extensive roof areas were fitted with gutters9 piping9 and storage to col- lect rain water for non-po\able uses0 The larger installation comprised 13 acres of roof area? and supplied a QM laundry during rainy weather. The other installation had a roof area of four acres. No data are available as to their annual yield. Obviously9 it was impractical to provide sufficient storage to hold torrential downpours of any dura- tion so but a part of the annual rainfall could be collected. Small roof catchments were installed by various units in several instances to augment their supply from the main island water supply. (9) The following table summarizes the capacity of the various types of sources® \ Number of Sources Capacity gallons per day Potable water Springs 7 Shallow wells 0 Deep wells 18 Infiltration Tunnel* 1 270,000 0 1,890,000 2^8^000 TOTAL 26 4-,608,000 Non-Potable water Springs Shallow wells Deep wells Roof catchments 2 13 12 160,000 1,322,000 772,000 No data TOTAL 29 2,254-,000 Total. All Sources: Springs 9 Shallow wells 13 Deep wells 30 Roof catchments 3 Infiltration Tunnel* 1 4.30,000 1,322,000 2,662,000 No data 2.U8.000 56 6,862,000 Completed but not placed in service. e. Distribution of water.--Since occupation of the island, water mains were continually extended to supply all heavily populated areas with piped water, (See map of distribution system*)1^ (1) Approximately two-thirds of all water consumed was piped from the source to the points of consumption, and one-third hauled by tank trucks from distribu- tion pointso There were seven distribution points for potable water and two for non-potable water® (2) Rationing®Minimum allowances of water were estab- lished as follows 20 January 194-5:14 (a) Five gallons per person daily. (b) Hospital patients, 30 gallons per patient daily. (c) Units having their own supply of non-potable water were allowed 5 gallons per man daily of potable water® Non-potable water was available in practically un- limited quantitieso On 22 February the allowance was increased to 10 gallons per man per day,14 but in June 194-5 it was reduced to 8 gallons per man daily® None of the army hospitals had adequate water supply to permit the use of installed flush toilets. (3) Storage®—=Storage reservoirs of 1$025 million gal- lons total capacity were a part of the water distri- bution systemo This figure does Hot include innum- erable small tanks in unit areas® 13°0 million gal- lons of storage were provided in underground reser- voirs constructed by the Japanese, and 2®25 million gallons in wood-stave tanks above ground erected by Uo So troopso Two reservoirs of 1106 million gal- lons total capacity were used exclusively to supply ships. (4-) Many of the first laid water mains were of wood- stave pipe® It proved because of continued leakage, and was systematically replaced® Some Japanese transits mains were used after occu- pation by U, S0 troops9 but they failed under the pressures imposed upon them by U0 S® pumping instal- lations® One stretch of 10” Jap transits main had to be replaced because of failure of the cast-steel couplings. One year after invasion, the central water distribution system consisted of the following lengths of mains: 10 A* steel and cast iron 6.1 mi 6" steel and cast iron 6,75 mi 12" steel and cast iron 0,6 mi 8" Transit© 3o3 mi 12” Transit© 1.25 mi 4.” Wood-stave 1.65 mi 6” Wood-stav© 2o00 mi 8" Wood-stave 2o00 mi 12" Wood-stave 1*0 mi TOTAL 24.065 mi In addition, the following lengths of Installed wood- stave mains were not in services 6 inches, 1 l/2 miles; 8 inches, 13/4 miles; 12 inches, 6 l/2 miles, (5) Pumpso““All pumping units were driven by gasoline engines and after long use presented serious main- tenance difficulties due to lack of spare units and partso f0 Water Consumption “~By mid-1945, average daily water con- sumption was as follows: Total G.PoDe Potable Water 1,550,000 680:000 Non-Potable Water TOTAL 2^230^000 This was roughly equivalent to 14 gallons per day of potable water and 7 gallons per day of non-potable water per man, exclusive of hospital patientso go Quality of waterImmedlately after invasion, routine tests were made for heavy metals and poisons, but were discontinued after conditions indicated they were no longer necessary* Routine bacteriological examinations were made of all potable waterso Until August 194-5 samples were collected by the units operating the various components of the water supply, and examinations were made by a general hospital laboratoryQ In August 1945, when opera- * tion of the Island water supply was taken over by the Navy, collection ' and examination of water Samples were made by a Naval epidemiology laboratory* There were no outbreaks of water-borne diseases0 11 Bacteriological quality of potable waters was generally satisfactory0 Hardness of waters ranged from 200 to 450 parts per mil- lion (ppm), Salinity of potable waters did not exceed 30 grains per gallon of NaCl except in a few instances• h0 deep-well waters were chlorinated regularly to maintain a minimum residual of 1.0 ppm at the source0 Be- cause of the use of wood tanks and mains, and because of varying volumes in storage, chlorine residuals were not always present at points of use. Potable spring waters were always treated by coagulation, filtration, and chlorination, in four treatment installations * Port- able and mobile Corps of Engineers equipment was in use continually. Later a Navy knock-down type rapid sand filter was installed at one source. A concrete rapid sand filter was constructed at another source0 Only two of four filtration installations provided sedimentation prior to fil- tration, as required in areas where amoebic dysentery was prevalent, Non-potable water for showers and washing was required to have a residual chlorine content of 3o0 parts per million after 30 min- utes contact.Two distributing points on the central island water supply system provided no such treatment, but relied upon the consuming units to apply chlorine manually. Four unit sources provided no such treatment. Corps of Engineers mechanical equipment for filtration and chlorination was difficult to maintain because of lack of spare units and parts. Three gas type chlorinators, recently installed, eliminated much of this difficulty, i. Summary,--In spite of operational difficulties due to lack of equipment, spare units, and spare parts, water supply at this island was adequate in volume for minimum needs except in temporary, isolated cases. Absence of outbreaks of water-borne diseases speaks for its quality. TINIAN17 a. This island, about 40 square miles in area, is unlike its neighbor, Saipan, in that its topography is rolling, with no precipitous slopes except at the shore. Like Saipan, the ground structure is largely coral, be The only body of surface water was Hagoi Lake, with its surface about two feet above sea level. It was grossly contaminated, and brackish, and was used as a source of non-potable water for laundry and washing uses, (1) An excellent source of potable water supply existed in the Marpo Valley, an extensive sink-hole with its 12 floor just above sea level0 Here basal fresh water, floating on salt water, was almost at ground level. A Japanese installation consisting of a con- crete “lined dug well 30 feet in diameter and 10 feet deep, pumping station with duplicate Diesel driven pumps each of 1100 gmp capacity, and a 97,000 gallon concrete storage reservoir, was early put in use by Uo So troopso It yields 5v2,000 gpd of water of 145=165 ppm chloride contento At Tiniantown, a Jap- anese deep dug well was in use, but its yield (20,000 gpd) was smallo (2) Basal fresh water near sea level was drawn from 19 drilled wells by gasoline engine driven turbine-type pumps and stored in wood-stave tanks at roadside distributing points* Pumping rates varied from 15 to 65 gpm. Their water was of excellent bacterio- logical quality and their salinity was lowQ (3) In the Marpo Valley sink-hole, an infiltration gal- lery was constructed*, It was situated at a location ' where ground water level was near the surface and consisted of a long trench with its invert below ground water level0 A double row of perforated steel drums was laid end to end, terminating in a collect- ing sump at one endQ The trench was refilled with crushed stone, and diked and ditched to exclude sur- face waterc Co Distribution*—About one-half of the water consumed was de- livered by tank trucks0 A general piped distribution system was about 75 percent completed0 Piping was steel0 Pressure was approximately 50 pounds per square incho The 97,000 gallon Japanese reservoir mentioned in paragraph 2, b, (l) provided storage* do Water consumption*—The average daily water consumption reached 1,430,000 gpd in July 1945o This was equivalent to 22 gallons per man daily0 effl Quality of water*-Weekly bacteriological samples of wa- ter were examined by the laboratory of a general hospital« Potable water was consistently of excellent qualityQ f0 Treatment*--All water was hypochlorinated* Non-potable water from Hagoi Lake had a minimum residual chlorine content of 1.0 ppm. Potable water averaged 0oB4 PPm residual chlorine at the points of delivery. 13 g0 Summaryo =°“This island was blessed with an ample supply of water of excellent quality, capable of development without any engi- neering difficultieso IWO JIMA18 a0 Water supply was a unique problem here from the start0 Not only were geological conditions unusual, but the concentration of such large numbers of troops on so small an area presented complica- tions O bo At the south end of the island is Mt, Suribachi, a small active volcano0 At the northern end of the island the rough terrain con- sists of volcanic tuffo The central portion of the island is flat, and consists of a fine volcanic sand0 There is no surface water on the is- lando The northerly end of the island exudes steam through fissures in the ground, and latrine pits in certain areas must be ventilated to pre- vent burning of patrons0 Co The Japanese had collected rainfall from the air strip, as at Saipan, and had fitted condensing heads over steam outlets to augment their supply® Drinking water was obtained only from distilla- tion units, the volume produced reaching 75,000 gpdQ To provide water for washing and bathing, wells were drilled and dug0 Several shallow dug wells furnished highly brackish water0 Deep drilled wells, strik- ing water at about 10 feet above sea level, produced water of varying quality except one well which yielded only steam0 The volcanic sand in which they were drilled was excellent protection against surface con- taraination0 do Quality of water0“~All deep well water varied in tempera- ture from 120° F to 180° F, averaging 14-0° F0 No deep well water was potable, for varying reasons0 In some, chloride content was too high, all had excessive iron and silica contents, one had a magnesium content of 70 ppm, and one contained 1,7 ppm of hydrogen sulfide. Aeration for cooling formed "red water," or iron hydroxide® All were bacteriologi- cally excellent, due either to the nature of the soil or to the high tem- perature of the ground water, ec Treatment®°“Distilled water was treated with lime to elim- inate its corrosive qualities0 All water was chlorinated® Drinking water had a residual chlorine content of 105 to 2o0 ppm at the point of distribution Deep well water was aerated to reduce its temperature, and chlorinated. Residual chlorine content averaged 0o5 ppm at points of use0 Two filter plants were constructed for removal of iron from deep wellso f0 Distribution® (1) At first9 all distribution was by tank trucks0 A distribution system for supplying well water to all units was 75 percent completed by August, 1945o (2) Water was rationed as follows? (a) Drinking water: 3 gallons per man daily® (b) High quality non=potable water (deep wells): 3 gallons per man used for culinary purposes and washing mess gear® (c) Brackish water: Unlimited distribution® (3) Deep well pumps presented a unique problem® Tur- bine type pumps, of 30 gmp capacity, operated satis- factorily, but reciprocating pumps could not be used because of failure of plunger washers at the prevailing high temperature of water® Field impro- visation of substitute material finally solved the problem® 15 CHAPTER VII Disposal of Waste Human0—The straddle trench latrines were replaced with standard latrine boxes which were for a time without a protective house0 As lumber became available9 standard semipermanent latrines were con- structedo Fly control was effected by the use of sodium arsenite in the early phases of operation but due to the possibility of contaminating the water supply9 this was discontinued and the standard latrine oil mix- ture was usedo PDB (paradichlorbenzene) was later available and proved most satisfactory for latrine fly controlo (See memorandum PDBC) Some few installations including the hospitals have water-borne sewage sys- tems but the deep pit latrine was in general the standard0 (See figure 4o) The water-borne system consisted of a septic tank from which the untreated effluent was piped to the sea0 TrashCombustible trash was burned either in unit areas or centralized trash dumps9 while the noncombustible trash was either dis- posed of at sea or authorized trash dumps which were controlled and covered with dirt to prevent fly and mosquito breedinga (See figure U and Memorandum No0 60) Garbageo—The system of garbage disposal varied considerably, but three main disposal methods were used0 The sanitary fill was used when other methods of disposal were not practical0 The second method consisted of disposal at sea by use of a barge to take the garbage be- yond the reefo The third and most desirable method was disposal direct- ly into the sea from the shore0 (See figure 4.0) This method was de- pendent upon having an adequate current in order to carry the garbage out to sea0 The system used in this area for direct disposal at sea along with the method of washing and steam cleaning garbage cans has been previously reported03-9,20 Shower water0—Shower water was disposed of by use of standard soakage pit which consisted of a rock-filled pit with a ventilator and a cover of earth0 Kitchen waste water0—The disposal of kitchen liquid waste pre- sented a problem due to coral formation and difficulty in digging ade- quate soakage pitsD The system used generally consisted of an improvised grease trap usually made out of 55 gallon drums and a soakage pitc (See figure 5o) When a semipermanent camp was occupied for a considerable period of the kitchen and mess tended to become a problem due to the spilling of waste water on the ground0 Most kitchen liquid wastes contained some food as did the water used for washing of mess gear and over a period of time ground contamination was inevitable and fly breed- ing became a problem0 A concrete deck 15 by 20 with a 6 inch lip5 17 adequate slopef and a drain9 would have prevented this ground contamina- tion0 This deck is of adequate size to contain the garbage one or two sets of cans for mess kit laundry9 and can be used for washing pots and pans if the kitchen facilities were not adequate for this purpose. (See Memorandum and figure 6.) 18 MEMORANDUM) NUMBER 73 ) 10 October 1944 PARADICHLORBENZENE lo PDB* Paradichlorbenzene is now available and will be used for latrine fly control and for its deodorant effecto a volatile white crystaline is convenient to use and is extremely effective in fly controlo It will be used in place of all other chemicals and latrine sprayso 20 The effectiveness of PDB is due to the formations of gas0 Too weak a concentration is not effective and too high a concentration is irritating to the skin0 The following precautions are necessary0 a0 Dirt must be kept around base of latrine box to prevent the escape of gasQ b0 Latrine box must be made as air tight as possible by seal- ing large cracks and knot holes and by maintaining well fitting seat covers0 Co Ventilators and fly trap vents must be closed« 3o The amount of PDB necessary will vary somewhat with the depth of the pit and the following is the recommended amount to be used. Three (3) ounces of PDB per latrine hole twice a week0 In a standard eight (8) hole latrine the amount necessary twice a week (24, ounces) is equivalent to the contents of a #2 l/2 can. PDB should be uniformly sprinkled over the base of the pit* and the lumps should be broken upQ 4,0 PDB will be issued by Quartermaster on the basis of fifteen (15) pounds per 100 men per month and battalions or larger units will draw in lots of 200 pounds in the original container0 Smaller units will draw their monthly requirement and will supply a suitable container0 5o Since PDB is perishable it must be properly stored in a suitable container to assure dryness and prevent the escape of gas. By command of Major General JARMANs G9 Mo 0 ‘CONNELL Colonel, G0S0C® Chief of Staff OFFICIAL: R0 0o DANIELSON, Captain, Adjutant General’s Department Assistant Adjutant Generalo DISTRIBUTION:*E* HEADQUARTERS ISLAND COMMAND SAIPAN MEMORANDUM) NUMBER 6) 12 January 194-5 TRASH DUMPS AND GARBAGE DUMPS 10 The following directive rescinds all previous memorandums and directives published on this subject, 2, Five authorized trash dumps and three garbage dumps have been established on this Island. Dumping of trash and garbage will be con- fined to these dumps0 All organizations will haul their waste to the most readily accessible dumps to their camp areas regardless of arm or service operating the dumps. Approved trash and garbage dumps are located as follows: a, Trash Dumps: NOo lo TA 227-T&Y & TA 228-P&U (S,E, Pier "Btt Tanapag)0 NOo 2. TA 260-M&R (S.Eo of RJ $5). Noc 3o TA 177-S (near C.R, 172)e NOo -4o TA 102 K (West side Nafutan Point)« NOo 5b TA U2-0&J (near RJ05)o bo Garbage Dumps: NOo lo TA 117=M (Agingan Point), No0 2C TA 292-M (Marpi Point), NOo 3o TA 180=X (Rorogattan Point), Co Trash dump No0 5 and garbage dump No0 1 are now in operation Readiness dates for the other dumps will be announced in later Bulletins0 3o Segregation of trash and garbage will be as follows: ac To go to trash dumps: (1) All combustible items of waste0 (2) General debris not otherwise classified. 1 b0 To go to garbage dumps: (1) Liquid garbage. (2) Flattened cans0 (3) Glass and bottles (broken), (4-) Small non-combustible items that will not float in watero Co To go to scrap metal dumps: (1) All scrap metal. 4.0 The attendant on any trash or garbage dump will refuse any loads of waste not properly segregated and report unite 5o Dumping of all waste will be between the hours of 0700 and l600o 60 Operation of Island Trash Dumps0 aQ Trash dumps will be operated on the principle of concen- trated dumping and controlled burningc b0 As part of the responsibility of operating an Island Trash Dump, the Commanding Officer of a unit assigned the operation of a trash dump shall: (1) Be responsible for controlling the burning of trash to insure that all trash is burned and that no fires continue to burn after darko (2) Be responsible for extinguishing all fires in the dumpo (3) Post signs, barriers and take other action con- sidered necessary to prevent dumping of trash ex- cept between the hours of 0700 and 16000 (4-) Have dump attendants make inspections of trash being dumped to prevent any explosives or other unauthorized waste being dumped0 Co Fire fighting equipment, such as pumps and hose with noz- zles, with sufficient capacity to extinguish all fires in the dump prior to night fall will be installed and operated by the unit assigned the operation of the trash dump0 70 Operation of Island Garbage Dumps0 aQ All garbage will be dumped into the oceanQ Only waste as will not float will be dumped at the garbage dumps0 b0 As part of the responsibility of operating an Island Garbage Dump, the Commanding Officer of a unit assigned the operation of a garbage dump shall; (1) Post signs, barriers and take other action con° sidered necessary to prevent dumping of garbage except between the hours of 0700 and 1600* (2) Have dump attendants make inspections of garbage to prevent any combustible waste or other waste that would tend to remain afloat for long periods from being dumped. (3) Keep dump area policed0 Co Boilers, steam lines and water lines provided for cleaning the garbage cans will be operated and maintained by the units assigned the operation of the dumpQ do The washing and steaming of the garbage cans will be the responsibility of the unit dumping0 The unit operating the dump will provide supervision only0 8o Organizations assigned the operation of the various Island Trash Dumps are as follows; Trash Dump No0 lo TA 228»P&U, CO, Naval Base0 “ » NOo 2o TA 260-MR, OinC, 101st N0Bo • » NOo 3o TA 177«S, CO, East Fieldo " « NOo Ao TA 102K, CO, Prov0 Air Base #10 * " No0 5o TA U2-0&J, CO, 1398 Engr Cons Bn0 3 9o Organizations assigned the operation of the various Island garbage dumps are as followss Garbage dump No0 lo TA 117-M, CO, 1878 Engr Avn Bn0 » « NOo 20 TA 292-M, CO, 101st NCBo " « NOo 3o TA 180-X, CO, East Fieldo By command of Major General JARMANs Go Mo O’CONNEL, Colonel, Go Sc Co, Chief of Staffo OFFICIALS /s/ CoEoRichardson Co Eo RICHARDSON, Lto Col, Ao Go Do, Adjutant General0 DISTRIBUTIONS A & B u View of garbage disposal, Saipan Trash dump, Saipan Figure 4 Standard Grease Trap Soakage Pit Figure 5 HEADQUARTERS ARMY GARRISON FORCE APO 244 MEMORANDUM) NUMBER 80 ) 16 October 1944- MESS KIT WASH RACK lo Plans have been prepared by and are available at Headquarters, 1176th Engineer Construction Group for a standard mess kit wash stand, garbage can rack, and grease trap. 20 All future construction of these facilities will be in accord- ance with that plan (#G-255)o Units having sanitary facilities approved by the medical inspectors are not required to revise their installations. 3o All units not having adequate sanitary facilities will Install them in accordance with above plan without delay. command of Major General Jarmans G0 Mo 0*CONNELL Colonel, G0S0C0 Chief of Staff OFFICIALS JAMES Do BAILEY JR. Major, Adjutant General's Department Adjutant General DISTRIBUTION: E g>E CTION TURD &REASE Tl?£P 3 CALC y/2"-- 1-0" 1 VUMOLES , Wake fron\ *> ■» V4 &tp?ap It?Or-/ FASTEN vN'TH® O SCR. - tG) MOLES EACM SIDE ON ALL 4 SIDES? PLAN OF WASH STAMP DETAIL OF DRAIN ConeC SCVlc kIz"'\'-0" Detail of vent scale 'le"= r-o” SECT IQ in A-A SECTl QN) THRU GiEEASE trap Mote Dimewsone of Wash 4 gacba&e cam ‘STAwd me-ss hall “oize SIZE OF STAND . - * 20, Go, loo MAM \Z Fr x 15 FT^ 15o, 2oo, 2So MAM l2 FT. x a’oFT^ 5oo MAM IZFT. * 2 5 FT •OECTION JMRU <,UMP HEADQUARTER.^ P,R5A.pPoRt^NG’1 B*l&' KiT Wasp <=>tand Garbage can rack trap SCALE: %'£. '/2" = ijp" DATE’.OCT. G, 1944; REVISIONIST ' BY CH. Date Submitted by !j~C. iLxJhjnl. Approved by £Z /^CL/l/vw*- ■5H , '©FT I. Wood BAFFLES At>t)EC> 2BAFFLFS ReMo/B FR-oM last 3 DRUMS P'PinGl Relocate D From Bottom To Top of DRUMS Jr. 0.13 /m m £o Vtc.ZSm t D ISA W W, j.ts, ' File Na APT CoR^' Design/oec. Col. C oF F r Commanding a0 Waste Motor Oil - Used against larvae0 b0 No 2 Diesel Oil - Used against larvae0 Co Kerosene - Used against larvae0 do DDT - Used against larvae & adults0 (Contact & residual) o Supply - WD Cir No 151, dtd 17 April 44° (1) Dissolving Powder - QM Stock No 50-L-120, Larvicide, DDT, powder, dissolvingo (2) Kerosene Spray - QM Stock No 51-1-305, Insecticide Spray, DDT, residual effect0 (3) Emulsion - QM Stock No 51-1-310, Insecticide, spray delousingo (4) Dust - QM Stock No 51-L-122, Larvicide, DDT?, powder. e0 Individual Control Measures0 (1) Freon Aerosol Bombs - Adult contact kill. (2) Repellentso 3o Insecticiding Equipment0 a0 Continuous Hand Sprayer, QM Stock No 41-S~4106, Sprayer, liquid, insect, continuous spray. bo Three gallon Decontamination Sprayer, CWS, Apparatus, decontaminating, 3-gal capacity, M-l. Co Five gallon knapsack sprayer, Engineer Stock No 41-7839«. 5-5, Sprayer, insect, knapsack type, 5-gal cap0 do Power Sprayers0 (l) Eng Stock No 4-0-903006-3, Sprayer, insect, portable, gasoline engine driven, for larvi- cide, with four 50 ft lengths of 3/8n oil resistant hose and spray nozzle0 31 Pag® A* lo MOSQUITO CONTROL (C0NTfD)o B, do (2) Sprayer, Paint, Model E-2, Pneumatic with Compressor, Gasoline Engine, Gun, Hose, Tanks, Extension and Tools, as per Corps of Engr®s U S Army Tentative SpecQ T-1153-C (EDS Cat 786500=000) (3) Improvised Pressure Drum Type Sprayers0 e0 Rotary Dusters - Eng Stock No Al-3115o5-10, Duster, insect, hand rotary blower type, paris green or pow- der, 5 to 10 pounds capacity. fo Hand Dusters - QM Stock No Al-D-3750, Duster, insect, powder, plunger type0 go Aerosol Bomb - QM Stock No 51-1-159, Insecticide, aerosol, one pound dispenser0 Ho CONTROL OF OTHER MEDICALLY IMPORTANT INSECTS OF THE PACIFIC OCEAN AREASo f A0 Seriousness of The Problem0 1. The insect-borne diseases constitute the most important communicable disease group in all tropical regions„ 20 Insect-borne diseases present and of military importance on this islands aQ Dengue Fever - Transmitted by mosquitoes0 bo Filariasis - Transmitted by mosquitoes0 Another, fly-borne, form of filariasis does not occur in the Marianas, but is sometimes encountered in other islands of the Pacific0 Co Dysenteries - Transmitted by flies0 3o Insect-borne Diseases of Potential Importance On This Island! a0 Typhus Fever„ 32 Page 5. II. CONTROL OF OTHER DISEASES (CONTBD), A, 3, a, (1) Mite-borne - Of extreme importance in the islands of Japan* (2) Fiea-borneo (3) Louse-borne. b0 Plague - Transmitted by Fleas. 4.0 Insect-borne diseases not found in the Marianas , but en- countered in most forward areas of the Pacific; a* Malaria - Transmitted by Anopheline Mosquitoes0 b0 Pappataci Fever - Transmitted by Sand Flies0 Bij| Nature of Insect-Borne Diseases, and Modes of Transmission 1, Blood, and more rarely skin, Infections transmitted by Biting Insectso a0 From Man to Man (e0g®, Filariasis, Louse-borne Typhus)* b0 From Animals to Man (e.g*, Plague)0 2, Intestinal Diseases, transmitted by Mechanical Contamina- tion of Food (e0go. Dysentery)* C, Control Measures* 1. Flies. ac Transmit intestinal diseases by the mechanical con- tamination of food* b0 Biology. (1) Eggs, laid in feces, garbage or decaying organic matter, hatch in B - 24 hours* (2) Larvae, called maggots, feed on the organic matter* After 4- - 6 days, maggots migrate to drier, cooler place to pupate* 33 Page 60 Ho CONTROL OF OTHER DISEASES (CONT8D)0 C, 1 (3) The pupa, a stage lasting 3-10 days, is inactiveo (4) Adult has certain habits which simplify control0 (a) Attracted by odors„ (b) Fly toward light. (c) Usually rest on vertical surfaces. Co Control consists chiefly of general sanitary measures. (1) Feces disposed of in fly“tight latrines, sprayed with a chemical fly-larvicide weekly, and covered with at least 2 feet of hard- packed dirt when closed. (See FM 8-A0). (2) Screening of latrines, mess-halls, and kitchens* (3) Proper disposal of garbage0 (U) Use of baited fly traps, fly paper, and residual DDT in mess-halls and latrinesa DDT dust is highly effective against adult flieso (5) Fly Larvicides includes (a) No 2 Diesel Oil. (b) DDT Solutions. (c) Sodium Arsenite (Penite-6). (d) Paradichlorbenzene (PDB). 20 Mites - (Not insects, but closely related to ticks and spiders)0 Page 70 II. CONTROL OF OTHER DISEASES (CONT»D)o C, 2. aQ Form of Typhus (Tsutsugamushi, Scrub Typhus) is transmitted by one species (Trombicula akamushi) which occurs in Japan, New Guinea, Ryukyus, etc0 b0 Biologyo (1) Adults free-living, occur in grasses«, (2) Larvae seek animal blood and some bite man. a. Controlo (1) Impregnation of clothing with dimethyl phthalate repellent (See TB Med 121)0 (2) Control of rodents (usually field mice) which serve as animal reservoirs of the disease and as hosts for the larval mitesQ (3) Burning of tall grass, especially Kunai grass0 3o Fleas - The rat flea may transmit a form of typhus known as endemic Typhus or murine Typhus, and also transmits Plagueo The most effective method is control of the rodent host, but other, more temporary measures are available; a0 DDT residual spraying is effective against fleas in buildingso b0 DDT dusting powder may be used on domestic animals, and is very useful when used in rat harborages0 Lice - Transmit epidemic typhus, relapsing fever, trench fevero Human body lice attack man onlyQ a0 Lice are commonly spread in situations where many people are crowded together, and when bathing and laundering are infrequent b0 Eggs are fastened to body hairs or clothing fibers9 and hatch in about 8 days; the lice must have a blood meal within 24- hours after emergence0 Adult lice cannot survive more than 8-10 days without food. Page 8, Ho CONTROL OF OTHER DISEASES (C0NT*D). C, Uo Co Usual control measures consist of bathing and laundering, or dusting with DDT. Clothing may be impregnated with DDT emulsion0 5o Insect Pests. a. Bedbugs are easily killed by DDT solutions, and l/2 pint of 5% solution per bed (Including mat- tress a pillow, frame, etc) furnishes a resi= dual lasting from 6 months to a year0 b0 Ants are greatly diminished in numbers in a given building by residual spraying or dusting with DDTo Co Roaches are usually killed by dusting kitchen and ware-house corners and cracks with sodium fluoride0 DDT dust, though not quite as effec- tive against all species of roach, is much safer to use0 /a/john P0 Swenson JOHN P0 SWENSON Capt, Snc Comdg 36 REFERENCES - INSECT CONTROL WAR DEPARTMENT PUBLICATIONS Circular No 117, Paragraph IV, 14- April 194-5. Training Circular No 16, 14. April 194-5. TECHNICAL BULLETINS Med 6, Data From Field on Malaria Control, 15 Jan 44-o Med 14-, The Use of DDT As A Mosquito Larvicide, 3 Mar 44o Mod 42, Data From The Field On Malaria Control, 13 May 440 Med 87, Data On Malaria Control, 23 Aug 44« Mod 110,Use of DDT As Insecticide To Kill Adult Mosquitoes, 25 Oct 44<, Med 121, Impregnation of Clothing With Insect Repellent (Dimethyl Phthalate), December 44-° Med 134, Data on Malaria Control, January 4-50 FIELD MANUALS FM 8-40, Field Sanitation,, FM 21-10, Military Sanitation & First Aid0 POA AND ISLAND DIRECTIVES Letter, HUSAF, POA, APO 954, subjects An Organization And Program For The Control of Malaria & Insect-Borne Diseases, 23 Mar 45o Memo No 70, Hq, Island Command, Saipan, subjects Insect & Rodent Control, 10 May 1945<, Training Memo No 1, Hq, 1109th POA, Prov AGF, APO 244, subjects Insect Control School, 29 May 45. Memo No 6, changes 1-5, Hq, Island Command, Saipan, subjects Trash Dumps & Garbage Dumps, 12 Jan 450 Memo No 9, Hq, Island Command, Saipan, subjects Police of Abandoned Areas, 15 Jan 45. NAVY PUBLICATIONS Naval Medical School, National Naval Medical Center, Bethesda, Mary- land; Laboratory Guide To Medical Entomology with notes on Malaria Control. United States Pacific Fleet & Pacific Ocean Areas, Hq Of The Commander In Chief; Malaria And Epidemic Disease Control Bulletins Nos 1, 2 & 3, 1945a 37 CHAPTER IX Control of Rodents The islands vary from moderate to heavy infestation with rodents and an active control was instituted early0 The species found in the area are Rattus norvegicus f Rattus concolor (exulans). Rattus rufescons. mus muscuius. and mus muscuius momiyamaio Both live and dead rats have been examined for parasites and disease and no evidence of bubonic plague of trichinella or of leptospira has been detected; no fleas have been found on rats and the mites and lice noted have not been identified but are not believed to be of medical importance0 Control measures instituted included the destruction of food supplies and harborages9 trapping and especially prebaiting system of poisoningo The poisons used included Red Squill, barium carbonate, thal» lium sulphate and zinc phosphide0 Thallium sulphate was found to be the superior poison due to the fact that it is about 100 percent consumed and is an effective poison0 Both the prepared poison oats product and oats locally treated with oil and poison were used successfully0 The sanitary units played an active part in the rodent control program and necessary schools in rodent control were organized to teach proper control methods to assigned members of individual units0 The control program generally was very satisfactory and the rodent index has been kept to reasonable limitSo*^^ Specimens ,of rodents were sent to the Army Medical Museum, and were added to the collections of the U0 S0 National Museum0 CHAPTER X Immunization A constant program of immunization was carried on in accordance with existing directives0 Supply of material was constantly adequate and there were no unusual developments„ 39 CHAPTER XI Intestinal Infections During the combat phase, flies were very numerous but due to the fact that only K rations were used until screened kitchens could be improvised, the intestinal infections remained comparatively lowc As semipermanent camps were constructed adequate sanitation was pos- sible and the intestinal infection rate presented no problem,, (See tables 5 and diarrheas - dysentary0) CHAPTER XII Infections of the Respiratory Tract and Infections Transmitted by Discharges from the Respiratory Tract While the incidence of diseases of the respiratory tract varied, there was no marked fluctuation and the increase incidence was noted during the rainy seasonQ There have been no epidemics and no particular problems in this regard0 (See tables 7 and £, respiratory diseases,) CHAPTER XIII Venereal Diseases Venereal diseases have not been a problem in this area due to the fact that all natives, except those of Guam have been constantly segre gated from the military personnelo Practically all the cases reported in compliance with existing regulations have been contacted prior to the time of arrival in this area6 (See tables 9, 10, and 11, venereal disease0) TABLE 5.°-Diarrheas and Dysentery (all types) Saipan (APO 2J+U) 19 U Diarrheas Dysentary No. of Cases *Rate No. of Cases *Rate September 171 57o37 78 26.17 j October 96 36.71 16 6.12 1 November 57 19o50 9 3o08 1 December £9 22.22 K .99 *Rate: (per thousand per annum) TABLE 60—Diarrheas and Dysentary (all types) mi Noc W.P.B.C. Diarrheas of Cases *Rate No, Dysentery of Cases *Rate January 63 5o51 17 1,49 February 1 u 9o57 31 2,61 March 150 9.86 18 1.18 April 323 24.29 28 2.11 May 193 U.19 82 6.03 June 331 19.24 83 4o82 July i 142 10e 32 66 4.79 Saipan (APO 244) January 39 11,78 7 2.10 February 70 19o07 U 3.81 March 57 11.66 3 .61 April 27 7d7 4 1.05 May 44 110 80 21 5.61 June 50 10 o-48 24 5.03 July 20 5.69 20 5,69 *lRate s(per thousand per annum) 42 TABLE 7,—Respiratory Diseases 19U Saipan (APO 244) Common Respiratory Influenza Pneumonia (all types) No* Cases *Rate No 0 Cases *Rate No0 Cases *Rate ! September 289 97ol0 -- 12 4.01 I October 127 4.8o62 -- — 10 3.82 1 November 1 u 39.04 — — 7 2.39 j December 112 27.94 — — 20 4.97 *Rate: (per thousand per annum] TABLE 8. —Respiratory Diseases Saipan (APO 244) 1945 Common Respiratory Influenza Pneumonia (all types) NOo Cases *Rate No , Cases *Rate NOo Cases ~Rate January 62 18,32 -- —» 8 2041 February 73 19 <,87 — 15 4o09 March 124. 25o37 — 29 5o93 April 113 30d0 3 ,78 42 11.18 May 131 35 0 14 -- 34 9ol0 June 24.O 50o29 — — - 36 7o54 | July 266 75 063 2 »57 47 13.36 *Rate: (per thousand per annum) 43 TABLE 9.— Syphilis 1944 No W.I . of Cases 3.B.C. Saipan (APO 244) *Rate NOo of Cases *Rate September October — — 2 .76 . November — — --- f December — — 5 1.24 mi • January 26 2.28 20 6.04 February 15 1,26 3 .84 March 50 3o29 30 8,4.0 April 28 2.11 20 5.31 May 36 2,65 19 5.09 June 59 3.43 27 5 = 66 July 76 5.52 37 | 10,52 *Rate; (per thousand per annum) TABLE 10,—Gprmorhea 1944 No W oP oB cC O o of Cases Saipan (AFO 244) *Rate No. of Cases *Rate September „ A 1.34- October --- — 2 .76 November — - -- 2 .68 December — — — — mi • J anuary 4 .35 .... February 10 .84 2 .54 March 8 .53 6 1.23 April 17 1.28 A 1.06 May 16 1.17 8 2cl4 June 62 3.60 38 7.96 July 57 4.0 U 31 8.81 *Rate; (per thousand per annum) TABLE 11,—Other Venereal W.P.B.C, Saipan (APO 244) - 19 44. No. of Cases *Rate No. of Cases *Rate September 1 ,33 October — 1 .38 November —- --- 1 .34 December -— — — 1945 January 1 .09 1 .30 February — --- — —- March 1 C"- O O 1 o20 April — — — — May 2 ,15 2 ,52 June 7 ,41 — July 5 .37 — *Rate: (per thousand per annum) 45 CHAPTER XIV Arthropod“Born© Infections The arthropod-borne infections of the area of interest con- sist of dengue and filariasis0 (Dengue04-Dengue exists on the island of Saipan, Guam, and Tinian a11 three islands had dengue in the early phases of invasion a major epidemic occurred on the island of Saipan. At the time of the invasion of Saipan (June 15 194/.), mosquitoes were present and dengue began to appear among the troops0 As this was the dry sea- son, the rate at first was low, but as the rainy season began and the mosquito control measures could not be adequately instituted due to combat conditions, the rate began to climb0 By August 11, 194/ mosqui- toes were abundant and the dengue rate had reached 300 among the gar- rison force and continued to climb rapidly reaching a rate of 3500 by £ September 194/0 All possible mosquito control measures were in- stituted including airplane spraying of 5 percent DDT and the epidemic was brought rapidly under control.2” (See tables 12 and 13, dengue, and memorandum.) Filariasis 0 —While filariasis was present among the natives of Saipan and Tinian it was not a problem from the military There was no known case of filariasis contacted on these islands by mili- tary personnel and this was, no doubt, due to the low incidence of the disease and the fact that the natives were constantly segregated030 A report of the investigation of filariasis by the 217th Malaria Survey Detachment is enclosed. HEADQUARTERS ARMY GARRISON FORCE APO 244 iMEMORANDUM ) Inumber 63 ) 2 October 19UU DENGUE CONTROL lo Paragraph 3, Memorandum No0 109 this Headquarters (Forward Echelon)j 13 July 1944? is rescinded0 Effective all new cases of dengue fever or suspected dengue fever9 will be hospi- talized in one of the hospitals now operating on this Island0 20 The number of new cases of dengue on 14 September was 422 and on 26 September it dropped to 75o This decrease is definitely linked with the control that has been established over mosquito breed- ing o A large area of this Island has been recently sprayed with DDTC A marked reduction in the incidence of flies and mosquitoes has been notedo Attention is invited to the fact that spraying with DDT is only one of the factors in dengue fever control0 The attention of commanding officers is directed to the fact that the ordinary methods of mosquito and fly control are more necessary now than they were be- fore the use of DDT if our efforts in control are to be continuously successfulo DDT is still a critical item and its use must be reserved for emergency control0 Commanding officers are directed to bend every effort toward the suppression of mosquito and fly breeding in their areas and will be held responsible that every possible effort is ex- pended toward that end0 Troops will not repeat not be allowed to sleep without the use of mosquito bars at any time0 Frequent inspec- tions will be made by responsible officers to see that these mea» sures are carried out0 command of Major General JARMANJ Go Mo 08CONNEL GoS®C. Chief of Staff OFFICIALS JAMES Do BAILEY JR0 Major9 Adjutant General9s Department Adjutant General DISTRIBUTIONS E 48 TABLE 120=“Dengue Saipan (APO 2ij^) 19U Noe of Cases Rate per 1000 per Annum September October 221 1143.15/ 84.50 November 30 10o26 December 7 1.75 TABLE 13 o “'-Dengue 1945 Saipan (APO 244-) NOo of Cases Rate per 1000 per Annum January 6 i.ai February 8 2olS March 4 081 April 14 3o72 May 11 2o95 June 9 1.89 July 4 lol4 49 217TH MALARIA SURVEY DETACHMENT APO 2UU 15 September 194-5 SUBJECTS I Filariasis on Saipan0 TO ; The Army Garrison Force 9 APO 2IM.Q 1® Wuchereria bancrofti in Chamorros of Charan Kanoa. Saipan0 Thick blood films (approximately 20 cmm of blood per slide) were prepared by this detachment on 125 adult Chamorros at 21009 3 Mar 45o Twenty*five had microfilariae in their blood0 Of these9 19 have spent their lives on Saipan and 6 were born on Guam0 Slides made at various hours prove the microfilariae to be nocturnally periodic as follows: Number of slides Time Average number of microfilariae per slide 32 (25 people) 2100 3 and 9 Mar 18 7 ( 7 ■ ) 24.00 9 Mar O 7 ( 7 " ) 0200 10 Mar 57o5 15 (15 • ) 1200 11 Mar 02 Microfilariae examined on fixed smears stained in hematoxylin showed the following characteristics proving them to be Wuchereria bancrofti: sheath present, tail gradually tapered to a pointy no nuclei in tip of tail, excretory pore immediately anterior to excretory cell, body curved smoothly0 20 Wuchereria bancrofti in Japanese residents of Camp Susupe. Saipano Of 100 adults if 19 from Japan 9 81 from Okinawa) examined 0200 9 24 May 4-5 9 3 were positive, with an average of 56 micro* filariae per slide0 These 3 are Okinawans: Inamine Seisho * Saipan last 5 years^Tinian 3 years9 Okinawa before that; Irei Kosei * has been on Saipan 4- years9 Carolines 3 l/2 years after leaving Okinawa; Gima Kamezo * Saipan 13 years9 directly from 0kinawao Fixed slides stained in hematoxylin showed the microfilariae to be Wuchereria bancrofti0 3o Wuchereria malavi in Korean residents of Camp Susupe0 Of 100 adults examined 23 May 459 8 were positive9 averaging 26 microfilariae per slide0 These 8 people came directly to Saipan from Koreao 7 have been on Saipan;for 4 y$ars, 1 for 6 years0 The microfilariae studied on fixed smears stained in hematoxylin had the following characteristics proving them to belong to the species Wuchereria malayi: sheath present, tail swollen into a knob at tip which contains 1 or 2 nuclei,, excretory cell far posterior to excretory pore? body angular0 51 U* Clinical fllarlasis on Sa.inan0 None of the natives found positive for microfilariae in the above surveys showed clinical symptoms of filariasis0 However, several mild cases are on record at the US Navy Military Government Hospital #202. No troops on Saipan have contracted the diseases. 5 o Wuchereria bancrofti in laboratory-reared Culex quin- quefasciatus mosquitoes of Saipan0 On 8 Aug 4-5, 0100-0200? 137 adult female Culex quinquefasciatus (raised in this laboratory) fed on Pedro age 68f a resident of Charan Kanoa (Chamorro) who was born on Guam# and who has 105 Wuchereria bancrofti microfilariae per thick smear at 0200„ A few mosquitoes were dissected each day for 20 days and slides prepared with the following results* Day Date Noc mosquitoes Noc mosquitoes with infective with larvae* larvae in present but not proboscis in proboscis No0 mosquitoes with no larvae Total mosquitoes dissected 1 8 Aug 0 A 0 A 2 9 n 0 A 0 A 3 10 w 0 A 1 5 A 11 « 0 3 0 3 5 12 1! 0 3 1 A 6 13 « 0 5 1 6 7 U tt 0 A 0 A 8 15 ft 0 A 0 A 9 16 R 0 A 1 5 10 17 tt 0 1 2 3 11 18 tt 1 6 0 7 12 19 tt 2 2 0 A 13 20 It 8 3 1 12 U 21 tt A 3 2 9 15 22 It 7 2 3 -12 16 23 It A 1 0 5 17 2A tt 2 3 0 5 18 25 n 5 3 1 9 19 26 it 5 0 0 5 20 27 n 13 6 8 27 Totals for 20 dayss 51 65 21 137 Totals for 11th- =20th d: 51 29 15 95 Infective stage larvae reached the proboscis by the 11th day of development,, Of the 95 mosquitoes dissected from the llth~20th day? 51 (53o7%) had these worms in the proboscis and could have infected a human with filariasis0 The rest either had no worms (15) or had 52 worms in the abdomen, thorax, head or antennae, but not in the proboscis (29). The number of worms occuring in the proboscis ranged from 1-5, averaging 1070 The average number of worms in all parts of positive mosquitoes was 609, ranging from 1-40 0 In large mosquitoes having an excessively large blood meal, all the blood was not digested for three days0 In such mosquitoes dissected on the 3rd day, undeveloped unsheathed motile microfilariae still were present in the blood remaining in the abdomen, 2nd day larvae occured in the posterior part of the thorax, and non-motile 3rd day larvae were found in the muscles of the thorax0 This accounts for the frequent disparity in size of larvae from the same blood mealo It is evident from the above that Culex quinquefasciatus on Saipan is capable of transmitting filariasis0 About half the mos- quitoes feeding upon an infected person will be able to pass on the worms after they have completed their development in from 11-14- days0 60 Wuchereria bancrofti in wild mosquitoes of Charan Kanoa0 500 adult female mosquitoes were caught alive in native houses and air-raid shelters throughout the village of Charan Kanoa from 28 Feb=l Mar and 29 Aug-11 Sep 4-5® All 500 proved to be Culex quinque- fasciatus. a night-biting mosquito9 and the only species found in dwellings at Charan Kanoa0 All were dissected, slides prepared} with the result that 27 (5oIS) were found to harbor filaria worms of the following stages of development: Mosquito slide No. larvae Place Activity Stage W 6 thorax non-motile 7 day m 4 ( 1 « M 2 day ( 3 tt 6 day #35 4 M motile 1 day #42 3 ( 2 n non-motile 3 day (i » »» 7 day #45 4 n H 5 day #47 4 M motile infective #49 1 n non-motile 3 day #55 2 it n 3-7 day #125 12 it motile 6-9 day #135 7 t» it 7 day #157 4 n it 6-8 day #163 1 ti non-motile 4 day #170 6 n motile 1 day #201 2 » non-motile 3°4 day #225 6 » n 2-3 day #24« 3 ( 1 head motile infective ( a proboscis motile infective #251 26 (i thorax n 1 day (25 n non“motile 3 day #296 1 it n 5 day 53 Mosquito slide NOo larvae Place Activity Stage #297 2 thorax non-motile 3% day #33# 3 n n 2-3 day #336 1 n it 3 day #3U 3 ( 1 « motile 1 day ( 2 it non-motile 2 day ##15 20 K » 7“8 day ##16 30 tl tt 5“6 day #463 5 K it 3~4 day #4-68 11 ( 5 abdomen motile 1 day ( 6 thorax it 1 day mu 2 tt tt 10-11 day Only one mosquito had infective larvae in the proboscis, an in- cidence of 02%0 It.is evident, however, that Culex guinquefasciatus is a vector (at present the only one) of filariasis at Charan Kanoa. 70 Slides of larval filaria worms in all stages and specimens of Culex guinquefasciatus have been sent to the Commanding Officer, 18th Medical General Laboratory, APO 957 for confirmation of the identifications and data above0 8« The following 19 photographs of slides prepared at this detachment are included in this report: Fig 1 Rain-barrels in Charan Kanoa0 These were formerly the principal breeding places of Culex guinquefasciatus. At present all are covered as shown on barrel to left® Fig 2 Pedro Sablan. Fig 3 Wuchereria bancrofti microfilaria X 54-0 from thick blood smear of native,, Hematoxylin0 Fig U Microfilaria of W0 bancrofti in human0 X 1500 Hematoxylin, Fig 5 Wo bancrofti 1st day in abdomen of Culex guinquefasciatus« X 150o Heraatoxylin0 Fig 6 2nd day in thorax , hematoxylin X 150, Fig 7 3rd It it n it it Fig 8 4th n n » w t* Fig 9 5th « H n It n Fig 10 6th it it n It it Fig 11 7th » it H n » Fig 12 8th it H n M n Fig 13 9th M n it H M Fig 14 9th It n it It It Fig 15 11th It n it fixed, unstained. X 150, Fig 16 15th day Fig 17 " » 9 living, M in proboscis, X it n 150o n same mosquito as #160 54 Fig 18 15th day, living, in proboscis, X 1505 same mosquito as #160 Fig 19 ” n fixed, emerged infective larvae, X 150o /s/Robert So Beam ROBERT So BEAM 1st Lt Sn C Entomologist Commanding /s/joe To Marshall, Jr0 JOE To MARSHALL, JR. 1st Lt Sn C Parasitologist 55 CHAPTER XV Miscellaneous Infections A rather large number of cases of jaundice were admitted to hospitals and the number were particularly great during the time that dengue was prevalent0 Studies were made of the cases of jaundice in an effort to establish its etiology and any correlation with dengue but the only pertinent information available showed that (a) the sped fic type and cause of the jaundice has not been determined, (b) there is no apparent correlation between the appearance of jaundice and the administration of any serum or vaccines, (c) Leptospira have been demonstrated in the sterile urine of two cases(See tables 14, and 15, jaundiceo) 57 TABLE 14-.— Jaundice Saipan (APO 244) 19U _____ _ ____ _ No, of Cases Rate per 1000 per Annum September 126 42,28 October 19 7.25 November 13 4.U December 5 1,24 TABLE 15 o— Jaundice -1945 ______ Saipan (APO 2^) No* of Cases Rate per 1000 per Annum J anuary 1 .30 February 5 1.32 March 4 .81 April 7 1.86 May 14 3.75 June 18 3.77 July 10 2 084 58 CHAPTER XVI Diphtheria Diphtheria was rare in the Western Pacific Base Command except for a short time on the island of Saipan when it appeared that an epidemic was threateningo The first case was diagnosed on 15 July 1944 and between 15 August and 15 November a total of 69 cases were diagnosed0 Strict control measures were immediately instituted and a search was made for any existing cutaneous diphtheria and the threat- ened epidemic was avoided® All cases were sporadic and incidence in any one organization was not sufficiently high to be of epidemic pro- portions .32 CHAPTER XVII Nutritional Diseases There, are no nutritional diseases to report. CHAPTER XVIII Environmental Diseases There are no environmental diseases to report. 59 CHAPTER XIX Extra-Military Sanitation and Liaison Activities The Civil Affairs was organized by and under the control of the Navy but liaison was kept between the Army Medical Inspectors on islands of Army commando The destruction of practically all civilian establishments, institutions and facilities was complete due to the ravishes of war and the civilians only gradually and with considerable apprehension turned themselves into the U, SQ Civil Affairs0 The personnel and sup- plies for the care of the civil population was at first but meager and the best had to be made out of an almost impossible situation. Safe areas were set aside for the civil population and the construction of shelter out of remaining scrap was undertaken. In due time the con- struction of some form of shelter was accomplished as were sanitary facilities. Since the use of night soil was universal, flies abundant, and living conditions very crowded, the institution of sanitation was a major problem, Deep pit latrines, washing and bathing areas were constructed and supervision of sanitation and supply of food and cloth- ing was instituted. At first, the deep pit latrine was the only practical method of disposal of human waste and this was maintained sanitarily only with great difficulty. The lumber and tin used in the construction of the latrines had to be guarded or the civilians would take the building apart and use the material for further improvement of the home. The en- forcement of proper sanitation regarding use and maintenance of the latrines also proved to be a major detail, but the sanitary detail that was formed proved successful0 The maintenance of the latrine fly con- trol could only be effected by the use of sodium arsenite at first as the number of latrine seats was inadequate and the latrines were in constant use. (See figure 7.) In due time a water borne sewage system was constructed to accommodate about 2000 persons and this lessened the load on the overtaxed pit latrinese The water system consisted of a wooden fly proof building over a concrete pit that was flushed along piping that lead to a septic tank0 Maintenance of these units proved comparatively easy, (See figure S9) As the latrine seats became more adequate and the people were better trained, sodium arsenite was dis- continued and the use of latrine oil spray proved to be adequate for fly control. Round concrete decks with an adequate lip and drain were in- stalled for the purpose of washing and bathing0 Water was supplied by a shallow well and the water was drained by means of open ditching0 (See figure 9.) 61 Housing varies depending upon the amount of destruction and on the island of Saipan the Chamorros lived in the village of Charan Kanoa and occupied the civilian homes that existed prior to the invasion.. About one-third of the population lived in barracks constructed after the invasion and the remainder lived in Camp Susupe in the originally built houses that were somewhat improved,, (See figures 10 and llc) Except for the Chamorros who lived in family groups. food was prepared in public kitchens which were closely supervised0 (See figures 12 and 13.) Due to extreme adverse conditions and the lack of personnelf supervision of sanitation was at first almost impossible but gradually an organized sanitary detail evolved„ With employment and training of civilian personnelf the sanitation improved satisfactorily and has pro- gressed to a high degree,, (See figure 1U„) 62 Typical Early Latrine Inside View Figure 7 Water Borne Latrine Inside View Concrete Deck for Washing & Bathing Figure 9 View of Housing, Camp Susupc Barracks in Korean Camp Figure 10 Interior View of Housing, Camp Susupe Interior View of Housing at Korean Camp Figure 11 Exterior View of Kitchen, Camp Susupe Interior View of Kitchen, Camp Susupe Figure 12 Interior View of Kitchen, Camp Susupe View of Kitchen at Korean Camp Figure 13 Sanitation Headquarters, Camp Susupe Figure 14 CHAPTER XX Civil Public Health33,34-^35 Due to the ravages of war, the civilian population was found to be in dire circumstances at the time the islands were occupied0 This was most markedly manifested on the island of Saipan since the combat phase was of longer duration The natives were found to be homeless, without food, and in general, in a poor state of healths, During the early phase of occupation the death rate was markedly high, sanitary facilities non-existent and due to the lack of adequate per- sonnel to treat the sick and injured and render general care to the needy a state of chaos existed« The Military Government and the field medical units assisted in the care of the civilian and in due time order was restored and people were fed and the sick and injured adequately cared for. As the occupation progressed living conditions and medical care improved and the health of the civilians progressed comparably. Since adequate records are not available for a discussion of the total civilian health picture and the author is familiar with the situation on Saipan from personal experience and hearsay, the following discussion will pertain specifically to Saipan„ It should be pointed out that the picture of the civilian condition on other islands, while comparable, was not identical with that found on Saipan due to the existing condi- tion and the length of the campaign. Hospitalization was first established by the medical field units and later by the station hospital assigned to the island which in turn was relieved by a Navy G-4- hospital the latter part of January 1945 o The nutrition of the natives at the time of the occupation was extremely poor and accounted for a considerable number of the hos- pital admissions and deaths in the first few months0 While specific clinical diagnoses were not established, marked malnutrition was evi- dent in most people. The total population including Chamorros, Koreans, and Japa- nese was about 20,000 and the death rate was at first very high but gradually declined as adequate housing, food, and sanitation were effected. The following is a rough summary of the death rates per months During the months from June 15 to September 1, there was an average of about 800 deaths per month. September 508 October 225 November 98 December 65 63 This rate gradually declined and a new low was established during October when only 4.0 deaths occurred 0 Scabies at first was almost universal but this condition cleared in spite of the fact that possibly but about 5 percent of the people were treated for the condition,. While yaws was very prevalent among the Chamorros it was rather uncommon among the Koreans and Japanese and this is believed due to the fact that only the Chamorros were natives of the island0 The Chamorros showed almost 100 percent evidence of yaws while there were but 10 cases among Japanese0 The high rate of positive Kahn tests among the Chamorros varied considerably on a small number of re- peated tests and while there was considerable clinical evidence of yaws among them,, the positive blood was believed to include a number of false positiveso Intestinal parasitism was extremely common and the following chart is rather representativeThis chart was prepared by the 217th Malaria Survey Detachment. 30 Japanese Civilians Name of Parasite Number of People Positive Hookworm ova 19 Ascaris lumbricoides ova 18 Entamoeba coli 15 Trichuris trichiura ova U End o Umax nana 8 Strongyloides stercoralis larvae 3 Small flagellates 2 Entamoeba histolytica 2 One of the cases of Entamoeba histolytica had the pathologic type of in- fection characterized by bloody stoolf and large amebae containing inges- ted red blood cells„ The other had only the small type of ameba without ingested red blood cells and with a normal stoolo 62 Japanese Orphans (previously treated for worms) Name of Parasite Percent of Orphans Infected Hookworm ova “§875% Strongyloides stercoralis larvae Trichuris trichiura ova U5.7% Entamoeba coli u2o0% Pentatrichomonas hominis 27.& Endolimax nana 17.7% Entamoeba histolytica 1 64 Name of Parasite (Cont’d.) Percent of Orphans Infected Giardia lamblia U.5$ Ascarls lumbricoides ova 8,5* Hyraenolepis nana ova 2,B% * Chilomastix davainei 1M lodamoeba butschlii Eleven children (17o7%) had Entamoeba histolytica but none of these had bloody stools * In all 11 cases9 the amebaes were of the small type which did not contain red blood cells9 and are apparently non- pathogenic. The incidence of tuberculosis was high and the following statis tics based on x-ray evidence of active tuberculosis gives an idea of the prevalence: Hospitalized patients with chest pathology 2% Orphans Picked healthy civilians 2% General population (routine hospital ad- mission) 10* Universal vaccination for smallpox and typhoid was carried out and the following is a report of smallpox take: Chamorro children 37% Chamorro adults 59% Japanese children 53% Japanese adults 52% Korean children 17% Korean adults 3% The absence of some diseases is of interest and the following is a summary of the diseases not encountered: Ulcers Hypertension Arteriosclerosis Tonsillitis Arthritis Appendicitis (rare) Malignant diseases (rare) Pelvic diseases Pernicious anemia Psychosis Venereal diseases (rare or absent) 65 REFERENCES Report of Medical Department Activities, Headquarters Island Command, Saipan, 1945= 2 and 3gase Development Plan, Saipan, A Annual Report of the Medical Department Activities, Headquarters Island Command, Saipan, 1944, To: The Surgeon General, U, S. 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Survey of Tinian, from 217th Malaria Survey Detachment, 31 March 1945, File Surgeon’s Office, Headquarters WPBC, 710.10. from Headquarters AGF APO 244, 9 September 1944 to Commanding General, POA, APO 958, Subject: "Jaundice cases observed at APO 244 since August 15 1944.” 32 Essential Technical Medical Data, Headquarters Island Command, Saipan, 7 December 1944. 33 Personal observation and conversation with medical personnel concerned. Sanitary Reports, Civil Affairs File 721.5, Surgeon’s Office, WPBC 68 Military Government Section, APO 244, 2 March 1945, Subj; "Proposed Plan for Adequate Medical Care and Public Health Program for Civil Population under Direction, TJ„ S« Navy," to The Commander in Chief, U. S. Fleet and Pacific Ocean Areas, File 700 Surgeon's Office, Island Command, Saipan. of Survey of Intestinal Parasites, Camp Susupe, Saipan, by 217th Malaria Survey Detachment, APO 244, 18 September 1945• 69