FINAL REPORT OF TEE PREVENTIVE MEDICINE OFFICER OFFICE OF THE SURGEON MEDITERRANEAN THEATER OF OPERATIONS UNITED STATES ARMY 1 January - 31 October 194-5 This report is being made available pending the completion of the official History of the Medical Department in World War II, Persons finding errors in facts or important omissions should communicate with the Historical Division, Army Medical Library, Washington 25, D« C. It is emphasized that all statistical data in this historical report are tentative and subject to revision when tabulation of individual sick and wounded report cards has been completed. This document is reproduced from unedited, unreviewed material on file in the Historical Division, SGO, and statements of opinion, any comments, or criticisms contained herein do not necessarily represent the views of the Surgeon General, Department of the Army, or official policy or doctrine. Therefore, this document is not to he reproduced in any part or in its entirety. HEADQUARTERS MEDITERRANEAN THEATER OF OPERATIONS UNITED STATES ARMY Office of the Surgeon APO 512 2 November 1945 314.7 * SUBJECT: Final Report of the Preventive Medicine Officer, TO : Surgeon, MTOUSA. Submitted herewith is final report of the preventive medicine officer, Office of the Surgeon, MTOUSA, covering the period 1 January - 31 October 1945. /s/Kugh R, Gilmore HUGH R. GILMORE, Colonel, MC, Preventive Medicine Officer. 4,61. 1st Ind. HEADQUARTERS MTOUSA, OFFICE OF THE SURGEON, APO 512, 3 November 1945. TO: The Surgeon General, U. S. Army, Washington 25, D.C. Approved. /s/E. Standlee E0 STANDLEE, Colonel, M.C., Surgeon, 1 Incl: Final report of preventive medicine officer, office of the surgeon, MTOUSA (dup) TABLE OF CONTENTS Page I GENERAL . 1 II PLANS . . 3 III MILITARY IMPORTANCE OF DISEASE AND INJURY ........ 5 IV GENERAL EXPERIENCE 9 V RESPIRATORY DISEASES 11 VI INTESTINAL DISEASES 15 VII INSECT-BORNE DISEASES . 19 VIII MISCELLANEOUS CONDITIONS 25 U SPECIAL TOPICS . . 31 X NUTRITION a ■ j , • XI VENEREAL DISEASE 43 APPENDICES 1 through 33 52 LIST OF APPENDICES 1, Respiratory diseases (chart) 2, Intestinal diseases (chart) 3, Malaria and FoUo0, (chart) A. Venereal disease (chartj naK through "ln--tables, directives, etc,) 5, Jaundice and trench foot (chart) 6, Sandfly fever and miscellaneous diseases (chart) 7, Non-battle injuries and battle casualties (chart) 8, Noneffectives for medical reasons, MTOUSA, 194-3-194-4--194.5 (chart) 9, Permanent total losses—MTOUSA (chart) 10, Disease (chart) 11, Non-battle injury (chart) 12, Battle injury (chart) 13o Battle wound (chart) 14-c Common respiratory diseases (chart) 15, Pneumonia, primary (not atypical) (chart) 16, Pneumonia, atypical (chart) 17, Bacterial food poisoning (chart) 18, Common diarrheas (chart) 19, Dysentery, unclassified (chart) 20, Malaria, vivax, "new” (chart) 21, Malaria, vivax, noldH (chart) 220 Fever, undetermined origin (FoU,0„) (chart) 23. Gonorrhea, *new,? (chart) 24.0 Gonorrhea, Hold“ (chart) LIST OF APPENDICES (continued) 25o Chancroid9 "'new" (chart) 26o Urethritis (cause undetermined) (chart) 27o Penile ulcer (cause undetermined) (chart) 28. Hepatitis9 infectious (chart) 29. Mycotic dermatoses (chart) 30. Analyses of stool specimens examined 19AA (also 30a and 30b) (charts) 31. Omitted [Cultures submitted to the 15th Medical Laboratory (table)] 32„ Report of malaria“Control activities in the Mediterranean Theater of Operations during 194-5 (includes 57 illustrations-"photographs, mapSj figures--and "A Study of Winter DDT House-spraying and its Concomittant Effect on Anophelines and Malaria in an Endemic Area*1 by Thomas H. G0 Major9 SnC and "Oil Spraying Equipment for the A~20 (Douglas) and PT-17 (Stearman) Airplanes* by William Jc Wyatt9 Major9 SnC) 33o MTOUSA safety and accident prevention program FINAL REPORT OF THE PREVENTIVE MEDICINE OFFICER OFFICE OF THE SURGEON MTOUSA - 1945 PREVENTIVE MEDICINE HISTORY CHAPTER I General The troops which landed in North Africa in November 1942 were not well trained in matters of housekeeping and sanitation. This is not said in depreciation of the training which these men had been given, but merely as an explanation for the serious out- breaks of gastro-intestinal disease, malaria and trenchfoot, which occurred in 1943» The development of high standards of sanitation in an Army in the field is dependent on detailed knowledge of "good housekeeping11 which extends down to the lowest echelons. In the United States, people in general have come to take sanitary meas- ures so much for granted that few people realize the importance of chlorination, of pasteurization, of waste disposal,of food inspec- tions, etc. Until the company and platoon commanders and noncommis- sioned officers are convinced that water sanitation, food handler examinations, waste disposal, use of repellents, bed nets, etc., are necessary. useful and sensible procedures0 it is unlikely that they will adequately carry out the various little steps so necessary for protecting the health of troops0 Once the forces saw the results of neglect in the diarrhea outbreak which was al- most universal in 1943 and in the serious malaria outbreaks in Sicily, it was no longer necessary to convince anyone of the im- portance of sanitation. From this time forward, the problem con- sisted in organization of preventive medicine activities to in- sure adequate supplies being at the right place at the right time; to maintain a continuing inspectorial system to insure the application of both old and new lessonsi to indoctrinate new troops entering the theater; to develop improved methods for pre- venting disease and to expand the program to encompass many of the numerically less important but still significant diseases. During 1945 the preventive medicine program has operated smoothly and efficiently. Troops had been well trained in sanita- tion principles and adequate supplies were available for carrying out all disease control procedures. As a result, disease rates in 1945 were appreciably lower than in 1944 or 1943. 2 CHAPTER II Plans The 1944 experience indicated that the following dis- eases would be of major importance in 1945: Malaria Diarrheal Diseases Infectious Hepatitis Trenchfoot Venereal Diseases Plans to control these diseases were essentially an ex- tension of the 1944 plans into 1945. The malaria control program was based on the following basic procedures? I. Control of mosquito breeding by larviciding, ditching and draining. This work was largely done under the su- pervision of malaria control units, although troop units were held responsible for their own immediate areas. Airplanes were avail- able for larviciding large areas. 2c Destruction of adult mosquitoes by spraying houses and bams with DDT, and by the use of freon bombs. 3. Individual protective measures, such as the use of bed nets and insect repellent. 4o Suppressive atabrine therapy for troops in ma- larious areas. The control of diarrheal diseases centered upon fre- quent sanitary inspections to insure proper mess and food sanita- tion! proper disposal of waste! fly control and examination of food handlers to detect carriers of intestinal diseases'. The availability and widespread use of DDT was of great importance in reducing the fly population to a minimum. Since the method of spread of infectious hepatitis is not known, it is difficult to know how to prevent it". However, emphasis was placed on mess sanitation since some evidence exists that the disease is spread by ingesting infectious material. 3 Plans for preventing trenchfoot centered upon the use of shoe pacs, which had not been available in 1943~44s and on an educa- tional program regarding care of the feet and methods of preventing trenchfoot0 The venereal disease control program was a continuation of the 1944 program plus the use of medical prophylactic platoons to operate prophylactic stations in cities 0 Late in 1944 condoms were made more readily available to troops by issuing them to units with- out charge and in such numbers that issue to individuals could be un- restricted * In 1945 the use of the intraurethral injections of a silver salt was stopped0 The administration of sulfa drugs with a prophylactic was initiated in 1944o In reviewing the experience in this theater with prevent- ive medicine measures two important points stand out? (1) It is essen- tial in planning for any campaign to include preventive medicine plana and to impress the importance of these plans upon commando All unit commanders must be made to realize the importance of carrying out the preventive medicine measures (2) To carry out pre- ventive medicine measures it is essential that supplies get to troops promptlye These supplies include such items as screening* sprays and sprayers* DDT* diesel oil* Paris Green* and insect repellents‘e One of the causes of the high diarrhea and malaria rates in 1943 was the early failure to provide troops with fly and mosquito control supplies These outbreaks in the summer of 1943 impressed upon commanders the importance of sanitation and the necessity for adequate supplies* and, as a result* planning for the invasion of Italy included preventive medicine measures and supplies. 4 CHAPTER III Military Importance of Disease and Injury In assessing the military importance of disease and ia« it is necessary to consider a number of different factors such as: Morbidity Noneffective rates Length of hospitalization Mortality Percentages evacuated to the Zone of the Interior Percentages reclassified from general to limited service All important statistics are shown in the attached appen- dices. IT Morbidity (appendices 1-7), The number of cases and rates for all conditions are shown. 2, Noneffective rates (appendix S), The fact that the percent of disease noneffectives is lower for the first few months of 1943 calls for explanation in the face of the generally higher rates for communicable disease during those months. This is be- lieved to be due to the following: (a) Reporting, There is reason to believe that many cases were not reported in the early part of 1943 before the reporting system became thoroughly organized. Also,, in the early months of 1943$ many United States troops were treated in British hospitals because sufficient United States hospitals were not available in the theater. (b) Trench foot,, jaundice. These conditions which occurred in epidemic proportions in the latter months of 1943 and early months of 1944 added materially to the early 1944 noneffec- tive rates because of the long period of hospitalization entailedT (c) Malaria, The large number of cases of malaria which occurred in the early months of 1944 were chiefly the result of infections incurred in North Africa and Sicily in 1943* which because of suppressive either became apparent for the first time or which relapsed during the early months of 1944o Until May 1943 troops were not exposed to malaria to any appreciable extent. The same holds true for diarrheal diseases. 5 (d) Strength , During 1943 the strength of the thea- ter was increased constantly and at atrapid rate, Hence, fresh troops which had but recently been screened at Ports of Eknbarkation in the United States were arriving constantly* thus increasing the strength* but adding little to the hospital population during their first weeks in the theater. In 1944-45 the rate of increase in strength was less and consequently the troops were more thoroughly seeded with jaundice and malaria. (e) Weather, It seems probable* although no figures are available* that the first period of prolonged combat during bad weather which an army undergoes will bring to the fore these condi- tions such as arthritis* or psycppathic disorders* which had not pre- viously become manifest under the less vigorous demands of training in the United States , If this then it is to be expected that this would tend to affect abnormally the noneffective rates during the first winter which a new combat force experiences. 37 Length of hospitalization (appendices 10-29), These appendices show the duration of hospitalization and the ultimate dis- position for all important conditions encountered in the Mediterran- ean Theater of Operations (MTOUSA), These appendices are based on data collected from the machine records system operated in this theater. 47 Mortality and evacuations to the zone of the interior (appendix 9)7 This graph illustrates the tremendous importance of the Medical Department in the matter of permanent total losses7 It will be seen that nearly half of these losses were carried through medical channels. Considerable discrepancy will be noted between the figures in the following table and the figures used for appen- dix 9o This is especially true of the missing in action and killed in action figures'. In order to keep the chart current it was often necessary to make estimates and these estimates were never corrected* hence the figures in the table are considered more accurate. 6 Permanent Losses in Theater Strength 19 43 J 19 44 ] L945~lst 8 Mos 3 Totals Cases i Cases % Cases L .1 1 Cases % . , Missing in Action* 8531 21o0 18969 20.1 4183 T2,i 31683 19.8 Killed in Action* 9986 24o7 32646 34o7 3083 12o0 45715 2806 ** (Disease 218 0o5 293 0o3 160 0o6 671 0o4 Died Of (Injury ?09 lo7 1428 lo4 757 3o0 2894 I08 (Battle Wound 809 2o0 2626 207 346 lo3 3781 2o3 *** Evac- (Disease 10568 26o0 16460 17o5 8869 34o6 35897 22o4 uated (Injury 3139 7o6 4580 4,8 2964 110.4 10683 606 to ZI (Battle Wound 6.446 15,8 16726 17,8 5134. 20ol 28306 77.7 TOTALS /0406 ..222.28 _25426j 159630' * AG figures as of October 1945 O ** 86ab0 *** 86fo 5o Percentages reclassified from general to limited service0 (appendices 10-29) These graphs show the percentages reclassified for all conditions of major importance0 Appendices 10-13 are shown because of the comparisons which can be made between Fifth Army Infantry and other ele- ments of the theater0 These studies are not based on the entire theater experience and therefore the figures on types of final disposition will vary to some extent from the theater totals taken from S6ab data which are as follows8 19A3-A5 to 1 Sept i Disease In: ury Battle Casualty Cases!Percent Cases Percent Cases Percent Returned to Duty 755676 95oi 105738 88 o 6 84141 72,4 Evacuated to ZI 35897 4o5 10683 6.9. 28306 24.o3 _ ....... ... __ Died 671 .08 2894 2o4- 3781 „J02 Totals 119315 116228 7 CHAPTER IV. General Experience The major problems encountered in the theater were% Malaria Diarrheal diseases Venereal diseases Infectious hepatitis Typhus fever Trench foot Non-battle injuries Small outbreaks of the following occurred but never con- stituted a serious problem; Plague (No cases occurred in United States Troops ) Diptheria Atypical pneumonia Poliomyelitis Infectious polyneuritis (Guillain-Barre Syndrome) Sandfly fever The only conditions to which the term epidemic may properly be applied from the theater viewpoint were? Condition Period Diarrheal Disease Summer » 1943 Malaria Summer - 1943 Infectious hepatitis Winter 1943-44 and 1944-45 Trench foot Winter 1943-44 Venereal disease Fall of 1943 onward In addition to these conditions, non-battle injuries ex- acted an enormous toll in terms of life, disabling injury, man-days lost and equipment destroyed,, These conditions together with many less important condi- tions will be discussed in the following sections; The figures for November and December 1942 are so unreliable that no attempt will be made to include them in this report. In general,, it may be said that no serious disease outbreaks occurred during this interval. 9 CHAPTER Vo Respiratory Diseases/^Appendix I) lo Epidemiological experience 0 a, General„ The peak incidence of respiratory dis- eases in the winter of 1944a=45 was reached in January 1945 with a rate of 183 per 1000 per annum: as compared with a peak rate for 1943”44 of 2?4 In January 1944. Since January 1945 the rate has declined steadily reaching 60 in July which is lower than any rate previously shown in this theater. bo Common respiratory diseases (mild in type) accounted for 34$026 cases or 78 percent of the total respiratory diseases, (First 8 months of 1945)4 Co Influenza. There were 1101 cases reported for the first 3 months of 1945» It is doubtful whether any of these cases represented true influenza0 No epidemic outbreaks that might be at- tributed to influenza occurred0 From time to time in the latter part of 1944 intelligence communications from enemy territory re- ported influenza being epidemic0 These reports were not confirmed0 Arrangements were made to obtain blood specimens from patients with suspected influenza in order that tests might be made for influenzae Results showed that true influenza was rara0 d. Pneumonia (primary*, secondary or atypical.) was reported 6*, 016 time's, (l4 percent of the total respiratory dis- ease cases for the first 8 months of 1945 *) These are subdivided as follows? Cases Pneumonia, primary 85 0 Pneumonia, atypical 5101 Pneumonia, secondary ■ 65 Atypical pneumonia showed an increase in 1945 as compared with 1944$ In 1944$ 3$960 cases were reported for the entire year while in 1945$ 5$101 cases are reported to 1 September» This in- crease, in part, represents better reporting since atypical pneu- monia did not appear on weekly statistical, health reports till May 1944 although reporting of the disease had previously been required under the "remarks” section of the report0 However, there was no doubt an actual increase in the disease0 Fifth Army reported several outbreaks of a disease clinically similar to atypical, pneumonia and reported as atypical pneumonia but which differed epidemiologically from atypical pneumonia in that a large number of cases appeared sud- denly in an organization? The outbreaks would extend over a period of 3 or 4 weeks and then subside after affecting perhaps 20 or 30 percent of the unit„ All outbreaks could be traced to farm buildings0 Investigations by the 15th Medical Laboratory suggest that this dis- ease may have been "Q" fever, e0 Other respiratory diseases. A comparison between 1943, 1944 and 1945 cases is shown in the following tables 1943 s 1944 • 1945* ..JEgtalai. Diphtheria (a) 211 ; 624 • « 336 9 1171 8 Meningitis (Meningococcic) 167 : 241 8 in O • 519 s Scarlet fever 52 : 102 O 103 • 257 8 Septic Sore throat (a) • o 650* « 459 • — : Rheumatic fever (b) g 89 s 211 0 96 g 396 : Mumps 550 s 576 0 288 0 O 1414 s Measles 351 ; 179 • 154 a 684 i Measles, German 0 189 : 106 ; 124 g 419 s Poliomeyelit is 0 0 32 s 61 8 59 8 152 % Chicken p$x o • 2? 8 60 o 0 11 o o 98 ? Small pox g 9 8 3 • 1 e 13 : Whooping Cough o 2 8 1 o o 1 g Tuberculosis (c) (all forms) o 238 8 367 • • 225 • 830 . ■jr ■^bnths^nlyr (a) Diphtheria and septic sore throat0 The difficulties involved under field conditions in differentiating diptheria from septic sore throat no doubt resulted in some error in the reporting of these two diseases„ The relatively few cases of post-diphtheritic paralyses which have occurred seem to indicate that few cases of dijhtharia were mistaken for sepfcic sore throat, v- (b) Rheumatic fever0 In a special study of rheumatic fever in MT0USA, Lt, Colonel Edward P‘, Bland estimated that "There have been to date (1 November 1944) approximately 1,200 pa- tients in MT0USA with rheumatic fever and/or rheumatic heart disease"0 He further states, "In retrospect, if those patients with known heart disease and those who had had rheumatic fever within one year of entry into the service had been excluded, the problem presented to the Army in this theater would have been reduced by 49 percent." (c) Tuberculosiso These figures are believed to be reasonably accurate0 In a special study of tuberculosis conducted 12 by Captain George T, McKean and Colonel Donald S, King* it was found that 25 percent of 270 tuberculous cases studied had not had chest X-rays prior to induction* In another series of 26? cases* they found that 18 percent gave a history of tuberculosis in their families* It is the understanding of this theater that approxim- ately 10 percent of the Array failed to receive chest X-rays prior to induction and that about 10 percent of the demonstrable lesions were overlooked or those who were X-rayed* If these figures are correct and if it is borne in mind that this theater probably re- ceived an abnormally high percent of the early inductees who were not X-rayed it would seem likely that a considerable number of the cases reported existed before arrival in this theater* It is under- stood that this aspect of the problem is being studied in the Zone of the Interior by examination of induction films in cases returned to the Zone of the Interior. 2* Preventive Measures* a* Clothing* bedding and housing'. Supply difficul- ties resulted in shortage of clothing* bedding and overshoes in the winter of 1943-44* but during 1944-45 the troops were adequately clothed'. Bedding and housing standards wereas good as could be obtained under the conditions which existed! The importance of these matters from a morale as well as a health point of view was fully recognized by the command, and no serious or large scale deficiencies occurred* b. Special measures. Isolation of cases and iso- lation or observation of contacts and other necessary restrictions were promptly applied at lower echelons whenever deemed advisable „ Group or mass quarantine measures were not used. c* Sulfa prophylaxis* Because of the extremely small (1684*) number of cases of sulfa-susceptible diseases* it was the policy of this headquarters to restrict the use of sulfa drugs as a prophylactic measure* and it was never necessary to use sulfa prophylaxis for respiratory diseases. *This figure consists of all cases ofs Pneumonia*, primary 850 Pneumonia* secondary 65 Meningitis* meningococcic 111 Scarlet fever 103 Septic sore throat 459 Rheumatic fever 96 Total 1*6£4 (first 8 months 45) 13 3 , Military importance. The costs in terns of man-days lost, reclassification, deaths and evacuations to ZI are shown in appendices 14-16 for three of the most prevalent respiratory conditions. 14 CHAPTER VI. Intestinal Diseases \ (Appendix 2) 17 Epidemiological Experience. aT General, MTOUSA is an area in which the filth diseases of man have been extremely prevalent for generations. The peace-time sanitary standards are extremely low. The sanitary habits of the people are bad, sanitary facilities are generally inadequate or non-existent and waste disposal methods are in general unsatisfactory". The destruction of war has made these inadequate facilities still less satisfactory, so that the whole problem of preventing intestinal disease is extremely difficult. Despite these handicaps, the intestinal disease rates have remained at a satisfactory level excqjrb for the theater- wide epidemic which occurred in 1943 id North Africa, The only other outbreak of any importance was a small typhoid outbreak which occurred in Fifth Army in October and November 1944o This outbreak was thought to be the result of two factors? (l) Poor water discipline. There appears to have developed a temporary general laxness in individual water dis- cipline in some units" Many of the men who became ill admitted they had drunk water from unauthorized sources, and that they had not chlorinated the water. (2) FoodT It is felt that the attempt to pro- vide hot meals to forward troops was also partially responsible for this outbreak. Since the distance, in time, from kitchens to for- ward troops was often several hours, it is easily understood how thermos containers could serve as incubatorsT These conditions were promptly corrected and the rate declined to an acceptable figure, b. Common diarrheas and bacterial food poisoning accounted for 6,181 cases or 89 percent of the total intestinal diseases, (first 8 months 1945)7 When it has been possible to do careful bacteriology most of these outbreaks have been found to be due to bacillary dysentery infections, so that to the relatively small number of bacillary dysenteries reported as such should be added a large percentage of the common diarrheas. c0 Dysenterieso There were 268 cases of unclassified dysentery,, 170 cases of bacillary dysentery and 277 cases of protozoal 15 dysentery. It is believed that many of the so-called protozoal dys- enteries are- actually bacillary cases in which protozoal were also foundo It is felt that the increased number of cases of protozoal dysentery reported in 1944 and 1945 as compared with 1943 cases is largely a reflection of the greater interest in the problem of etiology in intestinal diseases0 This was shown by determining the diagnosing hospital for a sample of 304 cases of the total of 841 reported in 1944o This showed that 245 (60o6 percent) were reported by five hospitalss all of which contain personnel trained at Tulane or other Southern institutions where the interest in amoeba is higher than in the United States as a whole0 An analysis of stool specimens found are shown in Appendices 30 kg 0o The report from the 15th Medical Laboratory does not contain all confirmed cases within this theater but is a fair representation of the distribution of these organisms in Italy0 Out of a total of 778 cultures submitted to the Laboratory for 539 cultures were found to be and 239 coliform and paracolon bacilli0 d0 Typhoid and paratyphoid fever0 There were a total of 9 cases of typhoid and 17 cases of paratyphoid0 With the excep- tion of an outbreak of typhoid fever which occurred in the 349th In- fantry Regiment9 all cases were probably due to individual infrac- tions of food or water regulations0 There were no typhoid or para- typhoid deaths reported in 19450 20 Preventive Measures. a0 Gsneralo The experiences of 1943 with intestinal diseases were such that all concerned were ©ware of the importance of good food and water sanitation. b0 Supplyo Advance made it possible in 1944 and 1945 to supply all units with adequate amounts of screen9 5 percent DDT in kerosene9 and other necessary supplies0 No serious problems developed0 c0 Unit sanitation,, Disposal of wastes (human^ animal and kitchen) was well handled by United States units0 In many instances 9 units were forced by circumstances to bivouac near civil- ian or foreign military installations whose sanitary standards often were extremely low0 Some of these problems were difficult to handle9 but in no instance did these circumstances result in serious out- breaks in the associated United States troops0 Allied Military Government (and latqr Allied Control Commission) were able to develop a semblance of normal sanitary disposal in most civilian areas where United States troops tiers operating OA5 S8p463 72 132 (l) These figures demonstrate the, tremendous loss which occurs from injurieso Examination of the cases9 rates and curves (appendices 10-12) for injuries and battle casualties shows that injury rates are not closely related to battle casualty rateso Special studies conducted in this theater have demonstrated the following as the general causes of nonbattle injuries! Percent Falls 29.6 Vehicles 23ol Weapons and Explosives llo7 Brawls and fights 9*5 Burns 606 Falling Objects, Machines and Miscellaneous -15^ Total 100.0 (2) Detailed study of individual injuries often reveals an element of carelessness or negligence® bo Preventive measures*. The extent of the manpower loss resulting from injuries was brought to the attention of the MTOUSA staff and a safety committee was formedo This committee began to function and drafted a safety policy for the theater which is expressed in a MTOUSA Circular Letter (appendix 33)* The lowered number of cases and deaths and the strikingly low rate in December 1944. and 1945 give evidence of the effectiveness of this program* Co Military importance* See appendices 11 and 12. CHAPTER IX Special Topics 1. Clothing, shelter, bedding, individual equipment and reportingo a. General, On the whole, United States Army supplies of these types were satisfactory0 In planning, it should be borne in mind that most nontropical foreign areas are not well supplied with fuelc Most houses are not centrally heated. For the most part, troops live in teats and in combat areas, they frequently must sleep on the ground0 Therefore, in wet and cold weather, it is difficult to keep warm unless satisfactory equip- ment or facilities are provided. If they are not provided, improvi sation will be made, some of which result in mishaps, such as burns. b0 Footgear„ In a climate such as in Italy, it is essential that combat troops be supplied with warm and water- proof footgear. Provision must be made for frequent changes of heavy warm socks 0 Training of troops for areas such as this can- not overstress the importance of foot care. Finally, outer cloth- ing (trousers, raincoats and overcoats) should be designed so they do not serve as wicks for Tunneling water into shoes and shoe pacs. The use of the shoe pac, heavy socks, and rigid foot discipline kept the problem of trench foot at a mini- mum in the winter of 19A4~4-5a Some complaints were registered to the effect that shoe pacs were heavy and clumsy and further study to develop a lighter but equally sturdy shoo pac would seem desirableo c. Outer clothing. Satisfactory, no changes recommended, except as noted under footgear. d„ Water repellents• All outer garments should be water repellent and facilities should be provided for local reimpregnation of cleaned and laundered clothing. e0 Opts and bedding, A collapsible metal and canvas cot similar to British and German models should be develop- ed for use in shelter tents so that it would be possible to sleep off the groundo In general, sleeping bags are to be preferred over blankets as bedding0 In forward areas, sleeping bags must be so constructed that the individual can quickly release himself and get free in the event 6t surprise raids0 f# Mosquito bars, nets and gloves. Mosquito head nets and gloves have proven impractical and were considered unnecessary after satisfactory insect repellents became available. The stand- ard mosquito bars were considered excellent and no changes are recommended. go Shelter tents. There is a need for better water repellents and a canvas floor for tents. 2. Bathing and Laundry. a. General. Bathing and laundry units, while of great value, cannot possibly be provided in sufficient numbers to meet all bath and laundry requirements of troops in the field. b. Bath Units. Bath units are of primary value in forward areas where no other facilities are available to troops. It is impossible and wasteful to attempt to provide this service to rear area troops as well. It is therefore necessary for then to provide their own unit facilities, and this requires improvi- sation. The provision of simple valves, shower heads, water heat- ing units, etc., which could be utilized in a variety of ways would be highly desirable. Simple instructions and simple designs for improvising such facilities would also be useful, c. Laundry Units, Laundry units cannot be provided in sufficient numbers to serve all troops. Experience has shown that a great deal of the laundry service of troops in this theater is provided by native women. This has proven to be one of the chief sources of spreading scabies to our troops. Therefore, it would be highly desirable to provide small units with some simple practical equipment necessary for doing their own laundry, 3o Records and Statistics. No comments. 4« Medical Records. Only two aspects of this subject will be discussed, a. Statistics for month of November 1944. Because of the transfer of large numbers of troops from this theater to ETO on 20 November 1944 certain difficulties developed with respect to medical statistics. 32 The facts of the situation are: (1) Hospitals under the jurisdiction of this theater cared for all casualties occurring in southern France. (2) Patients from southern France continued to be evacuted to Italy until 9 December 1944° (3) Units which utilized MTOUSA medical facili- ties and their strength are shown in the following table: Week Ending Seventh Army . XV Corps . 1st ABTF 100 & 103 Inf Diva “'I CONBASE DELTA BASE TOTAL 4 Nov 11 Nov 18 Nov 25 Nov 115X60 130796 w 150855. 28696* 28696* 28696* 34671 11714 12207 12675 i_12198* 38461* 33461* 38461* * 33461* 23546 25690 34513 _4S162 30149 3G$88 31744 37835 247746 266433 293735 314182 * G-l Reports ** Estj .mated (4) Since this office as well as the Surgeon General's Office commonly makes reports on 4 or 5 week periods, it was necessary for this theater to drou the Southern France figures in order to have a reasonably complete picture for the month. (5) Inasmuch as many of the communicable diseases were not diagnosed until the evacuated Individuals had reached hospitals in Italy (and were therefore reported by those hos- pitals), it appears that the most nearly accurate method to adopt is the latter, and this was adopted in this theater. b0 / Medical machine records0 (1} General. Because operations in this theater had demonstrated a number of serious defects in the standard re- ports and records system as applied to an active theater of oper- ations, a careful, detailed study of the whole problem was begun in the early part of 1944» Some of the major defects are: a. The medical statistical report (WD MD 86ab) does not relate diseases to the organization to which the individual is assigned or attached but to the higher echelon operating the hospital in which the diagnosis is made. This criticism applied to all sections of the report so that the only accurate information available on incidence of various diseases, on noneffective rates, is for the theater as a whole. Such figures obviously are of no value from the preventive medicine standpoint in a theater of this size. 33 b. The directions for completing the B6ab form are complicated and often lead to confusion at the lowest levels where the reports originate. c. The 86ab report even if properly com- pleted does not provide a great deal of statistical information which is operationally necessary within a theater of operations, d. These defects lead to the establishment of numerous intra-theater reports which often are partially duplicating and create unnecessary burdens for the units which submitted the basic reports, e. The informational needs of AG, G-l and other sections of the staff with respect to hospitalized personnel are not properly Integrated into the Medical Department reports and record system, after thorough analysis of the problem, it was concluded that the solution was to be found in the applica- tion of machine records procedures. It was decided that the problem should be considered from two main aspects, namely that of MTOUSA, and also that of the Medical Department as a whole, (2) Solution, With this in mind, a request was made on 8 April 1944 that a "Medical Biometrlst of Doctor Lowell Reedfs caliber be sent to this theater on high priority for sufficient time to study medical statistics and record system and be prepared to make appropriate recommendations to the War Department for necessary changes,w It was impossible for Doctor Reed to visit the theater, but Major Harold F, Dorn was sent to the theater on 15 May 1944, The problem was reviewed with Major Dorn and visits were made to various installations and headquarters throughout the theater. These studies demonstrated that the problem was not purely medical. Certain information regarding hospitalized per- sonnel is of great interest to the Adjutant General, G-l, the Replacement and Training Command, G-3, Transportation Corps and others. It was obvious that if each of these staff sections collected the information it needed independently of other sections, the result would be: a. Duplication of reports required of hospitals, b. Variation in definitions which lead to con- fusion. 34 c. Variations in resulting figures on supposedly identical conditions. do Duplication of effort at higher echelons as the result of multiple analyses of similar or dupli- cated reports« The system designed as the result of these studies was, therefore, intended to be flexible enough and suffi- ciently wide in scope so it would embrace the needs of all con- cerned and gradually centralize into one report, most of the statistical and administrative information required of hospitals. The single report received from hospitals would then be utilized in accordance with individual sections’ needs by all staff sections concerned« Accordingly, although the AG and the Surgeon’s Office took the leading role in developing and implementing the system, the needs of G-l, the Replacement and Training Command and others were carefully considered and so far as practical integrated into the system. (3) Procedure. a. Basic Report, The basic report required for the operation of the system is an admission and disposition report which was standardized as a preliminary to the start of the systemo b. Development of codes. Since no codes were available which would fit the purposes of this system, it was necessary to develop a series of codes* for; 1. Diagnosis. 2. Anatomical locations. 3. Causative agents, 4.0 Surgical operations. These codes were then arranged in alphabetical sequence for the use of the medical coders. c. Training of coders. A short course of instruction was given to the medical coders in which they were made thoroughly familiar with? * The codes and coding and manual used in the Statistical Division of the Surgeon General’s Office formed the basic pattern for these two items. 35 1® The Coders Manual.* A booklet prepared for their guidance and containing various rules governing the selection of the proper codes for various conditions® 2® The use of a medical dictionary. 3® The general concepts of anatomy and pathology0 (3) Operationso a® After the above three steps had been com- pleted and coders dispatched to the mobile machine records units, the system was placed in operation as of 15 September 1944 with the in- tention of including in the system gill units (including those in Southern France)0 It was considered desirable to do this because: (1) The system depends on receiving notifi- cation of all primary admissions and all final dispositions occurring within a given closed system (Theater of Operations)® (2) The Surgeon of the Seventh Army was desirous of having the system instituted for Seventh Army® b0 However. Machine Records Units attached to units in Southern France failed to transmit punch cards on all admis- sions to and dispositions from hospitals in Southern France® The result was that none of the few punch cards which were furnished could be used® However, since evacuations from Southern France to Italy continued until 9 December 1944, we were constantly receiving into the MTOUSA hospital system, large numbers of patients on whom no primary admission reports were received® The result was that our system was thrown out of balance to the point where it was impossible to main* tain any controls, checks for errors or otherwise perfect the MTOUSA system® c. Shortly after evacuations from Southern France ceased, it was possible to survey the MTOUSA hospitalised personnel by means of machine records to derive an accurate census of the hospital- ized personnel and thus rebalance the system® d® Having reestablished the balance of the system, routine weekly reports were resumed and flowed from the system at weekly Intervals until 29 June 1945 when it was necessary to close operations because of redeployment of machine records units® *The codes and coding manual used in the Statistical Division of The Surgeon General9s Office formed the basic pattern for these two items. 36 e0 The time lag involved in processing A and D reports and rendering tabular reports at theater level was A to 6 weeks9 but there seems to be sound reason for believing that this could be reduced to fcout 10 to 14 days ® (4) Reports rendered by the system® a0 Medicalo lo Routine. (a) Admissions by type of case and by diagnosis by higher echelon® (b) Dispositions by type of case and by diagnosis by type of disposition. (c) Remaining cases by higher echelon by type of case and by diagnosis0 (d) Venereal disease cases by diagnosiss by race# by higher echelons® These reportst while similar in nature to those obtained on 86ab reports were potentially much more useful because the number of separate diagnoses was much greater than on the 86eb and included a fairly detailed break® down of noncommunicable diseases and traumatisms® Furthermore f these reports related the various conditions to the higher echelon in which the man was serving when he became ill and not to the echelon in which the diagnosis was made as is the case with the 86ab report® 2® Special. (a) Days of hospitalization required for specific conditions. (b) Evaluation of triage as carried out® (c) Study of evacuation practices of various hospitals. (d) Determination of amount of readmission for such conditions as malariag Jaundice9 psychiatry, etCoj which occurs. 37 (e) Study of causative agents causing various types of trauma* b. Nonmedicalo In addition to these medical uses, the system also provided information to the Adjutant General which was obtained by a simple reproduction of parts of the medical card. Some of the uses were as follows! I. Postal service* With the institution of this system, the Adjutant General was provided wiijh a source of information regarding the location of all hospitalised personnel in the theater* 20 Service records. By furnishing a set of locator cards to Peninsular Base Section, it was possible to great- ly expedite the flow of service records In the case of those personnel, evacuated from Army to Base* 3o Wounded progress reports. Prior to £be inauguration of the system, it was necessary for hospitals to furnish semi-monthly wounded progress reports to the Adjutant General* These were eliminated by the system. Ac Casualty reports* The information furnished by the system served as a useful check on casualty reports received from field units* While the reports could not be dispensed with, it appeared that the resulting check reduced errors and lead to sharper definitions and improved casualty reporting by field units* 5* Type of disposition* Final disposi- tions were reported as: Class A-l Class A-2 Class B Class C Died in Hospital Dead on Arrival C.R.O. A.WoO.L. The result was that G»1 and the Replacement and Training Command accumulated accurate data on the percentages disposed to each type of disposition* (5) Conclusions* Although the system was operated for only 9 months and still required refinement, it seemed clear that the basic approach was sound* The whole problem of clinical records and reports as applied to an active theater under modern conditions of warfare has been carefully studied by this theater and those observations considered to be of immediate practical value to the Army as a whole have been reported to the Surgeon Generalfs Office. CHAPTER X Nutrition lo f B Ration0 a0 Adequacyo The WBW ration, as issued, with fresh meat, butter and vegetables, was entirely adequate from every standpoint. During 1944- and 1945 only isolated complaints regarding rations occurred and these were either unjustified or due to transportation difficulties0 There was no evidence of vitamin deficiencies at anytime0 b0 Preparation Commanding officers learned the im- portance of good personnel in maintaining good messes* The nBH ration is believed to be as varied as is practical, but it can become monoton- ous if insufficient care goes into its planning and preparation This problem was largely solved in this theater, but our experience suggests the need for greater emphasis on this aspect of the problem, as well as in the selection and training of mess personnel*. Co Distribution The "B* ration was continuously sup- plied to all troops except for the forward elements of the combat troops. The Fifth Army attempted to provide these troops with at least one hot meal (nB* ration) daily0 20 Emergency rations 0 MC“, "K", and KU* rations were used extensively only by the foremost elements of the combat forces0 Here, it was often necessary for food to be provided on an individual or at most, a squad basis0 Efforts to bring hot food forward, by means of thermos containers seem to have led to some outbreaks of food-borne dysentery0 Under these conditions, troops cannot maintain their mess gear in a clean condition and often they will not even burden themselves by carrying it0 Consequently, it would be useful if some simple chemi- cal heating unit could be provided for warming **Cn rations and eating utensils provided which could be discarded after use0 The modifications in the nC” ration were well received0 The WKW and ”UW rations were satisfactory*, CHAPTER XI Venereal Disease lo General The problem of the control of venereal disease has been the most difficult problem encountered in Preventive Medicine in this theater and one which has taxed the resourcefulness and ingenuity of both commanding officers and medical officers0 The results obtained have been discouraging in so far as a reduction of the incidence is concernedo The rate for 194.$ showed a gradual reduction until VE day in May, after which it took a sharp upswing and the zenith does not yet seem to be in sight© During this year, the majority of the troops have been stationed in Italy where contact with a large white civilian popu- lation cannot be avoided0 Many individuals stationed in this theater have been overseas from 2-3 years, another factor which, it is believed, contributed to the high venereal disease rate*, The cessation of hostil- ities in May found the troops with a great deal of free time and nothing to dOo To combat this, rest camp facilities were increased, tours of Switzerland, France am Italy were established by Special Service and the University Training Command conducted a school in FlorenceQ In spite of the redeployment to the United States of a large number of troops each month, the incidence has continued to increase0 2 o Epidemiology aQ Rateso The rate in January started out high but showed a gradual decline to 78 per 1000 per annum in April„ After the cessation of hostilities, rates have increased each month (see appendix 4a)0 The rate for white troops varied from a low of $6 per 1000 per annum in April to a high of 8$ in January*, The rate for colored troops has been about three to four times the rate for white troops*, The syphilis rate is considered to be high as compared to the rate in the United States, having varied from a low of 12 per 1000 per annum in June to a high of 1708 in February0 The rate for other venereal disease, which is mostly chancroid, showed a marked reduction this year*. This may be attributed to the use of the new prophylactic kit containing 1$ percent sulfathia- zole in a cream base and the improvement of prophylactic facilities with the installation of running hot water in unit as well as metropolitan prophylactic stations0 The rate of other venereal disease dropped to 907 per 1000 per annum in June, having started out in January with a rate of 21C3C Gonorrhea as was expected accounted for most of the venereal disease cases0 Only 12 cases of granuloma inguinale were re- ported , all in colored troops0 Fifty-six cases of lymphogranuloma in- guinale were reported, 37 in colored and 19 in white troops0 (Note: These figures are taken from the monthly statistical venereal report which is lower than the figures from the 8oab report0) bo The rates for the major commands of MTOUSA for white, colored and combined white and colored troops are shown in appendices 4b, 4c and 4d0 The rates for Penbase, the Replacement and Training Com- mand, the AAF Service Command and the AAF Engineering Command showed con- sistently high rates as compared to combat troops or units not located in the large cities of Italy0 Troops stationed in and around Naples have always had higher venereal disease rates than troops stationed in other areaso The reasons for service troops, which were usually stationed in cities, having higher rates than combat troops needs no explanation Co The percentages of the various venereal diseases acquired by troops in MTOUSA is shown in appendix 4©o The high inci- dence of chancroid in white troops noteworthy0 No cases of granuloma inguinale were diagnosed in white troops0 3o Preventive Measures ao General The responsibilities for venereal disease control of all concerned are clearly indicated in MTOUSA Circular Letter No0 54, dated April 1945® A letter to all major commands by the theater commander calling their attention to the high venereal disease rates and requesting that immediate action be taken to further a reduction was published on 2 January 1945 (see appendix 4f)c b0 Prostitution (1) All known brothels in the theater were placed out of bounds by order of the theater commander0 Clandestine prostitu- tion flourished in all cities in Italy in which troops were stationed0 Individuals had no trouble to make pickups on the streets or in bars or at dances to which native girls were invited, even though the girls were screened and approved before they could enter the dances0 (2) Physical examination of licensed prostitutes or women suspected of being sources of venereal infections to allied troops by Italian physicians was done in a haphazard and slipshod man- ner, if at alio Lack of proper drugs prevented the treatment of Italian women who were found to be infected0 Hospital facilities in many In- stances for the isolation of venereally infected individual® was insuf- ficiento An effort was made in conjunction with the British Medical Section through Allied Commission to improve diagnosis and treatment in Italian hospitals but our efforts never materialized0 A meeting was held in Rome in February 1945 with the Italian Health Authori- ties 9 Allied Commission and representatives of the United States and British Medical Sections9 in which the proposition was made to station an Allied Medical Officer in Italian hospitals in which venereal cases were treated for the purpose of bringing the Italian standards up to Allied standardso The supply of drugs, including penicillin for sulfa- resistant gonorrheas was to have been furnished from army stocks® The proposition was rejected by the Italian health authorities0 As a re- sult many infected women still roamed the streets for lack of treatment® Co Education (1) The usual educational program consisting of poster, talks and films have been followed0 (2) The appointment of a nonmedical commissioned officer to serve as venereal disease control officer for each unit was encouragedo Noncommissioned officers were appointed to assist him so that education could be conducted for small groups of men0 (3) Each major command was requested to establish schools for the education of the above individuals so that they could return and educate others in their respective units® The schools con- sisted of about 6 hours of instruction and covered all phases of venereal disease control0 It is believed that .this concentrated in- doctrination assisted in lowering the rates before VE day® (4) A survey was conducted throughout the theater to determine what percentage of the individuals have acquired venereal disease since being overseas0 This was reported in the Essential Technical Medical Data report® It was found that a relatively small percentage of soldiers is responsible for the major percentage of the venereal diseases in this theater® Only 6®20 percent of the white troops and 18® 86 percent of the colored troops stated that they had acquired a venereal disease since being overseas® Efforts were made by units to concentrate the education on individuals who have had venereal disease previously and on the repeaters® The keeping of ros- ters of venereal cases in each unit was encouraged® Instances were reported in which individuals had two cases of primary syphilis in one year while one individual was reported as having gonorrhea ten times since being overseas® d® Contact Reports (1) No contact reports were required by the theater surgeon because if was found that the information submitted 45 was worthless due to language difficulties and the unfarailiarity of the troops with Italian cities0 (2) In order to determine in which cities in Italy troops acquired venereal Infections, each case was questioned during January and February with the following results: JANUARY FEBRUARY City Cases Percent Cases Percent . 32.6 Naples o • • . 39.0 • • . 1492 • Rome o . o • . 21.5 6 • . 1080 • . 23.6 Florence .... 208 . • • . 4.7 • • . 238 • . . 5.2 Leghorn o • • 2 o 4 • 9 . 157 • ... 3.4 Foggia o • • . 2.2 • • o . 81 • • • 1.8 Bari , . • • . 2.1 • • • . 80 • • 0 1.8 Lucca . .... 102 . • # . 2.3 • • . 131 • . . 2.9 Caserta • • . 1.2 o • . • 61 0 e .1.3 Montecatini , © a . 1.6 0 • . « 86 • . . 1.9 Miscellaneous TOTAL .... ?87 . • • . 23.0 .lOOcO o • . 1162 .. • . 2£oj> It will be noted that over half of the infections were acquired in two cities, namely Rome and Naples0 This picture changed each month depend- ing on the tactical situation except in cities such as Naples, Rome, Leghorn, Bari, and others where the situation was more static. e o Prophylaxis 0 (1) Individual (a) Individual prophylactic items, both mechan- ical and chemical were available without cost in adequate quantities. The number that could be issued to each individual was not restricted but precautions were taken to prevent wastage and to prevent them from fall- ing into the hands of the black market. (b) The one- tube prophylactic kit containing 15 percent sulfathiazole and 30 percent calomel ointment replaced the old two-tube kit in January in prophylactic stations in the Naples and Leghorn areas0 In March, theater stocks were sufficient to make the use of the one-tube kit universal throughout the theater0 The theater cir- cular letter on venereal disease prophylaxis was revised (see appendix 4g)0 The procedure of venereal disease prophylaxis was changed radically. Injections into the urethra were omitted entirely0 Sulfathiazole, 2 grams, was continued as a routine part of prophylaxis. The new method was very simple as compared to the older procedure in which injections of 0.75 percent protargol were used. The reaction of the individual was very 46 favorable to the new type of prophylaxis0 No official complaints have been received by this office* (c) For the number of mechanical and chemical prophylactic items issued by medical supply, MTOUSA to units and prophylactic stations see appendices 4h and 4i. During the months of May and July over 3 million condoms were issued each month which figures about 6 per month per individual for May and about 7 l/2 for JulyQ The number of chemical pro items issued was much smaller0 In May about 1 l/2 kits were issued per individual per month and in July about 1 l/4o (2) Unit prophylactic stations All units were required to maintain a prophylactic station with running hot water and a bidet in lieu of a straddle stand0 Condoms were available in all pro stations without cost to the indi- vidual as well as being available in other places throughout the unit area such as orderly rooms, motor pool, post exchanges, and clubs. Much time1was spent in advising and inspecting units so that prophylactic facilities would be up to standard0 Attendants at pro stations were re- quired. to attend schools for instruction in the proper procedure to ad- minister prophylaxiso The standard of unit prophylaxis has been diffi- cult to maintain during redeployment0 However, all staging areas and replacement depots have constructed pro stations that meet theater standardso (3) Metropolitan prophylactic stations : (a) Prophylactic stations were operated in all cities in Italy in which troops were concentrated„ No effort was spared to make these stations as attractive and inviting as possible to the individualo Running hot water was a basic requirement0 The European bidet was used in lieu of the straddle stand so that the individual could sit down and be as comfortable as possible while receiving pro- phylaxis o In many instancesf booths were constructed to insure indi- vidual privacy0 Condoms were always available without cost in all pro stationso The number was not limited but usually not more than six were given to an individual at one timec (b) The stations were well patronized as evidenced by the number of treatments administered.. (See appendix 4.j°) The tak- ing of the name, organization and serial number of the individual and the issuance of pro slips was discouraged but the final decision re- garding this was left up to the major command which operated the stations In most stations only a daily tally was kept of the number of pro treat- ments given0 During the 9 month period, Jan - Sept 194.5, the number of pro treatments given in the larger cities in Italy was as follows (these figures do not include unit pro stations); Jan-Sept-194.5 Average per month Naples 383,389 42,592 Rome 24-3,791 27,088 Leghorn-Florence Area 75,597 8,399 Bari-Foggia Area 45,049 5,005 Towns adjacent to Naples 17,635 1,959 (c) A mimeographed list of the street addresses of the pro stations was sent out to all major commands who in turn sent it down to the units. Men going on pass were briefed regarding the lo- cation of pro stations in cities to which they were going. (d) After the break-through into the Po Valley in April, stations wore established immediately in the important cities under the jurisdiction of the Surgeon, 5th Army. (4.) Medical prophylactic platoons (a) Six medical prophylactic platoon# were utilized to operate prophylactic stations in cities. Each platoon con- sisted of 27 enlisted men commanded by one Medical Administration officer. Because of the large number of pro stations that it has been necessary to operate in Italy, personnel were difficult to obtain before the acti- vation of these platoons in the latter part of 1944* Usually the pro station personnel had been obtained from hospitals and other medical installations that were located in the vicinity. This procedure put a severe strain on the medical units because their T/O did not allow per- sonnel for the operation of pro stations. This personnel problem was solved by the activation of the pro platoons which has worked most satisfactorily, (b) The six pro platoons were assigned as fol- lows within the theaters 302nd Pro Platoon was assigned to the 15th Air Force to operate stations in the Bari-Foggia area. Later it to the Adriatic Base Command and is scheduled for deactivation in October 194-5. b, 303rd, 304th and 305th Pro Platoons were assigned to Peninsular Base Section, The 303rd operated pro sta- tions in the leghorn area. The 304th and 305th pro platoons operated stations in the city of Naples and surrounding area. c. The 307th and 308th P$*o Platoons were assigned to the 5th Army and operated stations in the Florence area. After the break-through into the Po Valley, stations were established in all important cities in which there were troop concentrations„ The 308th was inactivated in August 194-5o d. The pro stations in Rome were oper- ated by Italian civilian personnel under the jurisdiction and super- vision of the Rome Area Surgeon0 This arrangement has worked out very satisfactory and has saved critical army personnel„ f0 Cooperation with Civil Authorities The assistance rendered by Italian civilian health authorities in the over-all venereal disease control program in Italy has been of limited value„ Italian physicians have been handicapped by a limited supply of drugs and a failure to realize the value of the treatment of women in a venereal disease control program,, In addition, the standards of medical practice in Italy are inferior to that of the United States0 Due to the economic conditions in Italy, physicians were very susceptible to the acceptance of bribes for rendering false reports on the examination of the women suspected to be sources of venereal infection to the Allied troops0 Joint efforts were made by the British and American Medical Sections through G-5, requesting the Allied Commission to in- crease the emphasis on the isolation and treatment of the women who were found to be infected with venereal disease0 Since much of the govern- mental functions in Italy had been returned to the Italians, Allied Commission stated that they had no jurisdicion except in an advisory capacity,, The proposal was made to place an Allied medical officer in each hospital in selected cities in Italy, for the purpose of super- vising the Italian doctors In the diagnosis and treatment of venereal diseaseso Shortages in medical supplies were to be supplemented from army stockse This proposal, after much time had elapsed, was rejected by the Italian authorities on the basis that many of the‘physicians in the venereal disease hospitals were professors, who were capable of handling the cases,. They requested an increase in the supply of drugs but the theater army medical supply could not furnish these as this was an Allied Commission function,, A 4.00"bed venereal disease hospital operated in Naples under the supervision of a British medical officer0 Italian physicians were used for the examination and treatment of the women,, This was mad© possible because Allied Military Government still retained jurisdiction in Naples,. The hospital was filled to capacity most of the time0 The majority of the women were picked up by American and British vice squads and were held in the hospital until rendered noninfectious0 Similar hospitals operated in.Rome, Florence, Leghorn and Milan, but no Allied medical officer supervised the diagnosis and treatment,, 49 4.o Diagnosis and Treatment The diagnosis and treatment of the venereal disease pre- sented no unusual problems0 The treatment of syphilis with penicillin which was started in August 1944., was continued using the dosage of 40,000 units every 3 hours for 60 injections or a total of 2,4-00,000 units0 In Jan- uary 194.5, latent syphilis was included in the type of syphilis to be treated in addition to primary and secondary syphilis„ No figures are available on the cases of syphilis that relapsed after penicillin ther- apy, but a few such cases occurred and were re-treated using a total of 4.,000,000 units of penicillin„ All cases of syphilis were hospitalized during treatment0 In the 5 th Army, a special venereal disease hospital was set up and operated by a platoon of a medical battalion. Gonorrhea eases were treated in the clearing stations to save transportation to the venereal disease hospital0 Throughout the theater, gonorrhea cases were treated on a carded-for-record only status, Penicillin was used in all cases0 i All penile ulcers were hospitalized until the possibility of syphilis was eliminateda A minimum of three negative darkfields was required on all penile ulcers0 The percentage of venereal disease cases diagnosed as chancroid varied from 19o4- percent in January to 10,8 percent in Augusto (See appendix 4$,) In the Air Forces, uncomplicated gonorrhea was treated in the air force dispensaries but all other types of venereal disease were hospitalized, 5o Military Importance of the Venereal Diseases a, From the standpoint of loss of time from duty, vene- real diseases have ceased to be of great importance to the armed forces. With the use of the sulfonamide drugs and penicillin, the time lost has been cut to an almost irreducible minimum. In July and August 194-5, only 3,3 days per venereal disease case were lost from duty. In June, only 316 days were lost from duty by venereal disease cases per 1000 strength per year. This means that one individual out of each 1000 would be absent from duty for 316 days during a year's time on account of venereal disease, (See appendix 4-k.) b. It is believed that the venereal diseases should be handled like other communicable diseases and less emphasis placed on the rates since the time lost from duty is small. Adequate prophylactic 50 materials and facilities should be provided and the individuals educated in the use of these and the dangers of contracting infec- tions o Since the line of duty status has been changed to rtyestt and all forms of restriction removed such as loss of time and pay, unit commanders frequently have remarked that persuasion is the only method of attack that they have left to keep the Incidence of vene- real disease at a low rate in their units0 Since the survey in this theater has shown that all of the venereal diseases are contracted by a relatively small percentage of individuals, (6C2 percent of white troops and 180S percent of colored troops) and that many of these indi- viduals are repeaters, a plan to handle this small group should be worked out® Some kind of disciplinary action should be taken against the individual who repeatedly contracts venereal disease® S 6 > Follow-up of Venereal Disease Cases \ Because of laxness in the follow-up of venereal cases by some medical officers, a plan was started by which the Surgeon®s office MTODSA would receive a 3 x 5 card on each case of venereal dis- ease in the theater0 (See appendix 41o) A follow-up card at the end of the 3 month follow-up period is received on all the venereal dis- eases except syphilis0 A card is received on each case of syphilis at 39 and 9 months0 The syphilis register serves as the 12 month follow-upo In many instances syphilis registers have been held in unit dispensaries many months and in some instances years when they should have been closed and forwarded to the theater surgeon0 This follow-up system would enable the surgeon?s office to determine when the register was due and in the event it was not received9 a tracer would be sent requesting the register to be forwarded0 However, this system was put into effect just about the time that redeployment'started and because of the return of personnel to the United States and the transfer of personnel from one unit to another, the follow-up system has not worked efficiently® Tracer letters have been sent out on cases that are de- linquent but many have gone unanswered or returned because of the in- activation of unitso On each syphilis register that was forwarded to The Surgeon General9 a card was made showing the date it was forwarded0 This has been of assistance to the Replacement Depot in the process* ing of the service records in regards to the date on which the syphilis register was closed0 Many of the service records fail to show the date on which the syphilis register was closed0 It is believed that such a system should be perfected to insure adequate follow-up of venereal disease cases0 CESPIRATOCY DISEASES ePTES PEC. 1000 PEC, ANNUM EATE5 common besoicatogy s 4 & 4 « 4 4 a fr • ► ® 3 § .... #4 3 S to <4 3 to a 2 “ 3 4 8 4 Ok ® to o 4 o 4 1 s 4 CM 4 4 a 4 S ® 4 3 4 8 to 8 8 s T] ® to •o •O CM MM CM CM 4 O Ok « ■4 4 CM 4 4 4 CM CM to to * tO ® w CM 4 pneumonia, primary * ■ 4 *4 4 O o o o o O o O to ® ® tO ® 4 ® CO * 2 ® CM ® o to pneumonia, atypical 1 I i CASES COMMON C.ESPIMTOCY 1 M a " § •4 S CM 8 CM CM 8 CM Ok £ 8 S to 1 2 c- e- & CO 1 1 to 8 >o 2 to 4 *- to 4 ► 4 4 5 3 to 3 to Ok 2 1 Ok ® 3 ® 3 S a 2 | s to 3 h CM § CM 4 s 4 3 r^- r-t PNEUMONIA, PRIMARY S 4 3 *4 #4 O *4 CM 6 8 s 2 s *4 to 2 a 4 to 3 S ® ® •0 C- a 4 at s 8 8 0k ® CM Ok a ® ® 4 a 4 *• r- 4 ® tN CM 3 4 ? ..... 4 -- 8 - Cj* PNEUMONIA, ATYPICAL 2 #4 *4 ■O N 4 •4 4? 00 00 • ® ® 4 3 3 .4 to 4 a CM s to ® s 4 2 ® 4 “ « 4 CM ® 4 CM 4 2 A ® CM 1 8 tO ® 4 ® M a ® CM S * 4 fr- to 3 l! is. OTHER RESPIRATORY DISEASE CASES INFLUENZA fF S N 4 3 i _S CD * 3 •9 • * 3 .3 1 1 s § 3 8 to 3 | 2 8 ® to CM If 7 4 a CO CM ; CM 4 O CM A CM H 8 2 * MUMPS A «5 • o 3 5 * to CM • e- r4 CM CM t© 2 3 S o to CM 2 •0 3 e» 4 4 CM a to tO to ® 3 •o c- S 4 - . MEASLES o 13 3 4* t- I O CM 3 •0 ® 4 to 2 * C- 4 to S CM s to to * to to n 4 4 O A to ® 4 to 4 ♦ O ..1. TUftEKULOSS, ALL FORMS ~o “A 4 «P 4 • ’ « ** _ M to •0 to CM CM CM CM to .4 S to •4 a 4» * a o to r- to CD to CD to S 2 at to o CM to to tO to CM to A CM tO to CM to 4 1 1 OlPHTHEClA 4 4 *4 to <*> 00 4 o *4 CM r- •0 o 0- s CM 4 to o CM 41 ® ® to to s Ok tO 3 3 CM 4 a a to C- a 8 3 %_ CD CM o • UINCENTS ANCINA CD 2 OO M Ok #4 •o to 00 *4 C- 0k to 3 « Ok 4 ® *0 to 4 Ok to 4 4 4 4 8 ® kO at t- 0k to ® 8 to A to O 4 S r^ MEASLES, CECMAN N 3 •4* ® 3 2 4 to N 4 to CM " *• 2 to CM 00 4 CM O CM to 4 ► CM ® C* to »- CM CM to o ceeesbospinal fewer (MENINGOCOCCIC) o 4 2 ® 4* •4 CM •4 to 4 CM a CM OD o s 8 4 s N 4 CM ® " Ok CM e* 4 Ok " to 2 3 4 4 a 2 ® o O 2 Rheumatic feueg to * CM MX Ok 00 o o •4 s z >4 z O CM CM to CM « CM CM 4 ~ S CM • 4 a (O a A 4 ® 4 «o 4 t- “ PNEUMONIA, SECONDARY oo •o *4 *4 o •4 to to *4 to tO • * o 4 CM M 3 M 4 Ok ® 4 » at 4 4 r- 4 ■* o 4 a to CM 4 SCARLET FEWER. * * I- O « H * CM 4 •4 CM 4* 4 4 CM to o! * 3! •* «“ *- ! 9| M i • 2 3 5 T r? a #4 •O i>o 1 01 1- S i .. cases *4 •O 1 3 4 N a «D 9 S 5 #4 CM CM S S to •*- S •4 41 •O a ♦ Ok «-c M 1 CM CM 2 r4 CO 04 8 S 04 04 S CM •4 *■ 00 CD 9 e 9 2 S 9 t- CD O 04 Sit s 8 " - 8 * 1 s * 04 to t- 9 LJ § 4 CM CD CASES OF SPECIFIC inTCSTlDAL DISEASES MCTEDaL WP POfiOmHO • • • CM 4* • r-4 Ob H S3 *4 C" to I to ' to 3:3 3 * to - to r4 CD 4 " 0 - CO N : «1 ! 1 common oiaccwea c a 3 9 to •■4 o> CM IO tO o» 3 a CM 00 H 2 CM CO to 9 9 o> CM jj •O « to CM to CM tO r4 S 9 H H o 1 4" CM CO to CM 2 •4 IO *9 CM to tO to «o 5805 5X75 2239 1417 £ CM to t- to to 9 e 2 0 CO to **- ; vO CO 1 ! 1 P'lStMTEC'i, UNClJSSiE<£0 • *4 •% O 9 4 CD *o 4 Ok *4 1 r*- 8 CM to o to Ok 4 8 to r- •-4 aV ao to CO 3 Ok K 4* O IO S 3 508 227 179 96 3 GO CM tf> 4 9 0 •0 to 4 CO <4 8 saciu.ac'i co - - 00 8 n a» 60 CO 9 8 CM t- a a CM Ok «o 4* IO S H CD W to CM 4* tO E to *4 4 CD CM *4 to r4 CD CM •4 r*. oo 4 IO CM 4 CM CM CM 4 *4 s S 3 a . 1 ; PCOTOroflL o» ** o 0 CJ 1 u CX cO t-U k- rx cv cares cases ►1 • i I -!- j •4 9 * m 2 N 3 * 1 •! 3!T m» 3 s 8 3 M 3 6 9 9 3 • •9 9 9 9 3 S Si J t 8 r > i*« 1 a 3 3 ► 3 s £ *4 *4 £ *15 • j •• j 9 s m s •M s Ml *4 11 i 1 j 1 m 3 3 S s 3 #4 3 r-» 1 *4 Ok Z o» ► 3 3 •4 a £ *4 57 APPENDIX £ VEnEREflL DISEASE CAT&5 PEC 1CXX) PEC ANNUM COLOCEO CATES s s A « & s *4 s 94 3 - m 8 p4 * • #4 •4 ok 8 a co 8 «o 2 tO IT CM o ■o « CM 3 9 j ■* CM tO A CM CM K CM a 3 CM 3 *• CM N Id. Ki N CV. C\j l_.i 1..1- cases * s s *9 • CD •O •4 s ♦ 5 8 m a ► 3 M • | M a #4 8 N Ok 3 *4 3 »4 8 <* r4 * s - lislsja1? -1- 5 94 -4 #4 S 3 •v* Ok 94 5 3 i S S Ml \V)HITE gates CO M S M « s »o N Ok N 8 s •Q 8 3 s 8 <0 * «o CO o ► Sl6|8i||2 s § s - 8 CD «o , « »e1 i CASES s 4> * 8 8 co e ♦ 8 M S i 8 94 r4 <41 3 1 *4 t- M CM •o l*j 3 3 *- »- * . 3 ii 2 « CO CO *0 ■ s I ’ :!l CD tO , t > . M-.1.— a «o •o 8 £ CM CO § § CM CO 4> 5 •O 2 a CM C- « ■& I Sj ~i -L- APPENDIX 4 SOUCCe: MOMTMLV STATISTICAL 06MECEAL B6POCT Venereal Disease Rates per 1000 per Annum? by Color & by Disease MTOUSA - 1945 M S !» ss Ch NO & & § 9* *d * ® o4 y 4- On 00 VO 79 89 61 On ON s 71 00 Ot WHITE {t» o P M . Cfl < K) 30 30 30 30 30 30 30 t*J M <3 M 00 O 30 ~0 O 4*- M O V*> -o <3 30 on 4>- COLORED > g w m w a CO w »fc* M i-1 90 M f—1 f M Vo o 00 OCX H -3 no oo on O O O vO TOTAL O " <1 <3 ' -o ~XCT~ ' KD • 1 m ■ © Vo • vO • M o o o 4*- O H O o o nO WHITE CO K *Tj On On C 4^ On On O' ■4- w O O o o H O vO O <2 o OCX o COLORED M f on on ON 4^ o ON <3 Vo M CO M M M M M M 1—1 M 'OX o 4- « 30 ® 30 O VjJ • ON O <3 o 4^ • TOTAL M O O 4- <3 30 00 On <3 O On 4^ fe O 4- on O' O O M 6 ON • VJt o vD O VO O o 4- • WHITE M o M VO M vO 30 on &5 O t—1 M M M M M H 3—1 *3j On <2 on O O M vo 30 COLORED pri vD <3 O 00 4- <3 -0 On B O O o e O O © O t?d M v£) vO 30 ~o vo 00 4> oo 00 ON On on on O' 4- o M o OX o <2 o M • 4*> • o o VO o TOTAL vD -O <3 <3 o 30 00 M ' M ' 4"- on On 4- ON <3 O' M WHITE o • • O • O o O vD U) on vO on o Oi <3 Ot on VO 4*> On ON ON O O 4- • M o O nO o VH o o o ON O COLORED f-3 £S 30 <3 ON o M on 4>* fO M M M M M M 30 M • ro o nO O M o VjJ 0 4- G VJt o M O TOTAL o o -2 30 on ■4- M vo Source: Monthly statistical Venereal Report, Appendix: 4 a Venereal Disease Rates per 1000 per Annum by Major Commands MTOUSA - 1945 Combined White and Colored p. «Lh t* b p> BS «-t 5cic!fi9W»i yi o ALLIED FORCE HQ.COMMAND ■f>- vO vn os -vl vO vn M CTs v/t o^. ADRIATIC BASE COMMAND \Jt -*3 VJt \Jt Q\ sO 00 so 4S. M vn o M 12 TH AF O Qs rv> O M O^MO 15TH AF 112 105 93 70 92 107 162 151 aafec/mto 143 129 110 116 109 127 137 138 aafsc/mto M M fooooo^'Jtosoooo !-*V*>O^V*>00lV5O^^O TOTAL AAFMT0 Source: Monthly Statistical Venereal Report* Appendix: 4 b Venereal Disease Rates per 1000 per Annum by Major Commands MTOUSA - 1945 White Jul Jun May Apr Mar Feb Jan M nO F^ vn CO VjO s $ vn ON » 2 00 vn TOTAL MT0USA o <3 ON vn Ol V*) vn VjJ fe vn M vn M vn vn 5TH ARMY 00 00 vO VO ON vn vn <3 vn M ON O ON vn 00 <3 PENBASE H On VjJ TO TO ■F- TO •Fn. ON TO N0RBASE 5 ON ON MBS 131 119 111 118 M TO VjJ 107 157 186 REPLACEMENT COMMAND ON M Sj Ot M VjJ 30 vn O £ -F'- vn ALLIED FORCE HQ COMMAND fc vn VjJ TO VO & ON vn .<3 ADRIATIC BASE COMMAND vn 00 <3 •F-* fc £5 vn VjJ on <3 vn 12 TH AF 00 ON 00 M ON ON fc ts £ vn vn v£> 15 TH AF ON -F- M O -F" <3 M vn vn S vn -0 vn 00 S aafec/mto 00 <3 VM <3 Ot vn vn 00 ON vn l3 vO M AAPSC/kPO 00 <3 00 ■<3 O vn O £3 vn O ® o M * TOTAL AAFMT0 Source: Monthly Statistical Venereal Report* Appendix: 4 c Venereal Disease Rates per 1000 per Annum by Major Commands MTOUSA - 1945 Colored f »1 M > Ch B 0> NO £ g «§ s » O' IB . B vn JO JO M jo JO JO JO JO TOTAL <1 00 JO o M VO -3 vn MT0USA o -3 ■p- O -3 JO JO M -3 JO O M M M 00 M vn M vn H* ON M <2 5TH ARMY VO -^3 H •>3 . >0 297 VO £ JO S) M nO 00 JO H» nD JO 00 O VO 8 JO vn M PENBASE M M JO VO vo NOR BASE vn S3 vD Vo O ON vO ON M JO MBS Vo 00 M M vo vn ON ON <2 REPLACEMENT vn OQ vn O OO VO £ JO 00 M ON -3 "3 M VO COMMAND Vn Vo JO JO JO JO JO ALLIED FORCE JO O C> nO (—* -3 O O 00 vn O 00 -3 ON vn HQ COMMAND o M M a M M vn 00 M n£> <2 ro £ ADRIATIC BASE COMMAND JO 00 VO I-* 00 M M VO Vo O ro B VO VO ON M ON 12 TH AF ro M B H M JO M 15 TH AF vn O <2 o $ vo <2 00 M VO Vo vo VO ON JO vo JO H M P JO M JO vo M -*3 aafec/mto ON 00 vO vn -0 vo 00 o Vo 00 VO vo 7V> O JO vO VO JO & JO 336 VO $ aafsc/mto vo JO JO M M M VO JO TOTAL Vo M * VO -s3 M VO ■>3 vn 00 ->3 O -0 vn O AAFMT0 Sources Monthly Statistical Venereal Report. Appendix: 4 d »—1 Cm Cm g > fej Cm CO £ c g ST ® R era H* P ** O' P cn 00 M O M O I-* M 03 cn M 03 s WHITE O o o 0 9 0 9 o 00 o cn CO to cn cn CO M M CO H* 00 CO CO CO CO cn to 6T COLORED 3 0 o 9 o 0 9 9 0 t- CO M 03 03 03 M co H* M 03 M H* H- H* COMBINED 03 03 03 cn -3 CD >0 03 0 0 o 9 o 0 O 9 tt* o 03 03 cn M co 03 00 oo 00 00 -0 -0 WHITE , cn 03 H-» o cn 03 cn 9 o 0 o O 0 9 03 CO cn co to 00 S3 C71 03 03 cn rf* cn rfs* COLORED o s 00 03 03 03 to CO O CO Cm o 9 o O 9 O O 9 CO CO 03 03 03 03 . r - ■ - 3 M CO 03 O o O ' o o 9 0 9 -«a 03 H* co 03 03 H1 -0 , . i a » — 1 r<—1— »-* CO CO CO CO 03 COLORED CO CO 03 cn o O 9 9 o O ■ 9 O O 0 s 03 CO 00 oo -0 o CO H G M H* h-> t—• H-* M M COMBINED O O O 03 03 l-P» to 00 00 cn cn M 03 co o O O O O o o o WHITE o o o O 9 o 9 o CO CO o cn H-1 o 03 03 o tl* o < k o O o 9 O o o o o o o o o o o o COLORED s s £> cn rf* H o o o o o o 0 O o Q O O O o o O o COMBINED rf* CO M to o 03 M H 00 03 cn 03 WHITE H Q S3 {> o o O o o o o o tg a C -2} o o 0 O o o o o o o o o o o 9 COLORED M Cj M O 03 03 -0 o o O o o o o o COMBINED o 9 0 o o o o CO o 03 o M -0 o Cn o cn o to Percentages of Venereal Disease Cases That Occurred in MTOUSA, 1945 by Months, by Color & by Disease Source; Monthly Statistical Venereal Report# Appendix: 4 e HEADQUARTERS MEDITERRANEAN THEATER OF OPERATIONS UNITED STATES ARMY APO 512 EHF/gem AG 726.1/002 C/S-0 . SUBJECT! Venereal Disease Control. TO ! All Concerned, 2 January 194-5 1, MTOUSA rates for venereal disease are far too highQ This theater has the poorest record for the control of venereal disease of all United States’ commands, at home and overseas0 The attached rate tables for the month of October indicate a deplorable condition. The venereal rates among both white and colored troops in Peninsular Base Section units, in the Air Forces and in the Replacement Command are particularly unsatis- factory. 2, Correction of this condition demands a better troop lead- ership, Unit commanders are responsible for the health of their troops and must take steps to see that War Department and theater policies on Venereal disease control are enforced. They must, through leadership and appropriate use of their staffs, improve the standards of discipline and increase individual cooperation in venereal disease control measures, 3, Venereal rates at least as low as 30 per thousand per annum for white personnel and 60 per thousand per annum for colored personnel can and must be attained. Unit and organizational commanders will take aggressive action to have their commands reduce their present rates to this level. One measure of the efficiency of each commander will be his success or failure in attaining the desired low rate. By .command of Lieutenant General McNARNEY j C, W, CRISTENBERRY, Colonel, AGD, Acting Adjutant General, Appendix 4- f HEADQUARTERS MEDITERRANEAN THEATER OF OPERATIONS UNITED STATES ARMY Office of the Surgeon APO 512 23 March 194-5 CIRCULAR LETTER NO„ 10 SUBJECT; Venereal Disease Prophylaxis0 lo All previous letters. Office of the Surgeon, NATOUSA and MTOUSA, pertaining to venereal disease prophylactic stations and the administration of venereal disease prophylaxis are rescinded; Section I Circular Letter Noc 19, dated 26 June 1943o Circular Letter Noc 33, dated 7 June 1944° Section III Circular Letter No0 42, dated 7 August 1944o (Designated as Section II by Circular Letter No0 43, dated 13 August 1944) 20 ' Provisions for prophylactic supplies and stations» aQ Prophylactic items for individual issue*, (1) In accordance with Section I, WD Circular Number 410. dated 19 October 1944. which revises AR 40-210, paragraph 23 b (2) (b) individual*venereal disease prophylactic items will be made readily available to all military personnel0 (2) Individual prophylactic materials will be issued by medical supply officers to units and prophylactic stations without reimbursement in the same manner as any other expendable item of supply0 An adequate supply of both mechanical prophy- lactic (condoms) and individual chemical prophylactic items will be maintained in the unit for distribution without cost to the individualo In no case will prophylactic items be soldo While the number to be issued to each individual is not limited, dis- cretion will be used to prevent wastage0 Appendix 4 g SURG MTOUSA Cir Ltr #10 (cont'd) bo Unit prophylactic stations and supplies0 (1) A prophylactic station will be maintained in each unit of company size or smaller in accordance with Section I. WD Cir- cular Number 410 dated 19 October 1944 which revises AR 40c*210, para- graph 23 b (2) (a) and in accordance with letter, Headquarters NATOUSA, dated 12 July 1944, file AG 726d SURG-0, Subject: "Venereal Disease Control.* (2) The following articles are considered the minimum requirements for the efficient operation of a unit prophylactic station: MD Item No0 9118100 Prophylactic, mechanical (condom) 9118000 Prophylactic, Chemical, individual 1412000 Soap, soft, 1 lb0 jars (GI soap if soft soap is not available) 1464100 Sulfathiazole, U.S.P., 7C7 gr tablets 7936000 Towel, paper, 150 per package (3 for each patient) 7778000 Cup, paper, collapsible, 250 per carton 7868000 Paper, toilet, roll Bidet or straddle basin Facilities to provide running warm water c. Metropolitan prophylactic stations and supplies0 (1) One or more prophylactic stations should be estab- lished in all cities or towns which are visited by large numbers of U, S. Army troops0 Stations will be conducted under the supervision of the sur- geon of the command concerned. (2) The following articles are considered the minimum re- quirements for the efficient operation of a metropolitan prophylactic station: MD Item No. 9118100 Prophylactic, mechanical (condom) 9H8000 Prophylactic, chemical, individual, or 1322110 Prophylactic, ointment, 1 lb„ jar (15$ sulfathiazole-30$ calomel ointment) 1412000 Soap, soft, 1 lb. jar 7493000 Soap, white, floating, 6 oz. 7489000 Soap, laundry, 1 lbc 7778000 Cup, paper, collapsible, 250 per carton SURG MTOUSA Cir Ltr #10 (cont'd) MD Item No* 14.64100 Sulfathiazole, U.S.P*, 7*7 gr0 tablets 7936000 Towel, paper, 150 per package (3 per patient) 7868000 Paper, toilet, roll 3668000 Depressor, tongue, 100 per carton Bidets or straddle basins Clock; Procured locally or hour glass Closed receptacles in which to keep the wooden tongue depressors0 Lavatory for patient to wash his hands* Lyster bag for drinking water Facilities to provide running warmwater 3* Location, installation and operation of prophylactic stations, a* Unite (1) Location,, The unit prophylactic station should be located in a room or tent which is used solely for the purpose of administering venereal disease prophylaxis and located so that it will be easily accessible to the entire personnel with a minimum of effort0 It may be located next to the showers to avoid duplication of water heating facilities« Stations should not be established in a latrine or toilet* (2) Installations * Ample floor space should be pro~ vided to prevent over-crowding0 Usually one bidet or straddle stand with running warm water is sufficient for one company or smaller unit. The bidet should be raised to an overall height approximately 18-20 inches for the comfort and convenience of the patient* Facilities necessary for ample running warm water can be provided or improvised with reasonable effort* Movable screens may be installed for privacy* b* Metropolitan* (1) Location* Care will be exercised in the selection of sites for stations in cities so that they will be near place of ex- posure and easily accessible to all troops* Stations should be located on the ground floor* Existing civilian buildings should be used and remodeled to make a suitable station* When no existing buildings arc available, a prefab or one constructed of dunnage should be considered* (2) Installation* Stations should be of adequate size, approximately 12 x 15 feet for small stations* Where it is necessary to provide for more than one prophylaxis being given simultaneously, SURG MTOUSA Cir Ltr § 10 (cont'd) a larger space should be obtained. Rooms should be painted white and made as clean and attractive as possible. The floor should be concrete or tile to facilitate easy cleaning,. Bidets with running warm water will be installedo Sufficient bidets should be installed to me6t demands. The bidets should be raised to an overall height of approximately 18-20 Inches to facilitate easy washing and comfort of the patient; should face the medication shelf which should be out of reach of the patient; should be placed about 5 feet from the wall and should be spaced not less than J+ feet from center to center of each bidet0 The pipes to each bidet should be buried in the concrete. Hot and cold water should be piped to each bidet and the pipes connected with a T so that the tempera- ture of the water can be regulated by the patient. The pipes should ex- tend above the bidet 8-10 inches with the delivery pipe extending sev- eral inches over the bidet*. An ample quantity of running warm water should be made available Partitions or screens should be installed for privacy and should be movable to facilitate easy cleaning of the sta- tion. A toilet or lavatory should be provided for the attendants. Stoves should be installed for heating in cold weather. Adequate light- ing facilities in the stations should be provided. Co Posting of Stations. (1) Unless prohibited by blackout regulations9 a green light should be kept burning during darkness on the outside of the sta- tion so that it can be seen from a considerable distance. A sign "U. S, Army Prophylactic Station" should be placed on the outside of the station so that it can be read easily from a considerable distance. Directional signs should be placed at strategic places in camps and cities to point out the location of the station, d. Operation. (1) Stations will be kept open during the entire 24 hour period and maintained in a clean and orderly condition. Condoms will be available for issue without cost to personnel of the U, S. Army, U, S. Navy and U. S. Merchant Marine, e. Inspection of Stations, (1) The responsible medical officer will inspect the sta- tion at frequent intervals to determine that the station is operated effi- ciently j that supplies are adequatef that prophylactic treatment is ad- ministered properly and that the attendants are well trained, Uo Training of personnel to administer venereal disease prophylaxis. SURG MTOtlSA Cir Ltr #10 (cont'd) a0 Individualo (1) The unit medical officer is responsible for the instruction of all troops in the necessity for the proper use of con- doms and individual chemical prophylactic kits during and following exposure to prevent venereal infections0 The value of proper cleans- ing with soap and water will be explained carefully0 Because venereal disease exposed individuals, especially when intoxicated, will not always administer an efficient prophylaxis to themselves, the neces- sity for reporting to a prophylactic station for supervised prophy- laxis immediately after exposure even though condoms and the prophy- lactic kit have been used, should be emphasized,. b0 Unit and metropolitan station attendants„ (1) Prophylactic station attendants should be of good character, conscientious, trustworthy and thoroughly trained in the proper technique of supervised prophylaxis0 (2) Units not having attached or assigned medical en- listed personnel to serve as attendants in unit prophylactic stations should designate two or more enlisted men to attend schools under the direction of the surgeons of each base section, army or air force0 At these schools, they should receive sufficient instruction to qualify them to properly administer and intelligently instruct individuals in the proper technique of venereal disease prophylaxis0 The course of instruction should cover the following subjects? (a) The meaning and method of obtaining surgical cleanliness0 (b) The simple facts about the pathogenic micro- organisms with special reference to those causing venereal disease0 This instruction will include laboratory demonstrations of cocci, bacilli, and spirochaetes whenever practicable0 (c) Simple descriptions of the anatomy and physio- logy of the male and female organsc (d) Descriptions of the ordinary symptoms and course of gonorrhea, syphilis and chancroid„ (e) The mechanism of venereal disease prophylaxis* 1, Mechanical prophylaxis (condom)* The proper and correct use of the condom will result in maximum protection against all venereal infections of the genitals0 Instruction in the SURG MTOUSA Cir Ltr #10 (cont'd) use of the condom should cover the scientific explanation by which vene- real infections are prevented and the proper technique for the applica- tion and removal of the condom. 2. Individual chemical prophylaxis. The new type of chemical prophylactic kit issued by the Medical Department will be used in addition to the condom in administration of venereal dis- ease prophylaxis in this theater. The component parts of the chemical prophylactic kit and the action of each component part in the prevention of venereal infections should be thoroughly understood. The prophylac- tic kit for individual use will be the same as that used in unit and metropolitan prophylactic stations. Therefore, it will be necessary to explain to the individuals the reasons why it is -necessary to report to a prophylactic station for prophylaxis as soon as possible after ex- posure, At the prophylactic station, adequate supervision is provided; hot water, soap and sulfathiazole tablets are available. Individuals may fail to follow the proper technique thoroughly in a self administered prophylaxis, especially if they are under the influence of alcohol. Station Prophylaxis, The following direc- tions for the administration of venereal disease prophylaxis are recom- mended to be used in this theater and should be posted in both unit and metropolitan prophylactic stationss a. Patient will wash hands. b. Patient will remove trousers and drawers and roll up shirt to the waist. c. The attendant will examine the patient, without touching him, for evidence of venereal disease. No prophylaxis will be given if evidence of venereal disease is present. He will be sent to the appropriate medical installation for treatment, d. If no venereal disease is present, patient will urinate if possible, This act flushes out the urethra and washes away many micro-organisms. e. Seated on the bidet or the straddle basin, the patient will pull back the foreskin (if present) and wash head of penis thoroughly with warm water and liquid, soft soap or soap rag. It is very important to pay special attention to the thorough cleaning of the under surface of the penis. The thorough washing will include the lower part of the abdomen, the scrotum (or bag) and the inner surface of the thighs. This procedure should take about five minutes. SURG MTOUSA Cir Ltr #10 (cont’d) “ f0 Rinse off all the soap using plenty of water and dry with paper towel. go Each patient will use one individual prophylactic kit or an equal amount of the prophylactic ointmentc h. Have the patient pull back the fore- skin (if present) and rub the prophylactic ointment thoroughly over the penis, scrotum, pubic hairs and inner side of the thighs0 .Be espe- cially careful to rub the ointment on the underside of the heacl of the penis around the **G String,” and in the furrow behind the head of the penis. The rubbing of the ointment should continue for not less than three minutes0 Injection into the urethra should be omitted. i0 The penis is wrapped in toilet paper to prevent soiling of the clothes0 The paper should be left in place for several hours or overnight0 2. Have patient wash hands and dress. k. The attendant will give to all patients except flying personnel of the Air Corps, and those who have had a previous station prophylaxis with sulfonamide administered within 8 hours, four (1+) tablets or 2 grams of sulfathiazole or sulfadiazine and at least a canteen cupful of water to drink. Attendants will be especially careful to see that the full amount of water is consumed. This is important. SURG MTOUSA Cir Ltr #10 (cont'd) (f) The importance of the prevention of venereal disease will be impressed on the attendants and everything possible will be done to arouse their interest, pride and cooperative spirit in their work0 60 Recordso A daily count will be kept showing the number of prophylactic treatments given at each station» Recording of names will not ordinarily be done except when special evaluations of prophy- lactic methods are being made0 For the SURGEON: /s/ E0 Standlee E, STANDLEE, Colonel Mo C,, Deputy Surgeon, DISTRIBUTIONS Surgeon* PENBASE - 300 Surgeon, N0RBS - 20 Hq0 A/G of S -10 Surgeon, Adriatic Base Command - 100 Surgeon, Fifth krmy - 600 Surgeon, AAFSC/MTO - 700 Surgeon, Replacement Command - 50 Surgeon, Rome Area Command - 25 Surgeon, Hq0 Command, AF - 30 Surgeon. MTOUSA - 300 HEADQUARTERS MEDITERRANEAN THEATER OF OPERATIONS UNITED STATES ARMY Office of the Surgeon APO 512 16 July 1945 CIRCULAR LETTER N0o 23 SPECTACLE PRESCRIPTIONS 0 . ..... . . . RESCISSION OF PARC CIRCULAR LETTER N0o 10 I - SPECTACLE PRESCRIPTIONS Considerable delay is being encountered in filling of spectacle prescrip- tions because of failure of the requisitioning units to indicate correctly the plus (/) and minus (-) signs on optical prescriptions0 These signs are an essential part of an optical prescription and must be indicated before the pre- scription can be filledo Personnel responsible for transcribing optical pre- scriptions to or from service records will take necessary action to insure complete and accurate transcription of all pertinent data0 II - RESCISSION OF PAR0 4b(2)(e)3k. CIRCULAR LETTER N0o 10 par0 4h(2)(e)a3k, Circular Letter No0 10, dated 23 March 1945, is rescinded and the following substituted therefors nk0 The attendant will give to all patients except those who have had a previous station prophylaxis with sulfonamide administered within eight (8) hours four (4) tablets or two (2) grams of sulfathiazole or sulfa- diazine and at least a canteen cupful of water to drinkQ Attendants will be especially careful to see that the full amount of water is consumed0 This is Important0W /s/Eo Standlee E0 STANDLEE5 Colonel, MoGoj Acting Surgeon. DISTRIBUTION: Surgeon, PENBASE - 350 Surgeon, Adriatic Base Command - 100 Surgeon, Fifth Army - 500 Surgeon, AAFSC/MTO - 400 Surgeon, Repl & Tng Comd,MTOUSA - 50 Surgeon, Rom© Area Command - 25 Surgeon, Hq0 Command, AF - 30 Surgeon, MTOUSA ‘ - 100 1 Number of Individual Chemical Prophylactic Kits (9118000) Issued to Units & Pro Stations by Medical Supply, MTOUSA ±945 Gross Number 10 Dec 10 Jan 3,500 504,000 10 Jan 10 Feb 2,817 405,648 10 Feb - 10 Mar 3,026 435,744 10 Mar » 10 Apr 4,327 623,088 10 Apr - 10 May 4,727 680,688 10 May 10 Jun 5,091 733,104 10 Jim 25 Jun 1,237 178,128 25 Jim 25 Jul 3,530 508,320 25 Jul - 25 Aug 3,617 520,848 25 Aug 25 Sep 542 78,048 Appendix: 4 h Number of Mechanical Prophylactic Items (Condoms) (9118100) Issued to Units & Pro Stations by Medical Supply, MTOUSAs Gross Number 10 Dec - 10 Jan 5,500 792,000 10 Jan - 10 Feb 12,772 1,839,168 10 Feb - 10 Mar 12,238 1,762,272 10 Mar - 10 Apr 13,800 1,987,200 10 Apr - 10 May 14,170 2,040,480 10 May - 10 Jun 22,165 3,191,760 10 Jun - 25 Jun 6,945 1,000,080 25 Jun - 25 Jul 21,187 3,050,928 2$ Jul - 25 Aug 16,131 2,322,864. 25 Aug « 25 Sep 12,703 1,829,232 Appendix? U i Number of Venereal Disease Prophylactic Treatments Given at Certain Metropolitan Prophylactic Stations in Italy for 194-5, MTOUSA (Unit Pro Stations not Included) City of Rome Bari-Foggia Area City of Naples Towns Adjacent to Naples Leghorn- Florence Area Jan 27,468 2,993 28,388 2,066 1,882 Feb 31,187 2,055 36,191 917 3,038 Mar 36,898 8,493 46,319 983 3,319 Apr 28,170 7,191 37,428 1,157 2,581 May 26,353 7,331 53,505 1,470 8,749 * June 30,936 5,791 46,278 2,326 15,652 July 20,755 4,659 58,508 3,838 19,453 Aug 24,74-9 4,129 41,131 3,016 13,100 Sept 17,275 2,40 A 35,641 1,862 7,833 TOTAL 243,791 r 45.049 I 383.389 17.635 _ 75*597 * Stations taken over in cities previously operated by Fifth Aro$r Appendix; 4 j Average Number of Days Lost from Duty Per Venereal Disease Case, Number of Days Lost From Duty by Venereal Disease Cases Per 1,000 Strength Per Year MTOUSA - 1945 MTOUSA ~ 1945 Days Days Jan 4-o2 Jan 458 Feb 4°4 Feb a? Mar 4.9 Mar 419 Apr 4o5 Apr 354 May 4.0 May 325 June 3o5 June 316 July 3o3 July 358 Aug 3o3 Aug 366 Source? Monthly Statistical Venereal Report Appendix? 4 k HEADQUARTERS MEDITERRANEAN THEATER OF OPERATIONS UNITED STATES ARMY Office of the Surgeon APO $12 8 May 194-5 CIRCULAR LETTER N0o 1$ PRIORITY FOR DETERMINING CAUSE OF DEATH IN NON-BATTLE DEATHS 0 . . . I DENTAL RECORDS o««*oo*»»o««o»eoe.«oo»«®o«®II FOLLOW =>UP OF VENEREAL DISEASE GASES Ill I - PRIORITY FOR DETERMINING CAUSE OF DEATH IN NON-BATTLE DEATHS All non-battle deaths whose initial report of death gives cause of death unknown will be given first priority in the completion of autopsy determination of cause of deathc When autopsy findings are complete the AG Casualty Branch of the command concerned will be promptly noti- fied of the- finding. II - DENTAL RECORDS Daily work sheets0 In the future, in this theater, each dental office performing dental operations, will prepare and keep a daily work sheeto This work sheet will show the name of the patient, the hour the patient was seen, the diagnosis. the operative procedure or procedures performed0 the classification at the completion of each sitting and, if not placed in class IV, a notation showing whether or not a reappointment was given0 These work sheets will be retained in chronological order for a period of three months after which time they may be destroyed0 20 Register of Dental Patients, AGO Fora 8-116 (formerly WD MD Form 79 )o Attention is invited to par0 3* AR 4-0~101Co Examinations of dental services reveal that the provisions of the above quoted regula- tion are not being observed in numerous lnstarices0 A Register of Dental Patients should be prepared for every patient admitted to a dental clinico If prepared in longhand they should be legibly written and all required entries madec. All register cards should be retained in the organizatiaiL pending instructions regarding their final disposition*, / Ill V FOLLOW-UP OF VENEREAL DISEASE CASES lo In order to achieve higher standards in the follow-up of vene- real disease cases, the procedure outlined below will be adopteds Appendix: 4- 1 1 RESTRICTED aa The upper portion of a card (3” x 5W) as shown below will be completed in duplicate by the medical officer who diagnoses and treats a case of venereal disease, (urethritis, cause undetermined and penile ulcer cause undetermined will be considered to be venereal diseases for this purpose)0 These cards will be forwarded as follows; (1) One card will be sent to the Medical Officer respon- sible for the medical care of the individual's unite (2) One card will be sent to the Surgeon, MTOUSA (Attention; Venereal Disease Control Officer)„ Name ASN Organization Date of Report Diagnos is (fe) Organization of Medical Officer Signing Date 8 Result 8 9Date11 Result —p » t» i t Ml i i i t b0 The results of follow-up examinations will be reported by the responsible medical.officer to the Surgeon, MTOUSA (Attention; Venereal Disease Control Officer) on a card (3n x 5") form as shown below; Name ASN Organization Date of Report SEROLOGICAL TEST FOR SYPHILIS Date Test Results PHYSICAL EXAMINATION Date Result Remarks _ (S) APO Organization of Medical Officer Signing___ 20 Number r.£ reports required: a« initial reports as outlined in par0 la above will be required on all cases diagnosed subsequent to receipt of this notice0 Medical Officers will also survey the organizations to which they are assigned and complete similar forms on all cases now being followed by them and send one copy to the Surgeon, MT0USA, The date of report on these will be the date on which diagnosis was made, b0 Follow-up reports as outlined in par0 lb above will be made to Surgeon, MT0USA, as follows: (1) Syphiliso Three follow-up reports are required, 3, 6 and 9 months after diagnosis, (Since the 12 month follow-up will be contained in the Syphilis Register no special report of this is re- quired, unless it is decided that further treatment or observation is to be given)o (2) Gonorrhea, Chancroid, Lymphopathia Venereum-, Granu- loma Inguinale, Urethritis, cause undetermined, and Penile Ulcer, cause undeterminedo Only the final follow-up report, made three months after diagnosis will be forwarded to the Surgeon, MT0USAo (This is not to be interpreted as changing the follow-up procedures as outlined in Sur- geon’s Circular Letter No0 4-, ”Management of Venereal Diseases,* dated 25 January 194-5) o 3o Transfer of Individuals being followed up for Venereal Disease. In the event of transfer of an individual being followed up for a venereal disease, the follow-up card of the unit will be forwarded to his new unit. 4.0 Death, Capture, Transfer to Z«I*, Transfer to Another Theater, or Otherwise Missing Individuals0 When an individual who is being fol- lowed is lost in one of the above ways, a final follow-up report will be rendered to Surgeon, MT0USA, stating the facts under remarks section of card shown in par0 lb above0 For the SURGEON s DISTRIBUTIONS Surgeon, PENBASE - 4-00 Surgeon, Adriatic Base Command - 100 Surgeon', Fifth Army - 600 Surgeon, AAFSC/MTO - 600 Surgeon, Repl & Tng Comd,MT0USA « 50 Home Area Command - 25 Surgeon, Hqc Command, AF - 30 Surgeon, N0RBS - 20 Hq0. A/G of S - 10 Surgeon, MT0USA - 300 /s/EoStandlee Eo STANDLEE , Colonel. MoCo, Deputy Surgeono RESTRICTED JOUDDICE COTES PEC 1000 PEC ANNUM BOTES '. 1—■—'—'—'—'—'—'—i 1 —:—i—'—'—'—'—!—'—i—'—|—1—f—|—'—1—'—'—!— «• 8 2 ► mm M S M M S M «S.M ► : to | «0 | M . 8 | M M M M j COSES jasisaasjsssfssaasgjsssa s ?’sc’s s s | ] 3 - - a 9 a s a s s - * •* * a a s :.s Si aM *, •(• | TKEI1CH FOOT cores Pec 1000 oec annum carts e o o o e o o o o o 04 8 m m m ♦ 04 04 O o o o o 04 ►* • *4 04 m m 04 04 04 O o costs o e o o e o o o o o • 1 04 fc 04 3 * 3 * m 2 04 87 APPENDIX £ souece: wono Men mob SAPID FLY PCVEC CflTES PEC 1000 PEC flHHUM Cates cases 0 0 0 0 0 0 0 s 9 2 1 1 0 0 0 X 1 2 13 19 h— - 24 5 h l- 1 o ! T 1———r— O H *4 lO M | O N wj H 1 O OOOOOOJ® jJ»NOOOO*»JJ«gM®»*«>*0 S rt S H e J * S " il : ■ 1- : 1 : 1-.- III! °* a | g 3 ■ !' : I i l 1 miSCELLflnEOUS DISEASES M'iCOTiC 0ECMPT05E.S . • 1 1 • • • 1 1 1 • • 1 • 1 • 1 • • j 1 XT8 204 s H s H to —T a "1 vl CD 1 “i 04 ■o 9 S 04 04 to i M _l IT St' I -1— SCABIES s 3 s 8 3 to to 3 *H M 9 to (O to •4 a 8 to c- M a to « 3 CM M a M a s CM 8 CM a ■ T 3 10 t 8 *: ss s * a to to O to 9 S 8 M 10 a 1 ■ 4 04 | i o D&HGUE o O o K) o •0 H ► a •0 04 to o o M o o O , ♦ N o o o 10 o o o 1 O n! i ° 1 ! O 1 1 i e6LflPSiNC-P6v)6£ o o o o o *-4 tO N O o o O o .] o o o o 04 o o o o o o -rr i . T'fPwuS o N o o o N ♦ O o 04 o . o • 1 1 • 1 • • 1 • 1 • • o o : o 04 o ° o‘ i CR5 GOHGCEME o o o o o O o o o o a a If .. 04 M o a o 04 " o M ♦ " o to o o 04 O o a n ° i TETANUS H o o o o o o o o o o o o o O o o o o o *4 o o o o 04 o o i o o o O 1 i OTh£C MISC. 0l5£0SES — . 1 . c* i i 1 SOURCE: VOMO POC.M 8S«6 89 APPENDIX 6 dod-battle mjuciES C-PTES a m * 2 s to 2 to i~t CD •*• •O »■* §o K> CM •O CD o •H CO CO CM * <-c *■« a ** 2 to CM ► to <-4 « to r-4 139 107 to o CD o> 0D § CD , -1 J M ! 1 , C3SE3 m CD ** at g CM o» CD •O to s CM tO CO § o S 8 S *4 5837 «*- «o 8 to <* s *• 5 CD *o at C" CM tO «*• to *• 8 t- tO S •* r>- to f- H ?*• I 6724 H CO 8 *• CM S 8 S S —in J to to s | 3510 -- 8 JL 8 e*- K5 — IO to to 8' K> 1936 j j_ BATTLE CASUALTIES cares U S SI: J 5 •|«|8 S V *> «o S 8 S 2 3 ■o CD N * C « to a 3 '■# a 2 3 9 Ok #4 o oc - r-0 *4 •-4 H *4 cases r4 M •■4 a'g s s i i i , od «o • *- W(«> H h; N ri*. #4 3 CM § N 8 CO * 1 ga CD _J to s « o r4 to CM s •- CD N X H *4 3 *-c *- 9 9 8 2 H Ok 9 H a 00 s to *4 g CO Ok 00 CM CM M 8 *4 3 to ID £ w o Q soucce; two FOCM 86 F© APPENDIX 7 91 source: »soMO fo«m »©ajB J *: strength OttEWE* IhJURV WTTLt RLLCfMB | HJ r 56 ab RG cm cme> %>TR. CWZi JAM 187878 281735 2538 0,969 568 0.211 217 0.083 3308 1.263 Ff6 245252 294717 3899 1.323 1151 0.391 728 0.247 3778 1.981j m 298900 343672 5721 1.685 1777 0.617 1518 0.442 9018 2.624 AfA 3J9160 382483 6987 1.822 2812 0*883 4036 1.056 13617 3.561 if) Ml) 370377 485432 8770 1.884 2982 0.641 3008 0.646 14780 5.171 •7 JU* 431644 519873 9899 1.905 5282 0.832 1770 0.341 14951 2.878 *> JUL 480202 636675 12364 2,807 3675 0.S86 2833 0.529 18882 3.522 - AM 512571 537888 18293 3.029 3857 0,717 3398 0.632 23548 4.378 tff 511148 803691 16740 2.773 3848 0.537 3630 0.801 24218 4.011 oa 577172 825551 19488 3.119 4017 0.642 4521 0.723 28004 4.477 new 582381 579918 22013 3.796 4726 0.815 6063 1.045 32801 6.856 OK 805798 804568 24658 4.079 4772 0.789 6772 1.120 38202 5.938 ! jah 821904 621400 27914 4.492 5948 0.957 8865 1.426 42727 6.878 Fee 817495 635328 24732 3.893 5388 0.848 11947 X.880 42067 6.621 MAA 648724 878139 20130 2.977 4278 0,533 8882 1.314 33290 4.924 flf* 694278 706438 17588 2.489 4192 0.593 6571 0.930 28349 4.013 •7 MAT 693128 729211 16031 2,198 4682 0.642 10116 1.387 30828 4.228 < JUH 699466 729320 15932 2,025 5088 0,646 11218 1.425 32231 4.097 JUL 894483 731632 18222 2.491 5312 0.726 10361 1.416 33895 4.633 - AUfi 701280 756025 17328 2.295 6073 0.372 8171 1.082 30572 4.049 tf» 685582 72 2756 17464 2.416 4784 0.659 10400 1.439 32828 4,514 OCT 697585 722407 21965 3.041 5873 0.813 18567 2.570 48402 6.423 NOM ,732431 505542 1460S £.335 5727 0.737 9533 1.888 27868 5,512 OK 504052 513126 14954 2.914 3413 0.665 4275 0.833 22640 4.412 JW* £12379 526738 17037 3,254 3342 0.634 2289 0.435 22668 4,303 ! FE6 517406 512053 15192 2.936 3336 0.645 2545 6.511 21172 4.092 HflA 433701 504437 12192 2.417 2507 0.513 2309 0.458 17083 3.3S* m 495909 50064 6 10618 2,121 2502 0,512 5993 1.197 19173 3.W «o MW 474613 452214 7371 1.741 1 '41 0.407 1553 0.374 1140 5 Z.S22 Jl* 403737 408931 7111 1.739 1522 0,372 375 0.091 9006 2.202 : «c -sTPseno-r *>eo tM computhsc ptucemnce PERCENT NOH-EFFECTME DtttMC INJURY MTTLE APPENDIX 8 - CvilSmTlCBL (Mtifl »IL Wll m ffi.99 D0>9 B'LS m >099 m xnsfesi* m seec^^c lw>pi oxs S08S ROS M orw K06 an S2L9 OS&I sea ira ttnsi 01 9W SSfel SKlj 1W6 8Wl IfiS'l tsw £rsi BKfi (Its list on ocsjm 166' BCH wli KC9 etc- Ifii* (CL' TZ0ifl3UTOW0 *HiH3Q W0U3W Ul 03TIOJ OJimUTO'iDUWIU St«z MW Ul Sttl 9l!l u« m mm SiGl SHI 5i ii 0WIOT fSW9W 60CJ 8M> ISO l W6t Sfi9 5961 WfijiGS tawjaon eicsfesss OD 687i Q.% is& K5b m bm sm &oa m SHV 3g!l Iwwtea 9W 1911 wit w* Z92t* tn* W1V tot KjCU isw wii Iks cw: IS81S ilLVilVZV/ MWintvcupruneo ptmmm total Lo#e*-intousa s»awKRfe maMVt »mavRfe ~1543 *iueo m actio* oe«w .iKunreo toz-i APPENDIX 9 DISEASE CUMULATIVE PERCENT OF DISPOSITIONS ft TYPE OF DISPOSITIONS OF HOSPITALIZED CASES PERCENT DISPOSED BY DAY SHOWN DAY 5 10 is 20 25 30 35 40 45 50 60 70 80 90 120 150 ISO 240 5TH army NfANTRY >0 0 13 0 60 4 61 0 60 2 71 6 78 4 81 9 046 86 9 90 6 93 2 96 l 96 4 99 4 99 9 100 0 - VH ARMY Oth£RS ?| r 62 6 68 o 76 6 00 6 04 0 86 0 89 1 90 0 92 4 94 6 96 0 97 3 98 2 99 8 100 0 - - i2Th a i5Th <•4 4 66 2 n i 70 5 01 0 0 7 1 89 7 91 7 93 1 94 9 97 1 98 3 98 8 99 3 99 8 99 9 99 9 100 0 OThER 22 5 63 0 69 7 7H 0 04 o 08 l 9i 8 93 i 94 6 96 6 97 6 98 3 99 4 99 7 99 9 99 9 100 0 - MTOUSA 20 7 40 4 66 0 74 6 00 0 010 06 8 89 2 91 2 92 6 94 0 96 4 97 4 98 1 99 7 99 9 99 9 I0OC S T H INF AN T R i Mh AM MY OThERO i?ih AiR fORCES OTHER AiR FORCES MTQUSA MEAN 24 2 17 2 14 6 14 5 17 5 MODE 5 2 3 8 1 8 5 0 4 4 FINAL DISPOSITION BY PERCENTAGE TOTAL TYPE A- 1 A-2 8 C DIED AWQl CASES */Th S* ANTR < 6^9 4 9 24 8 2 8 o ■ OS 966 7 Sth ARMY others 86 2 I 9 8 I 2 6 01 1 t 662 8 12 TH ftiSTH AiR FORCES 96 : 0 8 0 8 4 4 0 i 0 0 E,F>00 OTHER AtR FORCES 94 7 I s OS 4 2 0 I oo l l 97 mtousa 844 2 7 10 5 J 2 0 I 0 4 42967 APPENDIX 1£ 97 NON-BATTLE INJURY CUMULATIVE PERCENT Of DISPOSITIONS a TYPE OF DISPOSITIONS OF HOSPITALIZED CASES S T h ARM f •Nf AN TR* Mm ARMT OThERS i2Tm a isth air FORCES other AIR FORCES MTOUSA ME" AN 40 5 29 0 21 3 - 30 2 MODE 10 6 4 2 36 - 4 9 PERCENT DISPOSED BY DAY SHOWN DAY 5 10 IS 20 2 S 30 35 40 45 50 60 70 80 90 120 ISO 190 240 S T M NF ASt UT 3 4 12 3 21 4 306 39 1 46 S S2 6 S8 5 62 3 67 9 76 2 81 2 86 6 91 3 990 99 9 100 0 | Mm ARMr OlHf KS 16 I 31 S 42 6 Si 5 SB 2 64 0 675 71 1 74 9 79 0 842 90 5 94 1 96 1 99 6 1000 - - ? T H a.r f S 21 6 44 0 5 7 1 669 7? 8 77 1 8i 3 83 S 66 1 87 7 91 7 94 0 95 6 96 9 99 8 100 0 - - M Hf R A'R FORCES DATA INSUFF ICE NT TO BE STATISTICALLY SOUND MTOUSA 12 r 28 9 40 S 4 9 5 S6 3 62 6 67 S 71 7 755 78 7 84 4 89 0 92 2 946 99 4 99 9 100 0 - FINAL DISPOSITION BY PERCENTAGE TOTAL TYPE A-l A-2 B C DIED AJMJk CASES *)Tm ANTH i SS 2 14 5 22 7 77 00 0 1 1 82 7 tm OTHf H'j n r 8 9 6 2 S 6 OS 1 1 964 12Tm H iSTh 6if* FOROfS 84 1 7 0 1 9 6 3 07 00 91 5 CTnf H AiH V'jf*',fS - - - - - 1 1 3 MTOUSA 69 2 n 2 12 7 6 2 04 0 3 62 10 APPENDIX ij BATTLE INJURY CUMULATIVE PERCENT OF DISPOSITIONS a TYPE OF DISPOSITIONS OF HOSPITALIZED CASES PERCENT DISPOSED BY DAY SHOWN DAY 3 10 13 20 23 30 33 40 43 SO to 70 no 30 120 ISO ISO Z40 5TH army infantry 4 1 i4 e 28 8 41 1 52 l 62 2 67 6 72 5 75 9 79 8 64 7 88 7 92 2 95 I 99 3 1000 5TH ARMY OTHERS 12 2 290 458 51 9 65 6 66 4 75 3 77 9 80 2 83 2 87 8 90 l 93 1 94 7 99 2 100 0 - - 12 Th a iSTM AiR FORCES 3^8 5/ i 64 7 72 2 79 0 80 4 82 7 86 5 89 5 90 2 94 0 97 0 985 1000 - - - - OTHER AIR FORCES OA A IN Sue f CIENT TO BE STAT STIC/ LLY SOUf 0 MTOL’SA 7 9 19 7 33 0 440 546 634 68 8 73 7 770 80 5 85 1 89 5 92 7 95 4 99 4 100 0 - - STh ARMY INFANTRY 5Th army OTHERS I2TM ft ISTM AIR FORCES OTHER AIR FORCES MTOUSA MEAN 32 1 27 3 170 - 31 3 MODE 14 4 4 8 2 4 - 14 3 FINAL DISPOSITION BY PERCENTAGE TOTAL CASES TYPE I A-l A-2 B DIED WQL »,th army iNPANTRY £8 8 n 0 )4 2 4 7 O' 2 l 349 STh army others /e i 9 l 84 28 00 1 4 143 12 th a isth AiP FORCES es 7 0 7 0 7 II 2 07 00 1 43 OTHER AIR FORCES - - - - - - 2 MTOUSA 68 i 12 0 1* 2 55 02 I 0 l 780 APPENDIX 12 101 BATTLE WOUND CUMULATIVE PERCENT OF DISPOSITIONS & TYPE OF DISPOSITIONS OF HOSPITALIZED CASES PERCENT DISPOSED BY DAY SHOWN day ? 10 15 29 2? 39 55 40 45 50 60 70 80 90 l?0 150 ISO 240 STh ARMY 1 NTANTRY 3 8 8 4 1 3 l 1 7 4 23 8 30 8 39 1 469 532 59 2 69 1 77 4 84 6 90 4 98 8 99 9 100 0 - 5 T h ARMY OTHERS 6 1 12 4 17 2 21 6 28 7 36 1 46 0 S3 4 61 4 68 1 75 9 83 1 89 8 93 1 99 4 1000 - - 2Tm a i5Tm A'R FORCES C Tm£R R MTOJSA 4 i 8 8 | 13 5 18 0 24 7 31 7 40 1 47 8 54 4 60 6 702 78 5 85 6 90 9 99 0 99 9 100 0 - VH c-5 2 th 8 -5Tm AP fOPCES OTmEP AIR FORCES MTOU5A MEAN 47 2 42 2 - - 46 2 MODE 3. 9 31 7 - 31 9 FINAL OISPOSIT ION BY PERCENTAGE TOTAL CASES _ TYPE A-J A-2 B C DIED AWOU 5Th a»mv INFANTRY 44.9 14 8 18 0 20 0 2.1 0.2 8792 !>TH ARMY others 51 0 15 8 8 7 20 8 3 2 0 5 849 i 2Tm q 15 Th AIR FORCES 70 1 2 0 0 6 25 3 2.0 0 0 154 OTmER A)R FORGES - - - - - - 2 MTO^SA 43 3 18 2 18 6 17 9 i e 0.2 12048 103 APPENDIX 13 DAYS MODE 5 B PERCENT DISPOSED BY DAY SHC ■' i DAr ' s 1 'c | 'S j 2C 1 .I *0 j SS 40 1 4. I- UC j TO |S. V. 1 12 i S ! S C j 2 4 C PCT I * ; f,. h j ’90 8A 7j tt'< 4 ! S 4 j 7 9J s) S4 e ! >s 7! sc e 1st s i ss i . j ...., .. 7 ; 3S 71 iGC 0 1 COMMON RESPIRATORY DISEASES CUMULATIVE PERCENT OF DEPOSITIONS 8 TYPE OF DISPOSITIONS OF HOSPITALIZED CASES F iNflL D SPGS' T .ON T rPE Ai . A2_ . B C j DiFO A*Cl PCT 02 5 ■ 7 4 4 ' o I t TOTAL CASES - 5471 j DAYS MEAN 13 6 APPENDIX 105 DAYS MODE 20 5 PERCENT DISPOSED BY DAY SHOWN DAY S 10 ?0 25 30 | 35 | 40 45 50 60 70 80 90 120 50 80 240 PCT 05 4 6 IE 6 38 3 62 5 7 T 4 j 86 4 j 91 9 93 3 94 9 9?2 96 3 98 9 992 99 7 00 0 - " PNEUMONIA, PRIMARY (NOT ATYPICAL) CUMULATIVE PERCENT OF DISPOSITIONS a TYPE OF DISPOSITIONS OF HOSPITALIZED CASES FINAL DISPOSITION TrPE - 41 42 -8 4 c DIED AWOL POT 90 4 f /-s 70 I I 6 0 5 0 J 0 2 TOTAL CASES - 1084 MEAN DAYS 2' 107 APPFNTIX MODE DAYS 22 1 PERCENT DISPOSED 8* OAY SHOWN OAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 180 240 PCT 0 4 3 2 18 3 41 3 63 7 78 2 86 3 91 2 94 4 96 5 96 0 99 1 99 4 99 5 99 8 100 0 - - PNEUMONIA, ATYPICAL CUMULATIVE PERCENT OF DISPOSITIONS ft TYPE OF DISPOSITIONS OF HOSPITALIZED CASES final DISPOSITION TYPE Al A2 B C DIED AWOL PCT 90 5 85 08 0 1 0 1 - TOTAL CASES - 2539 MEAN DAYS 24 3 APPENDIX 2A MODE DAYS 4 0 PERCENT DISPOSED BY DAY SHOWN DAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 ieo 240 PCT 33 0 70 0 85 9 92 7 95 7 976 98 2 98 6 98 9 99 1 99 4 996 99 6 99 7 99 9 999 100 0 BACTERIAL FOOD POISONING CUMULATIVE PERCENT OF DISPOSITIONS & TYPE OF DISPOSITIONS OF HOSPITALIZED CASES final DISPOSITION TYPE Al A2 8 C DIED AWOL PCT 98 6 0 4 09 - - 0 1 TOTAL CASES - 2967 MEAN DAYS 89 APPENDIX 17 Ill MODE DAYS 4 6 ' PERCENT DISPOSED BY DAY SHOWN DAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 180 240 PCT 171 58 4 78 1 86 3 89 9 93 1 94 8 96 2 97 0 98 0 98 7 99 1 994 99 5 99 9 100 0 - COMMON DIARRHEAS CUMULATIVE PERCENT OF DISPOSITIONS 8 TYPE OF DISPOSITIONS OF HOSPITALIZED CASES final DISPOSITION TYPE At A2 B C DIED AWOl PCT 97 0 1 1 1 4 0 2 - 0 3 TOTAL CASES - 1741 MEAN DAYS 12 0 APPENDIX 28 MODE DAYS 4 7 PERCENT DISPOSED BY DAY SHOWN DAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 180 240 PCI 209 59 2 78 7 878 92 2 94 4 95 5 970 97 8 98 2 98 9 99 2 99 3 99 5 99 8 1000 - - DYSENTERY, UNCLASSIFIED CUMULATIVE PERCENT OF DISPOSITIONS* a TYPE OF DISPOSITIONS OF HOSPITALIZED CASES FINAL DISPOSITION TYPE A1 A2 B C DIED AWOL POT «, -.Vi 10*7 Q3ia J 6 ZV 17 3 a> 1 NOaiSOdSiQ IVNIi TOTAL CASES - 3147 MEAN DAYS 12 7 APPENDIX £0 117 MODE DAYS 94 PERCENT DISPOSED BY DAY SHOWN DAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 180 240 PCT 1 2 41 5 799 89 5 93 7 95 6 96 8 97 7 98 0 98 4 98 8 99 3 99 5 995 99 9 100 0 - — MALARIA, VIVAX, "OLD" CUMULATIVE PERCENT OF DISPOSITIONS 8 TYPE OF DISPOSITIONS OF HOSPITALIZED CASES FINAL DISPOSITION TYPE Al A2 B C 1 DIED AWOL PCT 96 0 I 2 1 9 07 LZj 02 TOTAL CASES - 2969 MEAN DAYS 13 3 APPENDIX 21 MODE DAYS 6 1 PERCENT DISPOSED BY DAY SHOWN DAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 180 240 PCT 13 8 61 0 79 9 877 90 9 93 1 93 1 95 0 954 96 3 976 98 1 98 2 98 5 99 8 99 9 100 0 - FEVER, UNDETERMINED ORIGIN (FUO) CUMULATIVE PERCENT OF DISPOSITIONS ft TYPE OF DISPOSITIONS OF HOSPITALIZED CASES FINAL DISPOSITION TYPE A1 A2 B C DIED AWOL PCT 979 1 6 1 0 0 3 - 0 2 TOTAL CASES - 1088 MEAN DAYS 14 7 APPENDIX 22 121 MODE DAYS l 2 GONORRHEA,"NEW" CUMULATIVE PERCENT OF DISPOSITIONS a TYPE OF DISPOSITIONS OF HOSPITALIZED CASES PERCENT DISPOSED BY DAY SHOWN DAY S 10 it 5-0 2S 30 3S 40 4*, SO 00 70 80 oc 120 iso 180 240 PCT m 3 03 i OS 4 V 4 07 i 070 OH 1 OH 3 OH 3 OH S OH 0 oh e 00 1 Oh 2 00 0 1000 - - ElNAl OPPOSITION TYPE Al *2 e c OlfO A*Ct PCT Ob 0 Ob 1 0 ■ - 0 ? TOTAL CASES - 3023 MEAN DAYS 4 7 APPENDIX 23 MODE DAYS 1 6 GONORRHEA,"OLD" CUMULATIVE PERCENT OF DISPOSITIONS a TYPE OF DISPOSITIONS OF HOSPITALIZED CASES PERCENT DISPOSED BY DAY SHOWN DAY 5 .0 '5 20 25 30 40 45 50 60 70 80 90 120 150 180 240 PCI 80 3 91 5 95 6 97 0 98 2 98 7 99 0 99 2 994 99 4 99 5 99 6 997 99 8 99 9 1000 - - PINAL DISPOSITION TYPE Al A2 a c DIED AWOL PCT W 8 0 i o. - - - TOTAL CASES - 3648 MEAN DAYS 4 4 APPENDIX 04 ■ u mhm X 125 MODE DAYS 4 7 CHANCROID, "NEW" CUMULATIVE PERCENT OF DISPOSITIONS d TYPE OF DISPOSITIONS OF HOSPITALIZED CASES PERCENT DISPOSED BY DAY SHOWN DAY 'C IS 20 2S 1. 3S 4 0 4 S SO EG 70 80 90 120 IDO 180 240 POT IE 6 7: b 84 9 92 * 9S E 9E 9 97 9 9b 6 9b 8 9b 9 99 0 99 3 99 3 99 6 99 8 99 9 100 0 final dispose TlCN T rPE A 1 A2 B C DIED AWOL PCT 98 3 0 5 09 - - 0 3 TOTAL CASES - 1495 MEAN DAYS 96 APPENDIX o5 MODE DAYS | _LJ PERCENT DISPOSED BY DAY SHOWN DAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 ISO 240 POT 47 1 80 9 90 6 93 6 95 6 96 3 97 0 97 3 97 4 97 6 98 6 96 7 98 9 98 9 100 0 - - - URETHRITIS (CAUSE UNDETERMINED) CUMULATIVE PERCENT OF DISPOSITIONS 8 TYPE OF DISPOSITIONS OF HOSPITALIZED CASES FINAL DISPOSITION TYPE Al A2 B C DIED AWOL PCT 99 4 03 01 0 1 - 01 TOTAL CAS£S - 1331 MEAN DAYS 8 5 APPENDIX 26 129 MODE DAYS 4 1 PENILE ULCER (CAUSE UNDETERMINED) CUMULATIVE PERCENT OF DISPOSITIONS & TYPE OF DISPOSITIONS OF HOSPITALIZED CASES PERCENT DISPOSED BY DAY SHOWN DAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 180 240 PCT 456 870 934 957 97 3 97 9 98 2 986 98 8 98 8 99 1 99 2 99 4 99 5 99 9 1000 - - final DISPOSITION TYPE A1 A2 B C DIED AWOL PCT 99 5 0 1 01 - - 0 3 TOTAL CASES - 1727 MEAN DAYS 38 1 APPENDIX 2? 131 MODE DAYS 52 6 HEPATITIS, INFECTIOUS CUMULATIVE PERCENT OF DISPOSITIONS ft TYPE OF DISPOSITIONS OF HOSPITALIZED CASES PERCENT DISPOSED BY DAY SHOWN DAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 180 240 PCT 06 2 4 3 4 5 3 74 10 8 15 3 22 8 296 37 2. 52 5 65 2 74 4 80 4 95 8 99 9 100 0 - PINAL DISPOSITION TYPE Al A2 a c DIED AWOL PCI 78 5 15 8 4 1 3 4 - 02 TOTAL CASES - 1195 MEAN DAYS 62 4 APPENDIX ££ 133 MODE DAYS 14 2 PERCENT DISPOSED BY DAY SHOWN DAY 5 10 15 20 25 30 35 40 45 50 60 70 80 90 120 150 180 240 PCT 4 5 22 5 438 573 68 6 75 8 81 2 85 7 88 4 91 0 944 96 0 96 9 98 I 99 0 99 8 1000 - MYCOTIC DERMATOSES CUMULATIVE PERCENT OF DISPOSITIONS a TYPE OF DISPOSITIONS OF HOSPITALIZED CASES FINAL DISPOSITION TYPE Al A2 B C DIED AWOL PCT 96 3 I 1 1 7 04 - 0 5 TOTAL CASES - 1090 MEAN DAYS 23$ 135 APPENDIX 29 ANALYSIS OF STOOL SPECIMENS EXAMINED I9UU (15th Medical Laboratory) Civilian Pood Handlers JAN FEB MAE APE may JUN JUL AUG SEP OCT NOV DEC ' TOTAL Salmonella napoli 2 3 1 U 10 S„ orientenburg 1 1 5 7 S. paratyphi B 1 1 2 2 6 S. schottmulleri 1 l S. Benftenburg 1 1 S, derby 1 1 S. typhi (I* typhoee) 2 2 1 5 S. bareilly 1 1 S o anaturn 1 1 S, montivedeo 2 2 S. typhi-murium 1 1 S, tenesse 1 1 S. cholera-euis (var. knuns) F - I(MV«) 1 . F - II(»W«) 1 1 2 f - iri(«i«) P - IV p 27U 1 1 2 F - V(119) F - VI(Newcastle) 1 1 5 9 2 1 19 Boyd I (170) Boyd (27*0IV 2 1 1 1 1 6 Boyd T(I>*3) 1 1 Sh. alkaleecene 1 1 Sh. sonnet 1 1 5 3 2 3 2 1 18 Sh. madamPensis- deylan B 1 1 2 Sh. ambigua (schmitzii) 1 1 1 2 5 Sh.Sp,(477l(Arab a) Q3.167( rt b) C$02 1 1 Total Positive 2 u 7 9 2 10 15 19 18 U u 91+ Paracolon-Proteus 3 16 18 83 136 83 2U8 U63 299 2U5 189 97 1880 Negative lUO 52k 66l 735 U30 U25 „ j 705 U99 631 726 701 6610 Total *“ 1U3 H5T 1ET 751 880 515 683 j 1183 817 89U 919 802 ft CO ir\ CO Appendix! 30 ANALYSIS OF STOOL SPECIMENS EXAMINED 1944 (15th Medical Laboratory) American Food Handlers JAN FEB MAR APR MAY JON JOL aug) SEP OCT fJ£QL-| DEC ii ii ii total Salmonella napoli 2 i 3 So montivedeo A 3 1 3 11 So orienienburg 1 1 6 2 8 18 So typhi=mnrium 6 ' 1 7 Sho sonnei 1 3 2 6 Sacns Q771 1 1 2 F ~ II(*WB) 1 1 1 3 6 F - III(MZW) 1 3 A F ® Vl(newcastle) 1 2 3 Sh0alkalescens) 1 1 2 F - V (119) 1 1 F - IV(103) i : _i 1 ' 1 Total Positives 1 11 0 5 5 8 11 A 7 8 0 A Paracolon-Protens 0 2 1 1 26 33 69 56 28 30 12 8 229 Negatives p5 A1 1 39 \17A 208 141 156 252 58 71 A9 61 1277 Total u 5A AO 213 239 192 226 312 93 109 61 \ 73 16 AO Prisoners of War (German) Positives F « III Paracolon-Proteus Negatives m FEB MAR j APR MAI JUN JUL AUG SEP OCT Noy m TOTAL 6 3 19 K 1 3 30 Total 6 22 A 1 33 Appendix? 30 (cont8d) ANALYSIS OF STOOL SPECIMENS EXAMINED 1944 (15th Medical Laboratory) Hospital Patients 1 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL So napoli ' So orienienburg 1 -i 1 1 r 10 13 So Oregon 1 1 S, paratyphi(Para A) So schottimilleril(Fara B) 2 2 So seftenburg So d9rby So typhi fE, typhosa) 7 11 * 1 6 16 a So bareilly So anaturn ■ So montevedeo 5 , 1 6 So typhi-murium 24 j ! 24 So tennessee So cholera-suis (kunzendorf) 1 1 2 F - I(»vw) F - 1 1 F - III(»z») 1 2 2 1 6 F - IV(P 274) F - V(119) 1 1 ■ 2 F - Vl(newcastle) 1 3 8 12 Boyd I (170) • • Boyd (274)IV 1 1 Boyd V (143) AlkaTeescens ' She sonnei >•/ ;• 1 1 2 6 10 Sh0 madampensis ' Ceylan B 2 4 1 7 Sh0 ambigua 1 - 1 2 Sh0 sp0 Q771(Arab A) 1 6 7 Qll67(Arab b) Q 902 : Total Positives 31 9 15 9 10 29 22 10 2 137 P aracolons-Pro teus ! 2 1 21 22 15 50 11 1 3 3 2 130 Negatives 2 31 48 120 136 54 66 - 48 6 3 10 7 531 Total 2 64 58 156 167 79 7 p.45 SI 6 16 15 9 798 Appendix; 30 (cont’d) ANALYSIS OF STOOL SPECIMENS EXAMINED 1944- (15th Medical Laboratory) Cases JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL 1* Civilians (ItoFood Handlers) Positive Pharacolon-Proteus Negative 0 3 1^0 2 16 433 4 18 524 7 83 661 9 136 735 2 B3 430 10 248 i25 15 463 705 19 299 499 18 245 631 4 189 726 4 97 701 94 1880 6610 Total 143 451 546 751 880 515 683 1183 817 894- 919 802 8584 2« American Soldiers (Food Handlers) Positive a u 0 5 5' 8 11 4 7 8 0 4 54 Paracolon-Protens 0 2 1 34 26 33 69 56 28 30 12 8 299 Negative 25 41 39 174 208 141 158 252 58 71 49 61 r ' i Total 2o 54 40 213 239 192 228 312 93 109 73 "ISS) 3o Prisoners of War (Ger0Food Handlers) Positive 0 0 0 0 0 0 0 0 0 0 0 0 0 Paracolon-Proteus 0 0 0 3 0 0 0 0 0 0 0 0 i 3 Negative 0 0 6 19 4 0 0 1 0 0 0 0 30 Total 0 0 I 6 22 4 0 0 1 0 0 0 0 33 L. Hosp & Disp Patients (Ameri-French) Positive 0 31 9 . ' 15 9 10 29 22 0 10 2 0 ! 137 Paracolon-Proteus 0 2 1 21 22 15 50 11 0 3 3 2 1 130 Negative 2 31 48 120 136 54 66 48 6 3 10 7 1 531 Total 2 64 58 156 167 79 145 81 6 16 15 9 798 Grand Total 1 1 ' 11035 Appendix? 30 a ANALYSIS OF STOOL SPECIMENS EXAMINED 19U (15th Medical Laboratory) Percentage Tjan FEB MAR APR MAY JUL AtlC OCT DEC TOTAL lo Civilians (It= Food Handlers) Positive OoO Paracolon-Proteus 2 = 2 Negative 97=8 0=4 3=6 96o0 0o7 3.2 96ol 0o9 11.2 87o9 1.1 15,4 83 0 5 0o4 16,2 83 0 4 1.5 36.6 61.9 lc3 39,2 59=5 2.3 37.7 6O0O 2,2 27=5 70 0 3 0=5 21 = 0 78=5 0=5 12 = 2 87=3 lol 22=0 76=9 20 American Soldiers (Food Handlers) Positive Paracolon-Proteus Negative 3*9 OoO 96ol 22 o0 3o? 74=3 0.0 2o5 97=5 2„5 15o8 81.7 202 10o9 8609 4o2 17o2 7806 4.8 30.5 64.7 I08 17o9 80=3 7o5 30.2 6£=3 7=3 27=5 65 = 2 0.0 19=9 80,1 5 = 5 11.0 83 = 5 3=9 17=9 78=2 4= Hosp & Disp Patients (American-French) Positive OoO Paracolon-Protens 0o0 Negative 100o0 4-8 o 4 3o2 48 c 4 15 = 3 lo? 83 oO 9 = 6 13 0 4 77=0 5.4 13 a 1 8lo5 12.6 180 9 68 0 5 20.0 34o5 45.5 27=2 13=8 59=2 0.0 0,0 100=0 63 = 4 18.8 18 = 8 13=2 20,1 66=7 OoO 22=2 77=8 ■ 17.2 16=2 66=6 Appendix: 30b APPENDIX 2i (omitted) APPENDIX £1 RESTRICTED HEADQUARTERS 2655th MALARIA CONTROL DETACHMENT (OVHD) Office of the Malariologist, MTOUSA APO 512, U. S. ARMY SUBJECTi Report of Malaria-control Activities in the Mediterranean Theater of Operation during 1945. Surgeon, AFHQ (American Section), APO 512, U, S* Army. /s/ Thomas H. G, Aitken THOMAS H. 0. AITKEN, Major, Sanitary Corps, Malariologist, MTOTTSA Malaria Control D. D. T. By; Date; _ Per favore Non Ri muovere 135 Med. Serv. DeJ (Malaria Control) DDT house sign used in Foggia area. APPENDIX 32 DDT house-spraying Application, by means of knapsack sprayer, of 5% DDT- kerosene solution to walls of enlisted men’s barracks. HEADQUARTERS 2655th MALARIA CONTROL DETACHMENT (OVHD) Office of the Malariologist* MTOUSA APO 512* Uo Sc ARMY THGA/rlk 30 September 194So SUBJECT?/ Report of Maiaria-control Activities in the Mediterranean / ! Theater of Operation during 19450 TO? *; The Surgeon,, AFHQ (American Section)* APO 512* Uo So Amy<> lc The following report is an account of the UoSo Amy military- malaria control campaign in the Mediterranean Theater of Operations dur« ing 1945o Whereas theater headquarters personnel were responsible for the overall planning and administration of the program* actual super- vision and accompli slim© nt of operations were largely the responsibility of a small malaria-control organization*, It is the intent of this re- port to record the results of this program only through 30 September* inasmuch as large scale operations will cease at this timeo For pur- poses of historic background* reference is made to the MReport of 1944 Malaria Control Activities in MTOUSA (ITATOUSA)”, submitted to the Sur- geon* MTOUSA* by the Malariologist, MTOUSA* on 30 November 1944o 2o General policy and administration- Malaria control policy and general a (teTnTit'ra liT MTOUSA originated in the Med- ical Section of theater headquarters with the Surgeon* the Chief of Preventive Medicine and the Malariologist0 ao It seems unnecessary to go into a detailed discussion of policy and administration* inasmuch as these matters were very ably described in the 1944 reports suffice it to say that in general* policy and administration have remained the same*. One notable exception has been the attitude adopted toward atabrine suppressive medication*, Whereas last year the daily taking of atabrine was required with few exceptions throughout the theater* this past season has seen very little of the drug in use© The theater malaria directive (see Circular No0 54* 9 April 1945) calls for the taking of atabrine only in areas designated as malariouso With the exception of one instance in the Po Valley where 5th Army designated a few atabrine areas* the drug lias been limited to an occasional unit having an unduly high malaria rate or to individuals recovering from an attack* Mosquito bars and repellent were available to troops from 15 Apidl to 30 November* bo Estimates of malaria control supplies required in the thea® ter during 1945 were submitted by the Malariologist to the Chiefs Pre® ventivo Medicine Section in the Office of the Surgeon* MTOUSA early in. the year* included in these were estimates of airplane requirement®!* Constant check of supplies on hand in various depots throughout the thea* ter was maintained by the theater Malariologist and his associates* and shortages called to the attention of the Chief* Preventive Medicine Sectlono „ APPENDIX 2S. Oo Administration of the special malaria control organization was maintained by the theater Malariologist through a small malaria con- trol headquarters- 2655th Malaria Control Detachment (Ovhd)0 Movement and assignment or attachment of personnel or units was made, in general, on the basis of recommendations of the Malarialogist to the Chief, Pre- ventive Medicine Sections Activities of malaria control and survey units were reported weekly to the Surgeon of the responsible canmando These were combined into monthly reports by the local malariologist and submitted through channels to the Office of the Surgeon, MTOUSA, with information copies being sent directly to the Theater Malariologisto In addition, the latter submitted to the Chief, Preventive Medicine Sec- tion a situation and status report on the 15th of each montho do At the close of the 1944 season, when it was realized that the theater would shortly no longer have committments in North Africa or in the islands of Sicily, Sardinia and Corsica, it was decided that the malaria control organization could afford a drastic cut both in person- nel and unltso True, the theater was confronted with the problem of occupying the Po Valley, many sections of which are considered highly malarious, as well as remaining In the Foggia Plain and possibly the Grosseto area, but on the other hand, troops had moved out of such dangerous areas as Salerno, the mouths of the Voltumo, Garigliano and Tiber Rivers and Litteria Province with its Pontine and Fondi marshes. As a result, the officer strength of 2655th Malaria Control Detachment (Ovhd) was cut from thirteen (13)to six (6), and the malaria units reduced from seventeen (17) to ten (10) control units and six (6) to on© (1) survey unite Redeployment of officers took place during the winter months<> 3o Special organization for malaria control0- This organization consisted of 8 ""*2lS5th Malaria/Control a control and survey units, and a small detachment from a ferrying squadron re- sponsible for operating larviciding planes. For the relationship of these elements to the major subdivisions of MTOUSA® see Charts I and II„ 8,0 2655th Malaria Control Deto (Ovhd) and Theater M&lariologisto 1) This detachments consisting of 5-6 officers and 7-8 enlisted men* acted as a malaria control headquarters for the theatero From it* malariologists were attached to various commands and from time to time malaria literature was distributed to interested personnelo Special research projects also stemmed from this headquarterso 2) The commanding Officers. Major To Ho Go Aitkens Sno0os was attached to the Medical Section of Theater Headquarters for duty as Malariologlsts being responsible to the Surgeon through the Chiefs Pre- ventive Medicine Sect!on0 Constant liaison was maintained with various parties responsible for the Allied malaria control program^ bo Local malariologlsts- 1) The remaining officers in 2655th Malaria Control Deto 327th FERRYING SQUADRON I MALARIA'CONTROL AIR ARM MATS N I ROME AREA MTOUSA CHART I. MTOUSA SPECIAL MALARIA CONTROL ORGANIZATION I JUNE 1945 SURGEON 1 ACTING MALARIOLOGIST I 133rd M.C.D MOD. (OVHD) >2655 th SANITATION OfyFICER MALARIOLOGIST CHIEF OF PREVENTIVE MEDICINE 'PBS SURGEON I 134th MGD 137 th M.GD. 138th M.GD. COMMANDING GENERAL I MALARIOLOGIST SURGEON DEPUTY .SURGEON SURGEON I I30th MGD. 135th M.GQ 136th M.GD. 139th MGD. ABC 1 -MALARIOLOGIST I AAF/MTO I AAFSC/MTO SURGEON I 42nd M.GD. FIFTH ARMY I DIRECTOR MALARIA CONTROL I 28th M.C.D. 206th M.S.D. SURGEON MEDICAL INSPECTOR Appendix 32a 327th FERRYING SQUADRON MALARIA'CONTROL AIR ARM MATS ROMENAREA MTOUSA 6652nd MC D. (PROV) ’ CHART 2. MTOUSA SPECIAL MALARIA CONTROL ORGANIZATION I AUGUST 1945 I ACTING MALARIOLOGIST I SURGEON I MCD. (OVHD) 28th MCD. 137th MCD. 138th M.GD. 6651st M OD. (PROV) -2655 th SANITATION OFFICER MALARldlDGlST I I CHIEF OF PREVENTIVE MEDICINE ✓I 'PBS SURGEON COMMANDING GENERAL MALARIOLOGIST- SURGEON I 130th MOD. ' 136th MCD 6653rd MOD (PROV) DEPUTY .SURGEON I SURGEON i ABC I —MALARIOUOGIST- AAF/MTO AAFSC/MTO 42nd MCD. SURGEON I FIFTH ARMY DIRECTOR MALARIA CONTROL SURGEON ■ MEDICAL INSPECTOR APPENDIX 32b (Ovhd) were available for attachment to the Surgeon’s Offices of various commandso They had technical direction of malaria units assigned or attached to their respective headquarters* With the restriction of con- trol activities to the Italian Peninsula and the reduction in the number of major commands# fewer malariologists were required; furthermore# 5th Army provided its own malariologist (Director Malaria Control)* 2) Major Fo Wo Whittemore# Sn0C0 # served as m&lario- legist to AAFSC/MTO (Army Air Forces Service Command# Mediterranean Theater of Operations) from December 1944 to 15 October 19450 In April# after Adriatic Base Depot became ABC (Adriatic Base Command)# he was further placed on TDY as malariologist with the Surgeon’s Office# ABC# inasmuch as the areas occupied by the Air Forces and ABC in eastern Italy were in general the same0 3) Captain Ho Jo Dain# M*C*# served as malariologist of PBS (Peninsular Base Section) from March until 30 August 1945# following which the position was assumed by the Chief, Preventive Medicine Section# PBS until the end of the season0 4) Major Wo J® Ujyatt, SnoCo, worked out of this head- quarters on civilian ditching contracts during the spring and later devoted his activities toward improving the oiling and dusting planes and determining their output of larvicide per acre0 5) Major Fo Ho Connell, Sn0Co9 was attached to the Air Forces during January and February for the purposes of conducting laboratory technician schools dealing with the preparation and identi- fication of malaria smearso He was assigned to 5th Army Surgeon*s Office from 1 March to 23 July 1945, after which he returned to this Headquarters and assisted Major Whittemore in the Foggia area0 6) 1st Lto A® Sulcov# MAC# assumed administrative responsibility for 2655th Malaria Control Det* (Ovhd) and assisted with the airplane larviciding program* / Oo /WD antim&laria units0- 1) Disbanctoent of units- As of 1 January 1946, there was a total of twenty-one^(Tn*imTts in tKe theater# fifteen (15) con- trol units (19th - 23rd (incl*), 28th# 42nd# 130th# and 133rd - 139th (inclo) and six (6) survey units 10th » 14th (incl*) and 206th* As of 15 February# the ten (10) oldest units (19th - 23rd control and 10th - 14th survey) were disbanded by WD order, and all but three of the officers returned to the United States* Steps were taken to assign a considerable number of the enlisted men to the remaining units# either as vacancy replacements or as replacements for undesirable or inexperienced per sonnel* 2) Distribution- Distribution of units during 1945 was as follows? (See Table I) TABLE I Assignment and distribution of Malaria Control and Survey Units in 1945 UNIT ASSIGNED ATTACHED — =s LOCALITY 28th MCU 5th krmy Florence «V©rona 42nd MCU PBS AAFSC/MTO Pisa 130th MCU ABC ABO (Advance) Cattolica 133rd MCU Rome Area, MTOUSA --- Rome 134th MCU PBS 0»CD Antignano 135th MC0 ABO ABC (Intermedo) Cerignola 136th MCU ABC ABC (Intermedo) Raaaitelli-San Sever© 137th MCU PBS PBS (South) ! Naples 138th MCU PBS cr> o&w '.Pisa 139th MCU ABC ABC (Intermedo) Foggia 206th MSU 5th Army S ¥iareggio-Mantua a) During the spring, as a result of an un- fortunate controversy between the Air Forces’and ABC as to the assign- merit status of malaria units , the 130th, 135th, 136th and 139th MCU3s were tossed back and forth between the two commands0 Effective 28 April, however9 all four units were relieved of their attachment to AAF/MTO and reverted back to their assigned status to ABC® The two month old controversy resulted in a great deal of misunderstanding, the efficiency of the involved unite was impaired and their activities curtailed be- cause of th© lack of laboro b) In general the units remained in one area during the season0 At the time of the spring' offensivef the two Army- units (28th MCU/206th MSU) moved north into the Po Valley to Verona and Mantua from their bases in Florence and Viareggio respectively,, 3) RedesigmtiQn of units- As of 29 March, units were redesignated as follows? Former Designation Present Designation Medical Service Detachments (Malaria Control) Malaria Control Detachments 42 nd 42 nd 130th 130th 134th - 139th (inclo) 134th - 139th (inclo) 28th Malaria Control Unit 2Sth Malaria Control Det0 133rd Medical Composite Platoon (FA) 133rd Malaria Control D©te 206th Malaria Surrey Unit 206th Malaria Survey Det0 4) Redeployment- With the cessation of hostilities in northern Italy and the Declaration of Amis tie© 9 9 May 1945 plans for redeployment of troops to the Far Eastern Theaters came into being| in- cluded in these plans were many of the malaria detachments« a) Five (5) detachments left the theater early in one (the 206th M0S«D0) for indirect redeployment through the TJ0S0Ao , and four (the 133rd, 134th, 135th and 139th M0C0D08s) for direct redeploy- ment to the Pacifico b) Three (3) detachments, namely the 28th, 136th and 137th, were scheduled for indirect redeployment early in September; however, the Japanese surrender provoked the decision to disband the detachments here in the theater0 c) The remaining three (3) detachments the 42nd, 130th and 138th MeC0Do,s are due to remain in Italy for another season. d) The loss of five (5) detachments in July resulted in considerable concern being registered over the security of the malaria programs The 206th M0SoD0 was released by 5th Army to the Nontecatini Redeployment Training Center six (6) weeks in advance of its departure from the theater; while staging, however, it assisted the Training Center in its control program0 Of the other detachments the 133rd MoC.Do managed to continue its work around Rom© up until a few days prior to departure, but the remaining three (3) (one in Leghorn and two in the Foggia area) cancelled their activities two weeks before leaving, thus exposing their areas to a possible build-up in anophel- ineso Fortunately, however, widespread DDT house-spraying undoubtedly played an important part in tiding over the critical period until new units could take over the area0 e) In order to safeguard the program, author- ization was obtained from MTOtJSA to organize three (3) provisional units, namely; the 6651st M«C0D* by PBS, the 6652nd M0C.D0 by Rome Area, MTOUSA, and the 6653rd M®C,Do by ABC (see MTOTJSA letter, file AG 322/088 G-0, 27 June 4.5, subjects “Organization of Certain Medical Units** )0 In addition, two (2) of these units, (6651st and 6653rd) were authorized an overstrength of fourteen (14.) enlisted men (MTOUSA letter, file, AG 320o2/8l6 C»0, subjects “Authorization of Overstrength*) and one (1) officer (MTOUSA letter, file, AG 320o2/8l6 C-0, 1 August 45, sub- jects "Authorization of Overstrength"), giving a total of twenty-five (25) enlisted men and two (2) officers0 Activation of these units was as followss 6651st MoCoD* (Leghorn) per Go00 #181, Hq0 P0B«So, dated 3 July 45, effective 5 July 45I 6652nd M«C«D0 (Home) per Go0o #18, Kq® Rome Area, MTOUSA, dated 5 July, effective same date; and 6653rd (Foggia) per S„0o #44, Hq0 ABC, dated 20 July 45, effective 23 July 45o Where possible an attempt was made to obtain personnel from the old units disbanded in the spring; this policy was about 30$ successful© f) Labor- Authorization was obtained early in the season from MTOUSA (Letter, file, AG 370o5/188 Surg-C, 13 Feb 45, subject; "Theater Malaria Control Program"), providing each malaria unit with two (2) Italian labor companies (approximate strength per company 100 men), the responsibility for compliance being that of the major command to which the unit was assignedo With the activation of the three (3) provisional units in July, the above latter was amended to include the new units (see MTOUSA letter, file, AG 370o5/l88 Surg-0, 12 July 45, subject; "’Theater Malaria Control Program**)« Shortly following the activation of the 6653rd M0C*D0 (Prov), it turned back its Italian labor, substituting for it German P0W9s who proved to be vastly superior to their predecessors0 g) Excess Equipment- In order to provide ade- quate equipment over and above that listed in T/O &. E 8-500, War Dept,, 18 January 45 for malaria control and survey detachments, authorization was obtained from MTOUSA (Letter, file, AG 400034/188 D=0, 20 March 45, subjects "Special Issue of Equipment to Certain Medical Units") to draw excess equipment to be used by the Italian labor companies between 15 March and 15 November 45o This authorization was amended in July to include the 6651st 6652nd and 6653rd Malaria Control Detachments (Prov) (AFHQ cable, kQ29Ao3, time of'origin, 071437B)o This very generous list made it possible for the units to work unhampered at all times during the season, and avoid much loss of time and red tape, which otherwise might have been caused in trying to obtain additional vehicles or special pieces of equipment over and above the authorized T/0 & Ec do Airplane dusting and spraying organization- Airplane larviciding operations were undertaken by a small group of American pilots and enlisted men from the 327th Ferrying Squadron, MATS (Medi- terranean Air Transport Service) under the technical supervision of the Theater Malariologist and his designated representatives0 This arrange** meat, as in 194-4, was requested by the Commanding General, MATS, and concurred in by the British Consultant in Malariology, AFHQ and the Tropical Disease Consultant, RAF0 1)' Personnel** This consisted of nine (9) pilots and eighteen (18) enlisted men (ground crew)0 At no time were more than six (6) pilots operating planes0 Of the remaining three (3) pilotsf on© departed the theater early in the season after supervising the modifies** tion of the first planes, and the other two temporarily replaced regular pilots for short periods0 2) Equipment** 2 L“5 observation planes 3 PT-17 (Steanaan) planes 2 equipped for dusting 1 ©quipped for oiling 10 A=20 (Boston) light bombers 6 equipped for oiling U equipped for dusting 2 l/l ~ton trucks 2 1A -ton trailers Originally all three Stearmans were equipped for dusting, but during July on© was modified into an oiler in order to overcome the difficulties and dangers caused by the very light diluent (diatomacious earth) blow- ing up into the face of the pilot; in addition, the modification permitted the plane to carry a larger load and operate farther from its bas©0 3j Distribution** Twc advance bases were set up in nor- thern Italy, leaving Capodichino Airfield, Naples (Hq0 327th Ferrying Squadron) as the home porto One group (3 pilots, 10 enlisted men, 1 L-5, 1 PT-17, 3 A-20 oilers, 2 A»20 dusters, 1 l/4 ton truck and trailer) established itself on Rimini Airfield and operated in conjunction with the 130th Ma- laria Control Detachment and the other group (same equipment and person- nel except that there were eight enlisted men) established itself on Rosignano Airfield and lived with the 134th Malaria Control Detachment near Leghorn0 Later in the season it became necessary for the Rimini group to move its planes to Cattolica Airfield and again to Villafranca Airfield, Veronaj likewise the Leghorn group was required to move its planes to Pisa Airfield, however, loading of larvicide continued to be done at the Rosignano Airfield* The third PT-17 was left as a reserve at Capodichino Airfieldo 4o Summary of Theater-antimalaria activitieso a° Antimalaria education program- Inasmuch ap many per- sons connected witlT the malaria controi program had received rather ex- tensive training (involving Wo Do Courses $1, 2 and 3) during tho 1944 season, it was felt that a comprehensive school program was unwarranted in 1945o As a result, the Theater Malariologist in January, after dis- cussing the matter with local Malariologists, proposed to the Chief, Preventive Medicine Section, Office of the Surgeon, MTOUSA, a modified educational program0 This consisted of one day schools, given by the local malariologists and his assistants, for; a) officers entrusted with antimalaria instruction of troops, b) officers who supervise the activities of organizational EM antimalaria details, and c) EM of the organizational antimalaria detailso In the main, schools were held during March. and April, just before the start of the mosquito season0 In general, the following aspects of the malaria problem in MTOUSA were covered? 1) Officers9 schools?: a) Outline of history of malaria in (MATOUSA) MTOUSA during 1944, with particular reference to the major command involved0 b) Analysis of the Theater malaria hazard for 19460 i c) Nature of control problems to be expected in 1945o d) Duties of antimalaria personnel (Malariologist, WD Malaria Control Units, Commanding Officers* Malaria Control Officers* Bf Antimalaria Details) and their relationship to one another0 e) Antimalaria education of troops (scope* sources of teaching aids, training films)0 f) Training and use of antimalaria details0 g) Supplies and equipment (how and where obtained, T/BA, stock numbers, etc,) h) Suppressive atabrine * Theater policy* "19450 TABLE II Summary of malaria-control training activities in MTOUSA by special malaria control organization COMMAND COURSES GENERAL . . . 1 TECHNICIANS Officers EoMo Officers EoMo AAF/kTO & ABC 855 1030 89 - 97 PBS 484 856 Rome Area#MTOUSA 30 no 5th Array 888 1691 MTOUSA zztf 9*r Grand Total 6 1 3 0 2) EM Schools- a) Importance of malaria - general sketch utilizing "Graphic Portfolio on Malaria" (WD Graphic Training Aid 8-4)0 b) Description of mosquitoes (anophelinos and culicines) and their biologies* c) Malaria control measures which will actually be practiced by EM antimalaria details* d) Care and us© of equipmento e) Field trip to demonstrate collection of mosquitoes* house spraying* oil larviciding and ditching techniques* 5) In addition to the above schools* Major Frank H* Connell* Sn*C<>* of this Headquarters* conducted in January and February a series of schools for officers and technicians in Air Force Group Aid Dispensarieso This was a highly necessary move as the Air Forces were in the process of equipping their medical units with microscopes* and the majority of the personnel were inexperienced in the preparation and diagnosis of malaria smearso 4) School locations- Schools were held in Naples* Rome* Grosseto* Siena* Leghorn* Pisa* Florence* Gattolioa* Torre Maggiore* Poggia, Cerignola* Spinazzola* Bari* Manduria and in the mountains of the 5th Amy Sector north and west of Florence* 5) Attendance- According to the local malariologists* reports* 6*130 officers and enlisted men received training, as shown in Table II by course and Command* This amounts to about la2% of the total American strength at the time the schools were conducted* and represents the same contact with the troops as was obtained in 19440 It is dif- ficult to evaluate the success of such undertakings, but judging from the well organized programs conducted by certain units, certainly some benefits must have been derived from attendance at the schools„ b. Survey activities- 1) Case investigation- As was the procedure last year, malaria statistics accumulated by the local malariologists during the 1945 season, have in certain instances differed markedly from those com- puted by the theater. The method of reporting by the malariologist varied with the different commands. a) Fifth Army malariologist reported the total num- ber of cases based on the v/eekly statistical health report plus cases reported by base hospitals. Since some cases of malaria in Army person- nel are first diagnosed in base hospitals and therefore do not appear on Army weekly statistical health reports base hospitals were requested to notify Army of all such cases so that they might be added to the week- ly statistical health report figures. A breakdown by species was ob- tained by a review of field medical records and emergency medical tags. b) PBS malariologist reported total cases based on daily hospital reports of positive diagnoses. Cases were broken down into primary and recurrent infections, type of infection and origin. It was thus possible to follow the history of a particular unit, and, if an undue number of cases appeared, to take the necessary steps to overcome the situation. Comparison of these figures with those of the consolidated monthly 86ab report has shown the two consistently to be equal or approximately so. Hence the theater and malariologist rates for the Base Section are essentially the same. Inasmuch as with few exceptions, hospitalization of all Base Section personnel takes place in its own hospitals, the malaria rates reported by the malariologist are as close an approximation as it is possible to obtain. c) Rome Area, MTOUSA malaria rates were computed on the basis of individual case histories obtained by the malariologist from the hospital wards. d) ABC malariologist reported total cases based on consolidated monthly 86ab reports. e) AAF/MTO malariologist reported total cases based on consolidated monthly 86ab reports as well as individual unit 86ab re- ports. This system has been necessary inasmuch as many Air Corps unit dispensaries diagnose and treat their own cases locally. In addition, the malariologist monthly culled out Air Corps cases hospitalized in various sections of Italy, and which otherwise would have been overlooked. As a result, theater rates have never jibed with those of the malariologist, but it is felt that the latter’s figures more closely approximate the: actual situation. TABLE III Summary of malaria case investigations in MTOTJSA by special malaria-control organization from 1 January to 31 August 1945 I U M B E R OF CASES COMMAND Reported Inter- By attack By diagnosis viewed Primary Recur- rent Clin- ical Vivax Falci- parum Malar- ias Unde- termined AAF/MTO 2034 2034 1158 876 146 1803 58 4 23 ABC* 53 53 37 16 3 45 4 0 1 5th Army# 1940 1323 87 1073 145 1156 3 0 19 PBS 860 353 308 552 1 348 0 0 4 Rome Area0 MTOUSA 10 10 4 6 0 10 0 0 0 MTOUSA 4897 3773 Attacks % of Tol 4897 ;al Above 2374 _ . 481 2523 52% Diago % of Tol 3773 1 ial above 295 8* — 4 7 8 92% Types 1 3478 |- % of Total above 3362 960 ; 65 1,9% 4 0.1% 47 1,4% *No reports for January and February #No report for August f) Total eases reported- The total reported by malariologists for the first eight months of the year is about seven- teen hundred less than the number shown in the official statistics for the same period0 The reason for the difference is due to the fact that several of the smaller commands are not included! also no report was forthcoming from the malariologist 5th Army for Augusto Nevertheless9 the forty-eight hundred cases reported, constitute a large sample of the actual total? and give a good idea of the 1945 malaria experience0 g) Recurrent malaria- Table III indicates that of 4897 cases 52$ were Recurrent** infections f i0e0 , the patients gave a history of on® or more attacks during the previous six months0 It is to be expected that some of these attacks may have been initial infec- tions as there is no reason to suppose that an infected person is not susceptible to a different strain of Plasmodium <> LEGHORN - TERENCE AREA. PQ 7ALLEY AREA ANCONA - RIMINI AREA BpMl AREA NAPLES AREA JDGGIA - LAKE LECINA AREA INSPECTIONS (Larval and-AduLt) - CONTROL PROGRAM - 1945 GF.AJ I APPENDIX 32c LEGHORN - ELQRTOp AREA PO VAT.T.W AREA ROM IT AREA ANHOWA - BIMINI AS PA NAPLES AREA rraT*'EAfig area LARVICIDING (DIESEL OIL-gals) - MTOUSA MALARIA CONTROL PROGRAM - 1945 (WAP* II IPPENDH 32d h) Primary infections- Obviously not all of the 2374 cases listed as primary infections in Table III can be credited to transmission this season* From January through May, local malariolo- gists reported 1,683 primary infections in the five major commands listed in Table III* Although a few of these could possibly have been true winter or spring infections, the great bulk of them must of necessity have been incurred during the previous fall months* Such delayed or latent primary infections are characteristic of Plasmodium vivax, which was responsible for about 90% of last season’s ma.la.ria cases* i) Clinical diagnosis- Table III indicates, that where this information is available, clinical diagnosis without benefit of laboratory confirmation occurred in only Q% of 3773 cases„ Schools for medical officers held both last season and again this spring have undoubtedly played a significant role in keeping the clinically diagnosed cases to a minimum* j) Types of malaria- In conformity with last year’s experience, the 1945 season has seen an overwhelming preponderance of vivax infections* Tertian malaria parasites were found in over 96*6%, subtertian in 1.9/£, quartan in 0d%3 and in the remaining l*4?o no specific diagnosis was made. 2) Splenometric and parasitologic” No such surveys were made of the civilian population this past season, due to the fact that all but one survey unit were deactivated in the spring* For lack of sufficient units, the one remaining survey unit operated in the capa- city of a control unit* It is felt, however, that little was lost by not continuing such surveys, as the troops have in general occupied the same areas where they were last year and a fairly good idea of disease conditions in the civilian population was known* With the exception of large cities and mountainous areas, a country such as Italy should be considered malarious from the military standpoint, regardless of the results shown by a few minor surveys* 3) Entomologic- In the absence of survey units, con- trol units this past season were forced to train their own survey teams„ Each unit in general had two men assigned to inspection service* Larviciding schedules were developed on the basis of entomological findings; in this manner, unnecessary larviciding was eliminated as only anopheline positive areas were treated* A standardized system of mapping control areas and recording information, which was adopted by all units at the start of the season, made it possible to obtain uni- form results as well as making it easier for the malariologists to keep close check on the progress of operations« In the absence of diagnostic equipment, it was impossible to specifically differentiate anopheline larvae and adults» Suffice it to say that about 98% of the adult captures were members of the Anopheles maculipennls complex0 A few Anopheles claviger were seen early in the season and on one or two occasions Anopheles superpictus was caughto Larval and adult in- spections in the six different regions of control are summarised in Graph I* The graphs for the Leghorn and Foggia areas represent the work of three units each, that of the Po Valley involved two units, and else- where the graphs represent the activities of individual unitsG The season8s work can be summarized as follows; of 21,764 inspections for larvae, aquatic areas were 9$ positive for anophelines and 12$ positive for culicinesi adult inspections were 22$ positive for anophelines and 20$ positive for culicineSo Co Control activities"- The summaries herein reported, refer only to the work accomplished, by units of the theater5s special malaria control organ!zation0 Obviously it is impossible to give con- ' sideration her© to the accomplishments of individual anti-malaria details0 1) Larviciding. a) General- The season9s total larviciding accomplishments have been summarised according to command in Table IV« Reference is made to Graph II (hand larviciding only)? which shows how the work varied in the different areas of occupation® It will be seen that the greatest amount of hand larviciding was accomplished in the Foggia area where three units were operatingo Elsewhere in the graphs generally reflect only the work of individual units0 TABLE I¥ Summary of larviciding activities in MTOUSA by special malaria-control organisation from 1 March to 15 September 1945* I arvicid© ' Man days GOMMAM) Area Covered (sqQ yds0) Pure Paris green (pounds) Diesel oil (gallons) DDT (pounds) aaf/mto & ABC 573,894,836 44,410 56,599 16,14? 3242 ' 5th Army 1,134,457 2,060 244 452 PBS 388,214,720 38,228 68,047 17,086 1996 Rome Area, MTOUSA 149,509 7,469 1,786 415 TOTAL (9^3,393,522 134,175 r35,2?f 6105 *Notes Airplane larviciding figures included. Although three units were also present in the Leghorn area, one of these carried on little or no larviciding activities as it was operating largely in an advisory capacity to Air Corps anti-malaria details0 Likewise, most of the larviciding in the Leghorn area was accomplished from airplanes because of the danger of land mines; reference is made to Graph V for results of this work0 b) Paris green- With the exception of a rela- tively small amount of dust which civilians (under PBS control) applied by hand in the Grosseto area, all Paris green used in the theater was distributed by airplanes (see Graph V)0 Diluents consisted of diato- iracious earth or cement; during the six months period (April - Septem- ber) 91,108 pounds of Paris green (Pure) were expended0 Inasmuch as last season8s experience demonstrated that unit anti-malaria details showed no interest in using Paris green, preferring oiling methods in- stead , no attempt was made to discuss the subject in the malaria schools conducted this past springe Notwithstanding the fact that an organi- zation such as the Rockefeller Foundation has amply demonstrated the merits of anophelin© larval control by means of hand casting Paris green (ice*, eradication of Anopheles gambiae from Brazil, largely by this method) , the writer is inclined to believe that the average GJo will do a more effective job of control using a knapsack sprayer full of oil rather than try to learn something about the application of a toxic insecticide he knows nothing about0 c) Diesel oil and DDT” Larvicide of choice was diesel oil, of which there were gallons applied during the season0 Airplane larviciding (as 5% DDT in diesel oil) accounts for 54$ of the total oil output% while most of the hand larviciding opera- tions were accomplished with straight diesel oil, 20$ of the total oil dispersed manually contained DDT as a 5% mixture 0 Unfortunately, no data is available to show how long the DDT applications ware affective5 ■undoubtedly some residual effect established itself after several appli- cations to the same breeding area, DDT, as a 2% dust (in talc) was broadcasted by hand in several marshy spots in the Foggia area with apparent good effecto With regard to airplane dispersal, oiling schedules were of a necessity placed on a weekly basis regardless, as one could never be certain that a particular canal or marsh had been completely covered because of wind deflection or obstructions such as wires, trees, atc0, which would later the course of the plane0 Refer- ence is made to Graphs II and V showing the amounts of oil used in different sections of Itsly0 2) Adult sprey-killing- This measure was perhaps the most important item used in mosquito control operations during the past season0 Table V shows the results of activities of special malaria control personnel as reported by local malariologists0 It should be pointed out that these figures represent only a portion of the total TABLE V Summary of adult spray-killing activities in MT0USA by special malarla-control organization from 1 March to 15 September 1945 COMMAND Freon Pyrethrum (pounds) DDT Number of Rooms Sprayed Labor (pounds) Military Civilian (Man days) AAF/MTO & ABC 0 18,137 4,467 64,694 . 3,515 5th Army 1716 1,8^8 111 51,848 1,933 PBS 0 15,361 47,828 42,323 6,879 Rome Area, MTOUSA 0 5,389 4,593 19,091 1,440 TOTAL IriS- h 5^999 177,956 " 13,767" output of insecticide for individual organizations were responsible for spraying within their own bivouac areas9 and those in rural sections sprayed all houses within a mile and a half radius of camp, the malaria control units picking up from this point and extending the control area to the two or two and a half mile point and sometimes farther0 It is interesting to note the drop in Freon-Pyrethrum Bombs over last year9 whereas in 1944 special malaria control personnel used bombs, only bombs were reported used in 194-5 s and these by Army units during the Po Valley offensive when it was necessary to treat houses quicklyj later th© unit went back and resprayed th© houses with DDT0 After the phenomenal results obtained with DDT as a house spray late last season9 plans were early formulated for an extensive program in 194-5o As far as this theater is concerned, 194-5 can be remembered ®s s DDT y®ar0 Whereas last season some pounds of DDT were applied to walls by malaria control units, over 40 ,,000 pounds of DDT were applied by similar units during 19450 Spraying the 5$ DDT kerosene mixture commenced9 in in March in order to kill the overwintering anopheline females* After the initial unit buildings were resprayed monthly and the surrounding civilian houses about every thre® months0 Later in the season it was felt that it would be more profitable to increase the protected zone by another half mil© to a mile rather than respray previously treated houses; in this way very large areas of countryside were "blanketed® with DDT0 It was also discoveredg that in order to get adequate control$ it was necessary to treat ©very shelter in the control otherwise small foci of adults continued to exist in the untreated shelterso In a few instancess however# it was necessary to restrict the LEGHORN - FLORENCE AREA PQ VALLEY AREA, ROME AREA ANCONA - RIMINI AREA NAPLES AREA [TOGGIA - LAKE LECINA AREA HOUSE SPRAYING (DDT-lbs) - MTOUSA MALARIA CONTROL PROGRAM - 1946 CBAP* III APPENDIX 32e amount of spraying. For example, in certain sections of the Po Valley where sericulture is in existence, DDT was applied only to civilian pigsties, stables and other out houses, as the silk worms which are raised in the houses would otherwise have been destroyed. Graph III shows the relative amounts of DDT applied by special malaria control personnel in different areas of Italy, Stocks of commercially pre- pared 5/t DDT in kerosene solution were augmented by others prepared within the theater by malaria control units and distributed to organizations in 5 and 50 gallon containers, . One of the malaria control units with PBS, which was responsible for mixing larvicides for the airplane operations, undertook to supply the Base Section Quartermaster with 5% DDT kerosene mix. During the season, the plant at Rosignano produced 68,470 gallons of 5% DDT in kerosene, which was furnished to PBS, Army and to some extent 12th Air Force units. In addition the plant produced 135,566 gallons of 5% DDT in diesel oil and 245,465 pounds of Paris green mix for airplane larvioiding pur- poses. Although DDT house spray was distributed on the basis of 30 gallons per 1000 men per month, it was always available and units needing additional amounts could always draw it. 3) Physical operations- Summaries of ditch con- struction, cleaning and maintaining are shown in Table VI* Again the work accomplishment of anti-malaria details is not included, but in this case the amount would be negligible* In three areas, namely Leghorn, Naples and Foggia considerable reliance was placed on civilian contract work* The extensive canal system in the Leghorn - Pisa area was badly in need of maintenance* Unfortunately the local malariologist was late in assuming his duties, and it wasn’t until the latter part of May that the necessary appropriations were approved permitting the letting of contracts and initiating the work* Although these projects have been classified under malaria control, some of them were obviously flood and storm control projects and an undue amount of labor was utilized; however some material benefits resulted in any event* Graph IV roughly illustrates work accomplishment in various parts of I ta ly» a) Labor- Early in the season MTOUSA authorized each malaria control unit two Italian military companies* These usually consisted of two officers and about 112 enlisted mens these were organized as Sanitary Companies, Quartermaster Companies or Air Service Companies* Due to the inherent nature of the Italians, this labor wasn’t too satisfactory* One or two of the malaria control units had better success by hiring civilians locally* In July, the units assigned to ABC turned back their Italian labor and in turn were furnished German POW! s; these men were greatly superior to their predecessors and far outclassed them in amount of work accomplished* TABLE VI Summary of physical malaria-control operations In MTOUSA by special malaria control organization from 1 January to 15 September 194-5 Initial New Ditching Maintenance COMMAND Clearing (sq yds) Length (Lin ft) Excavation (cu yds) Clearing {sq yds) Construction (Lin ft) J? Ill (cu yds) JuStDOy (Man days) AAF/MTO &* ABC 671,601 31,685 5,933 riirr-rtirnr- i i ry immt 309,660 35,270 109 16,149 5th Army 107,379 0 0 0 17,423 0 5,336 PBS* 2,363,085 260.288 & 459,082 5,490,145 9.43 1,563 65,719 Rome Area ? MTOUSA 34,186 2,050 0 0 47,945 0 3,310 T$TAL 3,176,251 294,023 1465,015 [5,799,805 101,581 1,672 90,514 includes civilian contract wertty 4) /Airplane malaria control-' a) Operation- Airplane application of larvi~ cides during the 194-5 season again became the responsibility of MATS (Mediterranean Air Transport Service) through one of its organizations, the 327th Ferrying Squadron,. Although MATS was responsible for supplying both personnel and equipments responsibility for coordinating the entire program was vested in the Malariologist, MTOUSA, who had authority to communicate directly with both MATS and interested British parties0 Early in the year the MalariologistMTOUSA, requested that the following planes be made available % Ten (10) A-20 Boston5s (6 oilers and 4- dustersthree (3) PT-17 Stearman8a (dusters) and two (2) 3>5 observation planes0 In addition, the necessary flying and ground personnel were requested, the general areas of operation outlined and an estimate made of anticipated weekly flying time and required larvici.de 0 Inasmuch as operations were to be carried out almost entirely in northern Italy, bases were established on the west coast at Rosignano Airfield (south of Leghorn) and on the east coast at Rimini Airfield,, Later because of changing conditions, it became necessary to move the western base to Pisa Airfield and the eastern base to Cattolica Airfield, and still later to Villafranca Airfield near Verona® In each the Commanding Officer of a malaria control unit was made responsible for coordinating airplane larviciding with ground activities; all requests were handled by them and forwarded to the Malariologist, MTOUSA along with reports of work accomplishments0 Inasmuch as the program I-iuinCHN - ARgA PO.YiUiitiY ARM ROMP. ARFA AMCQNA > RIMINI AREA. Mieiaa.arsa- WCI-UITA I AITR IJttprMA AHEA. PHYSICAL QPJiSATIONS (Ifcn Days forked) - MTOUSA MALARIA CONPROL PROGRAM - 1945 Military Civilian 'TRAIT1 IV APPENDIX 32f Airplane dusting with Paris green A-20’s dusting a marshy area near Pisa. PT-17 dusting overgrown canal near Leghorn. Airplane oiling with DDT A-20 oiling canal near Pisa, Another view of A-20 oiling canal near Pisa. on the east coast was largely a British affair, the Commanding Officer of the 10th Malaria Field Laboratory (British) designated the areas to be treated, forwarding the information to the American malaria control unit which in turn notified the pilots as well as the Malariolo- gist, MTOUSA. b) Personnel and equipment” The following is a breakdown of personnel and equipment in the two areas of operation. EASTERN ITALY Personnel Equipment Capto Go Co Dunfieldj A0C0 5 A“205s 1st Lto Co Go A0C, 2 - dusters 1st Lt0 Ro Ao A0Co 3 - oilers Ground crew = 10 members 1 PT»17 (duster) 1 L“5 (observation) 1 l/A-ton truck 1 l/4=>ton trailer WESTERN ITALY Personnel Equipment Capto Rc E0 AeC0 5 A~20fls 1st Lto Go Ho AoC® 2 » dusters 1st Lto Ho Wo Priest,. A0C0 3 • oilers Ground crew - 8 members 1 PT-17 1duster9 later oiler) 1 L“5 (observation) 1 l/4-ton truck 1 1/4.-ton trailer Two additional pilots, Capto J0 H0 Rowsey, A.C., and 1st Lt„ H0 VQ Jacobsen, AoC0, participated in larvicidihg flights for short periods of time0 The remaining Stearman duster was kept at Capodichino Airfield until August, when it replaced the one on the east coast which was de- stroyed during a heavy hail storm. c) Preparation and loading of larvicide- On the west coast this was the responsibility of the 134-th Malaria Control Deto and later the 6651st M0CoD0 (Prov)Q Larvicides were prepared in the Solvay plant at Rosignano, about a mile from the airfield. A 25$ Paris green mixture, using diatoroacious earth, was mixed in a revolving drum, formerly used for manufacturing chloride of lime. Plant capacity was 5-15 tons a day. DDT solution (5% in diesel oil or kerosene) was prepared in one of the several large stills formerly used for making trichlorethyleneo These stills had a capacity of 1,200 gallons5 inside, each was equipped with a set of large agitator paddles, which rotated at the rate of 60 RPM0 Oil was pumped in from above through pipes connected to a large storage tank outside the building0 DDT powder concentrate, in the proper amount was added through a hatchway in the top of the still* Following thorough mixing, the solution was drawn off through a tap at the bottom of the still directly into 50 gallon drums* This still had a capacity output of 2,400 gallons per day* Because of the ease of production, the 134th MoC.D. undertook to prepare large quantities of 5% DDT in kerosene for the PBS Quartermaster for distribution to units* A summary of monthly production figures of this plant is as follows; Month Paris green mix 5% DDT in diesel oil 5/o DDT in kero- (mix) (gals) sene (gals) April 30,756 20,000 0 May 72,700 23,996 14,770 June 82,395 32,970 0 July 45,327 36,300 7,700 August 14,287 22,300 36,300 September 0 0 9,700 Total 245,465 135,566 68,470 Loading of the planes with larvicide took place at Rosignano Airfield; later when it became necessary to base the planes at Pisa, loading opera- tions continued to be carried on at the former field* Italian military labor was used in this work. On the east coast, the larvicides were fur- nished and prepared by the British. Paris green mix was prepared under civilian contract at Cesena, packed in 60 pound bags and trucked to Rimini Airfield, a distance of about twenty five miles. The diluent used by the British was cement* At the start of operations a 25% mix was prepared, but later the ratio was dropped to 1:6 when it was learned that the heavy cement was carrying unduly large concentrations of Paris green straight down to the water surface. The DDT plant was located right oh the Rimini Airfield, Preparation of the 5% oil solution was accomplished by diluting 20% DDT in oleic acid and cyclohexane with HD-50, a heavy motorcycle oil. The prepared solution was stored in three 3,000 gallon tanks from which the planes could be loaded by means of a small gasoline driven pump* d) Accomplishments- In all, 91,108 pounds of pure Paris green and 33,509 pounds of pure DDT were dispersed by planes from April through the middle of September, at which time unfavorable weather conditions forced a cessation of activities„ Of these amounts, 52,880 pounds of Paris green (or 58$ of total) and 17,091 pounds of DDT (51$) were applied to eastern Italy and 38,228 pounds of Paris green (42$) and 16,418 pounds of DDT (49$) in western Italy; a small amount 5f Paris green dusting, 7,875 pounds was done at Elmas Field, Cagliari, Sardinia„ Reference is made to Graph V and Map 1 for airplane activities in Italy0 This required 2,048 hours of flying time which analyze as follows: for oiling, 522 hours (27$ of total); for dusting, 410 hours, (20$); for test flight, 63 hours (3$); for reconnaissance, 200 hours (10$); for observation, 174 hours (8$); for transport of planes, parts and personnel, 584 hours (29$); for transition flying (training) 62 hours (3$)0 Larviciding areas on the east coast, which were almost entirely in 8th Army territory, were as follows: "AIRPLANE LARVICIDING AREAS IN NORTHERN ITALY, 1945" MAP 1 APPENDIX 32g P*B*S. Inaeotioide Mixing Plant - - - Hosignano-BolTay Adding Paris green to mixing tumbler. •Bagging final product (29% Paris green in diatomeoious earth;. P*B.S. Insecticide Mixing Plant - - - Rosiguano Solway View of top of DDT mixing still, showing oil-inlet pipe, motor, and hatchway (below officer’s foot) for adding DDT powder (100#). Filling 50 gallon drum with 5% DDT in kerosene (or diesel oil), drawn from mixing still shown in upper left hand corner. AIRPIANE IARVICIDING - MTOUSA MALARIA CONTROL PROGRAM - 1945 u eS M e i OQ S WESTERN ITALY DDT (lbs) Paris Green (lbs) :T5 ;■ r V r APPENDn 32h Palmanova (British) Gervignano (British) Monfaleone (British) Lake Marano (British) Treviso (British) Mestre (British) Padua (British) Ferrara (British) Argenta (British) Fano (American) Mondolfo (American) Ancona (American) Lake Garda (American) Verona (American) Mantua ( Ameri can) Cervia (American & British) Larvidicing areas on the west coast were as follows: Grosseto, Piombino, Cecina, Rosignano, Leghorn-Pisa areas and the Lake Massiciuccoli area near Viareggio, also at Elmas Field, SardiniaQ Because troop concentra- tions remained relatively static in many of these areas, plane larviciding was in general a continuous thing. Several places in the 8th Array Sector of the Po Valley were presumptive ”hotn spots shortly after the spring offensive, but were later abandoned when the troops moved out. e) Observations- The 1945 airplane malaria control program, which had its origin during the 1944 season, reemphasized the feasibility of utilizing fast planes in the large scale application of dusts and sprays. Early in the season when it was necessary to control anopheline breeding in extensive canal systems -which were heavily mined, airplane larviciding proved invaluable* Likewise, the oiling of lengthy canals along the troop jammed highways of the Po delta area shortly after the German capitulation undoubtedly contributed considerably to „■ . decreasing the incidence of malaria infection in an otherwise unprotected population* With regard to the working efficiency of the planes from the standpoint of larvicide application, reference is made to a later section of this report dealing with a special study of the oiling planes» In the case of the A-20 dusting planes certain observations made during the slimmer can be discussed at this pointo (l) A-20 duster- Several tests were run to de- termine the rate of Paris green application throughout the width of the dust swath when the hopper was full and when it was one third fullo Diatomacious earth was the diluento The results showed that when the plane flew up wind (velocity of-wind 5mph) at an elevation of about 20 - 30 feet, the particle deposit of Paris green 70 feet distant from the line of flight was about one third less than directly under the plane„ Likewise, when the hopper was one third full, not only was the above ratio maintained but the amount of deposit directly beneath the plane was one third that obtained with a full hopper, indicating a great unevenness of dust flowo Although a 300 feet swath was easily obtained, the rate of deposition throughout was very uneven, varying from 63 particles per square inch to 6,438 particles per square inch„ Inasmuch as the dusters were not used to the extent, that the oilers were, no attempt was made to try and improve the dust discharge mechanism,, Rather, it was felt more profitable to spend the time trying to improve the quality of the oiling planeso 5o Summary of Theater malaria experience- The total monthly malaria rates per thousand population per annum for the Theater during 1945 are shown in Graph VI. For purposes of comparison, there have been superimposed on the same base line,,graphs depicting the malaria experience during the previous two years that NATOUSA-MTOUSA has been in existence. a. Comparison of three year’s experience (1943-1945)- The three graphs portray, with minor aberrations, definite, well defined trendsin a series of exceptionally interesting malaria experiences. The first season depicts a completely susceptible and inadequately prepared population exposed to a very severe malaria experience. In the second year, the bimodal curve suggests two things. First, the results of heavy exposure the previous season are manifested in the sharp.rise in cases, and second, although occupying a greatly enlarged malarious area under similarly difficult conditions, a more efficient program of malaria con- trol as well as individual discipline has been achieved which is reflected in a greatly reduced disease incidence. By the third year, the spring rise has been markedly reduced (each year this drop has been about double the previous season’s summer and fall maximum) and the population has firmly established itself in its new surroundings and improved its control techniques to the point where the disease has almost reduced itself to a minimum. A part of this reduction in 1945 must be attributed to troops moving into more healthy areas; however, many remained in highly malarious areas, yet they have experienced no undue amount of the disease. 1) The 1945 Experience- .At the outset, in 1943, we are confronted with a presumably susceptible population which obviously had little previous contact with malaria and was apparently incompletely pro- tected o During the winter and spring months little malaria was experi- enced; a total of only 738 cases were reported be'tween 1 January and 31 May0 With the advent of warm weather in June, the new season’s primary malarian infections commenced making their appearance0 Troops at this time were stationed throughout North Africa from Morocco to Tunisia,, At the start of the Sicilian campaign, 7 July, hospital admissions were al- ready on the increase. Many troops slated to participate in the campaign, failed to embark because of malaria. Others reached Sicily but immedi- ately came down with the disease, an incubation period too short to permit contraction of the infection on the island. Obviously poor malaria dis- cipline and inadequate precautionary measures in North Africa were respon- sible for these early cases. The malaria rate reached a peak in August of 176 per 1000 annum, which represents almost 7,000 cases. This situa- tion coincides with the end of the Sicilian campaign on the 17th of August. With the temporary cessation of hostilities, troops undoubtedly devoted a little more time to malaria discipline, and the consumption of atabrine probably became more regular. We thus find a drop in the rate in Septem- ber to 62 per 1000 per annum. The abortive rise in the rate to 98 in October is a reflection of the Salerno landings on the 9th of September, atabrine suppressive medication again fell off in the heat of battle and mosquito transmission was still being effected. With the coming of cold ' weather, the rates dropped off rapidly. In contrast to the 738 cases HaTOUSA - MTOUSa MALARIA SXjrSRXENCI! (1943 - 1945) Graph YX. Total monthly malaria admission rates/1000/year In NATOUSA and MTOTJSA during 1943, 3944 and 1945 (86ah reports). APPENDIX 32j GRAPH 3ZH MONTHLY MALARIA ADMISSION RATES IN AMERICAN MILITARY PERSONNEL ON CORSICA DURING 1944 RATE PER 1,000 PER YEAR CORSICA (TOTAL) CORSICA (PRIMARY) MTOUSA (TOTAL) APPENDIX reported during the first five months of the year, the following seven months saw over 22,000 hospital admissions0 As will be pointed out in the next paragraph, many more infections were obviously contracted, but they remained dormant during the winter months0 By the year's end 22,989 cases were officially recorded, giving an annual rate per thou- sand of 54-? It is not known how many of these cases were primary in- fections , but othershave suggested that 90 percent or more were new® If one considers the primary infections reported during the winter and spring months of 1944 as having been contracted during the previous fall, the transmission levels in 194-3 were much higher than the rates suggest. 2) The 1944- Experience- By 1944-, troops were well established on the Italian mainland0 Cassino fell on the 18th of May| the breakthrough at Anzio on the 25th of May permitted troops to push north through the flooded Pontine marshes and Rome was entered on the 4-th of June0 The advance northward continued through the highly malari- ous coastal lowlands, passing through Civitavecchia, Tarquinia, Orbetello, Grosseto and Piorabino0 Pisa was captured on the 2nd of September and with the advent of winter, troops were well established in the mountains north of Pisa and FlorenceQ Throughout this period, additional American forces (largely Air Corps) were occupying the highly malarious islands of Sardinia and Corsica® The graph depicts a sharp rise in spring cases which reached a peak in April with a rate of 79 per 1000 annum® While many of these cases were recurrences of infections contracted the pre- vious year a large proportion (approximately 4-0 percent) gave a history of no previous malaria experience® A few cases were undoubtedly con- tracted during the spring months, but the majority of these primary in- fections represent latent malarias with long incubation periods typical of many strains of vivax® This interesting situation of a high primary rate early in the year is clearly depicted in Graph VII showing the mal- aria experience on the island of Corsica® The spring experience, it is felt, is typical of what occurred throughout the theater| roughly half the reported cases were initial infections® Interviews with these Cor- sican convalescents revealed contact with a severe malaria situation the previous summer and fall largely in Tunisia® During the first five months of 1944- there were 15,34-9 cases of malaria reported in the theater® Following the drop in May, the rates started climbing again with the advent of warmer weather and the new season's brood of mosquitoes® Con- forming wi-fch typical malaria patterns, a peak was reached in August (9l/l000/annura)o Despite the fact that troops were occupying highly malarious areas, and many of them under combat conditions, the greatly decreased infection rate over that of the previous year, is a tribute to a vigorous and well planned control program which not only emphasized physical methods but individual precautionary measures as well® During the seven month period (June - December) cases were reported® While 4-0,834- represents the total number of cases recorded for the year, which is equivalent to a- rate of 6l/l000/annum, most, if not all of the 15,34-9 cases occurring prior to June are attributable to the 194-3 sea- son! in addition, probably a good many of the recurrent infections appearing after June can be referred back to 1943o 3) The 1945 Experience- The start of 1945 found Anny i oops ©sconced in the ’of Florence, preparing for the final offensive into the Po Vailey, After the highly satisfactory 1944 season, it was anticipated that there would be a considerable drop in the spring rise of cases, This was amply fulfilled as the months passedo The peak appeared in April, a month later than 1944, when a rate of 31 per thou- sand per annum was recorded,, During this five month preseason period, there were 4,591 hospitalized cases, of which approximately one half of these were primary infections. The spring offensive found Army troops rapidly pushing through the Po Valley, While it was felt that a slowing up of ..the offensive might provoke a serious malaria situation, par- ticularity around the rice growing sections of the valley, the quick cessation of hostilities (2 May 45) permitted Army to establish the bulk of its troops in the southern Alps, the remainder occupying isolated areas throughout the Po Valley, Elsewhere in Italy, U, S, Military personnel were more or less localized in five general areas, namelyi Foggia Plain and Beri area (also a few Air Corps troops at Lecc© in the nHeelM), Naples, Rome, Amo Valley from Leghorn to Florence (also small numbers at Cecina and Grosseto), and the Ancona-Rimini sector. Of these areas, Foggia Plain (largely occupied by Air Force) was by far the most dangerous malaria regions elsewhere, malaria was a potentially serious problemp with the possible exception of the upper Amo Valley and the southern portion of the Ancona-Rimini sector. At the start of the transmission season in June* it was expected that there could be some rise in the number of casesj on the contrary, however, there has been a steady drop in the incidence of the disease which, in the light of existing conditions, is quite phenomenal. True, with the capitulation of the German armies in Europe, redeployment of troops to the United States and to the Far Eastern theaters was quickly initiated. However, while this movement was going on military personnel have continued to occupy their former areas. Since June, approximately one half the theater strength comprised Air Force and service troops, who, in general, were established in the malarious areas. As the Army Divisions were redeployed, they too were required to occupy some of these same areas while staging. It is felt that the effective work accomplished by the special War Department Malaria Control Units in addition to the widespread use of DDT as a house spray, played a significant role in keeping malaria to a minimum. During the three month period, June - August, 2022 cases were reported. From January 1945 through August there was a total of 6601 cases reported by the theater, giving a rate of 2 2/l000/^rear, 4) FoU ,0o- In the past, attempts have been mad© to allocate a certain percentage of fevers of unknown origin to malaria. In this report, this has been deemed impractical, for the following reason. The cases and corresponding rates assigned to FUO are based on hospital admissions. Many of these, and last year 40$ was the figure estimated, later receive a diagnosis of malaria and are so reported. Hence, assign- ing 40$ of the present total, of FDD’s over to malaria would merely be TABLE VII Monthly FoU.Oo experience in NATOUSA-MTOUSA during 194-3, 1944- and 194-5 MONTH 1 9 4 3 L 1 9.4 4 194 5 CASES RATE CASES RATE CASES RATE January 97 7 244.8 51 1533 39 February 100 5 1585 33 1697 43 March 122 5 3596 58 1949 41 April 280 9 3234 61 16A9 43 May 415 15 2780 52 1374 38 Jui^e 1391 42 536A 80 1925 50 July 3837 H 7099 133 1537 57 August 7301 185 6557 122 1477 58 September 5611 132 6A11 97 October 6159 139 3557 66 November 2944 66 2794 46 December 2125 54 1826 38 TOTAL 3(1392 47251 70 , duplicating what has already taken place0 Rather9 it would seem more logical to deduct 40% from the total and then estimate that a certain percent of the remaining FU09s are probably malaria* Meanwhile although signifying little if anything9 the monthly cases of FU0 ad- mitted to hospitals and corresponding rates for the three year period (1943=1945) are reported in Table VII. 5) Resume» In summarizing a malaria experience such as has just been described9 unless one can wander far into the realms of the theoreticalo It is not the intent of this report to ascertain the exact amount of malaria transmitted each however the following statistics are set forth in an attempt to show to what degree transmission might have taken place0 It has been calculated that cases of primary malaria (rate of 54/lOOO/annum) can be attributed to the 194-3 seasons this is based on 90% of total infections TABLE VIII Monthly overall malaria experience in NATOUSA-MTOUSA during 1943, 1944 and 1945 (86ab) MONTH 1 9 A 3 1 9 4_.j4 i 9 4 5 GASES ! HATE CASES RATE CASES RATE ' January • 234 16 1392 29 759 19 February 270 14 2214 4? 636 16 March 64 3 4498 72 988 21 April 59 2 4223 79 1072 28 May 111 4 3022 56 1136 31 June 952 29 4691 69 1002 26 July 3532 i 77 43a 81 639 24 Augus t 6925 176 4897 91 387 15 September 2654 62 4870 74 October 4354 98 3270 61 November 2006 45 2181 36 December 1828 31 1235 25 n - - - , rm'rnyrrrr~r~'-~' -- TOTAL ” AVERAGE 229^9 L~ jLH Uo824_ _ 6l~ ~ ------ - - - - hospitalised during the year plus 40$ (6,140) of total infections (15,349) reported for the five month period January through May 1944o By the same token there were cases of primary malaria (rate of 32/1000/annum) ascribable to the 1944 seasons this calculation is based on 16,530 primary infections reported from June through December 1944 plus 2,136 primary infections reported from January through May 1945, all of which were taken from the supplementary, 86ab report„ Judging from the small amount of malaria experienced in 1945, it would not be at all surprising if the primary infection rate this past season were well below lO/lOOO/annumc The theater9s three years9 experience is summarised in Tables VIII and IX, which record monthly cases and rates as well as primary infections and corresponding rates0 TABLE IX Monthly primary malaria experience in NATOUSA-MTOUSA during 194A and 194-5 o MONTH 19 4 4.(a) 1 9 4 5 (a) 1 9 4 5(b) CASES RATE CASES RATE CASES RATE i January 272 7 • 195 6 February — 228 6 169 5 March 425 9 459 11 April 578 15 453 14 May 2062 39 633 17 407 13 June 3257 4s 476 12 408 12 July 2900 54 338 13 263 12 August 34-67 64 191 8 September 3548 54 — October 2044, 3e —— -- November 717 19 — December 597 12 —- TOTAL 18,522 —— Notes (a) Theater calculations based on supplementary 86ab which did not come into use prior to May 1944-c (b) Calculations based on figures from local malariologists for the following commandss Air Force9 ABC and Rome kre&$ MTOUSA. ,bo Civilian malaria experience- That passing through an endemic malarious can result in -a violent upsurge of malaria cases of epidemic proportions9 has been well demonstrated in Italyo This is perhaps9 more vividly portrayed to the individual pass- ing through the war-scarred low than it is by scanning what meager statistics are available0 In addition to the disruption of social and economic conditionss destruction of pumping stations resulted in the extensive flooding of farmland 9 canals and ditches became and screening9 through neglect rotted leaving the inhabitants of rural areas completely exposed to the nightly hordes of anophelines„ Prior TABLE X REGION 1939 1940 _.1941 . ... 1942 Piemonte lo4 2o0 • 3d 15o0 Liguria lol 0o6 2o3 3o9 Lombardia 6,8 606 8.2 12o3 Venezia Tridentina 2o3 1.7 1.8 13.6 Veneto 69.5 85.5 100o3 143.6 Venezia Giulia o Zara Ho 9 16.2 410,6 17o4 Emilia e Romagna 28.6 32.6 42o5 6606 Toscana 15ol 10o9 12o7 17.6 Marche 606 llol 10o3 16.9 Umbria 2.8 2.1 ■ 3.5 2.6 Lazio 55o9 45.0 " 41o2 94o5 Abruzzi e Molise 35 0 9 86.1 75o0 76,0 Campania 48,9 29o? 2802 43.8 Puglie 203 0 3 332 0 2 243 c 5 4260 5 Lucania 4910 5 90S 08 580o6 655.0 Calabria 384.5 453.8 35202 438o8 Sicilia 248.3 346.5 266ol 413.6 Sardegna I604ol 1267.0 1883.4 .1928o7 TOTALS 126.1 i .. 1380 5 140 0 7 177.6 * Statistics obtained from Istitui bo Superiore di Sanita. Roma. Malaria morbidity rates/lOOO/year for Italy to the war, malaria was decidedly on the decline in Italy (morbidity rates of about 100/10,000 inhabitants in 1905 and 13/10,000 in 1939), but in the past few years it has been on the increase0 Unfortunately, available statis- tics are very meager and incomplete, but they do show what has been happen- ing in this country0 Table X gives the malaria incidence in the different regions from 1939 through 194-2 o The malaria experience in the Veneto area, shown in Table XI, is a good example of what has happened along the low coastal areas (compiled by Istituto Antimalarico Interprovinviale, Padova)c TABLE XI Malaria cases in the Veneto area (1939 - March 194-5)* YEAR PRIMARY RECURRENT TOTAL 1939 973 3,696 4,669 1940 1,472 4,835 6,307 19a 2,790 4,126 7,096 1942 6,320 6,752 13,072 1943 7,621 10,793 18,414 19UU** 7,555 14,005 21,758 1945*** 919 hS*L i w *Includes provinces of? Padova9 Pola5 Trevisog Trieste9 Udine Venezia9 Verona® * Period from 1 November 194-3 to 31 October 1944 ***Period from 1 November 1944- to 31 March 1945| incomplete reports from Padova9 Verona, Trieste and Pola0 The two provinces producing the greatest numbers of cases were Venezia and Rovigo« The Veneto area was largely occupied by British Sth Army troops, yet in spite of the recent severe malaria experience of the region, it is understood that they have had a very low malaria rate this season0 Another example of a severe malaria experience is to be seen in Table XII, which shows cases and rates (incomplete as they are) reported by commune in Latina (Littoria) province from June through December 1944o All of these towns lay in the path of the advancing armies, which left behind them chaotic conditions resulting in a high degree of anophelism and subsequently malaria0 The phenomenal situation of over 19,000 cases in Fondi is particularly noteworthy® With the exception of the Region of Lazio (see Table XIII) and a portion of the Veneto Region (see Table XI), statistics for 1945 are not available0 Some work has been done by the Italian Government, but very little in comparison with the magnitude of the problem0 Malaria, of epidemic proportions, is in progress at Cassino again this yearD In August, the writer visited the Malaria Station in the town and noted that 554 blood smears had been examined between the 3rd and 31st of July and 343 (61$) were positive? Plasmodium falciparum TABLE XII Malaria in Latina (Littoria) province (June“December 1944)* COMMUNE POPULATION CASES | rate/iooo/year Aprilla 5,200 325 62,5 Littoria 25,000 1,004 40o0 Pontinia 6,065 1,871 310 oO Sabaudia 5 ,000 1,478 297 oO Bassiano 2 025 3$ 17ol Campodimel© 1,458 58 39.8 CasteIforte 10.750 344 32 oO Cisterna UU63 2,630 181,0 Cori 10,000 17 lo7 Fond! 18,326 19,734 1071o0 Formia 16,710 6,6l6 394o0 Gaeta 22,882 1,040 45o6 Itri 6,081 68 llol Legnola 3,44-6 1,509 440 0 0 Mo So Biagio 4,631 2,184 472 oO Minturno 12,356 5,280 426.0 Norma 3,623 51 14 oO Priverno 13,U5 1,309 97.8 Proseddi 2,284 12 5o3 Roccagorga 3,135 118 37o9 So Felice Circeo 4,425 643 145.5 Sermon©ta 3,524 311 87o6 Sezze ' 16,84.8 494 29o2 Spigno Sato 2,690 27 XOoO Sonnino 6,601 16 2 o4 Terracina , 25.000 7.630 306,0 TOTAL 245.968 54.104 223 oO obtained from Istituto Superior© di Sanita, Roma. TABLE XIII Malaria eases in Laaio (Jan0 thru Aug0 845)* PROVINCE JAN FEB MAE APR MAY JUN JUL | AUG TOTAL 1944 Frosinone Latina" 24-79 2110 2 3218 37 8211 2 3740 4677 3740 I 6948 41 35,123 ? 47,S68(0ct) Rieti 1 3 1 10 1 4 13 28 60 17(Nov) Roma 305 454 1026 '1220 1696- 1504 1475 1666 9,346 8^157(Nov) Viterbo 1 1 r“° 371 50 12. 35 j 58 .. 194 231(Nov) TOTALS 2785 rw LMST] 1 98ill 5489 r 6 197 5263 8700 44.764 IJEMI 1 obtained from Istituto Superior© di Sanita, Roma known as Littoria province 0 Inspections and physical operations Inspection for anopheline larvae in canal near an airfield located somewhere in the Foggia Plain. German P.O,W,fs occupied with a drainage project near Foggia. Personal precautionary measures. Enlisted men’s barracks, showing bed nets hung by means of two wires running the length of the room. A type of mosquito repellent dispensing bottle which was strongly recommended this season. This particular bottle was in use at the AFHQ Bathing Beach Rest Area at Mondragone, north of Naples. 133 M.C.D. C 6652 MCD Prov. ) Tiber Delta Experimental area Map 2 - ITALY (Map - 1:200*000» 1 inch equals 5 kilometers) Area of Rome Area, MTOUSA malaria control responsibility around Rome. Control Zones Malarious Areas Appendix 32k accounted for 18$ of the infections0 During the first three days of August9 34 of 72 examinations were positive (48$) and 26$ were falci~ parum infections0 The little village of Cellole (population 3,500) in the Sessa Bonifica at the mouth of the Garigliano River9 has had reported cases and 20 deaths (due to P0 falciparum) from January through Augustj a survey conducted in Cellole by this Headquarters during the fourth week of disclosed a parasite index of 1*2% and a spleen index of 63$. The fact remains,, that in spite of a high current morbidity rate in the Italian population9 the disease incidence in American troops has been very slighto 6° Malaria control program in the major commands- While the control program as a whole has been adequately summarized in previous sections of this report9 it was felt that a brief review of the problem, how it was tackled and the results obtained in the major commands might be of interesto a0 Rome Area. MT0USA- This command represented the American section of the Allied Command responsible for the military govern- ment in and around the city of Rome0 Aside from city workers, principal American troop concentrations were located at Guidonia and Ciampino Air- fields (north east and southeast of the city respectively)9 the 1st Replacement Depot and Headquarters9 Replacement Command in the Cecchig- nola area south of the city# and a few scattered areas north of the Tiber River0 1) Aside from the city proper,, the country around Rome has in the past been considered highly malarious9 particularly the low coastal areas at the mouth of the Tiber River (see Map 2)0 Land reclamation projects (bonification) have improved conditions in these low areas, but there still remain many aquatic situations favorable for anopheline larvae9 such as canals and'ditches along the coast and small streams meandering through the low hill around the cityG 2) Throughout this past malaria season has been hot and dry0 In the Rome area3 typical of the rest of the country9 during the five month period9 April - August9 only 3o39 inches of rain fell0 Critical temperatures9 favorable to malaria did not appear until late in May| the average minimum temperature for May was $5o7° Fj maximum temperatures were reached in July when a reading of 103° F was recordedo 3) Early season inspections in various parts of the southern half of Italy? indicated that the first spring brood of anophe~ lines probably made their appearance during the third and fourth weeks of Aprilo This first brood is not very large and larvae are consequently not seen in abundance until well into Junec Although conditions were not propitious for identifying the forms of Anopheles maculipennis col° •fc * ■/ ww* n»TOwm«wi»»i i inn Amw ni'imimaiaa lected5 it is known that A0 labranchiae is commonly found in this area. 4) For lack of personnel9 no malariologist was attached to Rome Area? MTOUSA| however9 this job was filled by the Com~ manding Officer of the 133rd Malaria Control Detachment through June9 and later by the Co0« of the 6652nd M.C0D0 (Prov)0 During the spring a malaria control school was with an attendance of 140 men (30 officers and 110 enlisted men)® 5) Control operations were carried on by the 133rd M.CeDo from April through June 9 when it received orders for direct rede- ployment to the Pacifico Effective 5 July 1945 the 6652nd M„CtDo (Prov) was activated9 but it was not until the latter half of the month that an adequate control program was operations were continued through September Malaria control activities consisted ofs mosquito inspections (adult and larvaephysical operations,, oil larviciding and house -spray- ing 0 Areas receiving attention (see accompanying map) wereg Guidonia and Ciampino Airfields9 Cecchignola area and the north Rome areac Elsewhere9 mosquito inspections and supervisory activities wore carried on at Anzio, Civitavecchia and Tarquinia; at the latter place some DDT house=spraying‘ was accomplished both around the airfield and around a Service Group Headquarterso Reference is made to Graphs II9 III and IV earlier in this report for summaries of work accomplishment, 6) The Allied Commission Malaria Demonstration Unit (Rockefeller Foundation) initiated in March a comprehensive DDT house- spraying project in the Tiber Delta area, comparable to that in the Gas- telvolturno area; approximately 105 square miles of coastland are in- cluded in the projecto The 133rd M®C,D® cooperated with the Malaria Demon stration Unit., by continuing the house-spraying along the Lido di Roma road up to the walls of the eity0 This area being contiguous with the Caechignola controlled area,, gave the Replacement Command considerable protection® 7) Control operations in the Rome area resulted in an exceedingly low incidence of malaria this past season0 Considering Rom© Area , MTOUSA 9 there have been only ten (10) cases of malaria9 of which four (4) were primary infections during the five month period9 April through Angusto In the entire area 9 during the same there have been 222 cases 9 of which 91 were primary infections0 Reference is made to Graph VIII showing primary and total malaria rates for Rome AreaMTOUSA superimposed on the theater experience0 b, Peninsular Base Section- This cbramand 9 although not spread out to the same extent that it was last year? nevertheless occupied a large amount of territory® Principal areas of occupation were: Naples9 Piombino, Leghorn and Pisa| following the spring offen- sive 9 advance points (largely trucking heads) were set up in the Po Val- ley at Modena and a few other spots® GRAPH 3ZHL MONTHLY MALARIA ADMISSION RATES FOR ROME AREA, MTOUSA DURING 1945 (Ma ! ari o/o g ist's Reports) RATE PER 1,000 PER YEAR MTOUSA (TOTAL) MTOUSA (PRIMARY) — ROME AREA (TOTAL) ROME AREA (PRIMARY) APPENDIX 321 Map 3 - ITALY (Map - 1:200,000, 1 inch equals 5 kilometers) Area of PBS malaria control responsibility around Naples Malarious Areas Control Zones Appendix 32m 1) Although the degree of malariousness varied con- siderably throughout the area of occupation (see Map 3 and 4), certain sections9 such as around Grosseto and Piombino? were particularly bad0 In former years9 the Leghorn-Pisa area has not felt much malaria, but with the upsetting of social and economic conditions by the there has undoubtedly been an increase in the incidence of the disease in this area0 The same situation is true for Naples; however9 it is known that the countryside to the north of the city along the Volturno River is highly malarious0 The territory occupied by PoB.S*5 being situated largely along the coasty is characterized by extensive bonification projects9 and their associated network of canals and ditches9 which un- less properly cleaned and larvicided? provide ideal aquatic situations for anopheline larvae. 2) Several forms of the macullpennis complex are to be found along the west coast of Italy*,. . Of the more dangerous vec- tors ? Anopheles labranchiae atroparvus is found around Pisa and Leghorn: Ao labranchiae occurs at Cecina# Piorabino? Grosseto and the area north of Naples;' and A0* sacharovi is restricted to the brackish water areas of the Naples region*, Anopheles superpictus appears to occur sporadi- cally throughout the entire area in the hillstreams; at least it is com- mon in the Salerno region laria control responsibility in northern Italy. Control Zones Malarious Areas Appendix 32q 48 7880 GRAPH X MONTHLY MALARIA ADMISSION RATES FOR AAF/MTO DURING 1945* AAF/MTO-TOTAL AAF/MTO-PRIMARY MTOUSA-TOTAL MTOUSA- PRIMARY APPENDIX 32 R RATES PER 1000 PFR YEAR * MALARIOLOGIST'S REPORTS GRAPH XL MONTHLY MALARIA ADMISSION RATES FOR ABC DURING 1945 (Malariologist's Reports) RATE PER 1,000 PER YEAR MTOUSA (TOTAL) MTOUSA (PRIMARY) ABC (TOTAL) ABC (PRIMARY) APPENDIX 32s Map 7 - ITALY (Map - 1:200,000, 1 inch equals 5 kilometers) Area of 5th Army malaria control responsibility in Po Valley. Control Zones Malarious Areas APPENDIX 32t 48 10829 GRAPH 3H MONTHLY MALARIA ADMISSION RATES FOR 5th ARMY DURING 1945 (Malariologist's Reports) RATE PER 1,000 PER YEAR MTOUSA (TOTAL) MTOUSA (PRIMARY) 5th ARMY (TOTAL) 5th ARMY (PRIMARY) i i i i APPENDIX 32n in April learned that there couldn’t possibly be much transmission going on in the spring because of low temperatures, they decided to call more of their malarias recurrences0 If this is true, it shows the fal- lacy of the present reporting system. Medical officers or their "assist- ants* either don’t get the necessary information from the patient or else they have no interest in doing so. As a result, cases are classi- fied in the 86ab only as malaria, and if there is no subsequent break- down as recurrent infections, the logical assumption is that they are primary malarias0 While the total Air Force rates during the trans- mission seasons of 1944- and 194-5 fairly closely approximate each other, it is felt that the 194-5 season has been a much more satisfactory onec The malariologist this year had made a definite attempt to pick up all cases hospitalized by other commands (PBS, ABC and Rome Area,, MTOUSA), so that a fairly accurate picture has been obtained0 Last year, rela- tively accurate statistics were available only from the Foggia area (15th Air Force), while elsewhere, many cases (largely 12th Air Force) were lost because they were not assigned back to the proper command| if this had been possible, the total Air Force rates would undoubtedly have been much greater than reportedo 10) ABC malaria experience is portrayed in Graph XI, which shows the rates of total and primary malarias superimposed on those of the theater. Most of ABC personnel were stationed in relatively malaria free areas - Bari and Senigalliaj however, those located at Foggia were exposed to possible infection0 Although the rates tend to indicate an undue amount of malaria, actually this was not the case, the illusion being created by the small strength of the command 0 dc Fifth Army- During the winter many of Army’s troops were entrenched in the Appenines north of Florence and Pisa,, the remainder being bivouaced along the Arno Valley0 Following the spring offensive, with its wild dash across the Po Valley, ending in the German capitulation on the 2nd of May, Army troops (Divisions) largely established themselves in the malaria free Alps from the French border east to the countryside near Gorizia0 The relatively few re- maining troops' took up locations on the Valley floor, generally in the area around Verona and south to Modena, the latter being a truck head for supplies coming from PBSo A great deal of rice is grown around Mantua, and this together with the general abundance of water every- where, accounts for the reason why a considerable amount of malaria exists in this region (see Map 7)0 It would appear from the existing literature that Anopheles labranchiae atroparvus is the principal vector in the central Po Valley, but a number of other anopheline species (all potential vectors from the military standpoint) exist in the areaD 1) No malariologist was attached to Army from 2655 M.CoDo (0vhd)? this the position being held by one of its own Sani= tary Corps officers (the same as in 1944)o Assigned to Army were two malaria units9 the 28th MoC.Do (Florence9 later Butapietra near Verona) and the 206th M9S.Dc later Mantua)0 During March and Aprils the 206th M«S.Do worked .around Viareggio0 In May5 it moved to Mantua, where it carried on control activities for one month and then received orders for indirect redeployment0 The 28th M0C*D. transferred its ac» tivities from the Florence area to Butapietra (near Verona) in May and continued operating in the same general region until 15 July when it moved back to PBS pending orders for indirect redeployments, Activities of both these unitss although unfortunately cut short by redeployment orders$ were largely concerned with house-spraying; some ditching and larviciding work was accomplisheds but on a relatively minor scale0 See Graphs II9 III and IV in an earlier section of this report0 2) While the taking of atabrine was not generally made compulsory in 1945. Army did designate certain atabrine areas in the Po Valley where the daily consumption of one tablet was mandatory0 Ata- brine areas were as follows? a few localities around Milan,, and a section of the Valley from Mantua east to the Adriatic9 bounded by the Po River on the south and on the north by a line running just south of Verona east to Padua and thence north along the coast bordering on the Gulf of Venice0 3) Airplane larviciding9 by planes based at Rimini9 carried on weekly operations in three Army areas9 namely? the southern shore of Lake Garda9 a small area pear Verona9 and the upper and lower lakes at Mantua9 formed by the Mincic River0 4) Malaria schools were conducted during March and April; total attendance was 2p97 persons (888 officers and 1691 enlisted men)0 ' ' 5) Army malaria experience superimposed on that of the theater is portrayed in Graph XII0 While closely approximating theater rates through May? the sharp drop in June and July would appear to be the reflection of the salubrious bivouac areas which the majority of Army troops occupiedo 7o Research- Several problems of a research nature have been investigated this past season0 Reports of two of these studies are to be found at the end of this report9 namelys a0- MA study of winter DDT house-spraying and its con= comitant effect on anophelines and malaria in an endemic area® Thomas Ho G0 Major9 Sn0Co b0 “Oil spraying equipment for the A=20 (Douglas) and PT=17 (Stearman) airplanes® William JD Wyatt9 Major9 Sn0C0 8U Conclusions. a0 Despite the fact that American forces have spent another year in Italy, occupying many areas which were highly malari- ous , and amazingly low malaria rate has been experienced., Total diagnosed cases during the first 8 months of 1945 were 6601, giving a total annual rate per thousand of 22, During the three year period that NAT0USA-MT0USA has been in existence, malaria incidence has steadily declined from the high levels reached during 1943 (reflect- ing North Africa. Sicilian and Salerno experiences)., Total malaria cases and rates (theater calculations) for the three year period are as follows j TOTAL MALARIA YEAR CASES RATES 1943 2299B9 54- 19 U 40.834 61 19-45* 6,601 22 First 8 months. One can perhaps obtain a clearer impression of the three year theater experience, if one considers that the high incidence of spring primary infections is largely the result of transmission the previous fall0 With this in mind, it has been calculated that there were 26,820 cases of primary malaria in 1943 giving a rate of 54/1000/annumo In 1944 there were 18,666 primary infections - a rate of 32/l000/annumo Judg- ing from the small amount of malaria reported in 1945, it would not be at all surprising if the primary infection rate this past season were well below 10/l000/annumo b0 This decline in malaria incidence is believed to be due to a variety of factors, which were largely summarized in the 1944 report, and which it is felt still hold true0 1) The presence of a larger, more highly inte- grated and coordinated malaria-control organization able to distribute malaria survey and control units where needed, to provide trained raal- ariologists to major commands and to supply airplane-larviciding facili- ties as required, 2) A greater command and line consciousness of malaria and its potentialities for imperiling military success0 This is due to the 1943 disease experience and the educational program carried on during the past two years0 3) A greater troop understanding of how to prevent malaria by personal measures due to the educational program., U) Adequate supplies of materials, equipment, trans- port and labor0 The special list of excess equipment authorized by MTOUSA in 194-5 to malaria control, and survey units has been of inestimable value in speeding up control activitiesc In addition, it is felt that the wide- spread use of DDT this past year has perhaps contributed more than any other single item to the lowering of the 194-5 malaria rate® 5) A determined effort on the part of malaria control and survey units, flying personnel (airplane larviciding) and EM antimalaria details to wage unrelenting war on all stages of the enopheline mosquito0 It is the belief of the writer, that the credit for the great reduction in the disease incidence over 194-3 largely goes to the malaria control and survey units and the malariologists who coordinated their activities® That many EM antimalaria details did play an important role is not denied, but in general, there was a lack of interest and the work was shoddy and, as a result, couldnat always be relied upon. Under such conditions, it was better for the control unit to undertake the job and do it thoroughly; fortunately, DDT house-spraying provided a tremendous margin of safety in areas not under close supervision0 6) The location, in 194-59 of a fair proportion of troops in malaria free or relatively free areas® c® As was the case last year, non-effectiveness due to malaria has at no time jeopardized military operations in 194-5. 9o Recommendations- None® 10o Acknowledgements- For their whole-hearted cooperation in making this seasoncs program a success, the writer expresses his deep appreciation to Major-General Morrison C0 Stayer, USA, Surgeon, MTOUSA, Colonel William So Stone, M0C., Preventive Medicine Consultant, MTOUSA, Colonel E® Standlee, M0C0, Deputy and later Surgeon, MTOUSA, other members of the Medical Section, Hq0 MTOUSA and other commands, and 327th Ferry- ing Squadron, MATS, who have done all in their power to assist the malaria control project, the members of the Rockefeller Foundation Malaria Demon- stration Unit, the Commanding Officers and enlisted personnel of the various malaria control and survey units, and last, but not least, the members, officers and enlisted personnel alike of 2655th Malaria Control Detachment (Ovhd) who have at all times demonstrated a remarkable spirit of loyalty, ingenuity and industry® , /s/Thomas Ho Gc Aitken THOMAS Ho Go AITKEN, Major, Sanitary Corps, Malariologist, MTOUSA. A STUDY OF WINTER DDT HOUSE-SPRAYING AND ITS CONCOMITANT EFFECT ON ANOPHELINES AND MALARIA IN AN ENDEMIC AREA THOMAS H. G. AITKEK Major, Sn.C., A„U,S, (Malariologist, Mediterranean Theater of Operations, UaS, Army) 5 October 1945 GENERAL Realising the potentiality of the lasting qualities of DDT, a number of people have expressed their interest in knowing what effect the elimination of hibernating anopheline females, by winter spraying of all resting places, together with no subsequent l&rvi- ciding measures, will have on the anopheline population of a given area during the following season0 Furthermore, will one complete treatment so reduce the mosquito population, that malaria transmission will cease, or at least be reduced to an insignificant level? Having discussed these thoughts with Colonel William S. Stone, MD, Chief of Preventive Medicine Section, Office of the Surgeon, MTOUSA, as well as with members of the Rockfslier Foundation Malaria Demonstration Unit, Allied Commission, it was decided to initiate studies in the Bonifica di Castelvolturno, about an hour's drive north of the city of Naples, Italy. In addition to being close to Naples, the Castelvolturno area was chosen because the Malaria Demonstration Unit, A0C09 had carried on DDT house-spraying and dusting studies in the boalfica during the 1944 season and had amassed a great deal of important data regarding; (1) the degree of malaria endemicity (parasite and spleen surveys were made in May, August, and October); (2) entomological data concerning the species of anophelines existing in the area; (3) the fluctuation in numbers of adult mosquitoes in treated and untreated shelters (based on weekly inspections); and (4) the longevity effects of single applications of % DDT in kerosene (determined by daily liberation of lots of 100 adults in treated ventilated and unventi- lated rooms and recording the results the day following)„ DESCRIPTION OF THE AREA The Bonifica di Castelvolturno occupies the coastal portion of a wide plain lying at the mouth of the Volturno River (see accom- panying map)e Whereas the 1944 experimental area only included a portion of the bonifica south of the river approximately six miles long by three miles wide, it was felt, after discussing the matter with Dr0 Fred Lo Soper (Rockfeller Foundation), that more conclusive results could be obtained if the test area were expanded« It was therefore decided that the enlarged area, which was bounded on the west by the Tyrrhenian Sea, should consist of a coastal strip, approximately five miles wide, extending from the Mondragone hills south to the village of Qualiano, thence following the hills in a southwesterly fashion to Mt* Cujna0 Included in this zone of approxi- mately 93 square miles, are two additional bonifiche, namely, the Bonifica di Varcaturo and the Bonif ica di Licola, also the towns of Mondragone (population 15,000 ?), Castelvolturno (population 1,500 ?) and Villa Literno (population 5,000 ?)c The area in general is thickly interspersed with canals and ditches, most of which have seen little maintenance in recent years and as a result are choked with vegetation; some ditch cleaning was accomplished in 1944-$ hut nothing was done in 1945 o A few artesian wells also exist in the area* Destruction of one pumping station in the Licola-Varcaturo area and three stations in the Castelbolturno area by the retreating Germans late in September of 1943 caused two marshy lakes to be formed with the resultant flooding of many houses„ The lake in the Varcaturo Bonifica which was approximately a half mile wide and three miles long, remained in continuous existence for almost two years| on the 18th of July 1945, the reconstructed pumping station commenced operations and within throe weeks the marsh was practically dryc The inundated area in the Castelvolturno Bonifica9 which was ap- proximately one and a half miles wide and four and a half miles long, became dry both summers as the result of rehabilitating one of the pumping stations; unfortunately this station did not have the capacity to compete with heavy winter rains, and as a re- sult the reclaimed farmlands were flooded each winter. This past season, the lake had disappeared by the first week in Junec Perhaps the driest part of the experimental area is the southeastern corner, from the shore of Lago di Patria east to Quallano where the land rises slightly, affording good drainagec Throughout this section one finds the old style of Italian farm house, consisting of several floors and many rooms and stables with very high ceilings, all of which tends to make house-spraying very difficult0 On the other hand, the bonifica houses are modern and simply constructed; treating these is an easy matter0 During the winter months of 1945* experimental activities were handicapped by cold, rainy weather, bad roads (acme impassable) and an abundance of mudo With the coming of summer, the rud turned to deep drifts of dusto A hot, dry season eliminated many aquatic situations; however, the principal drainage canals and many of the smaller ditches contained water and were completely overgrown with algae, duck weed and other vegetation, providing ideal anopheline larval habitats0 The following table gives local weather data, which of necessity had to be taken from Capodichino Airfield, Naples. It will be noticed that temperatures tended to be somewhat higher and rainfall slightly less in 1945o 186 TABUS I Weather Data for the Maples Area (1944 & 1945) MONTH AV_MaI TEMP AV ML N TEMP MEAN temp"1 RAINFALL 1944. 1945 1944 1945 1944 1945 1944 1945 53°F 49°i' 36°F 46°F 42°F Inc ihes January 39°K 4 c 20 Ho 37 February 51 56 39 40 45 48 4o99 0.91 March 54 61 41 43 48 52 3o79 0.20 April 69 68 52 50 60 59 2.05 0o54 May 75 78 57 56 66 67 1.18 20 84 June 80 85 60 65 70 75 1.41 Trace July 85 89 65 67 75 78 0.15 0.20 August 89 87 69 67 79 0o08 0„59 September 81 79 61 61 71 7.08 5.26 October 70 53 62 12.35 November 61 47 54 5o62 December 55 43 49 3o02 TOTAL •n m 45° 92 Inches THE 1944 SEASON The following is a brief review of the activities and accom- plishments of the Malaria Demonstration, a.Co in the Castelvolturno area during 1944* A complete report has been prepared by that orga- nization and submitted elsewhere. application of insecticide and its effectiveness - Original appli- cations in May were directed towards determining the relative merits of spraying with % DDT in kerosene and dusting with 1056 DDT in powder (pyrophylite)o Zones B & D received an application of oil, E and F were treated with dust and A and C remained as untreated controls (see map). Because of the rather poor results obtained with powder, houses which had received thistreatment were again dusted in July. In August, the entire bonifiea of 214 houses (all six zones) were sprayed with 5% DDT in kerosene, all except for two test bedrooms in Zone B, which received only the original spraying. 187 DDT spray was applied with a hand-operated knapsack sprayer having a Bordeaux nozzle,. Walls and celings were treated at the rate of 60 milligrams of DDT concentrate per square foot of spray- ed surface, or one quart per 1,000 square feet, In August, when the bonifica was resprayed, 328 pounds of DDT concentrate were required to treat the 214 houses. Effectiveness of the applications was determined both by the daily liberation of 100 mosquitoes in ventilated ( screened windows) and unventilated (glass window closed) bedrooms (previously sprayed) and counting the dead on the following day, and by making weekly' catches in survey stations (sprayed and untreated controls)® The August report of the Malaria Demonstration Unit, A,C0, records 100$ kills in unventilated rooms 105 days after spraying and around 90$ kills in ventilated rooms during the same period. The results obtained in unventilated rooms Are not particularly signifi- cant as similar results were noted in unventilated rooms which had not been sprayed, suggesting that factors of temperature and humidity were involvede It is known that effective control was still being obtained in ventilated rooms in October, approximately five months after spray application„ Effective control of adult mosquitoes entering human habitations and stables (as contrasted with the H100 liberated mosquito technique** results mentioned above) was obtained for at least 80 days after treatment® During a visit to the bonifica on the 13th of December, no mosquitoes could be found in several of the treated houses examin- ed, whereas 51 anophelines were counted in 15 minutes in a nearby untreated house, indicating that hibernating anophelines were present in the area. Entomological findings (anopheline species) - Anopheline species encountered in the area consisted ofs Anopheles labranchi&e« 4« Sacha- rovi, 4„ melanoon and 4, messeae, Whereas 4, labr&nchlae was the dominant species early in the year, August surveys indicated that A, aacharovi accounted for 80$ of the captured anophelines0 Degree of malaria endemie&ty - Of considerable importance to the 19-45 project, were the three speen and parasite surveys conducted during May, August and October of the previous season. Only bonifica children between the ages of 5 and 15 years were examined! fortunate- ly, it was possible to utilize the services of the same doctors in these as well as subsequent surveys, thus enhancing the value of the spleen palpations. The May survey was initiated prior to the house spraying, so «e have here a true picture of the malaria endemicity of the area (see Tables VI and VII), It is of interest to note the very rapid drop in the parasite index from 21% to B$ during the three and a half month period following the application of DDTo THE 1945 SEASON House-spraying activities - Using the 100$ DDT concentrate, prepa- ration of a % mixture in kerosene was initiated by the 137th Malaria Control Detachment in Naples late in December 1944o Mixing was accomplished by rolling 50 gallon oil drums back and forth dur- ing the hottest part of the day; that 'a -good mix was obtained is evidenced by the fact that at no time w£te a DDT sludge found at the bottom of the drums0 Spraying activities were commenced by the 137th on the 5th of January, and the 95 Square mile area was completed during the first week of April; an area of about eight square miles around the Mondragone bathing beach was treated by an Allied Force Headquarters team0 Every house, stable, pigsty, cellar and grass shelter that it was possible to find, was treated0 In cases where houses were flooded, access was obtained by boat, but it became necessary to return at a later date, following the recession df the waters,to give the ground floors a proper spraying; in addition, there were instances where certain rooms were locked, and because no key was readily available, treatment had to be deferred to a later date0 These temporarily unsprayed rooms provided sanctuary for mosquitoes, which resulted in abortive increases in mosquito densities.* and definitely indicated the need for complete overall spray application0 The number of teams varied from two to three, each consisting of an American soldier acting as foreman and four Italian soldier laborers. At times each man operated his own Dobbins knapsack sprayer, but usually two of the men were detailed to a knapsack sprayer having an eight foot extension spray red (devised and provid- ed by Malaria Demonstration Unit, A0C0) , one man operating the pump, the other the extension rod0 In this manner, high ceilings were adequately treated„ It was of interest to note, that in the bonifica, which had been sprayed the previous season, the people welcomed back the spray crews with open arms; whereas in the areas to be treated for the first time, particularly the town of Caatelvolturno, the people were quite hostile toward the temporary inconvience of a disordered householdo Once the people had experienced the benefits of DDT, they were continually asking for a return performance i 189 A summary of spraying activities, exclusive of the Mondragone AFHG area, will be found in Table II, A total of 1,383 houses re- quired 1,269 pounds of 100$ DDT concentrate, which amounts to about Go92 pounds per house* Application was made at the mte of approxi- mately 83 milligrams of DDT per square foot,, The discrepancies in the amounts of DDt used existing between urban and rural areas may be explained by the smaller type of house in the towns* At the start of this project Dr* Henry W0 Kuram (Rockfeller Foundation) voiced the opinion, that it was very difficult sometimes, particularly in a war torn area or in an area about to be occupied, to estimate DDT requirements on the basis of surface to be treated; he suggested that estimates might be made on the basis of population* In the Castelvolturno project it was found, that with an application rate of 83 milligrams per square foot, about two ounces (1.14- quarts of % solution) of DDT were required per person* Although population difference between rural and urban areas had a marked effect on the amount of DDT applied, it is felt, in the light of the highly satis- factory results obtained this season, that estimates might well be made on the basis of two quarts of % solution per person. Entomological investigations - Inspections for hibernating mosquitoes by an entomologist from the 15th Medical Laboratory commenced 22 December 1944? and weekly visits to the Castelvolturno bonifica were maintained thereafter until the end of September 1945« Mosquito counts, in gen- eral, were made in an upstairs bedroom, a stable a pigsty at each station visited, using methods similar to those employed by the Malaria Demonstration Unit, A0C0, in 1944« Total mosquito counts were not made| rather a specified area (preferred resting place) in each room was inspected and counts made accordingly; total counts were only made in pigsties0 Average wall and ceiling space inspected was as followss bedrooms- 23 square yards; stables - 27 square yards; pigsties • 14 square yards„ A total of twenty-three adult inspection stations and sixteen larval inspection stations were set up in th© Castelvolturno Bonifica and Qualiano areas (see map)* In addition, during July and August, inspections were made in houses other than the regular stations, many being in that portion of the bonifica north of the river and others were in the Licola and Varcaturo areas to the south; these varied in number from four to sixteen per week depending on how much time was available0 All of these houses had been sprayed* Mosquitoes were brought into the laboratory for determination, given the opportunity for oviposition, and watched for signs of DDT intoxication* 190 In April it was decided that an a rea of untreated houses should be set up for comparison with the Castelvolturno project. The Bonifica di Sessa was chosen (see map). It is a thinly populated area lying just south of the Garlgliano River and the town of Minturno, consisted of the small village of Cellole (population 3,500?) and a few scattered farm houses. It was here, after crossing the Volturno River at C$pua in October of 194-3, that the Allied Armies were held up for six long, dreary winter and spring months before they were able to force a break through and join forces with the Anzio beachhead on the way to Rome. As a result of German destruction of the pumping station near the Garig- liano River, the central portion of the bonifica was completely flooded, forming a marshy lake choked with vegetation about three and a half miles long and a half mile wide. In addition, anopheline larval habitats were to be found in numerous bomb craters, heavily overgrown canals and ditches and in a few small streams scattered throughout the area, Seven adult and seven larval inspection stations were established; because of the tremendous numbers of mosquitoes present, inspections were placed on a semi-month basis. Anyone who is not familiar with the habits of anophelines of the maculipennis group can hardly appreciate the tremendous populations which build up in an uncontrolled area. Because of their house-and stable-invading affinities, inspections for these anophelines are greatly simplified. In the Sessa Bonifica, mosquitoes were so abundant, the walls and cobwebs were black with them, and on being disturbed they sounded like a swarm of bees; in one pigsty, it was estimated that there were easily a thousand mosquitoes per square yard of wall surface. The first inspections made in the Castelvolturno area during December and January were negative, at least in the houses sprayed the previous season; other houses showed moderate numbers (as high as thirty-five) of hibernating adults. Mosquitoes brought into the laboratory at this time failed to feed or oviposit. Blood engorged anophelines were found in one pigsty on 28 D ecember and 12 January. The first anopheline larvae (Anopheles claviger) were observed 19 March; larvae (4-th instar) belonging to one of the members of the maculipennis complex were not seen until 12 April. This latter observation, coupled with the fact that large numbers of males and females of anopheles maculipennis (broadly speaking) were soon in the Sessa Bonifica on 28 April, suggests that oviposi- tion probably commenced during the middle of March and the first brood appeared around the middle of April. Anopheles claviger larvae were fairly common early in the year, but with the coming of warm weather its numbers fell off sharply. Of the maculipennis group, anopheles messeae was the predominant 191 species early in the season, where ovlpcsitions occurred| June collections showed a preponderance of Anopheles labranchiae but by August Anopheles messeae had resumed its former position• Anopheles sacharovi eggs were obtained on two occasions from the CasteIvolturno area during the last week of May. The results of adult mosquito inspections have been summar- ized in Tables III and IV« In the Castelvolturno area during June, three stations had appreciable increases in adults far oqt of proportion to anything occurring in the remaining stations,, Their monthly totals were as follows; Station III - 45 adults. Station IV « 154 adults, and Station V - 84 adults. \ The reason for the rise at Station III is not understood, because it drop- ped of its own accord in July and only nineteen anophelines were found during the following three months„ Investigations of Stations IV and V revealed two outdoor ovens and a wine cellar which had escaped the original sprayingj after treating these (avoiding the remaining portions of the houses), adult numtyirs diminished, but continued to prevail at a relatively low level® There were one or two other instances where it was necessary to return and spray an overlooked room or a formerly flooded outhouse, but in each case the spraying was restricted to the room or outhouse in question. In general, there was a slight buildup in the mosquito population along about'' the middle of July, but the numbers were insignificant compared with the Sessa compari- son area, and judging from the spleen and parasite surveys conduct- ed in August, they were too low to have any effect on malaria transmission„ As mentioned previously, additional checking stations, other than the regular ones, were visited at random during July and august. As expected, the numbers of adults recorded were in complete accord with the current situation existing elsewhere in the Cas t eIvolturno Bonifica0 Average monthly densities (per quar© yard of preferred resting surface), of adult anophelines have been summaraiaed at the bottom of Tables III and IV. The profound difference existing between the Castelvolturno and Sessa areas will readi- ly be seen. Whereas in the Castelvolturno area, monthly densi- ties have been reduced to fractions of mosquitoes per square yard, in the Sessa area they are close to two hundred mosquitoes per square yard at the height of the season. During the entire seven and a half month period following DDT spraying a total of 1,095 anophelines were captured in regular inspection stations in the Castelvolturno area? compared with this, in the Sessa Bonifica, more anophelines were observed in a single catching 192 stations on one visit than were collected during the entire season at Castelvolturno. The results of the larval surveys are to be found in Table V. Because of the scarcity of adults in the Castelvolturno area, anopheline larvae became very difficult to findc Although larvae must have been distributed rather evenly throughout zones C,D,E and F (Castelvolturno) as well as in the Varcaturo Bonif.ica, judging from the records of the adult stations, their densities were extreme- ly lowo Elsewhere in the experimental area, favorable aquatic situ- ations were scarce or non-existent, except in the bocifica north of the Volturno River; even here, while there was an abundance of favor- able situations, larvae were practically non-existent, On the other hand, while not outstanding, collections in the Sessa Bonifica dem- onstrated reasonably large numbers of larvae. Because of the tremen- dous adult population it was anticipated that a greater number of larvae would have been found. It is presumed that the heavily vegi- tated marsh lake was the principal source of anophelines; if this is true, it is quite possible, considering the extensiveness of the lake, for a large anopheline population to be present yet the density in any one location to be low* As originally planned, no larvae control was to be permitted in the experimental area. Unfortunately, a small amount of Paris green hand casting was done by the Italians in a few isolated local- ities, but after noting how carelessly it was accomplished and how many places were overlooked, it was felt that their work was incon- sequential. The AFHQ bathing beach section at Mondragqne (eight square miles), however, was oil larvicided in addition to being house-sprayed, but its location in the northwestern corner of the experimental area prevented it from having any unfavorable influence on the project. In summary it can be said, that with the exception of a 96$ larval reduction in aprii, their© has been a 99$ reduction of both anopheline adults and larvae in the Castelvolturno area, as com- pared with the Sessa comparison area for the months of april, May, June, July, August, and September. Spleen and parasite surveys - As mentioned previously, three spleen and parasite surveys of the inhabitants of the Castelvolturno Bonifi- ca (Zones A-F) were conducted by the Malaria Demonstration Unit, A.G., during the course of their studies in 1944* Surveys were made in May, august and October. Only children between the ages of 5 and .15 years of age were examined; spleen sizes were recorded after the method of Schuffner, 195 At the beginning of the present project, another survey was initiated in the same area in January Two additional surveys were undertaken this season, in May an during the last tw© weeks of Auguste Experienced personnel were kindly loaned by the Malaria Demonstration Unit, AoC0, and slides were examined by technicians from the laboratory of Professor A0 Missiroli, Institute Superior© di Sanita, Rome0 * The survey, in addition to the Bonifica di Castelvoltur- no included the town of Castelvolturno, which was DDT-sprayed for the first time this yearp but which had received a minor amount of py3T®thrum spraying by the Italians the previous season0 In M*y the survey was extended to include the Bonifica di Sessa comparison area and the town of Cellole, The results of these surveys are summarized in Tables VI and VII0 As pointed out by Hackett (1937), spleens persisting in winter ”indicate en masse precisely what we wish to know, namely the inten- sity of the malaria to which the population has been previously exposed”o* In the Castelvolturno Bonifica, at the start of DDT- spraying operations, there was a splenic index in May 1944 of 43$ with the average spleen having a value of 1.6 corresponding to position P of the average spleenc This alone is not particularly significant, but if one considers that there was a corresponding parasitic index of 21$, one might presume that there had been a fair amount of transmission taking place the previous fallo By May of 1945, after one season's limited experience with DDT, the splenic index had only dropped one point (42$), the value of the average spleen had remained the same (lc6), but the parasitic index had dropped to 5$o It is unfortunate that these studies are being terminated before it is possible to make another survey this coming winter$ such a survey should provide conclusive proof that there has been a greatly reduced malaria experience as a result of large scale DDT operations completed early in 1945® The fact that there has been a reduction in the parasitic index, at the height of the transmission season from 12$ (August 1944) to 1$ (august 1945) and a previous high of 21$ in May 1944, is indicative that malaria transmission has been decidely on the wane; coupled with this, there has been a definite shift to the left in the degree of splenomegaly, which suggests that malaria transmission in 1945 has been nil. Un- fortunately information is not available to make a specific break- down of positive smears except for the last survey made in august; *Hackett, L.W, "Malaria in Europe", Oxford University Press, Londons Humphrey Milford (1937) 194 of the six positive smears, one contained Plasmodium falciparum and five P.vivax. While the indices in Castelvolturno town have in general been lower than those in the bonifica, little information can be obtain- ed from them, as we have no means of comparing the two years’ experience. On the other hand, the conditions found existing in the com- parison area of the Sessa Bonifica and the town of Cellole are of extreme interest* In May of 19-45, there was a splenic index of 56$, with the average spleen having a value of 1*9, and a parasit- ic index of 18$. By August the splenic index had risen to 63$, with an average spleen value of 2,2 - a definite trend to the right in degree of splenomegaly; the parasitic index was now 4-1$. Of the 87 positive smears examined, 30 (34$) contained Plasmodium vivax. 53 (61$) demonstrated Pc falciparum and 4 (5$) were mixed infections; gametocytos were found in 35$ of the smears. In addition, certain statistics, although incomplete, are available from the local civilian heith officer. Cellole has a population of approximately 3,500o During 1944, there were official- ly reported 822 cases of malaria between May and December. This past season, there have been 1,058 cases come to official notice from January through the middle of August. In addition there have been twenty deaths attributed to malignant tertian infections; in all cases, parasites of Plasmodium falciparum were found0 Con- sidering these facts, the situation in the Bonifica di Sessa and Cellole town is in marked contrast to that existing at Castelvolturno. The high incidence of parasitism, together with the preponderance of Plasmodium falciparum, infections and gamouocyte carriers is indicative that malaria of epidemic proportions is present. 195 SUMMARX Between January and April 19-45 a single application of 5% DDT in kerosene was applied to the interiors of all houses and other shelters covering an area of approximately 95 square miles at the mouth of the Volturno River, near Naples, Italy, Interior surfaces were treated at the rate of about 83 milligrams of DDTper square foot; this in terms of population amounted to about 2 ounces (1,14 quarts of 5% solution) of DDT per person, Larviciding activities were car- ried on around the Mondragone bathing beach area (approximately eight square miles) in the northwestern corner of the experimental area; elsewhere, however, no larviciding was accomplished except for a small amount of extremely localized and desultory Paris green hand- casting by the local Italians0 Entomological investigations indicated the following species of anophelines to be present in the area: Anopheles claviger. Messeae. Xabranchiae. and 4 aaebarovl. Aaophelea labranchlae appeared to be the dominant anophellne during June and July, Weekly larval and adult inspections were made at regular stations from December 1944 through September 194-5; during July and august, additional treated stations were inspected at random. In April, an untreated compari- son area was established in the Sessa Bonifica, just to the north and separated from the Volturno River basin by a range of hills. Be- cause anophelines were so abundant, inspections were placed on a semi- monthly basis. With the exception of a 96% larval reduction in April, there has been a 99% reduction of both* anopheline adults and larvae in the Castelvolturno area, as compared with the Sessa Bonifica for the months of April through September, Spleen and parasite surveys, of children between the ages of 5 and 15 years of age, were conducted in the Castelvolturno Bonifica over a period of a year and a half and in the Sessa Bonifica during the past year. In the Castelvolturno area, a splenic index of 43% together with a parasitic index of 22% made during May 1944- is indica- tive of a considerable amount of transmission the previous autumn. By August of 1945, the splenic index had dropped to 25% and the para- sitic index to 1%; together with this drop in the spleen rate, the degree of splenomegaly has shown a decided shift to the left, sug- gesting that malaria transmission during 1945 had practically ceased. On the other hand splenic indices in the Sessa Bonifica had jumpefl from 56% to 63% between May and August 1945 and the degree of splenomegaly was shifting to the right. The parasitic index had also moved from 18% in May to 41% in August, and 61% of the infections were caused by Plasmodium falciparum. These statistics, together with the information from the local health officer to the effect 196 that therehad been 20 deaths dur to malignant tertian infections in the area this summer, indicates that malaria of epidemic propor- tions was present in the unprotected Sessa Bonifica during 1945o ACKNOWLEDGEMENTS The writer wishes to express his deep appreciation to the following individuals, without whose wholehearted cooperation, this study could not have been attempted; Cole W0S0 Stone, M.C, (Chief, Preventive Medicine Section, Office of the Surgeon MTOUSA), Dr0 F, Le Soper, Dr* H.W. Kumm, and Dr„ L,A. Richl (all of the Rockefeller Foundation), Captain L.M, Klfifounan, Sn0C„ and Sgtc CeR0 Collins (137th Malaria Control Det.), Captain R.A„ Fisher, Sn.Cc, 2nd Lt. A0We Ziegler, SneCe and Tec 4th C«S« Black, Jr, (all of the l$th Medical Laboratory)» RURAL AREAS URBAN AREAS Bonifica di Castel- voIturno (South Bonifica di Gastel voIturno (North) Bonifiche di Varca- tumo and Licola Largo di Pa° tria- Qualiano Area Castelvol- turno Towq’ Villa Lite mo Town Gals of DDT-Oirosene used 691 347 105 834 242 569 Pounds of DDT cone* used 314 158 48 380 110 259 No, of houses treated 255 146 36 313 275 313 No, of persons per house (ave.) 6 (?) ♦6,25 6 (?) 6 (?) ♦5,5(?) ♦16 (?) Gals, of DDT-Kerosene per house 2,71 2,37 2,64 2,7 0,9 1,8 Quarts of DDT per person 1,8 (?) 1,4 1,9 (?) 1.7 (?) 0.64 Oo 45 Grams of DDT conco per person 9301 (?) 74,4 100,8 (?) 93,9 (?) 23,3 23,5 Quarts of DDT per 1000 sq, ft ♦♦lo54(?) ♦♦*1,63 ♦*lo66(?) 7 7 7 Grams of DDT conc0 per 1000 sq,ft 79,7 (?) ) 84,1 86,4 (?) 7 ? 7 ♦Population estimates, obtained locally, as follows: GastelvoIturno~1500, Villa Literno~5000, CastelvoIturno Bonifioa-963 (actual count) ♦♦Average interior wall space estimated to be 7000 sq.ft, ♦♦♦Three house types were involved, with the following interior wall space: Type 1-4551.75 Sq,Ft, (99 houses). Type II~7922,75 sq.ft, (33 houses). Type III--9952,50 sq, ft. (14 houses) TABLE II SUMMARY OF DDT SPRAYING ACCOMPLISHMENTS IN THE T5ASTELVOLTDRNO AREA tabus hi average monthly anopheline adult densities fee square yard OF EXAMINING SURFACE .. CASTELVOLTUENO AREA * STATION** AREA ED SQ .JtCS™ JAN FEB MAE APR MAI JBN •raiTj m AUG SEP C-I (B.P.S.) 75 0.00 (ddt; 0.00 0.00 oroo 0.00 0.00 0.03 0.01 0.01 0.01 C-XI (B.P.S.) 3.42 (ddt; 0,12 0.00 0,00 0.13 0,03 0.01 0,06 C-III (B.P.S.) 9$ 3.14 (ddt; 0.05 0,00 0.01 0,01 0,09 0,01 0,01 0.03 C.IV (B.P.S.) 76 3,19 (ddt; 0,12 ■# 0,00 0,01 0.04 0.43 0.04 0,06 0,05 C-V (B.P.S.) 59 3.14 (dot; 0.06 0,00 0.01 0,01 0.28 0.0$ 0,03 0.27 C-VI (B.P.S.) 40 3,00 (ddt; 0.00 0,00 0,00 0,00 0,00 0.15 0.19 0.1$ C-VIX (B.S.) 90 0.00 (dot; 0,01 0,00 0,00 0.00 0,01 0,08 0,14 0.0$ C-VIII (Pill box) 16 3.00 (ddt; 0.00 0.00 0,00 0.00 0,00 0,00 0.00 Turn 0.00 C-IX (S.) 22 3.00 (ddt; 0,00 0.00 0,00 0,00] 0.09 o.osr 0.06 0,02 C-X (B.S.) 30 3.00 (ddt; 0.04 0.00 0.00 i 0,00 • 0.01 0,00 0,00 0.01 C-XI (S.) 23 3,00 (ddt; 0.00 0,00 0,00 0*00 0.00 0.00 0,00 0.00 C-XII (B.S.) 48 3,00 (ddt; 0,00 0,00 0.00 0,02 0.04 0.03 f 0,01 0,06 C-XIII (P.S.) 32 3.00 (ddt; 0,06 0.00 0,00 0.00 0.00 0,01 0,00 0,03 C-XIV (B.S.) 33 0.00 (ddt; 0.00 0.00 0.00 0,01 0,01 0.02 ' 0,00 0.01 c-xv (s.) 18 3.00 (ddt; O.OA 0,00 0.00 0,00 OoOO (ddt) 2.47 0.12 0.13 C-XX (B.P.S.) 48 (ddt; 0,00 0.00 0.00 0.00 0.01 0,00 0,00 0.00 C-XXI (B.P.S.) 48 0.00 (DDT) 0.00 0.00 0,00 0,00 0,00 0.00 0.00 C-XXII (B.P.S.) 48 0.00 (ddt; 0.00 0.00 0.00 0.01 0,00\a 0,00^ 0.00 C-XXIII (B.P.S.) 48 (ddt; 0.00 0,00 0.00 0.00 0.00 0.00 f » \ ■- 0.00 0,00 C-XXIV (B.P.S.) 48 (ddt; 0.00 0,00 0.00 0.00 o.oj 0.00 0,01 0.00 G-XXV (B.P.S.) 48 0.00 (ddt; 0.00 0.00 0.00 0,00 0.00 0.00 0.00 C-XXVI (Stair well) 8 (ddt: 0.00 0,00 0.00 0.00 0.15 0,18 0.06 0.31 C-XXVII (B.P.S.) 48 0,00 (ddt; 0,00 0.00 0.00 0.01 0.01 0.05 0.03 UONTHU AVERAGE 3,06 0*02 Q*oo 0.0QLr 0o0Q3 0,05 0,13 LQJ&. 0.06 *For convenience,weekly collections have been combined with monthly totals ** Station symbols B- bedrooms,? - pigsty, S - stable TABLE IV AVERAGE MQNTHII aNOPHELINE ADULT DENSITIES PER SQUARE YARD $)F EXAMINING SURFACE - BON BIG A DI SESSA * ** STATION area examined SQ.YDS. .1 • APRIL MAY 1 i JUNE ==1 JULY aUG SEP S-I (G.S,) 14 1.00 17.86 35.71 142.85 Discontinued *** s S-JX (S.) 24 0.58 11.45 25.00 85.55 50,00 50.00 *-*•* H It *** S IXX(S.) 6 A. S3 27.00 -—— 166,66 116,66 116.66 ■*** \M \* -M aTV/T *** S-IV (s.) 19 1.11 4*I$J 13.16 73,94 78.94 78.94 *** *-** *•** *** s-v (s.) 71 1.73 14.08 70.42 |^12o07 fc112.67 U W 4** *** *** S-VI (P.) 10 50.00 200,00 1000.00 ... 700.00 700.00 *** *** S-VII (s.) 20 —— 18.00 25.00 55.00 55.00 MONTHLY AVERAGE 9.87 41.84 167.04 118.50 185.54 185.54 * For convenience, semi-monthly inspections have been combined into monthly totals. ** Station symbols, G.S, - Goat shed, P. - pigsty, S- stable. *** Based on estimates of over 1000 mosquitoes , TABUS V AVMfGE MONTH!* ANOPHELINE LARVAL DENSITIES PER TEN DIPS OF EXAMINING SURFACE - CASTELVOLTURNO AND SESSA AREAS STATION TYPE APRIL MAf fcfc . JUNE JULY aUG SEPT C-l Canal 0,00 0.00 0,00 0.00 0,00 0,00 0^2 Flood area 0.00 0.00 0.00 0.00 0.00 0.00 C-3 N H 0.00 3.00 0.00 0.00 0.00 0.00 C-4 Canal 0,00 0.00 0.20 0,00 0.00 0.00 C-5 ft 0,75 0,00 0.00 0.00 0.00 0.00 C-6 n 0,00 0,00 0.00 0.00 0;po 0.00 C-7 * - 0,00 0.00 Dry Dry Dry Dry C-8 n 0,00 0.00 3.50(Dry) Dry Dry Dry C-9 ti 0,00 Dry Dry Dry Dry Dry C-10 Lake front dpOo 0.00 0.00 0,00 0.00 0.00 C-ll Canal • 2.00 0,00 Dry Dry Dry Dry C-12 H 0.00 0.00 0,00 0.50 0,00 0.00 C-13 Ditch 0 .00 0,00 0,00 0,00 0.20 . 0,00 C-14 Canal 0,00 Dry Dry Dry Dry Dry C-15 n 0,00 0.00 0,00 0.00 0.00 0.00 C-16 it 0,00 0.00 0.20 0.00 0,00 0.00 MONTHLY AVERAGE 0,17 0.21 0,32 0,06 0,02 0.00 S-l Swamp 0,00 2,00 21.00 0,00 11.00 S-2 Canal 0,00 0.00 0,00 0.00 0.00 —— S-3 ii 0,00 0.00 Positiv e 6.00 0.00 S-4 it 2,00 10.00 35.00 Dry Dry S-5 it 5,00 20,00 22.00 0,00 10.00 S-6 1 i’lood area 2*p0 47.00 Abundant 0,00 0.00 - S-7 Swamp 19100 51.00 n 0,00 Dry MONTHLY AVERAGE 4.00 18.60 11.60(* 1 ) 1.00 L_ 4.00 TABLE VI SPLEEN INDICES IN GA3TELV0LTURN0 AND SESSa AREAS (1944-45) LOCALITY AND DATE NO. SPLEEN % of sple; ENS AVERAGE SPLEEN EXaM. INDEX 0 p I 2 3H Value Position Castelvolturno Bonific May 1944 a 485 57 32 10 1 0 1.6 P August 575 ‘43 57 28 43 2 0 1.6 P October 533 39 61 22 % 3 0 1.6 P January 1945 355 27 74 15 10 1 P 1.4 i P May 410 42 53 30 il 1 o 1.6 P - August 423 25 75 20 5 0 0 1.2 P Castelvolturno Town January 1945 94 22 78 13 6 3 0 1.3 P May 104 39 61 26 M 3 0 1.6 P August 159 25 75 21 4 0 0 1.3 P Sessa Bonlfica and Cpl May 1&5 lole 228 Town 56 44 26 22 8 0 1.9 P August 210 63 37 22 27 12 2 2.2 1 > TABLE VII PARASITE INDICES IN CASTELVOLTURNO AND SESSa AREAS (1944-45) LOCALITY AND DATE NUMBER EXAMINED NUMBER WITH PARASITES PERCENT WITH PARASITES Castelvolturno Bonif i< sa May - 1944 485 101 - 21$ ' August 575 67 12 October 533 41 8 January 1945 355 10 3 May 410 20 5 August 423 6 1 Castelvolturno Town January-1945 94 2 2 May 104 7 7 August 159 12 8 Sessa Bonif ica and Cellole Town May -1945 228 40 18 August 210 87 41 r" ITALY - 1-200,000 CASTELVOLTURNO EXPERIMENTAL HOUSE-SPRAYING PROJECT 1944 AREA 1945 AREA ADULT INSPECTION STATION LARVAL INSPECTION STATION FLOODED AREA APPEHDH 32t HEADQUARTERS 2655th MALARIA CONTROL DETACHMENT (OVHD) Office of the Malariologist, MTOUSA APO 512, U.S. ARMY OIL SPRAYING EQUIPMENT FOR THE A-20 (DOUGLAS) AND PT-17 (STEARMAN) AIRPUNES. WILLIAM J. WYATT Major, Sanitary Corps. 15 September 194-5. Oil Spraying Equipment for the A-20 (Douglas) and PT-17 (Steanpaa) Airplaneso Ic INTRODUCTION. The use of the airplane to apply liquid in partic- ular DDT in oil, to marshy areas as a mosquito control measure was tested in the Mediterranean Theater of Operations during the summer of 19-44-0 As a result of these trials 9 it was learned that an A-20 airplane could safely carry 300 gallons of liquid and release this above a marsh at altitudes of 25 to 100 feet depending on terrain and wind conditions0 At the close of the 1944- malaria season, it was decided to cont- inue studies of oil spraying equipment for the A-20 airplane, and these studies were conducted during the winter of 1944“45o As a result of these efforts several A-20 airplanes were fitted out with 300 gallon tanks mounted in the bomb bay with a three inch discharge line opening below the underside of the fuselage of the airplane; a valve opened and closed by a hydraulic piston released or shut off the flow of oil from the tank to the discharge line0 Early in May 1945 ? two of the oil spraying A-20 airplanes were sent to th© Leghorn area to apply DDT in oil larvicide to the water surfaces of th© region0 Since the atomizing device of the sprayer had been constructed to produce a spray stream that would deposit oil at the rate of two quarts per acre over a swath 300 feet wide and most of the water surfaces in the Leghorn-Pisa area consisted of a network of canals which because they were so extensive and their banks mined made the use of an airplane both necessary and feasible9 experiments were undertaken to determine the means of maxing efficient use of the airplanes in the application of liquid larvicides to canals0 Initial trials in which the airplane was flown past a point in a direction at right angles to the line of a series of papers placed at 300 foot intervals showed that with the same height of release and under approximately equal conditions of temperature and wind the width of th© swath covered varied with the amount of liquid in th® tank0 With the diameter of the discharge orifice set at two inches and the airplane flying at a height of 50 feet, the width of the swath covered varied from 420 feet with the tank full to 200 feet with the tank only 1/3 full; in addition9 the average number of droplets per square inch varied from 25 with the-initial flow from a full tank to 15 at the time the level of the liquid in the tank was only 1/5 its capacity0 Tests were then conducted to determine the rate of flow from the tank during various time intervals while the airplane was in flight,5 results of these tests are shown in Table 10 Table 10 Percent of capacity (300 gallon tank) discharged from the A-20 airplane spray tank during various intervals of time after ini» tiation of flow from a completely full tank in which the head pressure was not equalized during discharge„ Test Number Diameter of Outlet Time in Minutes Gallons Discharged Percent of Capacity Discharged 1 2 inches 105 220 70 2 2 inches 1st minute 170 57 2nd minute 90 30 3rd minute 40 13 3 2 inches 1st minute 170 57 2nd minute 90 30 3rd minute AO 13 A 1 inch 1st A l/2 min 170 57 2nd A l/2 min 80 27 3rd A l/2 min 50 16 The results of the tests shown in Table 1 indicated that some method of obtaining a constant flow of liquid from the tank would be highly desirable„ Laboratory trials of various systems were conducted to devise some simple means of obtaining a constant flow of liquid from a vesselo From experience gained in these tests9 it was decided to make all external openings to the tank such as filler caps., etc0 airtight and to extend the air vent line entering the tank at the top to within four inches of the bottom| with these conditions 9 it was necessary to provide an escape for the air while filling the and this was done by inserting a valve in the top of the vesselo The valve could be opened as filling began and closed when the container was full0 When the valve releasing the liquid to the discharge line was opened9 the outgoing fluid could be replaced only by that air which entered the tank through the terminal opening of the vent under the surface of the liquido Fluid leaving the tank produced a suction that pulled air into the vessel9 but the flow of air was retarded by the pressure of the weight of the liquid exerted on the bottom of the vent pipeD Static pressure tending to produce an increased rate of flow was greatest when the container was full? but this height of fluid exerted the great° est limiting influence on flow of air into the tank0 As the depth of the liquid in the container decreased, static pressure decreased, but the pressure of the liquid at the vent outlet was less? so air could therefore enter the vessel at a more rapid rate0 Thus an equalized flow of liquid from the tank was obtained during the time required for it to emptyo Ho OIL SPRAYING APPARATUS FOR THE AIRPLANE, PT-17, UoS0AoA.Fo The installations of the front cockpit„ such as seat., instrument panels etc0? were removed from a PT-17 Stearman biplane to create room for a container the size of a 55 gallon oil drum0 The position and manner of installation of the container, discharge line and atomizing apparatus in relation to the structure of the airplane are shown in Figure lc Tank; A 55 gallon oil drum was modified to make the reservoir tank| the first step being the removal of the plug caps in the end of the barrel and the sealing of these openings by welding a metal plate into them0 A one inch vent line was passed through the for™ ward end of the upper side of the barrel and projected to within four inches of the bottom side; the line extended twelve inches above the upper side of the barrel9 and it was secured by welding it to the rim of the opening through which it passed into the barrel. At the rear of the upper side of the drum an opening the diameter of the filler cap assembly of the main gas tank of a P~47 was cut? and the outer portion of the filler cap assembly welded into the openingo A well six inches deep fashioned from sheet metal was attached surrounding the filler cap5 and a line extending from the lowest point of the well passed around the outside of the barrel and out the bottom of the fuselage0 Any fluid overflowing from the tank is thereby drained off and discharged outside the airplaneo At a point on the under side of the drum approximately diametrically opposite the filler cap., an opening on© inch in diam- eter was cut,, and coupling for one inch pipe was welded in place with the edge of its inner circle concentric with the edge of the hole. Mounting of the tank in the airplane: Two pieces of wood 9 4. x 4- inches in dimension9 were placed across the frame Of the air- plane at the bottom of the space originally utilized for the forward cockpit; they were separated by a distance slightly shorter than the length of a 55 gallon oil drum and were bolted to the frame0 As the central portion of each wooden girder had been cut out on an arc of the same radius as that of the oil drum,, they formed a cradle for the drum0 Each end of the barrel was moored to its respective wooden girder by a metal band passing over the drum and attached to th# ends of the girder; the band was tightened in place by means of tension nuts at each of its endsQ Checking of these nuts at intervals will insure the security of the position of the drum. When the drum had been fastened in place in the plane9 a one inch pipe was screwed into the coupling on its under sides the pipe was ex- tended through the fuselage to a point eighteen inches below the barrel. The pipe was terminated at this point and a right-angle pipe MLtt coup~ ling fitted to its end„ A plug type valve was connected to the lower end of the coupling9 and a one inch pipe twelve inches in length extended from the valve0 The pipe was braced by means of rods from it to the ends of the rear wooden girder supporting the tank. Valve; A simple plug type valve placed in the discharge line controls the release of liquid from the tanko The valve is operated manually through a direct connection to a lever in the pilot3s cock- pit as shown in Figure 1Q No calibration of the lever to control the rate of flow is us@d| the valve is either opened completely or closed. In lieu of furnishing the pilot with a gauge to register the level of the fluid in the a plexi-glass plate was mounted in the floor of the cockpit directly over the atomizer; so the pilot can watch the flow of the oil spray0 Irregular supply causes spurting of the stream just at the end of the tank. Atomizing apparatus: The atomizer consists of a truncated cone five inches in diameter at its open base and two inches in diameter at its top0 The cone was fitted over the pipe with its base forward and its long axis parallel to the pipe0 With the airplane in flighty air is cooped through the cone and converged on the stream of oil flowing from the pipeQ The con® was attached to the pipe by means of a hose clamp; this permits adjustment of the position of the cone? so that the distance between th® planes of the end of the pipe and the"terminal orifice of the con® may be altered. Performance Tests performed previously with the A-20 airplane5 shown in Table 4-? page 36, had demonstrated that the fluid sealed air vent effectively balanced the static head pressure in the tank and provided a uniform rate of flow of liquid from the tank while it was emptying0 Using a discharge orifice having a diameter of 3/4- of an six minutes and 25 seconds were required for the 55 gallon tank of the PT-17 (Stearman) sprayer to empty; this means that 34- quarts of liquid were released per minute and that a linear distance of approximately ten miles would be covered in the time required for the tank to empty0 Plane speed was approximately 90 miles per hour. Determination of coverage of sprayed surface 0 The oil used in the various trials to determine coverage was colored with the oil soluble SCALE . SIO DATE 1 20 Draw by 3 -8 - 45 i. 2£ Control, 7 DETAIL ADJUSTABLE VENTURI Of*' WOODEN SUPPORT BRACE N.021 /HSCMC ORIFICE HOLDER VENTURI - SCALE 112J 2655 MALARIA CONTROL DETACHMENT US. ARMY PT-17 AIRPLANE EQUIPPED FOR DDT AND OIL SPRAYNG FUSELAGE HOSE CLAMP r PIPE AIR VENT OVERFLOW WELL WITH FILLER CAP INSIDE OVERFLOW TUBE •ft . 1 -■ 2/-*. r: J~ * VALVE AJUSTIBLE VENTURI VALVE CONTROL LEVER 55 GAL OIL DRUM APPENDIX 32w dye,, Sudan III, mixed with oil at the rate of one pound of dye to eacla 50 gallons of oil0 The number of drops per unit area and the diameters of these drops were obtained by the use of jump cards and magnesium oxide coated plates0 The stain size/drop size ship curve for No,, 2 Diesel oil and the paper used for the jump cards was kindly calculated by Mr0 Jo Siddorn of the Porton Ex- perimental StationQ A water suspension of magnesium oxide was applied to clean glass slides? the suspension was used in a quantity sufficient to provide as heavy a deposit of magnesium oxide as could be obtained without cracking of the film when it dried0 Only the heavy uniform uncracked films were selected from the slides prepared0 The oil was released both with the airplane flying crosswind and with it flying upwind0 In crosswind flights the jump cards were placed at 30 foot intervals in a line at a right angle to the line of flight, some trials were made using ten foot intervals and in upwind flights the jump cards were placed in a series both to the right and to the left of the card over which the plane passed0 A magnesium oxide coated plats was placed in the center of each jump card* After a test flight had been made the jump cards and magnesium oxide coated plates were carefully labeled and brought into the lab“,, oratory3 Measurements of stain diameters were made by means of an eyepiece micrometer placed in the ocular of a stereoscopic microscope, and the number of drops per square inch were counted. Calculations of material per acre were made in the following mannero The diameters of 50 drops on each plate were measured and averaged, and the average drop diameter for that plate used in the following equations 0524 times the number of drops per square inch times the number of square inches in an acre (6,272,64-0) divided by the number of cubic millimeters in a quart equals the quarts of liquid per acre represented by the stains on the jump card and the magnesium oxide coated plate , (f°r rapid calculation this may be shortened tos times the number of drops per square inch times 3o47)o As a 5% solution of DDT containing approximately 0o45 lbs0 of DDT per gallon was used, each quart of solution contained about Ooll lbs0 of DDT? so the number of quarts of oil falling on a given swath were multiplied by 0oll to find the pounds of DDT fall- ing on that swatho The coverage of the swath was considered to have effective larvicidal properties if it contained 0ol lbD or more of DDT per acre; this is equal to one quart or more per acre0 The results of the spray trials with the FT“17 (Stearman) air- plane are summarized in Tables 2 and 3 and are shown in greater de- tail in the tables following them which represent the data on each individual flight0. 5' Table The effect of change in temperature and variation of the distance between the orifices of the atom- 26 izer of. the oil spraying apparatus fop a PT-17 (Stearman) airplane on the width of the swath and ianount recovered of No® 2 Diesel oil released at a height of 50 feet from an airplane flying cross wind® Flight Number Size of Outlet Distance between Orifices Range of Average Drop Diameters Average Drop Diameter Temper- ature Quarts Released per min. Quarts Recovered per min0 Percent Lost Effective Swath Width Average Coverage (Inches) (inches) (ram) (ram) (Fahr) (Feet) 'qts/aore 12* 3/4 Flush 014-o40 024 68 34 29o7 1Z% 50 2.7 8 3/4 Flush 0 09-o60 o23 93 34 29o0 1Z% 50 2.6 ' 13* 3/4 3/8 009-.23 0I6 76 34 32o0 6% 60 2o9 2 3/4 3/4 011-037 o206 90 34 I80O 47% 40 1.6 3 3/4 11/2 012-o65 024 92 34 9o0 74% 10 1.5 11 3/4 11/2 olO—o 26 »165 ' 93 \ 60 *7 34 9o6 72% 10 1.6 18* 3/4 3 916—0 35 o22 . 34 30»0 12% 40 4.0 14* 3/4 3 010-o 40 <>21 80 34 29.7 1Z% 50 3o3 7 3/4 3 •10-o76 ©286 93 34 10.0 71% 30 1.7 Notes Table 2. Flights in which the jump cards were placed at 10 foot intervals in the series; in all others the card interval was 30 feet. ■<* Table The effect of change in temperature and variation of the distance between the orifices of the atom- 3* izer of the oil spraying apparatus for a PT-17 (Stearman) airplane on the width of the spray swath and amount recovered of No0 2 Diesel oil released at a height of 50 feet from an airplane flying up windo - Flight Number Size of Outlet Instance between Orifices Range of Average Drop Diameters Average Drop Diameter Temper- ature Quarts Released per min0 Quarts Recovered per min0 Percent ; Effective Swath Width Average Coverage (Inches) ( Inches) (mm) (ram) (Fahr) (Feet) 16* 3/4 Flush 013-0 26 o20 84 34 27 20% 50 3o5 9 3/4 Flush •14-021 0I6 93 34 6 82 % 30 loO 1 3/4 3/4 010—»30 0I6 88 34 30 12% 30 5o0 10 3/4 1 l/2 •13-o16 e 15 93 34 2o5 95% none — 4 3/4 1 1/2 ©12-o23 017 93 34 6 82% 30 loO 17* 3/4 3 ol0-o26 0I6 60 34 32o6 4% 40 3o 7 5 3/4 3 oIS-o16 ol5 93 34 3o 3 91% none — Notes * Flights in which the jump cards the card interval vra.s 30 feet® Table 30 were placed at 10 foot intervals in the series 5 in all others Airplane Direction Flight Up Wind Wind Velocity 8 miles per hour Altitude 50 ft, Temperature 88 Fo Airplane Speed SO miles per hour Larvioide Used5% DDT in Nq0 2 Diesel oil Flight Size of Quarts Distance Paper Distance dumber Average Materia]) DDT Effective Number Outlet per between Number from Drops per Drop per per Swath Minute Orifices Spray Traci Sqa Inch Diameter Acre Acre Width (inches) Discharged Inches Feet m/m Qts Lbs XXXX 1 o75 34 o75 3R 90 2R 60 Figuring an effective swath width of 33 feet# the following results IE 30 4 .10 «01 © 001 were obtained: 1). 6 acres covered per min* 1 - 0 54 .3 4.99 .55 XXXX 2). Average of 5 qts recovered 1L 30 9 .10 .03 .003 per acre. 3). 34 qts released per minute. 2L 60 4). 30 qts recovered. 3L 90 Table 3a« Airplane PT-17 Direction Flight Cross Wind Wind Velocity 8 miles per hour Altitude 50 ft® Temperature 90 Fo Airplane Speed 90 miles per hour Larvicide Used 5% DDT in $2 Diesel oil Flight Number Size of Outlet Quarts |Distance per [between Minute [Orifices Paper Number Distance from Spray Track Humber Drops per Sq* Inch Average Drop Diameter Material per Acre ' DDT per Acre Effective Swath Width Inches Discharged Inches Feet m/m Qts Lbs XXXX 2 o5 34 o75 1 0 1 2 30 0 Figuring an effective swath width of 60 feet, the following results 3 60 12 o37 2.11 .23 XXXX were obtained: 4 90 17 .27 1.16 .13 XXXX 1). 11 acres covered per minute* 2). Average of 1.6 qts recovered 5 120 . 19 ol8 .38 .04 per acre. 3). 34 qts released per minute. 6 150 3 .16 .04 .004 4)c 18 qts recovered* 7 180 205 .11 .01 .001 8 210 1.5 .15 .02 .002 9 240 0 Table 3b. Airplane PT-17 Direction Flight Cross Wind Wind Velocity 8 miles per hour Altitude 50 fto Temperature 92 Fo Airplane Speed 90 miles per hour Larvicide Used 5% DDT in #2 Diesel oil Flight Size of Quarts Distance Paper Distance Number Average Material DDT Effective Number Outlet per between Number from Drops per Drop per per Swath Minute Orifices Spray Track Sq Inch Diameter Acre Acre Width Inches Discharged Inches Feet m/m Qts libs XXXX 3 o75 34 lo5 1 0 m 2 30 o 5 o 65 ,48 • 05 Figuring an effective swath width of 33 feet, the following results 3 60 14 ,31 1,45 o 16 XXXX were obtained: 4 90 7o 5 • 20 .21 ,02 l)o 6 acres covered per minute. 2), Average of lo5 qts recovered 5 120 5.5 • 12 • 03 • 003 per acre. 3)o 34 qts released per minuteo 6 150 2 • 12 ,01 ,001 4), 9 qts recoveredo 7 180 o5 ,14 ,004 ,0004 8 210 o25 ,13. ,002 ,0002 9 0 0 Table 3o. Airplane PT-17 Direction Flight Up Wind Wind Velocity 8 miles per hour Altitude 50 ft0 Temperature 95 F. Airplane Speed 90 miles per hour Larvicide Used 5% DDT in #2 Diesel oil Flight Number Size of Outlet Quarts per Minute Distance between Orifices Paper Number Distance from Spray Track Number Drops per Sq Inch Average Drop Diameter Material per Acre DDT per Acre Effective Swath Width Inches Discharged Inches Feet m/m Qts Lbs XXXX 4 .75 34 1.5 3R 90 0 2R 60 .5 .17 .008 .0008 Figuring an effective swath width of 33 feet, the following results 1R 30 .5 .12 .002 .0002 were obtained: 1 0 23 .23 .97 .11 XXXX l)c 6 acres covered per minute. 2). Average of I qt. recovered per 1L 30 11 .16 .16 .02 acre. 3). 34 qts released per minute. 2L 60 0 4). 6 qts recovered. Table 3d. Airplane PT-17 Direction Flight Up Wind Wind Velocity 8 miles per hour Altitude 50 ft0 Temperature 95 Fc Airplane Speed 90 miles per hour Larvicide Used b% DDT in :§2 Diesel oil Flight Size of| Quarts [Distance Paper Distance Number Average Material DDT Effective Number Outlet j per [between Number from Drops per Drop per per Swath j Minute [Orifices Spray Track Sq Inch Diameter Acre Acre Width Inches (Discharged! Inches T*eet IT m/m Qts Lbs XXXX 5 o75 j 34 3 3R 90 2R 60 27 o 16 o38 o O With three (3) inches between orifices on the Venturi the oil 1R 30 29 o!6 o 41 ,05 was so finely atomized that very little of it reached the ground 1 0 15 .13 .11 ,01 at a temperature of 93 F. 1L 30 2L 60 3L 90 Table 3e. Flight Size of Quarts Distance Paper Distance Number Average Material DDT Effective Number Outlet per between Number from Drops per Drop per per Swath Minute Orifices Spray Track Sq Inch Diameter Acre Acre Width Inches Discharged Inches Feet m/m Qts Lbs XXXX 6 .75 34 3 2R 0 0 l 1R - 30 18 • 24 .86 .09 With three (3) inches between orifices on the Venturi the oil 1 0 15 .23 .63 .07 was so finely atomized that very little of it reached the ground at 1L 30 17 .22 .63 .07 a temperature of 93 F. * 2L 0 0 Table 3f. Airplane PT-17 Direction Flight Up Wind Wind Velocity 8 miles per hour Altitude 100 ft* Temperature 95 F» Airplane Speed 90 miles per hour Larvicide Used 5% DDT in #2 Diesel oil Airplane PT-17 Direction Flight Gross Wind Wind Velocity 8 miles per hour Altitude 100 ft© Temperature 95 Fo Airplane Speed 90 miles per hour Larvicide Used 5% DDT in #2 Diesel oil Flight Size of Quants Distance Paper Distance Number Average Material rDDT Effective Number Outlet per between Number from Drops per Drop per per Swath - Minute Orifices Spray Track SqQ Inch Diameter Acre Acre Width Inches Discharged Inches Feet m/m Qts Lbs (W 7 ,75 34 3 1 Q v ' i 2 : 30 * ,25 .76 ,38 .04 i Figuring an effective swath width i ► * of 33 feet, the following results 3 60 16,00 .31 1,65 .18 xxxx were obtained: 4 90 19*5 ,15 ,23 .03 j l)o 6 acres covered per minute,, 2). Average of 1,7 qts recovered 5 120 15.75 ,11 ,07 .007 per acre* 3). 34 qts released per minute. 6 150 4.75 .10 ,02 .002 4), 10 qts recovered* Table 3g, Airplane PT-I7 Direction Flight Cross Wind Wind Velocity 8 miles per hour Altitude 50 ft© Temperature 95 Fe Airplane Speed 90 miles per hour Larvicide Used5% DDT in #2 Diesel oil Flight Sise of Quarts Distance Taper p Distance 1 Number [Average Material DDT Effective dumber Outlet per betwe en Number from Drops per Drop per per Swath Minute Orifices Spray Track Sq® Inch Diameter Acre Acre Width Inches Discharged inches Feet m/m Qts Lbs Ixxxx 8 o75 34 0 1 0 2 30 9c 05 o60 6® 93 o 76 XXXX Figuring an effective swath width of 60 feet* the following results 3 60 25o0 e28 I© 94 »21 XXXX were obtained; l). 11 4 90 19o0 o 21 o 62 c07 acres covered per minute® 2)0 Average of Zo6 qts covered per 5 120 4® 75 o 16 o07 o007 acre. 3). 34 qts released per minute® 6 150 60 75 o 17 o 12 .01 4)e 29 qts recovered® 7 180 6.5 c 12 »04 .004 8 210 7.75 *09 .02 .002 9 240 0 * Table 3h. Airplane PT=17 Direction Flight Up Wind Wind Velocity 8 miles per hour Altitude 50 fto Temperature 95 F. Airplane Speed 90 miles per hour Larvicide Used5% DDT in $2 Diesel oil Flight Size of Quarts Distance Paper 1" Distance Number Average Material i ggf-" Effective Number Outlet per between Number from Drops per Drop per per Swath Minute Orifices Spray Traci! Sq. Inch Diameter Acre Acre Width Inches Discharged Inches Feet m/m Qts Lbs TxoT' 9 a 75 34 0 5R 150 4R 120 0 Figuring an effective swath width of 33 feetj, the following results 3R 90 c25 o 14 .002 .0002 were obtained: 2R 60 *25 ,12 .001 .0001 l). 6 acres covered per minute. 2), Average 1 qt recovered per acre , 1R 30 29.00 .21 .93 .10 xxxx 3). 34 qts released per minute* 4). 6 qts recovered* 1 0 16.75 .18 .34 .04 1L 30 .25 .14 .002 .0002 • 2L 60 0 Table 3i. Airplane PT-17 Direction Flight Up Wind Wind Velocity 8 miles per hour Altitude 50 fto Temperature 95 Ft> Airplane Speed 90 miles per hour Larvicide Used 5% DDT in jf-2 Diesel oil Flight Number Size of Outlet Quarts per Minute Distance between Orifices Paper Number Distance from Spray Track Number Drops per Square Inch Average Drop Diameter Material per Acre DDT per Acre Effective Swath Width Inches Discharged Inc he s Feet m/ra Qts Lbs xxxxx 10 o?5 34 1,5 3R . - 2R 0 0 No effective swath width due to distance between orifices on the 1R 30 19 o 15 .22 .02 Venturi and the temperature,, 1 0 28.75 e 16 .41 .05 » 1L 30 10.00 .13 .07 .007 EL 60 0 3L Table 3j. Airplane PT-17 Direction Flight Cross Wind Wind Velocity 8 miles per hour Altitude 50 fto Temperature 95 Fo Airplane Speed 90 miles per houre Larvicide Used 5% DDT in 2 Diesel oil FX1. glrti Number Sl2© Of Outlet Quarts per Minute Distance between Orifices Paper Number Distance from Spray Track 1 dumber Drops per Square Inch Average Drop Diameter j Material per Acre DDT per Acre Effective Swath Width Inches Discharged inches Feet Qts Lbs xxXx~ 11 7C o i O 34 1*5 1 0 0 * 2 30 * 75 *25 *04 *004 Figuring an effective swath width of 33 feet„ the following results were 3 60 26*00 .26 1.59 *18 xxxx obtained* 4 90 27*5 *12 a 17 *02 l)o 6 aores covered per minute* 2)a Average of 1*6 qta recovered 5 120 8.0 *15 *09 *009 per acfe. 3). 34 qts released per minute. 6 150 8.25 .15 *10 *01 4)® 9*6 qts recovered* 7 180 6.5 .13 .05 .005 8 210 6*5 *10 .02 .002 9 240 0 Table 3k. Airplane PT-17 Direction Flight Gross Wind Wind Velocity 2-3 miles per hour Altitude 50 fto Temperature 68 F. Airplane Speed 90 miles per hour Larvicide Used 5% DDT in $Z Diesel oil Flight Size Quarts Distance Paper Distance Number Average Material DDT Effective Number of per between Number from Drops per Drop per per Swath Outlet Minute Orifices Spray Track Sq« Inch Diameter Acre Acre Width Inches Discharged Inches ——__—- *eet m/m Qts Tibi XXXX 12 .75 34 0 1 0 0 0 . ... 2 10 10 .4 2.31 .25 XXXX Figuring an effective swath width V . of 60 feet, the following results 3 20 20 ,4 4.5 .49 XXXX irerm obtained: 4 30 35 .34 4.44 .48 XXXX 1). 11 acres covered per minute. 2). Average of 207 qts recovered 5 40 50 .23 2.6 .28 XXXX per minute. ♦ 3). 34 qts per minute released. 6 50 65 o 17 1.04 .11 XXXX 4). 29 .7 qts recovered. 7 60 55 .19 1.37 .15 XXXX 8 '70 38 • 14 .30 .03 9 80 40 .16 .58 .06 10 90 58 .15 .61 .06 • 11 100 Table 31. ——. Airplane PT~17 Direction Flight Cross Wind Wind Velocity 4 miles per hour Altitude 50 fto Temperature ! t 76 Fo Airplane Speed_ 90 miles per hour v Larvioide Used 5% DDT in #2 Diesel Oil Flight Size of Quarts Distance Paper Distance Number | Average Material DDT Effective Number Outlet per between Number from Drops per Drop per per Swath Minute G 'rifices Spray Track Sq. Inch Diameter Acre i Ac i4© Width Inches Discharged Inches *eet m/m Qts Lbs. XXXX 13 .75 34 o 37 1 2 0 10 0 24 0 oil ; o 05 ’ .06 Figuring an effective swath width ol 60 feet a the following results were 3 20 110 .23 4.7 ,52 XXXX obtained: : ■ 4 30 90 .23 3.3 .36 XXXX 1). 9 acres covered per minute. 2), Average of 2.8 qts recovered 5 40 no .18 2.35 .15 XXXX per acre# - 3). 34 qts per minute released. 6 50 85 .2 2.24 .14 XXXX 4). 25 qts recovered. 7 60 85 .17 1.28 .13 XXXX 8 70 85 .11 .3 .033 9 80 60 .11 .23 .025 - 10 90 40 .09 .1 .01 11 100 Table 3m. Airplane PT-17 Direction Flight Cross Wind Wind Velocity 5-6 miles per hour Altitude 50 fto Temperature 80 F. Airplane Speed 90 miles per hour Larvicide Used 5% DDT in #2 Diesel oil Flight "umber Size of Outlet Quarts per Minute Distance between Orifices Paper Number Distance from Spray Track Number Drops per Sq Inch Average Drop Diameter Material per Acre f DDT per Acre Effective Swath Width Inches Dischargee Inches Feet m/m Qts Lbs XXXX 14 .75 34 3 1 0 0 0 0 0 2 10 10 ,4 2.1 .23 XXXX Figuring an effective swath width of 50 feet, the following results 3 20 80 .25 4.1 .45 XXXX were obtained: 4 30 70 .31 7.1 .78 XXXX l). 9 acres covered per minute. 2), Average of 3,3 qts recovered 5 40 92 .19 2.1 .23 XXX per acre. 3). 34 qts per minute released. 6 50 33 .23 1.4 .15 XXXX 4), 29. 7 qts recovered. 7 60 54 ,1 .1 .01 8 70 55 .11 .2 .02 9 80 60 .1 .16 .017 10 90 Table 3n. Flight Size of Quarts Distan.ce Paper Distance Humber Average TSaterial DDT "Effective Humber Outlet per between Humber from Drops per Drop per per Swath Minute Orifices . Spray Track Sq3 Inch Diameter Acre Acre Width Inches Discharged Inches Feet m/i Qts Lbs 16 o75 34 0 2R 20 5 .21 .16 .017 1R 10 25 0 26 lo 5 .16 XXXX Figuring an effective swath width of 50 feet, the following results 0 0 60 .22 2.4 c 26 XXXX were obtained; 1L 10 180 .19 4.2 .46 XXXX 1), 7. i 5 acres covered per minute0 2). Average of 3.5 qts recovered 2L 20 250 .2 6,6 .73 XXXX per acre. 3), 34 qts per minute released. 3L 30 70 .23 3.0 .33 XXXX 4). 27 qts recovered. 4L 40 8 .13 .06 .006 5L 50 5 .15 .06 .006 Table 3o. Airplane PT°17 Direction Flight Up Wind Wind Velocity 5=6 miles per hour Altitude 50 fto Temperature ; 84 Fc Airplane Speed 90 miles per hour Larvicide Used 5% DDT in #2 Diesel oil Airplane PT-17 Direction Flight Up Wind Wind Velocity 1 mile per hour Altitude 50 ft* Temperature 60 Fc Airplane Speed 90 miles per hour Larvicide Used 5% DDT in #2 Diesel oil Flight Size of Quarts Distance Paper Distance Number Average Material DDT Effective Number Outlet per between Number from Drops per Drop per per Swath Minute Orifices Spray Track Sq. Inch Diameter Acre Acre Width Inches Discharged Inches Feet m/m Qts Lbs xxxx 17 o 75 34 3 R3 30 20 .10 .07 .008 R2 20 47 ,12 .29 .032 Figuring an effective swath width of 50 feet, the following results were R1 10 100 .21 3,0 .33 xxxx obtained: 0 0 100 .26 6.2 .68 xxxx l). 9 acres covered per minute;’ 2). Average of 3.7 qts recovered LI 10 130 .21 4.0 .44 xxxx per acre. 3). 34 qts per minute released. . L2 20 160 .18 3.0 .33 xxxx 4). 32. 6 qts recovered. L3 30 114 .18 2.2 .24 xxxx L4 40 38 .11 .16 .018 L5 50 24 .11 .05 .005 Table 3p. Airplane PT-17 Direction Flight Cross Wind Wind Velocity 1 mile per hour Altitude 50 ft* Temperature 60 Fo Airplane Speed 90 miles per hour LarTicide Used b% DDT in #2 Diesel oil Flight Size of Quarts Distance Paper Distance Number Average Material DDT : Effective Humber Outlet per between |;1'I mber from Drops per Drop per per Swath Minute Orifices Spray Track Sq« Inch Diameter Acre Acre Width Inches Dischargee i| Inches Feet m/m Qts i»bs XXXX 18 o75 34 1 3 0 0 -j *'j ; i 10 81 o 26 2.2 o 24 XXXX Figuring an effective swath width of 40 feet a the following results were 2 20 70 <»35 10® 1 Id XXXX obtained: 3 30 34 0 25 1*9 8 2 XXXX l)o 7o 5 acres covered per minute® r 2)0 Average of 4 qts recovered per 4 40 32 .25 2o0 .22 XXXX acre® 3). 34 qts per minute released. 5 50 40 o 16 «58 .06 4). 30 qts recovered® 6 60 31 .17 .58 .06 7 70 23 .16 .48 .05 8 80 20 .16 .41 .04 9 90 11 .2 o 30 .03 Table 3q. Page 25 missing Pilot Comments: The 225 horsepower Continental engine is capable of carrying the load with sufficient reserve to meet emergencies en- countered in low level flying such as obstacles requiring quick pull- ups* The original propeller was flattened one degree to allow the use of a higher r*p*m* which facilitates take-offs and pull-ups* There is no noticeable change in the attitude of the plane when flying with the tank empty, but when loaded with oil, which adds about 425 pounds weight, it is necessary to use about four degrees trim tab on the elevator* The tank was constructed without baffles* The pilot has noticed that the unobstructed flow of oil and the quick shifts of its weight during turns causes sudden changes in the attitude of the plane and thinks that baffles in the tank which would greatly retard changes in the position of the liquid would add greatly to the maneuverability* The PT-17 (Stearman), with regular maintenance, requires no more mechanical attention for the work of the larvicidal oil spraying than for the purpose for which it was built, that of training flying students; it used 80 octane gasoline, which is generally available, and its gas consumption is such as to give good economy of operation for the load carried* The PT-17 can be flown from small and improvised landing fields, and the excellent visibility and maneuverability fully meet the requirements of low level flying. Figures 2 and 3 show the airplane at work spraying canals in the Leghorn area* Notice that the altitude at which the plane can be flown makes careful placement of the spray possible* Figures 3a and 3b show the discharge apparatus* Figure 2. The PT-17 (Stearman) airplane spraying a canal with DDT in oil; notice the stream of spray dropping dir- ectly into the canal. Figure 3. The PT-17 (Stearman) oiling airplane flying down a large canal in the Leghorn area; the widening stream of spray fog can be seen flowing past the under surface of the tail. Figure 3a. Front view of oil discharge apparatus (PT-17) showing adjustable Venturi sleeve. Figure 3b. Side view of oil discharge apparatus (PT-17) showing adjustable Venturi sleeve. APPENDIX 32y III. OIL SPRAYING APPARATUS FOR THE AIRPLANE, A-20, U.S.A.A.P. The position of the tank and the oil spraying apparatus in the A-20 airplane and detailed drawings of the valve and atomizing apparatus are shown in Figure 40 As shown in the drawing, the tank is mounted at the bottom of the bomb bays. Mo difi cat ions of the reservoir tank: The shape and dimensions of the reservoir tank used in the A-20 airplane are shown in Figures 5 and 6 which illustrates the plans for the tanks mounted in the airplanes in the spring and prior to the tests leading to the modifications shown in Figure 4 and described below0 The filler pipe was extended upwards from the top of the tank and curved toward the right side of the airplane and connected to an opening through the side of the fuselage, at a point about 2/3 of the distance above the bottom, into which the filler cap had been mounted, Thereby, the tank may be filled through an external opening which may be reached from the ground, and spilling of oil inside the airplane due to care- lessness is minimizedo Since there are transverse reinforcements of the bomb bays, a con- striction had to be built in the tank at about the midpoint of its length in order to fit it into the bomb bayj this constriction, in effect, di- vides the vessel into two compartments, During filling, the filler tube acts as an air vent for the forward compartment of the container, but a vent had to be provided for the rear compartment. This was done by ex- tending a 1 l/4 inch line from the top of the tank to the top of the bomb bay; an air tight valve is opened allowing air to escape, but when the tank is full, the valve is closed manually. The fluid sealed air vent, described in the introduction, was intro- duced into the rear compartment of the tank; its position is shown in Figure 4, Valves A three inch gate type valve was placed in the discharge line at its connection to the tank. An A-20 Cowl Flap Actuating Cyl- inder (hydraulic) was used as the mechanism to open and close the valve; the control lever for hydraulic pressure was put in the pilot’s cockpit. Control of the rate at which the liquid is released from the tank by the extent to which the valve was opened was triedo For this purpose it was desired to open the valve to expose a surface area the equivalent of that of a pipe one inch in diameter, two inches in diameter, etc* The valve was calibrated according to the calculations shown in Plate Ij the calibrations are shown in the form of a curve in Figure 70 Setting of the valve for a given surface area was obtained by putting an adjust- /.■• = 2 h j-md - 2 ( ?*a) ; "■ ,~: •- rc j/w 5X ~rV 1XXiRj") r2 - : F * n) 2 (Jrc sin 2 (Fi - sfi* ??-1 2 ) ■iF0S3 f - KR2 " n ~ t2 F = F06S i /:,f J'l/i rf2 - r Z & S % Re / r - Fi - r2 PIATE I* Reference diagram of gate valve mechanism and calculations used to determine the surface area of the opening eaposed as the gate valve is lifted. APPENDIX 32. It*u I sii J otrc J t £0 P"** I*-4-4*' 1 S U** N. 022/HSCMC £655 MALARIA CONTROL DETACHMENT US. ARMY A -20 AIRPLANE EQUIPPED FOR DDT AND OIL SPRAYNG Figure 4, I * 8 ,0 it * , M * $ I fit ill |M* 5iB HI; M 5- 5 H j ii-l l*S I lid Hpnli Pt*n Y** or r*nt< trsMMat-r J/oe- MnrJwnmw ifixMKM Ur*//- JUXI#--' -/*w iEW^l On /mm tmrnummv Chrn/mm . - MO _ wxy- APPENDIX 32dd able shoulder type stop on the stem of the hydraulic actuating cylinder; set screws held the stop fixed in the setting desired. Thus the hydraulic cylinder raised the gate of the valve the distance allowed by the stop. The position of the shoulder type stop with relation to the valve and the hydraulic actuating cylinder is shown in Figure 4. It was found however, that when the terminal orifice of the pipe was larger than the opening of the valve, the liquid did not flow out of the pipe evenly but spurted and bubbled. This bubbling was checked by putting a washer having an inner circle of the desired diameter in the discharge orifice; the washer was held in place by a screw cap on the end of the pipe. The diameter of the discharge orifice could be changed by the use of washers with inner circles of different diameters. The valve was then set to correspond with the diameter of opening used Sat the end of the pipe. Atomizing apparatus: The atomizer is essentially the same as that previously described for the PT-17 airplane and consists of a truncated cone six inches in diameter at its open base and four inches in diameter at its top. It was mounted over the pipe with its long axis parallel to the pipe. The cone may be moved forwards or backwards along the pipe, but is held in place at any desired setting by a set screw. Figures 11, 12, 13, 14, 15, 16, and 17 show the airplane at work in the Pisa area. Figure 11. Loading an A-20 with larvicide by means of a small gasoline engine driven rotary pump. Figure 12. A-20 demonstrating oil larviciding over Pisa-Leghorn barge canal. (Note oil-discharge pipe) APPENDIX 32 hh Figure 13. A-20 demonstrating oil larviciding margins of Pisa-Leghorn barge canal, (Elevation of plane approximately 25 feet). Figure 14, A-20 discharging 5% DDT in Diesel Oil Larvicide on small canal near Pisa, Italy, (Eleva- tion of plane approximately 35 feet). APPENDIX 32ii Figure 15. A-20 discharging b% DDT in Diesel Oil Larvicide on small canal near Pisa, Italy. (Eleva- tion of plane approximately 50 feet. Figure 16. A-20 demonstrating oil larviciding over field near Pisa, Italy, (Elevation of plane approx imately 35 feet). APPENDIX 32Jj Figure 17, Venturi sleeve on A-20 oiler (rear view showing discharge pip© within sleeve)* APPENDIX 32kk Performance Determination of rate of discharge: When the reservoir had been equipped with the fluid sealed air vent to balance the effect of static head pressures a sight gauge calibrated in gallons for the capacity of the tank was mounted externally to the tank in such a position that a person riding in the rear or tail gunner’s cockpit could read the gauge,, Test flights were then made to determine the rate of discharge; an observer riding in the rear cockpit read the gauge and recorded the gallons flowing out of the tank each minute from the time the valve was opened until the tank was empty 0 These flights showed that the liquid flowed out of the tank at an even uniform rate throughout the period the container was emptying; results of various flights are shown in Table 4. Table 4« The effect of various valve openings and diameters of the terminal discharge orifice on the rate of discharge in gallons per minute; the total time required for the 300 gallon tank to empty and linear distance covered during that period with the A-20 airplane flying 303 miles per minute* Number of Trials Valve Opening (inches) Diameter Terminal Orifice (inches) Rate of Discharge (gals/min) Total Time Required to Empty Tank (minutes) Linear Spray Track Covered (miles) 7 o71 1 21o5 14o0 460 2 10 lo 03 1 1/2 40o0 7o5 24c 7 5 . lo 5 2 66o0 4o 5 13 o 2 Coverage: Determination of coverage of sprayed surface was done according to the manner and methods already described for the PT-17 (Stearman)„ The results of the spray trials with the A~20 are summarized in Table 5 and are presented in greater detail in the tables following it which show the data for each individual flighto Table The effect of change in temperature and variation of the distance between the orifices of the atom~ 5o izer of the oil spraying apparatus for an A-20 airplane on the width of the spray swath and amount recovered of Noc 2 Diesel oil released at a height of 50 feet from an airplane flying cross windo Flight Number Size of Outlet Distance between Orifices Range of Average Drop Diameters Average Drop Diameter S1 © 0 L® -e £ * _ Quarts Released per mine Quarts Recovered per min Percent Lost Effective Swath Width I Average Coverage (Inches) (Inches) (mm) (mm) (Fa.hr) (feet) (qts/acre) 4 loO loO .11- o 24 o 17 88 86 42,0 50% 60 1,1 12 lo 5 Flush o 18= o 22 o 19 62 160 152,0 5;% 100 3.8 11 lo5 lo5 o 12= ,23 .18 62 160 152,0 5% 160 2,3 2 lo 5 lo5 .12- 024 .14 80 160 6,88 95% none 3 lo 5 lo 5 c 13- .29 .16 86 160 23.86 85% none — 10 lo 5 4o0 o 13- o20 .16 60 160 150,0 6% 140 2,5 13 lo5 4o0 o 15“ ®19 o 17 80 160 145,0 10% 160 2,2 6 2o0 2o0 .10- ®30 o 16 94 264 100,0 62% 80 2,6 7 2o 0 3o0 .10- <>29 o 15 94 264 42,0 84% 20 3,2 8 2o0 4<>0 .12- .39 o 19 96 264 21,32 92% none — 9 2o0 5o0 . 14- .27 .18 98 264 20,39 92% none —- Table 5. Airplane A=20 Direction Flight Up Wind Wind Velocity 3 miles per hour Altitude 50 ffco Temperature - 80 Fa Airplane Speed 200 miles per hour Larvicide Used 5% DDT in #2 Diesel oil Flight Tsize of Quarts Distance Paper pDistance "Number Average Material’ DDT Effective Humber I Outlet per between Number 1 f^om Drops per Drop per per Swath Minute Orifices 111 1 Spray Track Sq= Inch Diameter Acre Acre Width j Inches Dischargee Inches Feet mm Qts Lbs XXXXX 1 1=5 160 1=5 6R 150 4 • 5R 120 4o 5 014 = 04 = 004 Figuring an effective swath width of 50 feetp the following results 4R 90 IloO = 16 = 16 = 02 were obtained: 3R 60 20o0 = 17 = 34 = 04 l)o 20 acres covered per minute. 2)o Average of 7ol qts recovered 2R 30 8O0O c2 2 = 2 = 24 XXXX per acreo - 3}o 160 qts per minute released. 1R 15 250o0 = 21 8=7 = 89 XXXX 4)o 142 qts recovered. 5)0 12$ lost by evaporation^, 1 0 120o0 = 3 11=2 1=27 XXXX 6)0 Larvae were killed in a 60 foot swath on this run0 The 1L 15 9.25 = 15 = 11 = 01 larvae were in dishes 15 feet apart0 2L 30 1=0 = 3 = 09 = 009 - ■ 3L 60 0*0 Table 5a. Airplane A=20 Direction Flight Cross Wind Wind Velocity 2 miles per hour Altitude 50 ft© Temperature 85 F. Airplane Speed 200 miles per hour Larvicide Used 5% DDT in $2 Diesel oil Flight Number Size of Outlet Quarts [Distance per between Minute (Orifices Paper Number Distance from Spray Track Number Drops per Sq0 Inch Average Drop Diameter Material per Acre DDT per Acre Effective Swath Width Inches Discharged Inches Feet mm Qts Mbs XXXX 2 1.5 160 1,5 1 2 0 30 - Effectiveness lost by evaporation. 3 60 0 0 ■ 4 90 7.5 .135 .08 .009 5 120 7.25 .24 .34 .04 6 150 4.5 .126 .04 .004 7 180 4.0 .12 .02 .002 8 210 6.5 .123 .04 .004 • 9 240 1.75 .125 .01 .001 10 270 5.25 .123 .03 .003 11 300 1.25 .128 .006 .000', Table 5b.' 43 Airplane A-20 Direction Flight Cross Wind Wind Velocity 2 miles per hour Altitude 50 ft© Temperature ~ 86 Fo Airplane Speed 200 miles per hour Larvicide Used 5% DDT in $2 Diesel oil Flight Number Size of Outlet Quarts per Minute Distance tween Orifices Paper Number Distance from Spray Track Number Drops per Sq0 Inch Average Drop Diameter Material per Acre DDT per Acre Effective Swath Width Inches Discharged Inches i’eet mm Qts Lbs XXXX 3 1.5 160 1.5 1 0 0 I 2 30 0 Effectiveness lost due to evaporation# 3 60 0 4 90 9.5 .29 .80 .08 • 5 120 20.0 .21 .64 .07 6 150 20.5 .18 .41 .05 • 1. 7 180 11.0 .13 .08 .008 8 210 9.25 .13 .07 .007 9 240 16.75 .13 ,13 .01 10 270 12,0 .14 .11 .01 m 11 300 12,0 .14 .11 .01 12 330 12,0 .14 .11 .01 13 330 11.5 .13 .08 .008 •* . Table 5c. i ill HIM n ii Flight Size of Quarts Distance Paper Distance Number Average Material DDT Effective Number Outlet per between Number from Drops per Drop per per Swath Minute Orifices Spray Track Sqe Inch Diameter Acre Acre Width Inches Discharged 1nches Feet mm Qts Lbs XXXX 4 1 86 1 5R 120 4R • 90 4 .13 to o « .003 Figuring an effective swath width of 90 feet, the following results 3R 60 24.5 .24 1.2 .13 XXXX were obtained: 2R 30 25.0 .215 .9 .1 XXXX 1). 38 acres covered per minute. 2). Average of 1.1 qts recovered 1R 15 22.5 .24 1.1 .12 XXXX per acre. 3). 86 qts per minute released. 1 0 19.0 .2 .5 .06 4). 42 qts recovered. 5). Lost 50$ by evaporation. 1L 15 14.5 .14 .14 .015 2L 30 9.5 .11 .08 .009 - 3L 60 7.0 .13 .05 .006 4L 90 3.0 .125 .02 .002 Table 5d. Airplane A-20 Direction Flight Up Wind Wind Velocity 2 miles per hour Altitude 50 rta temperature 88 Airplane Speed 200 miles per hour Larvicide Used 5% DDT in jfe Diesel oil Airplane A°2Q Direction Flight UP Wind Wind Velocity 5 miles per hour Altitude 50 fto Temperature 90 Fa Airplane Speed 200 miles per hour Larvicide Used 5% DDT in Diesel oil Flight Number Size of Outlet Quarts per Minute Distance between Orifices "Paper dumber Distance from Sprvay Track dumber Drops per Sq, Inch Average Drop Diameter Material per Acre DDT per Acre Effective Swath Width Inches Released Inches ieet mm Qts Lbs XXXXX 5 2 264 2 6R 150 5R 120 I 'J f Figuring an effective swath width of 180 feet, the following results 4R 90 were obtained; 3R 60 18.25 *14 ‘ .17 .02 1). 73 acres per minute covered* • 2). Average of 2*2 qts recovered 2R 30 25*5 *28 2*0 *22 XXXX per acre„ • • 3)o 264 qts per minute released* 1R 15 33*5 *23 1*4 .15 XXXX 4). 160 qts recovered. 5)o lost by evaporation,, 1 0 64*0 *26 3*9 .43 XXXX 1L 15 54*0 *28 4*1 .45 XXXX 2L 30 48.0 *26 2.9 .32 XXXX 3L 60 14*5 .26 *9 .1 XXXX 4L 90 8*5 *31 *9 .1 XXXX 5L 120 16*75 .28 1.3 .14 XXXX 6L 150 NO PAPERS Table 5e. Airplane A-20 Direction Flight Cross Wind Wind Velocity 4 miles per hour Altitude 50 ft» Temperature " 94 F. Airplane Speed 200 miles per hour Larvicide Used 5% DDT in $2 Diesel oil Flight Size of Quarts Distance Paper Distance Number Average Material DDT Effective Number Outlet per between Number from Drops per Drop per per Swath Minute Orifices Spray Track Sq. Inch Diameter Acre Acre Width Inches Discharged Inches Feet irnmn Qts Lbs XXXX 6 2 264 2 1 0 0 0 . ' 2 30 25 .3 2.28 .25 XXXX Figuring an effective swath width : r ,, V r- ; V of 90 feet, the following results 3 60 54 .28 4.1 .45 XXXX were obtained: ' 4 90 40.75 .22 1.5 .165 XXXX 1). 38 acres per minute covered. 1 ! ... V? ■ | 2), Average of 26 qts recovered 5 120 8.0 .21 .26 .029 per acre. 3)* 264 qts released per minute. 6 150 8.0 .14 .07 .008 4). 100 qts recovered. „ \ | 5). 62% lost by evaporation © 7 180 6.75 .1 .024 .0026 8 210 5.0 .1 .02 .002 9 240 4.5 .11 .02 .002 10 270 4.0 .11 .014 .002 11 300 5.0 .12 .02 • 002 12 330 5.0 .11 .02 .002 13 360 NO PAPERS Table 5f. 47 Airplane A-20 Direction Flight Cross Wind Wind Velocity 4 miles per hour Altitude 50 fto Temperature . 1 . ■ r ' ’ 94 Fo Airplane Speed 200 miles per hour Larvicide Used 5% DDT in #2 Diesel oil i t T ' Flight Size of Quarts Distance Paper Distance 1 dumber ■ Average • Material DDT Effective Number Outlet per between Number from Drops per Drop per per Swath Minute Orifices Spray Track Sq. Inch Diameter Acre Acre Width Inches Discharged Inches Feet mm Qts libs XXXX 7 2 264 3 1 2 03 0 0 ? t ■ \ ■ Figuring an effective swath width oi • 1 *, • • 30 feet. the following results were 3 60 i ■ obtained: 4 90 38 .29 3.22 .35 XXXX 1), 13 acres covered per minute. * 2). Average of 3.2 qts recovered 5 120 29 .15 .34 .04 per acre. 3). 264 qts released per minute. 6 150 11 .14 .10 .01 4). 42 qts recovered. * v 5). 84$ lost by evaporation. 7 180 8.25 .18 .17 .02 8 210 12 .12 .07 .008 9 44Q 12.2 .14 .12 .01 10 270 14 .12 .08 .008 11 300 24 .10 .08 .008 - 12 13 330 360 14.5 NO PAPERS .12 .09 .009 Table 5g. Airplane A-20 Direction Flight Cross Wind Wind Velocity 4 miles per hour Altitude 50 ftc Temperature 96 F. Airplane Speed 200 miles per hour Larvicide Used 5% DDT in #2 Diesel oil Flight Size of Quarts Distance Paper Distance Number Average Material DDT Effective Number Outlet per between Number from Drops per Drop per per Swath Minute Orifices Spray Track Sq, Inch Diameter Acre Acre Width Inches Discharged Inches Feet Iran Qts t 7 130 19 .19 .5 .055 Table 51. Airplane A°20 Direction Flight Cross Wind Wind Velocity 2 miles per hour Altitude 50 ft3 Temperature 80 Fo Airplane Speed 200 miles per hour Larvioide Used 5% DDT in $2 Diesel oil Flight Number Size of Outlet Quarts per Minute Distance between Orifices Paper Number 1 Distance from Spray Track [Number Drops per Sq* Inch Average Drop Diameter per Acre DDT per Acre Effective Swath Width Inches discharged ■Inches J’eet mm Qts Lbs XXXX 13 1*5 160 4 2 20 270 *15 3*0 *33 XXXX 3 40 220 *17 3*7 *407 XXXX Figuring an effective swath width of 160 feet* the following results 4 ' 60 213 *16 2,9 ■ *319 XXXX were obtained; . w ' ‘ 5 80 140 *16 2*0 *22 XXXX l), 60 acres covered per minute* , 2)o Average of 2 *2 qts recovered 6 100 104 *16 1*5 .165 XXXX per acre* 4 3)o 160 qts per minute released* 7 120 75 .19 1.8 .198 XXXX 4)o 145 qts recovered* 5). lost by evaporation* 8 140 72 *16 1*0 .11 XXXX 9 160 60 .19 1.5 . .165 XXXX 10 180 60 .16 ,8 .088 11 200 21 .17 *4 .044 12 210 5 16*0 *07 .077 Table 5m. IV. DISCUSSION. Temperature: Very little oil is lost by evaporation at a tempera- ture of less than SO F. while more than half of the oil is lost at temperatures above 90 F. Atomization: Smaller and more uniform size drops are produced when the distance between the orifices on the Venturi is increased. Wind Velocity: The oil is most effectively applied at a wind velo- city of less than 5 m.p.h. Drift: With a wind velocity of 4 m.p.h. flying cross wind at an altitude of 50 feet the drift down wind is approximately 30 feet. Flying under the same conditions at an altitude of 100 feet, the drift is about doubledo Altitude: Apparently the effective swath width is not changed appreciably (eliminating the factor of evaporation) with altitudes above 50 feet0 However, the drift is increased. Effective Swath Width; The effective swath width varies with the amount of oil released per minute. For example, in the case of the PT-17, with a .75 inch outlet, the effective swath width is 50 feet, with a .5 inch outlet it is 32 feet5 while with a ,25 inch outlet the swath width is reduced to 16 feet. V. ENTOMOLOGICAL OBSERVATIONS. A small detachment from the 327th Ferrying Squadron, MATS estab- lished a base of operations at Pisa, Italy early in May 1945. In addi- tion to flying and ground personnel the detachment consisted of five (5) A~207s, one (1) PT-17 and one (l) L~5o Three (3) of the A=20*s were fitted for dispersing oil larvicide and two (2) for dispersing Paris green dust; in addition, the PT-17, which at the start of the season functioned as a duster, was later converted to an oiler. A description of these oiling planes, which were developed in this theater, together with a discussion of larvicide application has been given in the first part of this report. Unfortunately, due to insufficient trained inspectors as well as numerous setbacks, it has not been possible to carry on detailed entomological investigations. A few observations are available, and are reported here for what they are worth. The oiling planes commenced operations in the Pisa-Leghorn area on the 5th of June 1945. Ground surveys had been conducted and maps prepared for use by the pilots and for correlating air-plane larvicid- ing with larval collections. The area in question consists of a veritable network of long canals and interlocking ditches0 Many of tnese waterways are bordered by trees, end telephone and power lines; at frequent intervals the latter cross the canals, all of which tends to make flying at low levels dangerous, and the opportunity exists for a piece of canal near such an obstruction to receive little or no larvicide; likewise gusty winds may deflect portions of the oil stream away from the water sur- face o In spite of these hazards, it is felt that highly satisfactory results were obtained0 During June and a part of July, reliable entomological records are available which show the effectiveness of the larviciding0 On the 3rd of June, Area IV showed seventeen (17) stations positive for anopheline breedingo By the 7th of June, after one treatment by the A-20 of 5$ DDT in diesel oil, five (5) stations still remained anopheline positivec After one more spraying, only two stations were positive on the 19th of June, and by the 13th of July all stations were negative0 Similar re- sults were obtained in other areas where anopheline larvae had been present. Areas II and VI showed close to 90 reduction of both anopheline and culi- cine larvae after one month of larviciding by plane0 This suggests a cumulative DDT effect0 Late in the season several experimental runs were made by the PT-17 at GrossetOo An extensive canal system exists around Grosseto0 Many of the canals were heavily overgrown with horizontal and vertical vegetation, and, at the time of the experiments contained large numbers of both culi- cine and anopheline larvae0 On the 30th of August, 420 gallons of oil containing 5$ DDT were dispersed along the canals and ditches in the area, and again on the 4th and 5th of September, 500 gallons were applied0 Larval density has been reported in terms of "Few” (1-5 larvae in 10 dips), "Moderate11 (1-3 larvae per dip) and "Abundant" (5-10 larvae or more per dip)0 Reference is made to Table 6 and accompanying maps for results of larval collections before and after treatmente It will be noted that the first collections (before treatment) showed that 15 or 54$ of the 28 stations visited were mosquito positive (14 or 50$ harbored anophelines and 6 or 21$ harbored culicines)„ On the day following the first application of spray, the numbers of positive stations had been reduced to 11 (39$), of which 9 (32$) produced anophelines and 5 (18$) produced culcines; this represents a 36$ reduction in anopheline positive stationso Collections were made again on the 6th of September, the day following the second application of DDT larvicide* The number of mosquito positive stations remained the same (11), but the anopheline positive stations had been reduced to 4 (14$) and those harboring culi- cines had increased to 10 (36$); this represents a 71$ reduction of ano- pheline positive areas over the condition originally existing in the area* It will also be noted that the degree of larval density varied considerably in the three collections * Some stations9 which had few or no larvae in the first collections have been reported as having abundant numbers of larvae at the time of the third collection9 al- though the time interval could not have been much over a week. These results naturally reflect on the efficiency of the oil application9 however the thoroughness of the inspectors is likewise open to cri- ticism, The relative ineffectiveness in culicine reduction (64$) as compared with that of the anophelines (71$) is of considerable interesto The fact that the canals were heavily vegetated undoubted- ly was a prime factor in decreasing the larvicide’s efficiency. Table 6, Larval Collections after Airplane Larviciding in the Grosseto Area0 AREA 1st COLLECTION 1 2nd COLLECTION (before treatment) (Day after 1st Treat) 3rd COLLECTION 'Day after 2nd Treat) 1 Culex-lst & 2nd instar Moderate Anopheles-all stages Moderate Negative Culex-pupae-Few •* 2 Negative Negative Negative 3 Anopheles-all stages Few Negative Negative 4 Negative Negative Negative 5 Culex-all stages Abundant Anopheles - all stages - Abundant Culex-all stages Abundant Anopheles-all stag* Abundant Negative 9S 6 Negative Negative Negative 7 Anopheles-1st instar Few Culex-lst instar-f* 3w Culex-all stages- abundant 8 Negative Negative Negative 9 Culex-all stages - Abundant Culex-pupae-few Culex-all stages- Abundant 10 Anopheles-3rd instar Few Negative Culex-all stages-few n Negative Negative Negative 12 Negative Negative Negative 13 Negative Negative Culex-all stages- Abundant 14 Negative Negative Negative llJ Negative Negative Negative Table 60 (continued) AREA 1st COLLECTION (before treatment) 2nd COLLECTION (Day after 1st Treat) 3rd COLLECTION (Day after 2nd Treat 16 Anopheles-all stages Abundant Culex-all stages- Abundant Anopheles-all stages Abundant Culex-lst & 2nd instar- Few Anopheles-1st instar- Few 17 Anopheles-all stages Abundant Anopheles-all stages Abundant Anopheles-2nd and 4th instar & pupae - Few 18 . Anopheles-1st instar Few Culex-all stages- Abundant Anopheles-all stages Abundant Negative 19 Anopheles-a11 stages Moderate Anopheles-all stages Moderate Negative 20 Anopheles-all stages Moderate Culicine-all stages Abundant Anopheles-all stages Culex - all stages Abundant Negative 21 Anopheles-all stages Few Anopheles-all stages few Culex-all stages Moderate 22 Anopheles-all stages Abundant Anopheles-all stages Abundant Culex-all stages- Abundant Anopheles-all stage Abundant 23 Negative Negative Culex-lst and 2nd ins tar-Abundant u Anopheles-all stages Few Anophele s-pupae-Few Negative 25 Negative Negative Negative Negative Negative Negative 27 Anopheles-all stages Moderate Negative Negative 28 Negative ■ • Negative Anopheles-1st & 2pd instar- Moderate Culex-lst instar- Few RESTRICTED MAP OF GROSSETO I •• 50,000 SHEET 128-111 CANALS B ROADS = AKOPHELINE CULICINE NEGATIVE FEW MODERATE ABUNDANT 2610th REMOUNT STATION AREA GROSSETO Inspection of canals for larva previous to spraying of area by plane (1st collection). 1 APPENDIX 3211 MAP OF GROSSETO 1 •• 50,000 SHEET 128-111 CANALS ZZ ROADS H ANOPHE LINE CULICINE NEGATIVE FEW MODERATE ABUNDANT 2610th REMOUNT STATION AREA GROSSBTO Inspection of canals for larva after spraying of area by plane with Diesel Oil and 5% DDT — 30 August 1945. (2nd collect ion). APPENDIX 32inm .m—FTS ' MAP OF GROSSETO I « 50,000 SHEET 128-111 CANALS 1ZZZ ROADS ANOPHE LINE CULICINE NEGATIVE FEW MODERATE ABUNDANT 2610th REMOUNT STATION AREA GROSSETO Inspection of canals for larva after 2nd spraying of area by plane with Diesel Oil and 5? DDT - 4-5 September 1 945. (3rd collection). APPENDIX 3?nn Acknowledgement For the gracious cooperation shown by the pilots of the 327th Ferrying Squadron, MATS, Captain Gerald C, Dunfield, Captain Robert E, Gordon, Captain James H. Rowsey, 1st Lts, Chester G, Irwin, Russel W. Priest and Gene H. Sackey in flying the tests and for their many valuable suggestions the writer is sincerely grateful. Captain Harold C. Young, Sn.C., and the men of the 134-th Malaria Control Detachment very kindly assisted me on many occasions during the progress of the work, I am indeed indebted to Dr, Louis A, Riehl and Mr. Fred W. Knipe of the Rockefeller Foundation and the Malaria Control Demonstration Unit, Allied Commission for the valuable technical aid in the con- struction and testing or the spraying apparatus. 2655 MALARIA CONTROL DETACHMENT U.S.ARMY SCALE SI6 1.20 Draw tv- 3-a-45 1. Control. __ PT-17 AIRPLANE EQUIPPED FOR D.D.T. AND OIL SPRAYNG N.021 /HSCMC APPENDH 3?oo SCALE SI6 DATE 1 *20 Orwby 9-8-4-5 i' S Conhot 3655 MALARIA CONTROL DETACHMENT U.S.ARMY A -20 AIRPLANE EQUIPPED FOR D.D.T. AND OIL SPRAYNG N. 032 /HSCM APPENDH 3?PP HEADQUARTERS MEDITERRANEAN THEATER OF OPERATIONS UNITED STATES ARMY APO 512 CIRCULAR ) m NUMBER ) 15 March 1945 MTOUSA SAFETY AND ACCIDENT PREVENTION PROGRAM Circular Number 13B and Section I? Circular Number 145, both this headquarters, 1944, are rescinded and the following substituted therefor: I — POLICY 1. The MTOUSA Safety Program is designed to eliminate unsafe con- ditions and unsafe practices which result in injuries or occupational diseases to military personnel, prisoners of war and civilian personnel, or which cause damage to Government or other equipment and property or interrupt military operations. 2. a. G-l, MTOUSA is charged with General Staff supervision and the establishment of policies of the MTOUSA Safety Program, including staff supervision of activities of major commands and technical services. b, Provost Marshal General MTOUSA is operationally respon- sible for the MTOUSA Safety Program and charged specifically with: (1) Supervision of all MTOUSA agencies engaged in safety activities including; (a) Coordination with the General and Special Staff Sections of Headquarters, MTOUSA, in the develop- ment of the program. (b) Assembly and analysis of accident statistics for Headquarters, MTOUSA® (c) Procurement and distribution of visual aids, film, posters, publications and other media for the dissemination of safety Information and data as facilities permit. 3. Commanding Generals of the major commands are responsible for the Safety Program within their respective commands0 They wills APPENDIX 33 Hq MTOUSA Circular #J£L (cont'd) a. Designate a qualified safety director who will be known as the Command Safety Director, The duties of the Command Safety Direc- tor at installations at which the major command is responsible for the Safety Program will generally include the following; (1) Supervising and coordinating all safety activities within the command, (2) Assisting commanding officers of subordinate units in selecting unit safety directors, arranging for systematic investigation of accidents involving military and civilian personnel, lending techni- cal engineering assistance and providing posters, films and other safety promotional material as available. (3) Assembling and summarizing accident statistics, (4-) Representing and advising the commanding general on matters pertaining to safety. b0 Institute appropriate corrective action at installations whose reports indicate serious trends in accidents or where hazardous conditions are known to eirist, determine the adequacy of safety activities and organization, and submit to the installation recommendations when deemed necessary. c„ Supervise the assembly of information with regard to ac- cidents, submitting reports when and in form as directed by Provost Mar- shal General, MTOUSA, do Commanding General, Fifth Army, is authorized to exempt combat units from such parts of the program or the reporting system as he deems necessary and to exempt any element of the Fifth Army, when, in his opinion, the requirements of the safety program will interfere with combat operations, A. The commanding Officer of each subordinate unit of major commands will be responsible for the operation of the Safety Program, He will appoint,.a unit safety officer and will determine the proportion of such officer’s time to be devoted to safety work. There will be but one safety program at each installation; the program will include U6S0 Mili- tary and Civilian personnel and Italian Military and Civilian personnel, ac The duties of the unit safety officer will generally include the following; Hq MTOUSA Circular #41 (cont*d) (1) Establishing and coordinating a program to pro- vide accident controls for all personnel. (2) Compiling and maintaining a list of potential and actual safety hazards in and about the unit and making recommendation for the elimination of unnecessary hazards. II » ACCIDENT REPORTING PROCEDURES 1. Report a. Effective 1 May 1945, in the reports covering data for the month of April 1945, the procedures set forth below will govern the reporting of data pertaining to disabling injuries to United States and Italian military personnel and United States and Italian civilian personnel and accidents involving motor vehicles operated by all units of MTOUSAo b, Report forms to be used in connection with these pro- cedures are Forms A and B (inclosures 1 and 2), which will be reproduced locally. Co Commanding officers will prepare an Individual Injury Report (Form A) for each disabling injury, in duplicate, retaining one report in a file at the unit and forwarding one copy to major command or subordinate command headquarters, as directed, not later than 72 hours after hour of accident0 In addition, they will prepare Monthly Accident Summary Report (Form B), in duplicate, and will forward one copy to the commanding general or commanding officer of their respective command to be received there not later than the fifth of the succeeding month, do Commanding generals or commanding officers of major com- mands, upon the receipt of Monthly Accident Summary Reports (Forms B) will prepare, in duplicate, Monthly Accident Summary Report (Forms B) containing data from all Forms B received, and will forward one copy in time to reach Provost Marshal General, MTOUSA, not later than the 12th of the month following the close of the month to which the data pertains, 2, Definitions a. The following definitions will be used by all echelons of MTOUSA: (1)' Motor vehicle - Any self-propelled vehicle used for trans- porting persons or property, except those vehicles designed exclusively for off-the-highway use. Hq MTOUSA Circular #41 (cont'd) (2) Motor vehicle accident - (See paragraph 18c, AR 8$0-15) An accident involving a motor vehicle and in which: (a) A claim is made, or (b) Government property is damaged, lost, or de- stroyed in excess of |25, or (c) Private property is damaged, lost, or destroyed, or (d) Death or disabling injury results to military or civilian personnel. (3) Injury - Any injury resulting from accident, damaging or harming the physical structure of the body, (4) Disabling injuries (non-battle) are defined in (a) through (d) below. Deaths from natural causes will not be included. (a) Fatality - Any loss of life (non-battle) resulting from an injury. (b) Permanent total disability - Any injury (non- battle) other than death which permanently and totally incapacitates the injured person from following any gainful occupation0 The loss of, or loss of use of, both hands, or both arms, or both legs, or both feet, or both eyes, or any two of the foregoing, suffered in one accident, will be considered a permanent total disability. (c) Permanent partial disability - Any injury (non.- battle)other than death or permanent total dis- ability, which involves: 1. Complete loss of any member of the body or part thereof or 2. Permanent impairment of any function of any member of the body or part thereof. (d) Temporary total disability - Any injury (non- battle) other than death, permanent total dis- ability, or permanent partial disability, which, in the opinion of the doctor, makes it inadvis- able for the injured person to return to duty the day following the one on Hq MTOUSA Circular # 41 (cont'd) which the injury occurred or on some later day0 The term "doctor”, as used above is defined as the medical officer or authorized practicing physician whose opinion as to whether an injured person should return, or should have returned, is acceptable to the reporting unit, (5) Agency - Object or substance which was associated most closely with the injury and which, in general, could have been properly guarded or corrected, (6) Unsafe condition - Condition of the selected agency which could have been guarded or corrected„ (7) Unsafe act - That violation of a commonly accepted safe procedure which resulted in the accident, (8) Total Man-days (military) - Add the daily strength for duty reports for the period and divide the total by the number of days in the period. (9) Total Man-hours Worked (Civilian) - The total of all hours worked in a calendar month by all civilians engaged in the normal operation of the unit, 3, Instruetions a. Disabling injuries will be reported in the calendar month in which it is learned that the injury resulted in a disability, not the month in which the injury occurred. When a nondisabling injury develops into a disabling injury at a later date, it will be reported as a dis- abling injury and included in the current month®s report, A disabling injury will be included in an accident frequency rate only once, b. A motor vehicle accident will be included in the experi- ence for the month in which any of the four factors stated in paragraph 2a (2) becomes known to the unit. c. If no disabling injuries or no motor vehicle accidents occurred or became known to the unit during the month, a Monthly Acci- dent Summary will be submitted giving exposure date and showing zero accident experience. Hq MTOUSA Circular (contfd) d. The officer whose signature appears on the reports will be responsible for the accuracy and reliability of data contained therein. BY COMMAND OF LIEUTENANT GENERAL MCNARNEY: GEORGE D. PENCE Major General, GSC Chief of Staff OFFICIAL: /s/C. W« Christenberry Co W, CHRISTENBERRY Colonel, AGD Adjutant General 2 Incls: Forms nA“ & nB« DISTRIBUTION; Z 25 - G-l (A) extra Inclosure to Hq MTOUSA Circular FORM "A" REPORT OF LOST TIME INJURY (MTOUSA) This form to be prepared by the Safety Officer in cooperation with the Surgeon0 Forward one copy to major command headquarters, or subordinate headquarters as directed, not later than seventy-two hours after hour of accidento LOCA- TION (Unit Designation) APO Name of Commanding Officer ■ THE I INJURED Name Sex Age Length of Service or Employment __Race AoSoNo or Employee Noe Principal Duty Mo0oS. No0___ Date of Accident Hour *Place of Accident Name of Witness Person in charge or responsible at time of accident *As unit area, highway, ball field, motor park, air field TIME AND PLACE DESCRIBE IN DETAIL HOW ACCIDENT OCCURRED: (Use diagram where useful THE INJURY DIAGNOSIS AND DISPOSITION Nature of Injury and part of body affected, Describe clearly. TYPE; FATALITY: PERMANENT TOTAL: TEMPORARY TOTAL: PERMANENT PARTIAL Disposition of Case: QUARTERS: HOSPITAL: Estimated Length of Disability Date and Hour treated What machine, machine pari, or other physical agency was involved in the accident ? (UNSAFE CONDITION) _________ CAUSE ANALYSIS Was the failure of any person wholly or partially responsible for accident, and how? (UNSAFE ACT) CORRECT- ED ACTION What has been done to prevent a similar accident? REPORT MADE BY: APPROVED BY: NOTE: Use other side if necessary to expand details0 Inclosure #1 Inclosure to Hq MTOUSA Circular #4-1 FORM "B” MONTHLY ACCIDENT SUMMARY (MTOUSA) To be prepared at end of each month from tabulation of Form A reports; 1. MONTH one copy to be forwarded to major command headquarters, or subordinate headquarters, as directed prior to the fifth of succeeding month, 20 YEAR 3. Unit Designation 4- a APO 5. 6c i LOCA- TION EXPO- SURE 7c Total Man-days (military) U.S. Ital. 8, Total Man-hours worked (Civilian) U.S, Ital,_ INJURY RECORD TYPE INJURY NO. OF INJURIES (MILITARY) U.S. ITAL NO. OF INJURIES (CIVILIAN) U.S, ITAL 9. Fatalities 10. Permanent Total 11. Permanent Partial 12. Temporary Total 13. Total Injuries ! RATE 14-o Military Accident Rate (M.A.R.) U.S. ITAL 15* Civilian Frequency Rate (C.F.R.) U.S. ITAL 16. Total Number of Motor 17. Total Miles Driven 18. Number of Accidents 19o Motor Vehicle Frequency Rate (M.V.F.R.) MOTOR VEHICLE RECORD PREPARED BY: DATE Signature of C.O. DATE FORMULAS ON REVERSE SIDE Inclosure #2 Inclosure to Hq MTOUSA Circular #IX FORM nBn (cont'd) Military Accident Rate (M.A.R.) is the number of disabling injuries per 100.000 man-days, M, A. R, - No. of Disabling Injuries x 100.000 Number of Man-days Civilian Frequency Rate (C.F.R.) is the number of disabling injuries per 1,000,000 man-hours worked, C. F. R. - No, of Disabling Injuries x 1.000T000 Number of Man-hours worked Motor Vehicle Frequency Rate (M.V.F.R.) is the number of accidents per 100.000 miles driven. M. V. F. R, - No. of Accidents x 100f000 Number of miles driven Inclosure # 2