Sul Te (Co plat. tee “PAI, 34 \ mM ayes bey ed of © Report on the control of fTyphus In Naples, Italy, > December 9,1943 to January Zand, L944. ES C) Advice was received in Algiers on December 6th,1943, that the Deputy Chief of Staff had authorized on December 5th the use of Rockefeller HRoundation Health Commission personnel by AMG for the purpose of typhus control in Italy. Drs. Fred L. Soper and W.A. Savia arrived in Naples on the evening of December Sth where they were Joined by Dr.Louis A, Riehl on the 17th. | On December 9th, the local situation was discussed with Colonel Hume and instructions received to proceed with the organisation of typhus control measures under the general direction of Colonel Cri = mn, Chief of the Division of Publie Health and Welfare of Region 9 AMG, On Deember 10th, a group discussion of the typhus sitaation was held in Colonel Crieshton's office at which 1t was learned, 1) that a study by Dr. Marinelli indicated no typhus had occurred in Naples in the five year period previous to 1943 but that eases had been re ported for 1943 as follows + Jan.0,Feb.0,Mareh 1, April 3, May 6 June 0, July 2, August 11, Sept.1&, Oct. 29, Nov. 55,Dee. first to ninth,4l. (Although these figures were later modified there was no doubt as to the trend of events and the imminence of a serious epi- demic.) a 2) ‘that the typhus control service was to be organized witheut the financial collaboration of the Rochfeller Foundation and that necessary per~ sonnel and transportation would be furnished by the Health Departuen of the City of Naples under the direction of Major Gill and Profes- sor Bergani. 5) thet the typhus control service should limit its activities to delousing leaving case-finding and reporting of cases to the Health Departnent. t The first few days in Haples were unavoidably deyeted to the es- omnis problems of transportation, supplies, headquarters and per-~ sonnei. ge | drangporpetion. One command car was assigned from AMG and“ anoth- er from PBS for the immediate use of Drs. Soper and Davis.,...All other transportation whieh might be needed was promised from a pool of 19 motor oycle trigyele units belonging to the Civilian Air Raid Defense service, (Later experience was to show that very few of the- se units were available and that these were quite unreliable.) a “ On December 20th a change was made in the alletment of vehiples and from this date on one command oar, two eeps one town sedan were @ availiable from the 4M0 and S motor services, Sone days later the munieipel authorities, sent ueks around @ large passenger bus and acouple of fire department to supplement th#@ inadequate mctoreyele tricyeles. ok ~2- Additional PBS transportation began to become uvailable on December 26. Supplies. Official information indicated that only 200 000 tins of MYL no DDT were on hand in QM stores. The fifty tons of DDT ordered by AMG for Maples was not expected to arrive until early in January. A personal visit to the QM dump established the fact that there were available between 500 and 600 000 tind of MYL.-An initial requisition of 20000 tins was approved and on December 17th authorization was received to draw up to 200 000 tins. Available records also indicated the absence of hand dusters in QM stores. A personal visit to the dump revealed a small supply of small Hudson dusters whieh were later requisitioned. Adequate supplies of this item rapidly became aveilable. A small number of Dobbins dusters were received from North Africa. Considerable time and energy was devoted to the seareh for a sui-~ table diluent for the preparation of DDT inseetioide and to finding suitable equipment for the necessary grinding and mizing operations, fulocum wasg finally purchased at an exhorbitant prive and 4 very infer dor produst substituted on delivery. A mill for grinding the DDT con- centrate was found at the Instituto Seroterapico and a cement mixer box rowed from the Engineering Section was installed in the AMG warehouse. Due to the poor quality of taleun used, screening of the final produ- ot was nesessary and locally mixed DDT wes not available till Dec. 27th... At about the same time it was discovered that many of the two ounce tins supposedly containing MYL were actuaily loaded with DDT. Experigents were carried out to develop a satisfaetory eontain- er which could be manufactured locally for using compressed air in the appiieation of powder, Such a container is now available awaiting only sourees of compressed air for large scale applieation. Considerable delay was encountered in the receipt of special items sueh as flashlights needed for the organization of night work in the air raid shelters. Headquarters: Original plans of the aMG Public Health and Wel- fare Section called for an office at the Prefectura and a delousing headquarters at the Cotugno Hospital, This qgrrangement was considered unsatisfactory. An invitation fromfDr. Bemeduccio, the Director of the Provincial Laboratory, to establish headquarters for the Typhus Service in thie institution was received on December 14th and acted upon immediately, Operations began from tpis base on December 15th. , + All personnel for the Typhus Service was assigned from the Municipal Health Department of the City of Naples up to December 27th when personnel begn to come to the service directly from the ANG labor office. The first three dootors and the firat group of nurses assigned from the Municipel Department were highly satisfaetory and have formed the nucleus from whioh all of the delousing program hag bean developed, Requests for additional doctors, nurses,field workers and office staff were in general fruitless. Verbal authorisation for the hiring of personnel at from 30 to 40 lira per day failed to solve the problem. Only after the confessed inability of the Munieipality an@ of the Italian Red Cross to supply the personnel needed for an expanding service was recourse had to the labor office. -3- On December 19th, the local situation, as it might affect the military effort was discussed with Goloned Stone. This was followed by a discussion with General Fox, Colonel Stone and Colonel Crichton on December 21st. On Deesember 23, General Fox made arrangements for the Typhus Service to have access to PBS sources of supplies, trans- portation and personnel and announced that the United States of America Typhus Commission had been authorized to assume all respon- sibility for the control of Typhus in Naples. On December 24 th,offf cial advice was received from ANG Headquarters that 1t would be im- possible for the USATC to take over the responsibility for typhus control. Fortunately it was possible to make arrangements to take advantage of PBS facilities during the period of uncertainty as to whose would be the final responsibility. With the return of General Fox, the following week, the situatiom was clarified and arrangements made for the United States of America Typhus Commission to take over the active control of the fyphus Service as of January 3 1944 under the immediate direation of Colonel Bishop, DELOUSING PROGRAM. Ail available personnel and transportation were used in the beginning fe@r searching out and delousing the contagts os officially reported cases and of such additional cases as wight be found in visiting contacts. : veliminary training of personnel was undertaken at the Cotugno Hospital on December li’ using shaker tins to distri- - pute the powder on the immer surfaces of garments whieh had been re- moved from the weayers. Hudson dusters were requisitioned and avai- lable before field work began on the 15th. . The first field job attempted was the dusting of the passengers of the first passenger train autherized to leave Naplg for Bari following the Allied occupation, Passengers on later trains nave been regularly dusted in an attempt to reduee the risk of typhus being carried out of Naples. . . Gontagt Delousing. A list of the names and addresses of ail ty~ phus cases reported during November and December was compiled and & program drawn up for visits to all addresses. During these visits « Search was to be made for new cases and all contacts of both old and new cases were to be powdered, A very liberal interpretation of the word . Yoontact® was used in determining the extent of delousing to be gar ried out by the contact delousing units, In home work, the contacts of the immediate family were dusted, followed by the dusting of the ooeupants of the rest of the building where the patient had been liv. ing at the time of onset. Finally, a temporary delousing station was often opened in the sourtyard open to all comers of the immediate surrounding houses, In the case of LpSitutions from whieh cases had been reported, all inmates and attendants were dusted, It was found that contacts fgll into three general groups each of which presented special problems: home conta- ets institutional sontacts and Air Raid Shelter contacts. Home eon- tacts were moat efficiently traced and powdered by small units, insti- wh tutional contacts justified larger groups of workers, whereas Air Raid Shelter contacts required night workers with curfew pas- ses, some source of artificial light and night transportation. Original plans called for the institutional contact service to handle the large labor groups in contact with the Allied forces but this proved to be unnecessary since both American and British forces sent their own workers for training and assumed the responsibility of @elousing their own labor units. Mass Delousing. fhe organization of the masse delousing program which wae an integral part of the initial proposal became possible pnly efter the contact delousing service was operating satisfacto~- phly and after adequate stocks of insecticide became available, ‘Plans were drawn up for the installation of fifty delousing stations open to the general public placed at strategie points throughout the city. The first two stations were opened on December 25th, two ng re on the 30th and a fifth on January lst. The mass delousing sta- tions proved to be immediately popular. Gase Finding. One of the first results of th. contact delousing work which began on December 16th was the discov wry of a considerable nwaber of additional cases which had been neitne isolated nor reported. Discussion of the situation led on December 19 to authorization being given by Colonel Crichton for the organization of a case finding section and Major Cherry was ag signed by AMG as chief of this section. This new case finding ser- vies began field work on December 22nd and uncovered a considerable pusper of suspect cases in spite of inadequate transportation faci- os. As of December 3] 1943 working with : Transportation unite ;: ? 2 1 a 6 Personnel (civilian) Fie the typhus control service was motoreycle trieycles passenger bus, command cars amall sedan jeeps weapons carriers Office Home contact Delousing 5 Institutions Delousing 45 3 38 Air Raid Shelters Case Finding Masa Delousing During the period Dec.15 to Jan.2 an estimated total of 51780 persons were powdered with insecticide. Of these over 30000 were powdered as contacts of 315 reported cases, whereas sone 17000 were powdered at public powdering stations. Only about 2500 wderings, those of the RR. passengers, can be classed as cbliga- ory. : o/s HOME INSTITUTIO~ |aIK kaAID MASS TOTAL DATE NAL SHELLERS DELOUSING DAILY CONTACTS =f CONTACTS (StaT1UNS) | LUSTINGS. Dec.15 ~~ 700 -- -— 790 "16 ~- 581 -- a 581 nly 104 388 -- -- AGe * 18 325 740 -- -- 1065 ® 19 900 ~—- -- ~-. 900 " 20 1325 mam -~ ~— 1325 ® 21 1517 17 ~~ — 1534 " 22 1285 300 -- -— 1585 "23 897 -—- = — 897 2 24 | 1245 a 7 -- 1245 n 25 733 400 -- -- 1133 " 26 1354 437 ~~ -- 1791 "27 1568 300 600. -- 2468 " 28 2182 500 600 862 ALAA * 29 3155 500 180 1328 5163 e 30 3113 -—- 500 3718 7331 w 31 1428 one Aa 4041 5916 Jan. 1 2082 -——— 446 2523 $051 " 2 ~t--330% warn 5158 8459 26514 4863 2773 17630 51780 -T- The Contact Delousing Service was responsible between Dec. 16th. and January 2 for calling attention to 164 possible cases of typhus not found previously listed among reported ca- ses. The Case Finding Service culled attention to an additicnal S7suspect cases. No information is available as to what percenta ge of these cases were finally accepted as typhus.