A HISTORY OF PREVENTIVE MEDICINE HEADQUARTERS UNITED STATES ARMY FORCES MIDDLE PACIFIC Office of The Surgeon APO 958 HHD -Dec. 1941 - Aug. 1943 CPA - Aug. 1943 - July 1944 CPBC - Aug. 1944 - Sept. 1945 A HISTORY OF PREVENTIVE MEDICINE HEADQUARTERS UNITED STATES ARMY FORCES MIDDLE PACIFIC Office of The Surgeon APO 958 HHD “- Dec. 194-1 - Aug. 1943 CPA - Aug. 194-3 - July 1944- CPBS - Aug6 1944- - Septo 1945 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 completedc 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. TABLE OF CONTENTS History of Preventive Medicine United States army Forces, Middle Pacific Office of The Surgeon 19. Page Section 1 - Preventive Medicine in the Hawaiian Department ( 7 December 1941 - September 1943) 1 Section 2 - Preventive Medicine in the Central Pacific Area (USAFICPA) (September 1943 - July 1944). 23 Section 3 - Preventive Medicine in Central Pacific Base Command ( 1 July 1944 - 2 September 1945)..... 31 Chapter 22, Clothing 39 Chapter 23. Housing 41 Chapter 24. Nutrition.... 45 Chapter 25. Personal Hygiene. 51 Chapter 26. Section I - Water Supply 53 Section II- History of the United States Array Medical Department activities in anti-Biological Warfare in the Hawaiian Department 59 Chapter 27. Section I - Sewage Disposal 67 Section II- Disposal of Garbage and Rubbish 73 Chapter 28. Control of Insects 77 Chapter 29. Control of Rodents 103 Chapter 30. Immunization 153 Chapter 31. Intestinal Infections ....................165 Chapter 32. Infections of the Respiratory Tract and Infections Transmitted by Discharge from the Respiratory Tract .169 Chapter 33. Venereal Disease 173 Chapter 34. arthropod-Borne Infections 183 Chapter 35. Miscellaneous Infections 189 Chapter 36. Nutritional Diseases 191 Chapter 37. Environmental Disease 201 Chapter 38. Extra Military Sanitation and Liaison Activities (USPHS 203 Inclosure 1 - Dengue Mosquito Control Board of Health (USPHS) Territory of Hawaii (Monthly and Semi~ Monthly Narrative Reports, August 1945 ° September 1943)....219 Inclosure 2 - Dengue Mosquito Control Board of Health Territory of Hawaii (Plans for Permanent Mosquito Control in the Territory of Hawaii465 Inclosure 3 ~ Sanitary Aspects of the Control of the 1943 “ 1944 Epidemic of Dengue Fever in Honolulu, by Wesley E. Gilbertson, P.A. Engineer (R), F.A.P.H.A. 477 Chapter 39. Occupational Health .479 Inclosure 1 ~ Headquarters Hawaiian Department Office of the Department Surgeon Industrial Hygiene Program in Hawaii from January 1939 - July 1943 495 Inclosure 2 - Report of Activities Industrial Hygiene Division of Medical Inspector's Office, CPBC, 1 Jan- 31 Dec. 1944 499 Inclosure 3 - War Department Circular No. 19S, 20 May 1944, Industrial Medical Program of United States Army 505 Inclosure 4 - War Department Circular No. 155, 28 May 1945, Army Industrial Medical Program 506 Chapter 40. Civil Public Health 507 Chapter 41. Foreign Quarantine and The Disinsectization of Aircraft 519 * Only those chapters pertaining to History of Preventive Medicine HHD, Dec. 1941 - Aug. 1943, CPA, Aug. 1943 - July 1944, CPBC, Aug, 1944 - Sept. 1945, are reproduced in this volume. This history was compiled by members of the Surgeon’s Office, CPBC. CHAPTER 19 Preventive Medicine) Section 1 Preventive Medicine in the Hawaiian Department (7 December 1941 - September 1943) On 7 December 1941, the Hawaiian Department and the Territory of Hawaii were attacked without warning. Casualties among the military forces were heavy over a brief period of time. At the time of the attack, Ariqy medical officers and civilian physicians were assembled in Honolulu, attending a series of lectures on trau~ matic surgery in order to prepare themselves for just such an emer- gency. Both civilian and military surgeons were readily mobilized from their place of assembly. They had previously been organized into surgical teams. Evacuation of casualties to the hospitals pro- ceeded with marked efficiency, and all casualties were treated with- out delay. During the day on 7 December, the Territory of Hawaii was placed under martial, law. The Commanding General, Hawaiian Depart- ment, became the Military Governor of the Territory. Full martial law existed over the Territory until March, 1943* at which time cer- tain civilian functions, including matters of civilian public health were returned to the civilian government. During the period of ? December 1941 to March, 1943? the responsibilities of the Surgeon, Hawaiian Department, were exceeding- ly great. He was responsible to the Military Governor of Hawaii for the investigation and determining of all factors which affected the health of civilians as well as military personnel. He was respon- sible for recommending and supervising measures for the control of disease, adequate nutrition, and the provision of medical care and first aid facilities for the entire Territory. By afternoon of 7 December, almost all troops had reached their defense positions. Troops and civilians were necessarily brought into intimate contact with one another. The land mass in the Hawaiian Islands was relatively small, and every bit of it had to be defended. A great many of the troop units lacked training in field sanitation, but sanitary expediencies were surprisingly well carried out, and the health of the command remained excellent. Preventive medicine functions in the Hawaiian Department were carried out in the Medical Inspectors Office. At the onset of the war the Medical Inspector had no commissioned assistants. His work was largely carried out through close liaison with the surgeons of the various posts, the two infantry divisions, the Hawaiian Coast Artillery, the Hawaiian Air Force, and the Army Transport Service. With the sudden onset of the war and the institution of mar- tial law, the Medical Inspector assisted the Department Surgeon with the many immediate medical problems. Serai-permanent sanitary facilities had to be provided as rapidly as possible for the troops deployed in the field. Troop reinforcements began to arrive in large numbers from the U. S. mainland for the defense of the Territory, and military camps and medical facilities had to be expanded, particularly on the Islands of Hawaii, Maui, and Kauai. The U. S, Engineering Office hired large numbers of civilian employees and established field camps for feeding and housing them. These required much sanitary supervision. The Office of Civilian Defense required supervision, and frequent inspec- tions were necessary to insure that adequate provision had been made for civilian evacuation, emergency housing, food and medical care in event of enemy attack or epidemics of disease. Food and water supplies had to be protected against accidental or enemy contamination. Med- ical facilities were inadequate to care for the military and civilian casualties which could be expected in event of enemy invasion. Both Army and civilian hospitals had to be expanded, blacked-out, and splinter proofed. Materials, supplies, and personnel for the con- struction and operation; 1>f hospitals became critical, and decisions as to priorities had to be made. Problems in waste disposal and mos- quito and rat control developed because of labor shortages and mili- tary restrictions concerning the burning of waste. Dependents of military personnel and other civilians had to be evacuated to the mainland. Civilian Array and Navy employees began t© arrive from the mainland to swell the City of Honolulu. Restaurant and rooming facil- ities became over-crowded, and many temporary facilities opened with inexperienced personnel and inadequate equipment. The Territorial Board of Health was unable adequately to inspect and supervise the sanitation of these establishments without assistance from the Army. Certain medical practitioners and sanitarians applied for active duty with the Army, and decisions were required as to whether these persons were more essential to the Array or the civilian medical-sanitary or- ganization. Add to all these problems the constant expectancy of enemy attack, and a civilian population over half Japanese, among them many enemy aliens, and the complexity and magnitude of the problems which faced the Hawaiian Department Surgeon and his Medical Inspector can be appreciated. 2 Prior to 7 December, a number of new Army construction projects were in progress on Oahu, including Ft. Malakole and the canq? which was to become Ft7 ftase. Expeditions of construction workers under the U. S. Ihgineering Office, and supporting troops, had departed from Oahu in November to set up bases on Canton and Christmas Islands. These and other projects had been a training and testing ground in the problems of field sanitation in the subtropical Hawaiian Islands and the tropical Pacific coral atolls. Protection of food and water supplies became a matter of immediate importance on 7 December and thereafter. During the day of the attack there had been several reports that the water had been poisoned. These reports were investigated immediately, and in each instance were found to be false. Military guard was' established over food warehouses and water systems, and steps were taken to coll- ect all poisons which might fall into alien hands. In January 1942$ the Medical Inspector prepared a state- ment to the Department Surgeon in which he summarized the sanitary status of Oahu military installations,2 All installations were noted to be under efficient field medical inspections. Special sanitary problems noted included mosquito breeding, disposal of civilian trash, proper air and gas proofing of the advanced echelon command post, preventive medicine among the large numbers of newly arriving Army units, proper evacuation of Army dependents, evacuation of battle casualties, and sanitary problems of garrisons on the outlying is- lands. The disinsectization of aircraft was apparently functioning well, smallpox and typhoid-paratyphoid vaccinations were being given without delay, and mess sanitation was improving. No active communic- able disease menace was recognized, and particular attention was being given to the prevention of the enteric diseases. In March 1942, the Medical Inspector had been assigned two commissioned assistants! This was recorded in a letter from the De- partment Surgeon to the Medical Inspector, dated 29 March con-’ ceming a plan for systematic medical inspection of the command. In August, 1942, a third medical officer assistant and a Medical Adminis- trative Corps office executive were added. The number of enlisted clerical assistants, drivers, and sanitary technicians was increased concurrently. Several important preventive medicine functions, including venereal disease control, epidemiology, rodent control, garbage and waste disposal, and civilian liaison in sanitary matters were not directly nor entirely a responsibility of the Medical inspector in 1942, The Surgeon, Hawaiian Coast Artillery Command, later Hawaiian 3 Seacost Artillery Command, was charged with responsibility for ve- nereal disease control, sanitary aspects of large scale garbage and rubbish disposal problems, rodent control, and liaison with certain civilian organizations centering about the Honolulu Chamber of Com- merce. A medical officer in the Executive Office of the Hawaiian Department Surgeon's Office was charged with supervision over the disinsectization of aircraft and the search of aircraft for insects after spraying. An officer on loan from The Surgeon General's Office in connection with defense against biological attack was used by the Department Surgeon as an epidemiological consultant. Responsibility for rodent control was placed with the Medical Inspector late in 1942, and all preventive medicine functions were consolidated under him in 1943 . During 1942, the work of the Medical Inspector was largely con- fined to the solution of problems in general military sanitation and the training of troops in field sanitation. The Medical Inspector processed the sanitary reports, received daily reports of communicable diseases, kept records and charts of communicable disease statistics, both military and civilian, and kept close liaison with field force surgeons and the medical officers charged with special preventive medicine functions. When troops took up field positions on 7 December, housing was almost entirely improvised" Small camouflaged one and two man shanties of waste lumber, ground excavations, or vacated civilian habitations were commonly used for shelter. Tentage was difficult to camouflage, and, deteriorated rapidly from moisture, The equable climate required a minimum of shelter, and permitted adequate ventila- tion at all times. The Corps of Engineers designed and constructed large numbers of prefabricated portable wooden houses, 16 x 21 ft. in floor area. These buildings became standard for field housing throughout the command. They were issued on the basis of 40 sq, ft. of floor area; per man.3 Experience has shown this allowance to have been adequate. Upper respiratory infections have been mild and low in incidence. Careful attention was given to the troop water supplies throughout the year of 1942, Frequent bacteriological examinations were made for potability, and chlorination was instituted where necessary. On 7 November 1942, General Order No. 154 was published by the Military Governor directing the continuous chlorination of the principal military and civilian water supplies of the TerritoryIn effect, all military water was chlorinated by continuous chlorination or by hand methods. The Honolulu and suburban Oahu water systems were equipped with continuous chlorinators' These water systems supplied a number of military installations in and about Honolulu” 4 Extensive use was made of pit latrines as the most eco- nomical means of sewage disposal„ Where.sanitary or esthetic needs would not permit the use of pit latrines, cesspools and septic tanks were used0 Troop installations within the limits of Honolulu were provided with flush toilet facilities, usually connected to the City sewage system, in compliance with local sanitary codes0 Because of the need for conservation of materials and shipping, the use of plumb- ing was kept to the minimum consistent with good sanitation,, Because of the importance of producing as much food locally as possible, ed- ible portions of garbage hav* been disposed of by feeding to hogs0 This has been accomplished by sale through Quartermaster contract, and has continued throughout the v.aj „ won-edible garbage and rubbish has been disposed of on carefully sanitated dumps and sanitary fills„ Ex- perience gained during 1943, confirmed the dump or sanitary fill to be the most economic means of waste disposal under existing war time conditions» No unusual difficulties occurred in fly control during 1942o Standard procedures gave satisfactory results when carefully appliedo No mosquito-borne diseases were present«, Mosquito control measures were pressed wherever possible without undue interference with more important worko In general, both Aedes and Culex mosquitoes were plentiful, in both military and civilian areas„ The .importance of seepage and rain water standing in bomb shelters as mosquito breed- ing places was recognised during the year, however, and corrective measures were taken 0 Bedbugs became a serious problem in 1942., and remained a problem until 1944« There was no entomologist assigned to the staff of the Hawaiian Department Surgeon during 1942, and there were no well organized pest control organizations set up under post utilities, the Quartermaster, or the Engineer« Great emphasis was given to quarantine procedures in the control of communicable diseases during 19420 With the rapid expan- sion of the Army in the Hawaiian Islands a considerable number of cases of communicable diseases were from the mainland0 The Department Surgeon required that the Medical Inspector be notified of every case of communicable disease taken from a transport on arrival or hospitalized on Oahu* Usually some degree of working quar- antine was imposed upon the unit or immediate contacts of the case0 These quarantines were frequently relaxed where there was cause from the standpoint of military expediency.. An example of the action taken 5 in connection with a case of communicable disease is obtained from an entry in the Diary of the Medical Inspector's Office, elated 23 April 1942s “1720s Lto Bacchiani, 101st Sig® Bn®, phoned and requested information concerning quarantine of outfit because of scarlet fever® He stated that case is one of 57 new arrivals (one week ago)o About 50 of these had infected throats on arrival» ”1845J Major Dupriest and Lto Shapiro returned from visit to 101st Sigo Brio, School St® Advice was given as to quarantine of tent mates, daily inspection of command with special care being taken with new arrivals and hospitalization of suspects• •‘Lto Colo Smock was consultedo He desired that following recommendation be put in writing by the Surgeon to Commanding Offi- cer of 101st Sigo Bn® 'lo Absolute quarantine for tent mates of the case of scarlet fever0 '2® Yforking quarantine of all new men (57 less one case of scarlet fever)® :3» Inspection of people in working quarantine and taking of temperature 2 times daily® %0 Inspection of remainder of organization living in the same area once daily, temperature of each man will be taken in A® M® *5«> All contacts showing any suspicious prodromal signs, such as sore throat, elevated temperature, etc®, to be hospitaliz- ed for observation® “Arrangements have been made with Capt® Hoagland of Provision- al General Hospital #3 for the disinfection of tent and contents therein®” In May 1942, the Department Surgeon was still not satisfied with the degree of attention given to the control of communicable dis- eases* It is recorded in the diary of the Medical Inspector's Office, 27 May 1942, that the Surgeon charged the Medical Inspector's Office with not dealing firmly with the facts, not being sure of data, and not making full use of references* The Surgeon emphasized that preventive measures were most important at the outset, therefore it was important to get early information in event an epidemic was starting* He advised 6 thorough familiarity with the contents of Rosenau' s Text on Pre- ventive Medicine, page 667« Following this*, one officer in the Medical Inspector's Office telephoned the Territorial Board of Health for civilian communicable disease reports daily*, and re- corded these and information concerning military cases in a daily diary*, This officer was expected to keep all other officers of the Medical Inspector's Office currently informed of the status of com- municable diseases in both the military and civilian populations0 Except for an,,outbreak of bacillary dysentery on Canton beginning in there were no unusual difficulties from communicable diseases dicing 1942® Several small outbreaks of bac- illary dysentery occurred which were quickly brought under control„ These included 40 cases in an antiaircraft battery and 140 cases in an infantry company on 0ahuo Of the 69 cases of malaria report- ed during the year, there was no evidence that any had been con- tracted within the Hawaiian Department0 There was a moderate in- crease in common respiratory diseases during December, 1942 and January, 1943* with a peak incidence of 11B per thousand per annum® A large number of hepatitis cases secondary to yellow fever inocu- lation were not charged as communicable diseases0 An outbreak of 74 cases of typhoid fever in school children secondary to a carrier working in the school cafeteria occurred during 1942• Beginning in November, 1942, the Army began to hospitalize approximately 100 civilian tuberculosis patients who were infectious to the community and could not be admitted to the limited civilian hospital facili- ties® The immunizations which had already been required of Hawaiian Department troops when the war began were smallpox, typhoid-paratyph- oid fever, tetanus, and yellow fever® Frequent checks were made of the various units to insure compliance with immunization objectives, and reimmunisation against smallpox and typhoid-paratyphoid fever was required of all military personnel who had not been so immunized during 1941» In April, 1942, all yellow fever vaccine supplied by the Laboratory of the International Health Division of the Rocke- feller Foundation was destroyed, and in June 1942, the yellow fever immunization requirement for troops in the Hawaiian Department was revoked in compliance with War Department instructions0 Between March and August, 1942, there occurred 4465 cases of jaundice sec- ondary to yellow fever inoculation in the Hawaiian Department,” These jaundice cases had occurred at a time when Japanese attack was feared imminento Because it was assumed at the beginning that the jaundice cases were cases of contagious catarrhal jaundice careful isolation procedures were carried out® Special hospitals were set up on each of the Hawaiian Islands for jaundice cases® This was considered necessary, both for proper isolation, and to clear the established hospitals in event of battle® 7 Vaccination of civilian Army employees against smallpox and the typhoid-paratyphoid fevers was made compulsory in December, 1941, in compliance with AR 40-215, 4 March 1940* Beginning in February 1942, smallpox and typhoid-paratyphoid immunizations were made compulsory for all civilians in the Territory of Hawaii, ex- cept where excuse had been given by a physician*' The civilian immu- nization program was completed during 1942, it being estimated that 86$ of the population had been immunized against typhoid-paratyphoid fevers, and 88$ against smallpox* These immunizations were given up- on the recommendation of the Department Surgeon, and were considered justified because of the certainty of large-scale civilian evacuations to insanitated mountain valleys under conditions of great crowding had enemy attack taken place* Civilian Array employees were encouraged to take tetanus immunizations, but tetanus was not offered during the mass civilian immunizations* Parents throughout the Territory were urged to have childred between the ages of 9 months and 10 years immu- nized against diptheria* Immunizations were made compulsory for these children in 1943° During the early months of 1942, considerable study was made concerning the adequacy of local food supplies0° The likelihood of an/ enemy invasion of the Territory with a prolonged military campaign,or of an enemy naval blockade of the Hawaiian Islands was given consider- ation,, Study was given by the Office of Civilian Defense to the poss- ibility of utilizinglocally produced foods as sources of adequate amounts of the essential vitamins and minerals for the population* The University of Hawaii assisted in collecting data concerning the nutritional content of the various locally produced foods, also the ex- pected production of these foods* On the basis of these studies it was considered advisable to store reserves of vitamins B and C for possible emergency use* The Army had been placed on field ration A as of 9 December 1941* Fresh meat, fruits, and vegetables were not as abundantly pro- vided on the field ration as they had been on the garrison ration. There was some uncertainty in the mind of the Department Surgeon as to the complete adequacy of the field ration as provided in respect to all the essential vitamins and minerals. No Sanitary Corps officer nutritionist was available to assist in the necessary analytical studies. Such studies of the ration as were made by field surgeons failed to demonstrate any inadequacy in the ration. These analyses had been made of the ration as theoretically issued, and did not consider losses due to cooking, waste, failure of rations to be drawn, or ra- tions returned unused to Quartermaster Stocks, None of the common signs of vitamin deficiency were noted in the troops which could not 8 just as well have been attributed to other factors0 However, be- cause an uncertainty existed as to the adequacy of the dietary of the troops, and because it was a commonly accepted concept that certain sub-clinical vitamin deficiencies could exist affecting efficiency and morale without overt clinical signs and symptoms, the Department Surgeon considered it advisable to recommend the issue of a daily supplementary vitamin tablet to all Department military personnel?, A letter containing this recommendation was sent to the Adjutant General in March, 1942„ The recommendation was not given favorable consideration, pending the receipt of acceptable data showing specifically wherein the field ration was inadequate, however, a 3 months' supply of multivitamin tablets for all Department troops was approved for storage in the Department as a vitamin reserve?, The storage of this vitamin reserve was ac- complished during 1942 and has been maintained through the present time* Periodic determinations of the potency of these reserve vit- amin stores have been made, and stock has been rotated for issue through the medical supply depot in order to maintain fresh supplies in storageo Supplementary vitamin issues have only been authorized for troops on the coral atolls and troops on duty for long periods in underground installations?, The principal problems in garbage and rubbish disposal which faced the Army in 1942 concerned civilian facilities0 Many factors which developed with the war had contributed to a break- down in the civilian waste disposal systems0 The population in the City of Honolulu had greatly increased, while much of the labor, for- merly available to the City and County of Honolulu for the collec- tion of garbage and rubbish had been lost to the war industries» Restrictions against the lighting of fires on private premises in connection with total black-out had prevented the burning of com- bustible waste by householders on their own premises» Furthermore, many civilians left home for their war jobs before daylight and re- turned after sunset, many of them seven days a weeko City, County, and private dumps had become insanitary due to labor shortages and inadequate provisions for their burning» It was necessary for the Army to intervene and assist the civilian agencies for the common goodo Furthermore, with the Army units dispersed over the Island of Oahu it was convenient for military personnel to use established civilian dumps for waste disposal0 Complete study was given to these problems by representatives of the Department Surgeon and Department Engineer in liaison with the concerned civilian agencies0 As a result of the study, Section II?, General Order No0 122,° dated 1 July 1942, was published?. This order authorized private incinera- tors, established regular schedules of garbage and rubbish collec- tions and established official dumps which were to be properly burned and maintainedo Other dumps were cleaned up, many by troop labor0 9 Only established dumps could be usedo Later* General Order No* 13710 was published 11 Sept ember 1942* providing for a general clean-up of all premises in Honolulu under penalty of fine® The Army provided ex- tra trucks and prisoner labor to assist the regular collectors in re- moving the tons- of additional waste brought to the curbstones. So great was the amount of waste to be removed that the Army extended the period of assistance from one month to six weeks« This work solved the civilian waste disposal problem to such an extent that no more assistance from the Army has been considered necessary., From time to time the City and County of Honolulu has requested that enlisted men be placed on duty as Honolulu rubbish collectors or as laborers to assist in the construction of a new incinerator* but these requests have not been approved., Some Army assistance in the removal of Aedes mosquito breeding rubbish was given during 1943-45 in connection with the Aedes mosquito control program^ The same factors which forced the Army to assist in civilian waste disposal problems lead to Army support of the Bureau of Sanitation of the Territorial Board of Health» Beginning in September, 1942, the Army provided approximately 30 trained sanitary technicians for work as sanitary inspectors of restaurants and rooming houses, and as technicians in Board of Health laboratories0 For the duration of full martial law the work of the enlisted Inspectors was most effective0 Proprietors of insanitary establishments were fined heavily by the provost courts, and the sanitation in the City of Honolulu improved greatly to the benefit of war workers and service personnel on pass* Although the number of these enlisted sanitary inspectors has been repeatedly reduced, approx- imately ten were still assigned to this work in September 1945» An Araly disinectization service for military aircraft arriving from outside the Territory of Hawaii had been organized prior to 7 Decern™ ber 1941 with the approval of th® War Departmento The disinsectization of aircraft in peace time is a function of the IK So Public Health Ser- vice e However, the increasing number of military flights, the necessity for secrecy, and the uncertainty of the time of arrival of aircraft pre- cluded the continuation of this function by the Uo So Public Health Ser- vice o Just prior to 7 December 1941* War Department approval was fur- ther obtained for the substitution of an Army quarantine inspection ser- vice for the inspections of the Uo S» Public Health Service and the U* So Department of Agriculture» With the establishment of martial law over the Territory* General Order Noc 77 was designating the Sur- geon* Hickam Field* as the Air Quarantine Officer to accomplish these inspectionso Later in June, 1942, the Commanding General, Hawaiian De- partment, designated the senior medical officers of all Hawaiian Depart- ment airfields as quarantine officers for their respective fields, and instructions for quarantine officers were publishedo In May, 1942, the 10 Department Surgeon had designated a medical officer on his staff to institute a program of inspection of aircraft arriving at Hick- am Field from outside the Territory for check on the efficiency of disinsectization, and for collection of ail insects found in the aircraft, dead or alive, for identification0 The identifica- tions were made by entomologists of the Hawaiian Sugar Planters® Associationo This program of collection and identification of insects arriving in the Territory on Army aircraft has continued to a partial extent to the present time, and files of these ident- ifications are available in the files of the Department Surgeon0 In October 1942, the representative of the Department Surgeon in connection with the disinsectization of aircraft worked with an officer of the District Medical Office, 14th Naval District, to assist the Navy in organizing a disinsectization program similar to that carried on by the Army0 The venereal disease rate for the Hawaiian Department in 1941 had been 14<>lo During 1942, it declined to 9o6» During the first 5 months of 1942, control measures had followed the established policies, including education, operation of a number of prophylactic stations, monthly physical inspections, and reporting of information concerning probable sources of infection to the Military Police„ Early in 1942, a very competent venereal disease control officer was appointed by the Department Surgeon» This officer in cooperation with the Director of the Venereal Disease Control Division of the Territorial Board of Health made a very thorough study of factors affecting the incidence of venereal diseases in the commando Many aspects of the situation in Hawaii were unique„ A system of organized prostitution existed in the Territory0 Houses of prostitution had attending physicians who examined the operators at regular intervals„ Some of these “house physicians’* were physicians of high professional ability, and the practice was lucrative0 There was a great excess of males over females in the community„ Large numbers of troops and single male laborers were being added to the wartime population0 There was a curfew and a blackout, moderate prohibition, and the entire civilian population had been registered and finger printed0 Travel between the Hawaiian Islands and between the Hawaiian Islands and the Uo So mainland was under absolute control» There were strong forces in the civilian community favoring the presence of organized prostitution0 These forces included both a large group who obtained handsome financial support from a reportedly1'$10,000,000 business,” and others who felt that the prostitution system had contributed to the low venereal disease incidence in the islands and was a protection to the respectable women and girls of the community* An excellent statement of the case of the latter group was contained in an article entitled “a Bedtime Story* thought was 11 given to the possibility of closing the houses of prostitution. Ve- nereal disease rates were not such that it could be shown that pros- titution affected adversely the health of troops in the Hawaiian De- partment, To the contrary, venereal disease rates in the Hawaiian Department were approximately one quarter those for the Army on the U,S. mainland. There was some concern as to what effect the closing of houses of prostitution might have upon the large community of single males, under stress of hard work, wartime conditions, black- out and curfew, and whether an increase in sex crimes might result from such action. Although an order by the Military Governor would have been all that would have been required to abolish organized prostitution in the Territory, no such action was taken. The course taken by the army toward the control of venereal diseases in 1942, took the form of a vigorous program of prophylaxes, case finding, and thorough treatments. On 21 May 1942, the office of the Military Governor issued General Order No, 197, Section I of which outlines the control of communicable disease in the Territory of Hawaii and which applied particularly to the control of venereal diseases Venereal disease control activities under the provisions of General Order No, 107 were as follows: Reporting by special messenger, to the Territorial Board of Health, by both military and civilian physicians all contacts within 24 hours after diagnosis of a case of venereal disease„ The Territorial Board of Health energetically followed up all of the contact reports, and, as a result, large numbers of infected women and men were quickly placed under treatment. An intensive drive was carried out by both military and civilian police in the pick-up and examination of all !lstreet walkers” to determine whether or not they were diseased0 Hospitalization was provided under military control for all recalcitrant persons who did not take adequate treatment, for prostitutes found infected who had not been reported by their pri- vate physicians or those found infected after having been pronounced cured by their private physicians, and for "street walkers". In December, 1942, arrangements were completed for the hospitalization of all prostitutes found infected, an extensive educational program was carried cut. Four well equipped prophylactic stations were operated in Honolulu, and one in Wahiawa, As many as 50,000 prophylactic treatments a month were given in these Army stations0 Beginning in October, 1942, and extending through the spring of 1943, an outbreak of bacillary dysentery occurred on Canton This outbreak was of a serious consider- ing the large proportion of the command affected* the strategical im- portance of the island as an airbase on the route to Australia,, and the close proximity of strong Japanese bases in the Gilbert Islands* An excess of 400 cases of bacillary dysentery were diag- nosed by stool culture during the course of the and many other cases had the symptoms of dysentery but positive stool cul- tures were not obtained0 Before adequate control measures had been taken a large number of dysentery carriers had been built up* Diffi- culty had been experienced in the construction of pit latrines be- cause of the sandy nature of the terrain* Flies were prevalent* The ground water which had been pumped for bathing purposes was found to be heavily contaminated because of the numerous pit latrines and pervi- ous nature of the soil,* Sanitary deficiencies were corrected5 but progress against the disease was not made until a laboratory team was sent to Canton Island to take rectal swab stool cultures of all person- nel for the detection and treatment of carriers* Sulfaguanidine was used for the treatment of cases and known carriers with satisfactory results* Following this outbreak all personnel arriving and departing from assignment to the Canton Island garrison were checked by rectal swab stool culture for bacillary dysentery infection* This procedure was discontinued in 1943« The year 1943 marked the turning point in the war in the Pacifico The Japanese had been soundly beaten away from their threat against Midway and the Hawaiian Islands in Junes 1942* In early 19435 the Japanese were being beaten and driven out of Guadalcanal Troops staged and trained in the Hawaiian Department (24th Infantry Division) played a large role in the successful outcome of the Guadal- canal battle* During 1943* three more Infantry Divisions(the 6th* 24ths and 40th) were staged and trained in the Hawaiian Department and forwarded to participate in the offensives of the Southwest Pacific area* Concurrently with these activities the Medical In- spector °s Office* Hawaiian Department was expanded to cope with the greater tasks« For the first time in 1943* the allowances of person- nel for the Medical Office became sufficient9 and all preventive medicine functions were consolidated under it* During January, 1943® the personnel of the Medical In- Office consisted of five officer*, one warrant officer, and three noncommissioned officers® Most of the activities of the month consisted of routine inspections of units, investigations of contagious diseases, investigations of sanitary deficiencies reported by subordinate units, and cooperation with general and special staff sections, as well as with responsible civilian agencies, to bring about correction of sanitary deficiencies® Close cooperation was 13 maintained with the Department Engineer in all matters of con- struction in which sanitary or other medical considerations were involved. Inspections were made of all hospitals and fixed dis- pensaries on Oahu to determine the status of medical supplies. Attention was given to amounts of equipment on hand, the method of storage, and whether or not deterioration was occurring due to improper storage or excessive inventories, A survey wa.s made of all civilian hog raisers who were collecting Army garbage, and an index of names and locations was made. During January and February, 194-3, a rodent control school was conducted by a member of the Medical Inspector's Office for officers and enlisted men of the various organizations in the Depart- ment. During the latter half of 1942, there had occurred 16 cases of endemic typhus among military personnel. Inspections of military posts and camps had shown considerable infestation with rats. During 1942, the Medical Inspector had trained 16 enlisted technicians to carry out rodent control measures on Oahu. By December, 1942, it had be- come obvious that no central rat control team could carry on rat con- trol for all the troops. The only practical solution to the problem was the organization of a rat control detail for each Army unit, in- cluding companies. A letter, subject; Rat Control, dated 12 December 1942, had been prepared in the Medical Inspector's Office and pub- lished by the Commanding General.1 The rodent control school was conducted in accordance with this letter. A three day course was attended by a total of 45 officers, and a two weeks course was held for 97 enlisted men. These students returned to their organizations where they formed a nucleus for training more men within their units. It was required that all rats caught or found dead be forwarded to an island plague laboratory for examination. During February, 194-3, the pit latrines at Canton Island were replaced by impervious concrete vaults„ A truck mounted cess- pool tank had been sent to Canton Island for periodic emptying of the vaults, and the sewage was being disposed of through a pipe line running offshore. Search for a practical expedient for bedbug con- trol continuedo Methyl bromide was not considered practical for use on a large scale. Studies on the use of chlorpicrin and other fumigants were begun. In March, 1943, two medical officers were placed on tempo- rary duty with the Medical Inspector's Office for the purpose of making a detailed study of the diet of the troops of the Department. A report of this study was made in an unpublished letter, File 430, subject: Analysis as to Dietary Adequacy of the Field Ration, Hawaiian Department,1' The conclusions reached at the conclusion of 14 the study were that no dietary inadequacies existedo In retro- spect, however, it appears that although the analyses were made in a most careful and systematic way, they were made of the theoretical Quartermaster issue, and not of the actual issue from the depotso No corrections were made for cooking losses or waste,, The average caloric intake per man per day was calculated to be over 5000 calories0 Other activities of the Medical Inspector's Office during March 1943p included sanitary inspections of all U„Se Engineering Department messes0 The medical inspector of the 24th Division was accompanied on an inspection of all units of the division0 A practi- cal mosquito repellent ointment containing oil of citronella was improvised for incorporation in an individual medical jungle kit0 This jungle kit was being made up by the medical supply section for troops being forwarded to the South Pacific area0l° A new study was made of the water-sheds of . the Koolau mountain range on Oahu, and a map was prepared showing all the water-shed areas 0 This map was published as part of a directive prohibiting the use of water- sheds by troops for bivouac or training except with the specific permission of Hq„ Hawaiian Department 0J-9 During March*, 1943S two fatal cases of plague occurred among civilians in the Hamakua District of Hawaii*, the first since 1939* An increasing number of cases of rodent plague was being found in this area? an increasing proportion of these cases in the more domestic species of rats and closer to human habitations0 A letter was prepared by the Medical Inspectors Office for the Commanding Generali signature*, requesting the Civil Governor to intensify rat control measures in the Hamakua District0 The es- tablishment of a rodent plague laboratory on the Island of Kauai was studied,, The Territorial Board of Health had not maintained one on that islanda On 1 April 19432 a commissioned entomologist was assigned to the Medical Inspectors staff„ A comprehensive mosquito survey of the Fto Shafter - Hickam Field - Pearl Harbor areas was instituted without delay„ Six enlisted sanitary technicians were trained to assist the entomologist in this work0 All mosquito breeding places found in this area were noted and mosquito catches identifiedo It had been assumed that had Anopheles mosquitoes been introduced to Oahu by aircraft from South Pacific Islands they would most likely be found in the vicinity of Hickam Field and Pearl Harbor„ No foreign species of mosquitoes were found, but it was noted that more mosquito breeding existed on military than on civilian proper- ties 0 A directive to the troops concerning mosquito control was 15 prepared and published as Section V, HHD Circular No, 759 8 June 1943* A study was made of the plague control activities of the Territorial Board of Health on Maui and Hawaii, following which a letter was prepared for the signature of the Military Governor to the Civil Governor requesting that 85 additional men be employed for rodent control in the Hamakua District,20 There was always the contingency that plague infected rats might reach Oahu from the Island of Hawaii in shipping. Civilian, military, and naval agencies concerned were contacted Informally with a view to increas- ing the use of rat guards on the mooring lines of ships in Territori- al harbors as required by Board of Health regulations. Periodic checks were made by inspectors from the Medical Inspector's Office to determine the number of ships using rat guards,21 Other activities during the month of April, 19435 included publication to all commanding officer# of a letter, subjects Polio- myelitis (infantile paralysis)?2 An outbreak of poliomyelitis was occurring among the civilian population in Honolulu at the time0 The letter contained available information concerning the disease and possible means of protecting the troops from infection with it„ Letters were sent to all hospital commanders enjoining them to cur- tail nose and throat surgery until the outbreak of poliomyelitis had subsidedo The incidence of new cases of the disease was watched daily and plotted on a map0 There was a total of 74 cases of polio- myelitis during the outbreak, of which only 4 were among military personnelo With the arrival of numbers of military personnel to the Hawaiian Islands from areas in which dengue fever was endemic it was felt that special precautions should be taken to prevent the intro- duction of dengue to the Department„ Accordingly a publication was prepared concerning the clinical aspects and mode of transmission of dengue feverc This was sent to all medical officers'as a letter, subjects Dengue, dated 1 May 1943o23 The publication of this letter preceded the introduction of idengue to Oahu through civilian channels by approximately three months0 The letter stimulated greater effort toward mosquito control in military areas, but it is doubtful if the average medical officer was sufficiently familiar with mos- quitoes to distinguish between the Aedes and Oulex species „ No mos- quito control program existed for civilian areas, particularly Hono- lulu and Waikiki where so many military personnel congregated on pass. This letter showed a remarkable appreciation of the clinical and epidemiological characteristics of the disease0 It was directed that all patients with fever be suspected and screened, and that a careful 16 history be taken from all such patients as to previous movements and intervals involved,. Little emphasis was given to the classic- al clinical description of dengue. In May, 1943-> chlorpicrin was used experimentally for bedbug control by personnel of the Medical Inspectors Office, and demonstrations were given to major echelon surgeons of the command,, Chlorpicrin proved to be a safe and satisfactory procedure for bedbug eradication in barracks for small units, but was not so satisfactorily applicable to large buildings because of its cost and difficulty in procurement. Study of the Honolulu sewage disposal system for the lower Kalihi area was continued, with the pbject of assisting the civilian authorities to improve the system* Ft* Shafter and Tripler General Hospital sewage was pumped into this system, and the increased military strengh on these posts, plus the pouring into the system of increased industrial, wastes from the Honolulu area had caused frequent overflowing of sewage in lower Kalihi civilian areas* The commanding officer of a Ranger training school at Schofield Barracks had dammed up a stream which carried gutter and other waste waters from the post in order to create a ranger training pool into which he could have his students plunge fully uniformed and equipped from a high tower* This water was found to be highly contaminated with B* coli, but it appeared for a matter of several weeks that the Medical Inspector had met his match in the chief of the Rangers who believed that blood and guts and a strong constitution would cover many sanitary efficiencies* Eventually, corrective action was accomplished* Surveys were made of the bivouacs of military detachments within the Oahu water- sheds, in order to insure that sufficient sanitary precautions would be taken to protect the water supplies* Many changes in construction of the Waianae-Kai Military Reservation were recom- mended to the Department Engineer* The original construction had many inherent sanitary defects* Among the changes that were gradually being accomplished was screening of kitchen and mess halls* A civilian dump and large open civilian cesspool in the town of Waianae had been a periodic sanitary nuisance productive of flies and Culex mosquitoes* A final, report concerning the bacillary dysentery epi- demic on Canton Island was forwarded to The Surgeon General during the month of June, 1943 Th® control measures which had been taken had proved to be effective, and the epidemic had subsided* There had been nothing new or unusual about this epidemic 0 The island commander had not given sufficient command attention to sanitationo Extensive fly breeding had taken place in latrines, garbage, and around kitchen areas where waste water had been dumped. Flies were numerous, and kitchens and mess halls had not been pro- tected from flies0 Mess kits washing facilities were not properly maintained. An exceptionally competent officer had been sent to Canton Island with a laboratory team. Sanitation was greatly improved, and concurrently thousands of stool cultures were taken and dysentery carriers found were isolated and treated with sulfa- guanidine until proved noninfectious by stool culture, A paper con- cerning this epidemic and its control was written by Major James E. Weiss, Sn, C., and Capt, Wilmore B0 Finerraan, M,Ce, and submitted to The Surgeon General for publication during November 1943 In June 1943* the Medical Inspector acted upon a memorandum from the Department Engineer to the effect that inadequately treated sewage from.Array installations was polluting several streams on Oahu, Complete surveys were made in cooperation with the Engineer, and necessary corrective measures were subsequently instituted,, One particularly serious sanitary deficiency was noted where untreated sewage from an antiaircraft bivouac was being discharged into a stream flooding civilian watercress gardens supplying half the Oahu marketsa This discharge of sewage was stopped at once, and pro- visions were made whereby the sewage was retained in a septic tank and periodically removed by truck. In other instances where food supplies were not being contaminated, provisions were made for adequate chlorination of sewage before discharge. One sanitary problem in connection with these streams of chlorinated sewage effluent on Oahu has been heavy Culex mosquito breeding where the water flow has not been sufficiently rapid or turbulent. The rapid growth of thick, matted, coarse grass along the miles of stream banks through inaccess- ible places has made continuous mosquito control difficult. Should it be possible in the post war period to survey and determine all areas in which mosquito breeding is prone to occur in these streams, a mosquito control program utilizing DDT may be a relatively easy matter. A study of progress in rodent control since the rodent con- trol school had been conducted in January and February, 1943, showed that between 12,000 to 15,000 rats were being killed by poisoning per month, and that effective rat proofing and other general control measures were being carried out on a wide scale in military organiza- tions .25 a laboratory officer and an enlisted technician were sent from a station hospital on Kauai for training at the Territorial plague laboratory on the Island of -Hawaii, preparatory to the estab- lishment of an Array rodent plague laboratory on Kauai (this labor- atory began to check for evidence of rodent plague on Kauai in Augus.t), 18 A cold storage plant at Schofield Barracks, and several Quarter- master warehouses at Ft, Kamehameha were found to be rat infested, and necessary rat proofing construction was accomplished0 Attention was given to several fly control problems about military areas in Honolulu. In upper Kalihi Valley one Quartermas- ter camp was infested with flies from an unauthorized dump on a ci- vilian premiseo This was easily corrected through cooperation with the Territorial Board of Health, Fly problems in Quartermaster camps in lower Kalihi area were much more difficult. In this vicinity there existed at least 5 piggeries and 3 large poultry farms, in addition to the auxiliary City Dump, Movement of the military camps was impractical. Sanitary conditions were gradually improved through a program of regular inspections and education carried on by inspect- ors of the Territorial Board of Health, Other activities of the Medical Inspector's Office during June, 19A3, included conferences in connection with the organization of a permanent rodent and vermin control detail at Schofield Barracks under the Engineers, and the conversion of available Engineer equip- ment for bedbug control procedures. No immediate progress was made. Bedbugs continued to be prevalent. Severe infestations were found at Ft. Huger, Bellows Field, and Kahuku Air Base, and recommendations were made to local surgeons and commanding officers concerning bedbug control measures. Drainage and waste water disposal problems in the large Tent City area of Schofield Barracks were studied, and corrective action was taken including provision of sinks for the kitchens, grease traps, and an extension of the post sewage system to serve this area, A sanitary inspection of the large Schofield Barracks Reception Center was made, and sanitary deficiencies existing in kitchens and shower rooms were corrected. Toward the end of June 194-3» the Territorial Board of Health reported a high incidence of upper respiratory infections pre- sumed to be influenza. The Army common respiratory disease rates showed a rise from 71 per thousand per annum in May to 96 in July, but quickly subsided to previous levels in August. In July 19A3, several difficult problems and large amounts of routine work faced the Medical Inspector, Serious sanitary de- ficiencies again existed in connection with the Kalihi sewage system. Complete study was given to the problem in cooperation with the Engineer and civilian authorities. Large quantities of industrial wastes were being discharged into the sewer, and the system repeatedly 19 overflowed through manholes in lower Kalihi civilian areas 0 Pumps which moved this sewage across the city to an outfall near Ft, Arm- strong were worn out and sewer lines were so old that they could not withstand greater pump pressure0 Additional industrial wastes were being poured into Kalihi Stream and were being backed up into the City by the tides creating disagreeable odors, A letter was pre- pared for the Commanding General3s signature, to the. Civil Governor, requesting him to take prompt action to obtain a solution to the problem, and stating that the Army would contribute a just,proportion of the expense. During this time a series of conferences on quarantine were begun with the Department Veterinarian and Quarantine Director Uo So Public Health Service, with a view.to correlating all existing quarantine regulations, Army, Navy, Federal, and Territorial* Fre- quent inspections were made of new staging areas being constructed by the Engineer at Schofield Barracks, Kahuku, the Pali, Ft„ Hase, and Waimanaloo These camps were being prepared for the reception of divisional combat teams which were to train and stage on 0ahuo The sanitary aspects of new construction were studied, and changes in construction recoramended0 Ten cases of endemic typhus fever occurred within the Department during the month of June, seven of these in one infantry division0 A 10 day course in rat control was given to selected personnel of this division, and assistance was given to tworother divisions in instituting better rodent control programs* Rodent control inspections were made throughout the command, and recommendations were made where indicated* During the month of August, 19433 practically all other activities of 'thS Medical Inspector's Office were subordinated to the control of dengue fever. On 6 August, the Territorial Board of Health reported that 4 cases of dengue had been diagnosed among civilians ill in Waikiki, The disease had apparently been present since the middle of July, Dengue fever had not occurred in the Territory since 1913, Widespread outbreaks had occurred in Oahu in that year, and previously in 1903, Experiences with dengue fever in the United States and in the Philippines were indicative of how paralyzing this disease might be to a busy wartime community. Repre- sentatives of the Medical Inspector visited the reported cases and confirmed the diagnosis. Inspections were made for mosquito breeding on Ft, DeRussy (in the Waikiki area), and assistance was given in mosquito control, A letter was sent to the commanding officers of all Array hospitals directing them to screen all cases of fever of undetermined origin, and to notify the Department Surgeon’s Office of all cases of dengue By & August, so many cases of dengue had been reported in the Waikiki area that it was consider- ed advisable to recommend placing personnel at Ft, DeRussy on a 20 working quarantine and the Ft. DeRussy-Waikiki area off-limits to other military personnel,2' A letter was prepared for the signature of the Commanding General* was approved* and was’ for- warded to the Department Special Service Officer directing him to close the Department Recreation Center at Ft, DeRussy and the Willard Inn (recreation center for Array officers in Waikiki)„ The Territorial Board of Health had taken immediate action to con- trol the outbreak in Waikiki, In addition to Board of Health in- spectors* the Honolulu Chamber of Commerce provided 9 inspectors from their rat and mosquito control squad* and employed 24 addition- al personnel to assist. The Army provided five enlisted technicians. These men worked as a mosquito inspecting crew covering Waikiki sec- tion by section. However* the adult mosquito population had become infected and could not be controlled in this way. Upon the recom- mendation of the Department Surgeon* a demonstration of the use ,of power spraying equipment of the Chemical Warfare Service for exterior spraying of insecticide was arranged on 9 August, The Army offered the loan of this equipment to the Board of Health* and it was accepted. All supplies of suitable insecticides in Honolulu were mobilized* and all premises in Waikiki were systematically sprayed by Chemical War- fare Service teams during the remaining days of August, Upon re- quest for assistance by the Territorial Board of Health* the U0S8 Public Health Service sent a commissioned engineer and entomologist experienced in Aedes mosquito control to the Territory by air trans- portation, These officers arrived about 1 September, In the mean- time* the Array accomplished Aedes mosquito control in all military areas and their immediate surroundings including all 0, S0 Engineer- ing Department base yards. Commanding officers of the military garrisons on the other islandswere notified of the epidemic and directed to take preventive measures,2® An Array epidemologist was made available to the Board of Health, One hundred mosquito bars * and 12 insecticide hand sprayers were loaned to the Board of Health for distribution to civilian cases in their homes. Four trucks were loaned on 21 August, By 1 September* 14S cases of dengue had been reported* many scattered throughout Honolulu* thereby ending all hope of confining the epidemic to the Waikiki district and making it essential to inaugurate a city-wide Aedes mosquito control pro- gram at once. With the spread of dengue cases into other areas of Honolulu* and marked reduction of cases in Waikiki* the area placed off limits for military personnel in Waikiki was reduced. Restricted zones were established in other areas of Honolulu where epidemiolog- ical evidence indicated the disease had shifted. While the dengue outbreak was attracting the major attention, the fight against plague in the Hamakua District of Hawaii was con- tinuing. On 3 September 1943, the Office of Civilian Defense* whibh 21 had been supporting 30 plague control workers on Maui and Hawaii, announced through the Territorial Board of Health that it could not continue this support much longer0 A letter was sent to the Adju- tant General, Washington, D„ Co, dated 1? September 1943$ subjects Plague in the Hawaiian Islands, requesting that the Department of the Interior be requested to furnish assistance to the Territory for plague control work* In mid-September 1943.) the Hawaiian Department was re- designated Hqs* USAFICPAo Reorganization and expansion of the Medical Inspectors Office took place0 With the reorganization, activity was geared for the offensive® However, many domestic problems m- mained over from the Hawaiian Department, the chief among them being control of the dengue epidemic, solution of quarantine prob- lems, plague control on Hawaii, Aedes mosquito control for all the islands, and institution of an industrial hygiene program® 22 Section 2 Preventive Medicine in USAFICPA (September 1943~July 1944) The Medical Office,, Hq USAFICPA, consisted of ten officers and the necessary enlisted assistants0 The duties of the officers were generally divided as follows; Medical Inspector, Assistant Medical Inspector, Venereal Disease Control Officer, Assistant Venereal Disease Control Officer, Entomologist and Rodent Control Officer, Assistant Entomologist, Epidemiologist and Medical Intelligence Officer, Assistant Epidemiologist, In- dustrial ,Hygiene Engineer, and Sanitary Engineer0 All officers acted together in a coordinated program, however, and assisted one another in whatever aspects of the preventive medicine program were of the greatest importance at any one time0 Subdivisions of activity were not rigid0 One or more of the members of the office was frequently absent on special missions and inspection trips0 At one time in early 1944, the two entomologists were participating in the Kwajalein Campaign, the Epidemiologist was absent conducting the malaria control training program, the Assistant Epidemiologist was actively engaged with the Territorial Board of Health in bring- ing dengue fever under .control, and the Assistant Venereal Disease Control Officer was inspecting dispensaries and battalion aid sta- tions for quality of professional service* Jn September 1943* considerable attention was given to the collection of medical and sanitary data concerning the Gilbert and Ellice Islands and the Japanese Mandated IslandsA large amount of source material was available through the Bishop Museum, the University of Hawaii, the Honolulu County Medical Society Library, and the Pacific Institute0 Data was collected and record- ed by island groups and by specific islands, as much as possible„ Plans were made for the necessary sanitary and medical preparations to be taken for the coming campaigns„ These studies were completed before the corresponding War Department Technical Bulletins concern- ing medical and sanitary data on these islands were received in this theater0 The results of the local and the War Department studies correlated closely0 The initial Essential Technical Medical Data Report for this theater was submitted during September 1943$ and monthly re- ports were submitted without exception thereafter0 23 The control of dengue fever in Honolulu continued to re- quire the greater part of the effort of the Medical Inspectors Officeo On IS September, an additional 50 enlisted men were assigned to duty with the Board of Health for the Aedes mosquito control pro- gram, Through the remaining months of 1943, the early months of 1944, the number of Army enlisted men provided for the support of the^pro- gram steadily increased, until in May 1944, a maximum of 14S enlisted personnel were on Aedes control duty in Honolulu alone® The peak of dengue fever incidence in Honolulu occurred during October, 1943* Thereafter, steady progress was made until January 1944, when during a one week period no cases occurred. A temporary increase in dengue incidence occurred during February and March, bub the epidemic was definitely broken during April, A factor contributing to the increased incidence of the disease in early 1944, was increased rainfall with resulting increased Aedes breeding indices. During the period from September, 1943, through January 1944, the full time of an officer of the Medical Office, was made available to the Territorial Board of Health® Thereafter, only part time was necessary® Further details of the dengue fever outbreak are contained in the chapter on arthropod-borne diseases and its inclosures Other activities of the Medical Office, Hq USAFICPA during September 1943$ included preparation of a master plan for Aedes mosquito control programs in any area of CPA, prepara- tion of an order requiring yellow fever vaccination for all person- nel in CPA, inspections and recommendations concerning rodent control in the plague area on Maui where construction of two new military camps was anticipated, and preparation of a letter showing the in- cidence of endemic typhus fever in the Territory for representatives of the United States of America Typhus Commission0 Industrial hygiene activities were being rapidly developed*, For a full description of these activities see Chapter 39 of this history on industrial health*, The r equirement of yellow fever vaccination for all person- nel in CPA32 Was established upon the urgent request of the Assist- ant Secretary of War0 It was not the firm conviction of the Surgeon,, CPA, nor of the Medical Inspector that this vaccination was neces- sary , but it gave security against the possibility that yellow fever virus might be introduced and adversely affect the military effort o During October 1943, continued effort was given to the suppression of dengue fever® The rodent plague laboratory on Kauai submitted an initial monthly report of activities, supplies were 24 increased for its operation, and a system of reporting rodents examined by geographical areas was worked out with the local senior surgeons. The current practices in the application of quarantine procedures in the Territory were codified, and a summary of responsibilities charged by law to the various civilian quarantine agencies was prepared. Arrangements were made for a conference of all parties interested in quarantine, to take place in November, Reply was received from The Adjutant General, Washington, D.C,, to the effect that The Surgeon General was con- tacting the U. S. Public Health Service and the Department of the Interior with a view to increasing assistance to the civilian authorities in carrying out plague control in the Territory. Rat control schools were conducted for selected enlisted men of an infantry division and the Army Port and Service Command. Assist- ance was given to the Surgeons of nine different military posts in the improvement of mosquito control programs. Plans for a special economy type water-borne latrine were received from the Engineer and forwarded in Essential Technical Medical Data, During September, a military expedition had been sent to build an airbase on Baker Island preparatory for the campaign in the Gilbert Islands0 No enemy opposition was found at Baker Island, but the surf made landings extremely difficult, and the construction of sanitary facilities was delayedc An outbreak of bacillary dysentery spread rapidly through the entire island garrison during October„ On 25 October, a laboratory team was sent to Baker Island to institute stool cultures as had been done earlier on Canton Island*, With improvement of sanitation, control of flies, and isolation and treatment of carriers the epidemic was brought un- der control. Sulfaguanidine in doses of 10 gms daily was used for the treatment of detected carriers on an ambulatory basis but the number of drug reactions which resulted was high. On 1 November 1943, the meeting on quarantine procedures was held at the Office of the Military Governor. Representatives of the Surgeons Office, Hq USaFICPA, the Office of the Military Governor, the District Medical Office of the 14th Naval District, the U.S. Public Health Service, the Bureau of Animal Industry and the Plant Quarantine Office of the U. S, Department of Agriculture, and the Territorial Board of Agriculture and Forestry attended. All parties were given an opportunity to express their views as to what corrective action they thought should be taken by the Armed Forces to improve quarantine procedures in their respective spheres. The meeting was quite a satisfactory one, and the draft of a new Army quarantine directive was approved. This draft of this proposed quarantine directive was then forwarded to the Commanding Generals 25 of the Arngr Port and Service Command, the 7th Air Force, and the Array- Transport Command for comments or approval. Numerous inspections of new regimental and battalion com- bat training camps" were made during November,, A major problem de- veloped in the control of fly breeding in the large pit latrines which had been constructed for these camps. Recommendations were made for correction of deficiencies in flyproofing of pits and latrine houses. On 16 November, a conference was held in the Sur- Office, CPA, attended by the Medical Inspector, G«l, G“35 and G~4, CPA, and representatives of the Department Reserve, Array Port and Service Command, and four infantry divisions with a view to improving the sanitation of these camps. No provision had been made for station complements for them, their maintenance having been left to the organizations occupying them for training® It was agreed that an officer should be provided for each camp for supervisory custodial and maintenance purposes, and that a survey of existing camps be made by the Engineer and Surgeon, CPA, with a view to determining and correcting any major sanitary faults existing at the camps. Experiments were set up to test the effecv- tiveness of borax and a new chemical., paradichlorobenzene for fly control in the pit latrines. Other problems and activities included spot checking of the first aid applied in fracture cases, testing of flame throwers and shotguns as rat control expedients for tree nesting rats, ex- perimentation with yeast cultures in pit latrines, recommending a new sewage system for the station hospital on Maui, and study of the possible danger of evacuating military personnel infected with filariasia from the South Pacific Islands through Oahu where a large Culex mosquito population existed. The danger of introducing filariasis to the Territory of Hawaii through these military person- nel was determined to be negligible. None showed circulating microfilaria in the blood. Many Samoans infected with filariasis had been brought to live in the Territory as laborers in the past, and the disease had never spread, Samoans with microfilaria in the blood were found in certain communities on Oahu but no disease was found among their children who had never been to Samoa but who had lived with their parents on Oahu in mosquito infested communities for as long as 20 years. No microfilaria were found in Samoans on Oahu who had not visited Samoa for over 8 years. Attempts at ex- perimental infection of local Culex and Aedes mosquitoes from these natives repeatedly failed, it was believed because the numbers of microfilaria per cubic*centimeter of blood in most of them had fallen to low levels,-5^ 26 During the last week of November 1943* an outbreak of bacillary dysentery developed in several regiments of an infantry division conducting extensive field exercises on certain coral wastelands on Oahu, Prompt control measures were undertaken, in- eluding emphasis an proper sanitation St/ool cultures were taken of all personnel in affected units, and carriers were isolated and treated. This outbreak served as an important training lesson in sanitation for this division which subsequently assaulted and captured the southern islands of Kwajalein Atoll with a minimum of diarrhea, the first Pacific Island occupation in which dysentery was not a major problem* During December, numerous conferences were held with the Navy because of reports of exceedingly poor sanitation in the recently captured Gilbert Islands* In January34 1944$ numerous conferences were held with the staffs of the 5th Amphibious Corps, Navy, Army assault and garrison forces to prepare them for sanitary problems which were anticipated in the projected Flintlock Operation, At this time a method was developed whereby sodium arsenite could be used to treat the dead prior to burial so as to prevent flybreeding,^ 'Concern was felt regarding the importation of various diseases by incoming personnel. Responsibility for insuring ade- quate quarantine of incoming personnel was placed on the Commanding Officer, Arngr Port and Service Command and the Air Quarantine Officer, Troops arriving from forward areas were no longer allowed to disembark until cleared by the Office of the Medical Inspector, Representatives of the above office were detailed to meet all ships bringing in returning task force troops. Considerable emphasis was placed on training the three Sanitary Companies (715th, 717th, and 719th) stationed on Oahu, Intensive training in mosquito control was undertaken by the 715th and 717th Sanitary Companies, and in rodent control by the 719th, This served a dual purpose. It aided materially local control activities and was an important factor in preparing these organiza- tions for duties elsewhere. Likewise a malarial training program for divisions was worked out and put into effect. During the month of February arrangements were made with the Air Transport Command Headquarters for the handling of their Sanitary Reports by the Medical Inspector’s 0fficeo Mosquito sur~ veys of rural areas on the Hawaiian Islands were completed and control units assigned for corrective work, Rat control units 27 were assigned to various posts, Methods of plane disinsecti- zation were studied with Air Force Officers and improvement? made in the methods in current use. A representative of the Medical Inspectors Office was with the Flintlock Operation to supervise sanitary measures, par- ticularly the treatment of the dead prior to burial* In March the extensive study of medical and sanitary data on Micronesia was completed and publishedArrangements were made for the Army to establish and temporarily operate a bacteriology laboratory for study of plague at Hamaka, Hawaii* Mosquito and rodent control work continued,, Arrangements were made for the hospitalization of all known cases of filariasis coming to these islands* This would afford an opportunity for studying this disease under local conditions* Because of the arrival of in- creasing numbers of Negro troops with an appreciable higher preva- lence of venereal disease than that for white troops,special attention was given them and spinal fluid studies made* In April 1944p continued attention was given to the problem of burial of the dead and particularly to the advantageous use of sodium arsenite in this work* Studies and recommendations were completed on the use of respirators for the protection of sani- tary details from odors on the battlefields. A study of the avail- able literature on fatigue was made* After considerable study of Megarhinus splendens mosquito, it was recommended that it be intro- duced in an effort to control Aedes mosquito breeding. Schools in rat control were held for officers of the 77th Division and schools in malarial control for units of the XXIV Corps, Arrangements were made with the Board of Health, T,H0, to carry out a tuberculosis survey among USED employees. During the month of May the presence of suspected cases of filariasis at APO 242 caused concern and a team was organized to study this problem and sent to APO 242, Continued emphasis was layed on training units stationed here in malaria control. There had been only minor outbreaks of diarrheal diseases in troops stationed here, but as a precautionary measure arrangements were made for the study and treatment of intestinal, diseases in Prisoners of War at APO 95&, In June and July 1944*, tests were made of the use of powder- ed borax in pit latrines to control fly breeding,, A large shipment of Paradichlor©benzene was received and experiments could again be undertaken with this material, A study of available literature on dis- eases and sanitary problems of the Far East* particularly of the 28 Philippines, China, Formosa, and Japan was made0 An analysis of Army and civilian cases of endemic typhus fever was made, Con- ferences were held with the Navy regarding special Aedes mosquito control measures in the vicinity of Hickam Field0 Dengue fever had recently appeared in this area. Quarantine inspection of in- coming task force troops was delegated to the Army port and Serv- ice Command, Circulars on the purification of water at advanced bases were prepared for publication, A special course in sanita- tion and tropical medicine was given to the medical department officers of the 81st Division, 29 Section 3 Preventive Medicine in Central Pacific Base Command (1 July 1944 to 2 September 1945) The changes in command which took place 1 July 1944 placed the Medical Office under Central Pacific Base Command, It was not until 1 August 1944* that the Sta- tistical Health Reports (old WD* MD Form No, 86ab) went forward through AFMIDPAC, No important changes in the duties* functions* . and organization of this office occurred. The office continued to be oriented towards offensive operations and conferences were held with Brig, General Maxwell of SPEC regarding filariasis and other special diseases. Conferences were held with various offi- cers concerning sanitation of advance bases. Lectures on the use of sodium areenite in battlefield sanitation were given to a Graves Registration Unit and three Quartermaster Service Companies, in August, rat control work at airfields was completed and the 717th Sanitary Company transferred its control activities to posts and hospitals0 More large scale experiments with para- dichlorobenzene for fly control were conducted at the 13th Replace- ment Depot and areas JJ and HH of Schofield Barracks, Similar studies with DDT were undertaken at Aiea Staging Area, Studies with 5% DDT in kerosene for bedbug control, were carried out. The results of the last mentioned experiment were excellent. In September after many conferences with local author- ities* the houses of prostitution in Honolulu were closed. Simi- lar establishments elsewhere in the Territory of Hawaii had been closed previously„ There resulted a slight decrease in the al- ready low venereal disease rate among Army personnel and a strik- ing decrease in the number of prophylaxes given in Honolulu, A representative of the Medical Office who had been on temporary duty with APO 244 retumedo He (had observed drilling and testing of wells* inspected wells and garbage disposal dumps* fills etcand was consulted on numerous civil affairs problems* and proposed sites for hospitals and sanitary facilities on Saipan, Fifty additional lantern slides were completed by the 5th Museum Arts Survey Unit t© be used in conducting lectures on tropical diseases and their prevention„ At their request SPEC 31 was supplied with information concerning CPBG procedures in delousing PSPs. At this time the 6th Air Service Command Surgeon was notified informally that spraying of inter-island aircraft was suspended. The month of October 1944$ saw considerable activity of a routine nature, such as inspections, preparation of publications, training, continued liaison with Navy and Territorial Health officers, and investigations of minor outbreaks of communicable diseases. In November 1944$ a Sanitary Engineering Section separate from the Medical Inspector’s Section was established. Observations on precautions to be taken with patients evacuated from forward areas were systematized and published as an annex to Medical Service, CPBC, Administrative Order No, 1* The year 1944 closed with the completion of the important test series No, 1 comparing PDB and DDT for fly control in latrine pits and the forwarding of the report of this work to The Surgeon General, During January 1945$ there was considerable interest in nutrition. The allowance of perishable cold storage foodstuffs for troops in the Pacific Area was to be reduced to approximately 1 cubic foot refrigerated cargo space per man per month,, The chief dietitian of one of the general hospitals on Oahu was appointed by the Surgeon to assist the Quartermaster subsistence officer in writing a new menu for the CPBC ration, based upon the B ration plus one cubic foot of perishables. Several conferences were held to discuss the possibility of instituting large scale fishing to provide fish to supplement the CPBC ration. Representatives of Hawaiian Tuna Packers Ltd, attended these conferences. These people “stated that they could catch a species of tuna in large tonnage if Naval restrictions were remqved which prevented their boats from entering the best fishing waters. Some progress was made in having fishing restrictions lifted by the Navy, however, this type of tuna was a bloody fish, best suited for canning. No practical solution was reached which would bring fresh fish to the troop messes. Recreational fishing was increased, and what was caught was eaten, A program of mess inspections by teams was set up under the Quartermaster with a view to improving the quality of the preparation of food as much as possible. Lectures in tropical medicine and diseases of the Hawaiian Islands were given to the medical officers ©f a small station hospital which arrived from the mainland0 A school in rat control was given to personnel of a sanitary company,, The Industrial hygiene Officer was active, particularly in connection with study of the chemical 32 impregnation plants utilizing tetrachlorethane0 Comparative tests of DDT and PDB as fly control agents in large pit latrines were continued0 Administrative orders concerning first aid for fractures and quarantine were drafted,, During early 1945 s a number of cases of severe urticarial dermatitis, some with constitutional symptoms, developed among swimmers at Ftc DeRussyu After considerable study it was proven that these lesions were caused by a previously not described marine hydroid which was found attached to the swimming rafts in large numberso Periodic cleaning of the rafts was effective in prevent- ing cases* During February 1945s a paper was prepared upon the effect of tteiclosing of the houses of prostitution upon the Army This paper was read before a public audience for Social Pfygiene day0 Venereal disease rates had been reduced to such low levels during the period when prostitution flourished on 0ahu9 that no spectacu- lar further reduction was possible0 There was no rise in rates, and there had apparently been no fall in the morale of the service men as a result of the closing of the houses0 Other routine work during January and February 19459 in- cluded investigation of two small outbreaks of bacillary dysentery among troops training on Oahu, drafting of an administrative order concerning laboratory services, inspections of prophylactic sta- tions, and inspections of beaches for evidence of contamination by garbage dumped at sea, A Joint Army-Navy Disciplinary Control Board was formedo Two thousand two-ounce cans ©f louse powder were given to the Territorial Board of Health for use .to protect rat control personnel in plague areas„ Special studies were made con- cerning the health and housing of civilian employees of the Army, The availability of medical care for these civilians through civilian facilities was again checked and found to be adequate. 38 During March 19459 the Joint Army-Navy Control Board began the first of a series of inspections of civilian restaurants0 Several insanitary establishments were placed off limits for troops during the subsequent months0 Conferences were held on the corre- lation of laboratory and clinical studies in cases of tetrachlore- thane poisoningo A number of personnel from the chemical impreg- nation plants began to show laboratory evidence of poisoning and were relieved from this duty0 Three new sanitary companies were trained in rat control. An administrative order summarizing all quarantine procedures was published,. During April 1945* considerable time was given to assist- ing the Information and Education Office in preparing a medical issue of the publication "Fighting Facts", A number of inspections were made of the Honolulu piers. Garbage disposal had been inadequate on these piers* and better arrangements were made, A representative of the Medical Inspector accompanied an officer of the U0 S, Public Health Service in inspections of procedures in disinsectization of aircraft. Deficiencies were noted in procedures carried out by both the Air Force and the Army Transport Commando A complete report was submitted through channels. Comparative tests of PDB and DDT in pit latrines were com- pleted, Under the conditions of the experiments the PDB gave the more satisfactory fly control.. The DDT in spray or powder form was not active against fly maggots in the latrine pit* although it was irregu- larly effective in preventing the new emerged adult flies from flying out of the pit. The Industrial Hygiene accomplishments during this period included the design and supervision over installation of a venti-* lating system for an enclosed test firing range and inspection of several Quartermaster* Engineer and Ordnance Shops*, Routine sanitary inspections of all elements of the command carried on during the intervals between special problems0 In general* at least one company per battalion was thoroughly inspected, Organi- zations were inspected by major echelons on several days notice.. Sani- tary conditions were generally excellent during 1945 © The major sani- tary problems* when they occurred* were in connection with the post exchange restaurants utilizing civilian help* or service men on de- tached service*, These restaurants were frequently overcrowded*, During the last weeks of April 1945* an outbreak of diarrhea occurred in an infantry company attending a mortar school0 The kitch- en was inspected and found to be excellent* no faults in food prepara- tion were found* and the outbreak of approximately fifty cases of mild diarrhea of several days duration remained unexplained., Stool cul- tures taken of the entire company by a competent bacteriologist were negativeo The clinical picture had been consistent with an outbreak of mild Flexner dysentery, About two weeks previous to the outbreak about fifteen (15) men of the company had returned from Leyte where they had been observers„ The other dysentery outbreaks occurred about this same time in closely related field artillery battalions0 One suffered a mild outbreak of Flexner dysentery during a period of amphibious training0 34 The unit returned to bivouac where a large number of Flexner dysen- tery carriers were diagnosed by rectal swab cultures, among troops who had eaten at one kitchen. All personnel exposed to this kitch- en were given one tablet of sulfadiazine (lo0gm) daily for five days, after which all but two of forty (4-0) carriers had negative stools. These responded to a second course of sulfadiazine, approx- imately one week later an explosive outbreak of diarrhea developed in a unit bivouac nearby. Stools were negative for all cases. The clinical picture in this outbreak resembled more a mild infectious dysentery than a food poisoning. During the latter part of April, a number of mail sacks were delivered to the CPBC Base Post Office which were severly infested with insects. Positive identification of the insects was not made, but steps were taken to provide sprays and insecticides to Post Office workers. Later, at the suggestion of the Chief Quarantine Officer, U. S, Public Health Service, arrangements were made for the application of DDT residual spray to the walls and furnishings of post offices and baggage rooms at four month intervals0 During May 19A5s there were a great number and variety of preventive medicine activities. An Aedes mosquito problem in a coral pot-hole area on the Ewa plain was attacked by spraying atomized DDT insecticide from a DeVilbiss spray apparatus. The insecticide, it was hoped, would be carried into areas of dense vegetation on the wind. Control of adult mosquitoes was fairly satisfactory for a period of two days, aerosol generators have not been tried in this area. The DeVilbiss spray method was not repeated, as it appeared more practical to clear the vegetation, locate the breeding holes, and treat them accurately with DDT spray. A similar decision was reached in connection with a mos- quito problem about the Kahuku air Base where the Air Crops strongly desired to spray DDT from the air to eliminate a severe Culex infestation. A careful survey of the Kahuku Base showed the major Culex breeding to be in flooded basements and fire barrels and not in the adjacent waste areas. Airplane spraying would have been ineffective and wasteful, and local treatment was effective so long as Base personnel were sufficiently energetic to apply it. Conferences with entomologists for local agricultu- ral industries were also held concerning their feelings in con- nection with the airplane spraying of DDT on the island. Every civilian authority consulted was firmly convinced that promiscuous airplane spraying over the Hawaiian Islands would upset biological balances of insect control which had been established through long effort and would be catastrophic to Hawaiian sugar and pineapple 35 industries,, A general policy hag been adopted to disapprove DDT airplane spraying in this area,,' An infantry division on Oahu reported satisfactory fly control in large pit latrines utilizing approximately one quart of 5% DDT in kerosene finely atomized into the latrine pit twice a weeko Maggot activity could always be observed;, but the appear- ance of adult flies in the latrine house was controlled,, This same organization reported unsatisfactory results with PDB in latrines which were periodically filled with rain water or infested with the soldier fly* Hermetia illucens9 The Array provided quantities of dimethylphthalate to the Territorial Board of Health during May, for the impregnation of clothing used by plague control workerse A rodent control school was carried on for a newly activated sanitary company0 The epidemi- ologist of a projected Array task force was given several weeks train- ing at the Medical Office, A comprehensive report on rodent control activities in the Hawaiian Area was written for transmission to The Surgeon General.0 A number of Array dispensaries and battalion aid stations were inspected for quality of the Medical Serviceo Steps were taken to obtain new figures on the CPBC Quarter- master ration with a view to undertaking an accurate analysis of the ration for nutritional adequacy 0 One of the raajor industrial, hygiene problems of the year occurred in connection with an Engineer asphalt plant which had been improperly located to the windward of a permanent Ordnance Ammunition Area0 Smoke and dust from the- asphalt plant became a serious nuisance to Ordnance personnel„ Careful studies showed no silicosis hazard to Ordnance but steps were taken to secure the necessary smoke precipitators to lessen the hazard,, A possible silicosis hazard was found in the aggregate tunnel of the asphalt plant* and steps were taken to secure adequate ventila- tion for this tunnel„ The final three months of the war found preventive medi- cine activities* aside from the ever recurring inspections* con- sultations* and control measures* concerned chiefly with a mild influenza epidemic* disease among the Okinawa POWs* and mosquito and insect control of mail sacks* baggage* and salvaged tires0 Early in July arrangements were completed with the IBth Medical General, Laboratory and Malaria Survey Detachments to sur- vey POWs for intestinal and blood diseases6 Later in the month conferences were held at the MidPac Surgeon3s Office with 36 particular reference to filariasis and it was decided to screen all Okinawans for filariasis and any who showed micro-filaria in the blood were to be returned to Okinawa, By mid-August a directive had been issued to the effect that PCWs would not work in troop or officer messes; that POWs fi*om forward Pacific areas would work only within their compounds unless specified precautions towards preventing the spread of intestinal diseases were taken;, that POWs should be presumed to be infected until proved otherwise; and that POWs to be transferred to the main- land would only be surveyed and screened for filariasis, treated for vermin infestation and the critically ill transferred to medical facilities. The problem of mosquito control in salvaged tires was investigated and an administrative order was prepared on this subject and published in mid-July.'*0 Similarly the problem of infested mail sacks and baggage coming from forward areas was in- vestigated and procedures necessary for more adequate control were incorporated in an administrative order0^ Because of the inflammable properties of DDT Emulsion Concentrate, the use of this material was prohibited except on approval of CPBC Headquarters. In early June several suspected cases of Dengue occurred in the civilian population and an Immediate action letter to unit commanders directing that pre- cautions be taken to prevent an epidemic was drafted. In this month s report was prepared at the request of The Surgeon General regarding medical care and control of civilians in CPBC. In August the whole problem of preemployment examinations of civilians was gone into and new standards and regulations were recommended. The problem of chlorinated hydrocarbons as used for degreasing came up again in connection with the 963rd Ord- nance Company, and corrective measures instituted. Fly, mos- quito and odor nuisances in a civilian area adjacent to John Rodgers Airport were investigated and the cooperation of the Board of Health, T.H., secured in having existing conditions corrected. Working conditions in the aggregate tunnel at Red Hill Hot Plant were found most unsatisfactory and recommendations were made for their improvement. A representative of the Medical Inspector’s Office com- pleted an inspection of military installations at aPO 24-0 and aPO The Joint Army-Navy Board set up and enforced proper hygienic standards in local tatoo parlors. The Board continued its sanitary inspections of local restaurants, bakeries, etc. 37 A comprehensive investigation of the high non-effective rate in the 296th Infantry (a Puerto Rican unit) was undertaken in July 194$o This rate was out of all proportion to that of other Puerto Rican units0 The chief causes for this non-effectiveness were infestation with intestinal parasites and psychoneurosis. It was determined that gross inefficiency on the part of responsible officers during staging of this unit in the Canal Zone was responsi- ble for the accumulation in one organization and the forwarding over- seas of such a large group of the physically and mentally ill,43 As the war ended preventive medicine activities were con- cerned chiefly with maintaining standards of insect and rodent control and in sanitary hygiene among the Army units stationed in CPBC„ 38 LIST OF REFERENCES Chapter 19 1. Annual report for the calendar year 1941$ Hawaiian Department* 2* Diary of Med* Insp*, 1942 (5 Memos)* This chapter is based largely on the diaries (1942$ '3$ f4, and 15) of the Medical Inspectors Office* and unless otherwise indicated they constitute the authori- tative source for statements in the text* 3* File 620* Housing of Trps & Officers* Serial No* 6* 1941=42, HHD, Off of Dept* Surg. 4* General Order No* 154$ Chlorination of Water Supplies, Off of Mil Gov, T* Ho, 7 Nov 1942* 5* See below* 6* Pile 710* Jaundice, 1942, HHD Off of Dept* Surg* 7* For further details of the Inmunization Program see Chapter 30* 8* For further details see Chapter 24* 9* Gen Order No* 122, Sec lit Collection and Disposal of Swill, Dry Garbage, and Rubbishs Off of Mil Gov, T* H©, 1 Jul 1942* 10. Gen Order No* 137, Sec Is Rubbish and Refuse Cleanup Program for City of Honolulu, Off of Mil Gov, T* H*, 11 Sept 1942* 11. Gen Order No* 77, Military Aircraft Quarantine Procedure, Off of Mil Gov, T* H*, 24 Feb 1942* 12* Venereal Disease Controls A Bedtime Story; Fennel, E* Ao$ Hawaii Med J, (Nov - Dec) 1942* 13* Gen Order No* 107, Sec Is Control of Communicable Disease, T* H*, Office of Mil Gov, To H0, 21 May 1942* 14* Ltr to the Surgeon, Hq* APO 958, fr Maj James E* Weiss SnC, subjs Report of Bacillary Dysentery at APO 914, dtd 20 May 44, on file Surg Off CPBC, File 710 Bacillary Dysentery, Serial 19, 1943® 15* Diary of the Medical Inspectors Office 1943° 16* Ltr, Subjs Rat Control, by GG, HHD, 12 Dec 1942, file AG 729<>5 - Rat Control* 38a 17o File 430, Nutrition, Analysis as to Dietary Adequacy of the Field Ration Hawaiian Department, 24 Apr 1943* HHD Off of Surg. 18. File 475* Equipment of Troops, Proposed Medical Jungle Kit, Serial ISA, 1 Septo 1943* HHD Off of Depto Surg. 19o Cir #43* HHD, 31 March 1943. 20. Ltr, 26 Apr 1943* Gen E/TO Gov„ S, Secret 710, lyphus fever. 21. File 729«>5 Rat Control (1943)* HHD Off of Dept. Surg. 22« File 710. Polyonyelitis, Polionyelitis (infantile paralysis), 14 Apr 43 * HHD Off of Dept Surg. 23» File 710. Dengue, Dengue, 1 May 1943* HHD Off 01 Dept Surg* 24. Ltr to the Surgeon, Hq, USAFICPA, APO 958, from Capto Wilmore B. Finerraan, M0 C., and Maj. James E» Weiss, Sn.C., dtd 19 Oct 1943, with inclosed report, subj: The Control of Bacillary Dysentery, on file Surg Off, CPBC, 710, Bac0 Dys., 1943* Item No. 25. Forwarded to AG, Washo, Do C. by 2d Indo, dtd 6 Nov 43» 25. For a detailed account of rat control see Chapter 29 on Control of Rodents. 26. Ltr HHD, to all hospital coramanders, subj: Dengue, dtd 6 Aug 1943. 27o Radiogram of 8 Aug 1943* confirmed by ltr, HHD to all commanding officers, subj: Dengue Fever, dtd 8 Aug 1943* on file. Surg Off, CPBC, AG 704ol. 28. Ltr HHD, to all Commanding Officers, subj: Dengue, 12 Aug 43. File: Surg Off, CPBC, AG 710 (med) (Dengue), 1943° 29« Ltr HHD, to Adj U. So Array, Wash., D. Co, subj: Plague in the Hawaiian Islands, 17 Sept 1943. File 710, Plague, Serial 31A. HHD, Off of Dept Surg. 30. Ltr, subj: Medical and Sanitary Data on Micrones:*»HUSAFECPA, File AG 720.3/ 19* 22 Mar 1944. 31o Chapter 34 on Arthropod-borne Infections. 32. Ltr, Hq, CPA, 6 Oct 1943* File No. 720.3 Immunization, 1943* CPA, Off of Surg. 33o Filariasis Files, File No. 710 FLlariasis 1943* HHD and CPA, Off of Dept Surg. 38b 34* Diary of Medical Inspector’s Office, 1944. 35* See Chapter 28 on Control of Insects. 36* Pile No. 704<>11 Patients Returning to the Mainland, Miscellaneous, 1944, CPBC,* Off of the Surg. 37. The Effects of Closing of Houses of Prostitution on the Arny by Major Laurence J. Stuppy, M. C., AUS - in VD files. Office of Medical Inspector, CPBC, Off of the Surg. 38. The Joint Army-Navy Disciplinary Control Board was established in General Order No. 18, Establishment of Joint Army-Navy Disciplin- ary Control Board, HQ, POA, 6 Feb 1945. 39• File No. 441.1 Drugs, Poisons, Serial No. 36 Widespread use of DDT on Oahu, May 1945, CPBC, Off of the Surg. 40o File No. 725ol Mosquitoes, Serial No. 31 July 1945, CPBC, Off of the Surg. i *» 41. File No. 720.4 Quarantine, Serial No. 15, CPBC, Off of t&e Surg. 42o File No. 333 Medical Inspections, Miscellaneous, Serial No. 113 July 1945, CPBC, Off of the Surg. 43» Secret Rpt dated 1*Aug 1945, Capt. K. L. Brookens to Surg, CPBC, Subject: Hospitalization in the 296th Inf Reg Combat Team. 38c CHAPTER 22 Clothing (History of Preventive Medicine) No special cloth-in g requirements have existed in the Central Pacific Area. The climate is moderately warm with little variation. Headquarters CPBC, Administrative Order No. 1 (Index CPYQM 114.20), Basic Authorized Allowances of Outer Clothing for Ehlisted Men in Central Pacific Base Command, dated 12 April is representative of clothing requirements in the area. Requests have been received from time to time from forward bases on Pacific Atolls for shorts and short sleeved shirts, CKC. These items were at one time authorized for issue, but further procurement was rescinded in letter, file AG 421*1 (18 August 1943) 0B-S-SP0DG, subject: Short Trousers, dated 6 September 1943* "Bequest for reconsideration in this matter was not favorably considered by the War Department in March, Nevertheless, continued requests for such items of clothing have been received,^" Short trousers and short sleeved shirts have been contra-indicated for bases where malaria, dengue, filariasis, encephalitis, scrub typhus, and other insect or arthropod-borne diseases exist. However, there have been no such disease con- ditions to contra-indicate the wearing of such clothing on the coral atolls of the Line, Phoenix, and Marshall Islands. Dengue fever, the only problem in the Gilbert Islands, was infrequent after April, 1944* The issue of such short clothing could have been of value in the Line, Phoenix, Gilbert, and Marshall Islands from the standpoint of comfort. Such clothing could have been of light color, light weight, and loosely woven, inasmuch as it would not be required to give protection against insect bites. The khaki and herringbone twill cloths have been criticized be- cause they are too tightly woven, and because the latter is too dark in color. If short clothing had been authorized for Central Pacific bases where insect and other arthropod-bome diseases did not exist, precautions could have been taken to prevent the dissemination of such clothing to bases where not authorized. Training of all elements of the Central Pacific Base Command, except for personnel designated by order for employment in the Hawaiian area only, were given training in the use of wet-cold clothing and equipment during June 1945o Letter Head- quarters Army Ground Forces, File 710/111. (20 January 1945)GNGBI, subject; Prevention of Trench Foot and Frost Bite, dated 20 January 1945, was used as a basis for this training. 39 LIST OF REFERENCES Chapter 22 1* Adm 0 No, 1 (CPYC 114*20) 12 April 1945> subject: Basic Author- ized Allowances of Juter Clothing for Enlisted Men in CPBC, with table of Index 114*20 dated 9 January 1945, HCPBC. 2. Ltr from the Adjutant General ' o Commanding Generals (U, S. Army Forces in CPA and So Pac kret dated 6 September 1943, subject: Short Trousers, File 420, Clotiling and Equipment, Serial No* 3, Office of the Surgeon, CPA, 1942-43* 3* Radiogram, War Dept to Commanding General, CPA, File No* 420, Clothing and Equipage, Serial No. 3, Office of the Surgeon, CPA, 1944* 4* Memo to Surgeon from Quartermaster, dated 12 January 1945, subject: Shorts and Short Sleeved Shirts, CKC, File No. 420, Uniforms and Clothing, Serial No. 3> Office of the Surgeon, CPBC, 1945* CHAPTER 23 Housing (History of Preventive Medicine) The climate in the Central Pacific, is pleasantly warm to cool depending upon elevation above the sea0 No In- sulation of walls or ceilings against heat or cold has been necessary* Glass windows have been unnecessary for temporary troop barracks„ In some localities provision has been made foi shutters on the windward side,. During the years 1941 -» ,19435) a certain proportion of troop buildings were provided with black-out shutters to allow for work and recreation in the evenings* These black-out shutters consisted of black painted hoods over ventilation apertures, which allowed some passage of air but prevented lights in the interior of the building being seen from the- air tmtside* Wire screening has been desirable, because of zhe common night-flying mosquitoes 0 Rainfall varies from scant to heavy, depending on elevation and situation as to prevailing winds and mountain masses*, Watertight roofs with overhanging eaves or adjustable side walls for tents have been essential* Dust problems have existed in instances as a result of the excessive destruction of ground vegetation in bivouac areaso or if buildings are placed to© close to dirt, reads* Heavy rains during certain seasons in some localities have resulted in excessively muddy ground conditions0 Under these cir- cumstances bivouacs have been provided with coral.,, gravel, or asphalt roads and paths or board walks0 Otherwise building floors have become heavily soiled with mudc. It has been required that all buildings and tent floors be raised off the ground, preferably IS inches, t® prevent rat infestation, and that trees be cut back at least three feet from building rooff* to prevent climbing rats from gaining entrance* For protection from Insects and rodents all openings except door# have been, securely covered or screened, and doors provided with automatic closing devices* The floor area per man required in sleeping quarters has been minimal* The mild climate allow# for excellent ventilation* Upper respiratory infections have been mild and their incidence relatively low (75 *- 125 admissions per thousand per annum)* Pneumococcus pneumonia, meningococcus meningitis, and scarlet fever have been uncommon diseases in the Central Pacific, and when they have occurred they have usually been found among person- nel recently arrived from other areas* Measles, mumps, and chickenpox have not been a problem* Housing in the Central Pa- cific Area has been based upon a minimum standard of 40 sq* ft* per man, and experience has shown this standard to have been adequate. When beds have been placed closer than 5 ft, apart, head to foot ing has been required,1 When troops took up field positions on 7 December 1941, housing was almost entirely improvised. For reasons of camouflage very few tents were used. Small camouflaged one and two man shanties made from box wood or waste lumber, small excavations in the ground, bomb shelter or vacant civilian habitations were commonly used for shelter. During the middle period of 1942, the Hawaiian Department Engineer designed and began the mass production of a housing unit known as the 161 x 20;, portable prefabricated barracks. This unit was provided with heavy tar paper roofing and with solid wood lower and wire screen upper side walls. Including the wood floor it was prefabricated into 16 pieces, four floor, four end, four side wall, and four roof sections. At first these portable buildings were issued only to troops in field positions on the basis of one per six- teen men, to be used with double-decker canvas bunks As production caught up with the demand, the basis was lowered to one building per eight men. These buildings were also used singly or connected in series for kitchens, mess halls, offices, dayrooms, post exchanges, classrooms, shower rooms, supply rooms, and aid stations, A pre- fabricated screened latrine building in six sections was developed for use over pit latrines. The use of tentage was largely confined to posts, regimental combat team bivouacs, and training camps. Regimental and battalion combat team camps were con- structed in the Hawaiian Islands in 1943 for divisions training and staging in the area. These camps consisted of company size units of pyramidal tents on tent floors; enclosed, but unroofed showers, dressing rooms and washstands; screened-in kitchens, 161 x 201 in floor area; outside ice cooled refrigerators; waist-high tables without stools under tent flies for mess halls; and large, deep eight and twelve hole pit latrines in screened latrine houses. Each camp, was provided with buildings for headquarters, a post exchange, a classroom, and a dispensary. In addition, open air theaters and play- ing fields were constructed. Existing posts have been expanded during the war by the use of cantonment type buildings. Water and electric services, oil burning kitchen ranges, electric refrigerators, and hot water for washing and showers have been provided. Kitchens have been screened throughout the Command, and the majority of units have been provided with screened mess halls. 42 Hot water for bathing was dependent upon the initiative of troops in improvising facilities until 1944P when the Ehgineers were able to provide most units with hot water heaters <, Day- rooms, post exchanges, and beer gardens are provided to almost all units,. The unroofed shower room has been very satisfactory, hygienic, and easy to keep clean of mold growths on floors and walls* Kitchen and shower waste water nas been disposed of into covered soakage pits of natural stream beds, usually after passage through some type of baffle grease trap* Waste water run into natural drainage channels has been a-prolific source of pest mos- quitoes where mosquito control measures have not been taken* Concrete slabs with rims and drains leading to kitchen grease traps have been constructed by some organizations for washing of kitchen utensils and garbage cans, for garbage can stands, and for platforms for mess kit laundries * These concrete platforms have been very satisfactory in preventing pollution of the ground with food particles incident to the washing processes, and have eliminated fly breeding in the soil so polluted,, Water - borne latrines have been provided for field positions within con- gested civilian areas, and for the majority of units situated upon permanent Army posts* The following directives have been pub- lished concerning housing and utilitiess la Circular No* 64, Hq Hawaiian Department, subject; Accountabilities and Issue of Portable Buildings, dated 4 August 1942*2 20 Circular No„ 52, Hq, Hawaiian Department, subjects 3 Housing and Utilities, dated 12 May 1943o 3o Administrative Order No* 1 (Index CPENG 700©50), Housing and Facilities at Posts, Camps and Field Positions, 12 May 1945cA 43 LIST OF REFERENCES Chapter 23 lo Memorandum, Surgeon to dated 27 July 1942, subject: Floor, Space Requirements, File No, 620, Housing of Troops and Officers, Serial Noe 6, Office of the Surgeon, Hq Hawaiian Dept, 1941-42o 2, Circular No, 62, Hq Hawaiian Dept, subject: Accountability and Issue of Portable Buildings, dated 4 Aug 1942, File No, 620, Housing of Troops and Officers, Serial No, 8, Office of the Sur- geon, Hq Hawaiian Dept, 1941-42, 3, Circular No, 62, Hq Hawaiian Dept, subject: Housing and Utilities, dated 12 May 1943* File No. 620, Housing for Officers and Enlisted Men, Serial No, 7, Surgeon1s Office, CPA 1943* 4, Administrative Order No, 1, Central Pacific Base Command, subject: Housing and Facilities at Posts, Camps and Field Positions, dated 12 May 1945* File “New Unit File,” Serial No, 48, Med Insp Off, CPBCo 44 CHAPTER 24 Nutrition (History of Preventive Medicine) 1, Character of rations. Prior to the attack on the Island of Oahu on December 7, 1941, the ration allowance for the Hawaiian Department was considered ample. The food supply was abundant and with a few minor exceptions messes were well con- ducted and menus well selected under the garrison ration system. Following the attack on the island, however, ocean shipping ceased immediately. The Army was automatically placed on a field ration basis with the issue starting 9 December 1941 after the garrison rations on hand had been used up. On the field basis, menus were arranged and food issues were determined by the Quartermaster Department, With the reestablishment of ocean shipping under the convoy system there was no food shortage in the Hawaiian area. From 1942 through 1945 field ration flB”, supplemented by some refrigerated supplies, was used in the Hawaiian Islands. Overall food allowances were ample in general. There was some scarcity of fresh fruits and vegetables throughout the war, but these items were issued whenever availability permitted. No fresh milk was used by military messes except in the treatment of hospital patients. One reason was for security against biological another, because of an inadequate local supply. Both dried and evaporated milk were employed, Rations C, D, and K were utilized by task forces in the early stages of campaigns but were supplanted by the r,B,f ration as soon as practicable. The nutritional values intended to be ob- tained from these special rations were diminished in actual prac- tice by distaste for some components. In the operations on Kwajalein in early 1944, it was observed that the biscuits, malt and dextrose tablets, synthetic lemon powder and cheese in the K ration were rarely consumed in full amounts. Of the C ration, the biscuits, meat and vegetable hash, and synthetic lemon powder were usually discarded to a considerable extenta The assault ration appeared to be accepted satisfactorily, To supplement the UBU ration, reefers were used extensively at remote island bases, thus making the issue of some fresh frozen articles possible, A study was made of the 45 possibility of supplementing the dietary at distant island stations with locally caught fish of which there was an abundance,, The use of this type of food, however, presented technical difficulties, the securing of boats, the danger of poisonous fish, and the need for prompt refrigeration,, On Christmas Island a task force livestock farm under the supervision of a veterinary officer produced fresh milk, eggs, and pork for hospital patients, and some surplus was issued to troops* 2, Nutritional evaluation of rations, In May 1942 an estimate was made by the Hawaiian Department Medical Inspectors Office of the vitamins supplied by the issued field ration* All vita- min values exceeded the minimum daily requirements of the American Medical Association Committee on Foods* It was realized, however, that the rations actually accepted and consumed provided lesser quantities of vitamins than this issued ration* No deductions were made for waste or losses in Another estimate was made in March 1942 ©f the nutrient content of the ration for the 24th Infantry Division and the other North Sector, Oahu, troops by the division medical Inspector, All nutrients were found to exceed National Research Council standards, although deductions were not made for cooking and preparation losses, and the estimated consumption was based on the ©pinion of a mess officer and a mess sergeant rather than actual, observed amounts*" A nutritional analysis of the Hawaiian Department field ration menu in 1943 indicated that the ration offered to the troops was high in calories (5114) as compared with National Research Council recommended allowances (3000 to 4500, the latter for the very active troops)Specific nutrients, with the exception of riboflavin., "would have been adequate if the entire planned ration were consumed* It was noted, however, that this was not the dietary as actually no deductions were made for the refusal by organizations of items offered in the ration, nor for waste or losses in preparation and cooking*? A considerable proportion ©f the ration was not used, indicating that the organisations to a marked extent selected themselves the quantities and items of the consumed Among the factors cited as involved in lack of acceptance were overly large total issues, the inclusion of some unpopular foods, and poor preparation of food in some messes In April 1943 the question of the calcium content of the Hawaiian Department field ration came under study by the Department Medical Inspector's Office,, From an estimate of the over- all amount of food consumed from this ration, prorated to its calcium content, it was felt that the average calcium intake was of doubtful adequacy* However, it was recommended that the proposed addition of 46 calcium salts to the flour be considered only if measures to increase the issue and consumption of other foods — notably evaporated milk and cheese — proved to be unsuccesful0 The amounts of the latter offered in this ration were declared to be considerably less.than directed in AR 30-2210, and a revision was recommended,,10 An analysis of the intended issue for April at APO 957 on Oahu and APO 960 on Hawaii was made by the CPBC Medical Inspector's Office,, Even with an estimated 10$ deduction for waste, the caloric values of the ration offered to the messes was high; 4500 and 4710, respectively, as compared to a probable need of 3500 calories or less0 Vitamins Bi and B2 barely met the allowances recommended by The Surgeon Office* To obtain information on the values of the ration as actually consumed, data were obtained from the depot at APO 957 for the month of June 1945 as to the amounts of each item actually accepted by organizations out of the intended issueQ Analysis of these quantities indicated that in the process of self~selection by the messes from this issue the accepted dietary furnished less than the recommended allowances of Bi, vitamin B2 and calcium, with calories at a level of 3550o There was a failure of accept- ance of the full offered amounts of evaporated milk, flour and vegetables 0 It was anticipated, however, that the new menu then being prepared would improve the nutritional situation, along with the active educational program for mess personnel under the food service program,'^ In a nutritional survey conducted by a War Depart- ment team in April 1945$ the estimated nutrient intake of troops on Hawaii was found adequate by National Research Council standards except for slightly low riboflavin and calcium values*^ 3o Vitamin concentrates. In March 1942 a request was made to The Adjutant General, Washington, D„ C„, for sufficient multivitamin products to provide 100 daily prophylactic doses for each person subsisting on the Hawaiian Department field ration* The possibility was cited that enemy action might reduce the amounts of vitamin supplying foods in the ration, with adverse effects on the health and efficiency of the commando Supply of this amount was granted, with the recommendation by The Surgeon Generalcs Office that the adequacy of the ration and probable shortages be determined before issuing or requesting further suppliesTo acquaint units of the command with the necessity for determining the adequacy of the ration before requesting vitamin supplements, a Hawaiian Department memorandum to that effect was circulated in 1942* 16 Request was made of civilian drug wholesalers that they maintain larger stocks of vitamin concentrates, to be available if In addition to concentrates used in forward areas through- out the war for supplementing the Army ration, the number of vitamin capsules held in reserve was maintained at 5$ of the total number of reserve rations*18 The taking of vitamin capsules was left to indi- vidual choice in outlying bases until a Hawaiian Department directive in April 1943 instructed that the daily'ingestion of at least one capsule daily per man be insured* On Oahu, personnel in underground stations and in certain air corps units also received this prophy- lactic dose, as did those in headquarters 20 21 Troops in the immediate Hawaiian area on the standard ration did not receive vitamin supplements After seven weeks of the mandatory use of vitamin capsules by all personnel, it was reported by the First Station Hos- pital on Makin Island, that medical officers and unit commanders had observed beneficial effects, including a 40$ decrease in attendance at”sick call”, a lessening of susceptibility to infections, and a decrease in healing time of minor cuts and injuries* Although the dietary had been .improved in that time, it was recommended that ad- ministration of supplemental vitamins be continued*^ 4o Revisions of the In January 1945, a revision of the field ration menu, USAFICPA, dated 1 February 194.3, was worked out by the CPBC Quartermaster and Surgeon:s Office, It was designed to conform with new basic ration issues necessitated by a reduction of cold storage items to one cubic foot of shipping space per man per month in the Hawaiian area, (Simultaneously the refrigerated supply to forward Pacific Ocean areas was raised to 1,4 cubic feet per man- month, and, ranged up to 2 cubic feet, depending on supply, through- out In the new mem efforts were made to improve acceptabil- ity by attention to color and consistency of the meals, varied recipes for the less popular items, and adaptability to field ranges and mess kits In March 1945 this menu was submitted to the San Francisco Port of Embarkation for approval,^7 In May 1945 a response was obtained from the War Department in which it was stated that the quantities of different food groups in the proposed menu were excessive, and limits were set- on the maximum poundage of each food group to be allowed* Another menu was accordingly prepared* The quantities of various items were based not only upon the limits specified but also upon the amounts currently accepted by the messes from the local issuing depots Ice cream powder was included in this menu as part of an effort to increase the calcium and riboflavin intake*30 5o Food Service Program, A Food Service Program was established in CPBG in February 1945 under the Quartermaster* CPBC* as Director* Its aims were such as to improve troop feed- ing from the nutritional standpoint* particularly as to mess in- the preparation of food* and the training of mess per- in accordance with its provisions a food service supervisor was designated for the Medical Service* CPBC.,32 6* Civilian Feeding* In early 1942* because of the limited amount of refrigerated shipping space* the Surgeon was consulted as to the dietetic necessity of importing the relative- ly bulky oranges and lemons from the mainland* After investiga- tion the opinion was rendered that these items could be curtailed without detriment to the health of the people in view of the availability of fresh pineapple and papaya* It was felt* however* that the importation of canned fruit juices should not be cur- tailed* The recommendation was made that reserved stocks of vitamin concentrates should be established*33 Subsequently a request was made of civilian drug wholesalers that they maintain^larger stocks of vitamin, concentrates* to be available if needed*^ 7* Specialized Nutrition Personnel* In the course of a study of food and nutrition problems in the Central Pacific area in May 1942* a veterinary officer recommended the establish- ment of a food and nutrition office* with the assignment of nu- trition officers and other personnel to the CPA Surgeon's Office and to each sector* district and garrison force* This recommenda- tion was not accepted* however* as it was believed in the Surgeon3s Office that such a section would have no practical value*34 In January 1945$ 1st Lt„ L0S0M0 Nelson, Medical Department Dietitian, 147th General Hospital, was appointed Con- sultant in Nutrition to the CPBC Surgeon3s Office for the purpose of reviewing the ration issue for nutritional adequacy*. 3o Lto Nelson was succeeded on 21 March 1945 by 1st Lto Dorris Forbes, HD« 1st Lt„ W« H, Halvorsen, HD, served in this capacity from 15 May 1945 to July 1945 o From June 1945 the Nutri- tion Consultant, AFMIDPAC Surgeon3s Office, 1st Lt„ C0D0 Buss, SnC, was used part time in the same capacity by the CPBC Surgeon's Office,29 49 LIST OF REFERENCES Chapter 24 1, Ltr fr Brig Gen Edgar King, MC, Dept Surg, to The Surgeon General, Washington, D, C,, subj: "Annual Report, Medical Department Activi- ties, Hawaiian Department," undated, (On file CPBC Surg Off, File No. 319*1, Sec, 1, 1942, classified) 2• Ltr fr Col P, H. Streit, UfK CPBC Surgeon, to The Surgeon General, Washington, D, C,, subjj “Annual Report, Medical Department Activi- ties, CPBC,” undated, (On file CPBC Surg Off, File No, 319*1, Sec, No, I, 1944, SECRET,) 3* Ltr (Surg 350.05) fr CG, USAFTCPA, to TAJ, US Arrry, Washington, Do Co, subjs "Essential Technical Medical Data from Overseas Forces (Monthof Apr 44),” dta / May 1944. (On file CPBC Surg Off, File No, 350.05, ETMD, Serial No. 1, 1944* SECRET.) 4. Ltr fr Lt Col I, B0 Smock, MC, Medical Inspector* to CG, Hawaiian Dept, subjs "Study of Field Ration, Hawaiian Department, As Issued on Oahu, 1»10 May 1942," dtd 14 May 1942, (On file CPBC Surg Off, File No. 430, Subsistence, Serial No, 13, 1942.) 5o Ltr fr Capt C. L, Wilbar Jr,, MC, 24th Inf Div Med Inspector, to the CG, 24th Inf Div, subjs "Analysis of Food Elements in Diet (March 2 to 16 1942)," undated, (On file CPBC Surg Off, File No, 430, Vitamins, Serial No, 5* 1942, OPEN.) 60 Field Ration, Hawaiian Dept,, Publication 4119 Honolulu 10-1-43, EM, as modified by Subsistence Bulletin #7, Off of the Dept QM, Subsistence Division, dated 29 Dec 1942, 7, Ltr fr Lt Col H, A, Schulze, MC, to Medical Inspector, Hawaiian Department, subjs "Analysis as to Dietary Adequacy of the FlJld Ration, Hawaiian Department," undated, (On file CPBC Surg Off, File No, 430, Information on Adequacy and Acceptability of the Ration, No Serial No,, 1943* OPEN.) 8. Ltr fr Lt Col Walter L, Abrams, QMC, Subsistence Officer, to Dept QM, subjs "Field Ration, 15-Day Menu," dtd 13 Dec 1942, (In file cited above, no Serial No,) 9. Ltr fr Maj F, I, Haranan, VC, 27th Inf Div Veterinarian, to Lt Col Wo 0. Kester, VC, South Sector Vet Detach, subjs "Information on Adequacy and Acceptability of the Ration," dtd 1 Jan 1943. (In file cited above, no Serial No,) 50 10* Ltr fr Lt Col H. A, Schulze, MC, Assistant , to Med Inspector* Hawaiian Dept, subj: "Fortifying the Held Ration with Calcium," dated 26 Apr 43- (In file cited above, no Serial No.) Ho Ltr fr 1st Lt W» L. Halvorsen, HD, Dietetics Consultant, to Surg, CPBC, subj: "Analysis of CPBC Menus for Essential Dietary Con- stituents," dtd 20 June 1943. (On file CPBC Surg Off, File No. 430, Subsistence #1, Serial No0 77, 1945, OPENo) 12# WD Tech Manual TM 8~$00, Hosp Diets, Mar 45, Par 24, Chap 3» 13. Ltr fr 1st Lt C» Do Buss, SnC, Nutrition Consultant, to Surg, CPBC, subj: "Nutritional Analysis of CPBC Menus," dtd 18 Aug 45«» (On file CPBC, Surg Off, File No0 430, Subsistence #2, Serial No* 155, 1945, OPEN.) 14. Ltr fr Maj W. B. Bean, MC, et alo, to CG, USAFMIDPAC, subj: "Nutrition Survey in Army Forces Middle Pacific," dtd 16 Jul 45<» (On file CPBC Surg Off, File Noo 430, Nutrition Survey Report in MIDPAC, OPEN.) 15» Ltr fr Col R. Ho Dunlop, AGD, Adj Gen, Hq, Hawaiian Depto, subj: "Supply of Multi-Vitamin Products as Supplement to the Amy Ration, This Dept," dtd 28 Mar 42. (On file CPBC Surg Off, File No« 441, Vitamins, Serial No0 1, 1942, 1943, SECRETo) 16„ Memo #2, Hq Hawaiian Dept, subj: "Vitamin Concentrates Supple- menting the Ration," dtd 20 Sept 42o *(0n file CPBC Surg Off, File No® 430, Vitamins, Serial No0 32, 1942, OPEN.) 17. Ltr fr Col H. Green, JA GD, Executive, OMG, to five Honolulu drug wholesalers, subj: "Reserve Stocks of Vitamin Products," dtd 1 Apr 42, OPENo (On file CPBC Surg Off, File No. 430, Vitamins, Serial No, 15, 1942, OPENo) 18. Ltr fr OQMG, Washington, Do Cc, to CG, APO 958, subj: "Vitamin Reserves," dtd 5 Jan 43» (On file CPBC Surg Office, File No0 441, Vitamins, Serial No0 5, 1942, 1943, SECRET.) 19. Ltr fr CG, Hawaiian Seacoast Arty Cmd, to CG. Hawaiian Dept, subj: "Issue of Vitamin Concentrates," dtd 10 May -42. (On file CPBC Surg Off, File No. 430, Subsistence, Ser. No. 12, 1942 #1, OPEN.) 20. Memo fr Lt Col C. T„ Young, MC, Med Consultant, and Lt Col K0 H0 Gates, MC, Assistant tt> Dept Surg, to Gen King, subj: "Vitamin Reserve," dtd 20 Mar 43* (On file CPBC Surg Off, File No. 441, TSybamins, Serial No. 2, 1943, OPEN.) 50a 21* Ltrs fr CG, Hawaiian Dept (Med) 430 Vitamins, to C0rs, APO* s 967, 914, and 915, subj: "Item IK 61500-Vitamins, Multivitamin Capsule," dated S-(3/U./43)« (0n CPBC Surg Office, Pile Ho* 441, Vita- mins, Serial No* 6, 1942, 1943* SECRET*) 22* Ltr fr Col 0* No Thompson, AGD, Adj Gen, to District Commander, APO 9o2, subj: "Request for Vitamin Capsules," dtd 22 May 45» (On file CPBC Surg Office, Pile No* 400*312 Kauai District, Serial No* 128, 1944, OPEN*) 23* Ltr fr Maj Tell Nelson, MC, CO of First Sta Hosp, Station 634, to Hawaiian Dept Surg, subj* "Report on Use of Multi-Vitamin Capsules," dtd 18 Aug 42* (On file CPBC, Surg Off, Pile No* 430, Subsistence, Serial No* 9, 42 #1, OPEN*) 24o Memo fr J* Stuppy, MC, to Med Insjp, CPBC, APO 958, subjr "Nutrition and the Ration," dated 24 January 1945c (Oh file CPBC Surg Off, File No* 43, Subsistence, Serial No* 13, 1945 OPEN*) 25* Memo fr Maj L* J* Stuppy, MC, to Med Insp, CPBC, APO 958, subj: "Nutrition," dtd 20 January 1945® (On file CPBC Surg Off, File No* 430, Subsistence, Serial No* 13, #1 1945, OPEN*) 26* Ltr fr 1st Lt Lois Nelson, MDD, CPBC Consultant, to CO, Med Serv, CPBC, subj: "Progress Report of CPBC Dietetic Consultant," dtd 1 Feb 1945o (On file CPBC Surg Off, File No* 430, Subsistence #1, Serial No* 13, 1945, OPEN*) 27* R/S fr CPBC QM to G-4, etc*, subj: "Menu for the Hawaiian Island Group," dtd 8 Mar 1945* (On file CPBC Surg Off, Pile No* 430, Subsistence, Serial No* 17, #1 1945, OPEN*) 28* Ltr AG 430*2 (1 May 1945) OB-S-SPDDQ fr TAG, Washington, D* C*, to CG, USAFPOA (and other theaters), subj: "Ration Scales for Use in Theaters of Operation," dtd 3 May 45® (On file MIDPAC QM Off, Pile No* QM 430, Subsistence and Rations VIII, Serial No* 535, FY 1945®) 29* R/S fr CPBC QM to Surg, subj: "Preparation of a Menu," dtd 23 Jul 45® (On file CPBC Surg Off, Pile No* 430, Subsistence, Serial No* 129, #2 1945, OPEN*) 30* Ltr POYQM 434, fr Lt Col L, Duenweg, AGD, Asst AG, HUSAPMIDPAC, to CG, ASF, Washington 25, D* C*, subj; "Ice Cream Mix," dtd 2 Aug 45* (On file MIDPAC QM Off, Pile No* 434, Serial No* 33, FY 1945, OPEN*) 31* Admin Order No* 1 (Index 116*60), Hq, CPBC, subj: "Food Serv Pro- gram," dtd 15 Feb 45, (On file CPBC Surg Off, File No* 430 Sub- sistence, Serial No* 19, #1 1945, OPEN*) 50b 32, Ltr (Med 430), fr CO, Med Serv CPBC, to Director of Food Serv, CPBC, APO &56, subji "Food Serv Supervisor,” dtd 12 Apr 45<» (On file CPBC, Surg Off, File No, 430 Subsistence*, Serial No, 19* 1945* OPEN,) 33, Ltr fr Off of Military Gov, to Hawaiian Dept Surg, subj: "Diete- tic Value of Citrus Fruit vs Pineapple Juice," dtd 23 Feb 1942, (On file CPBC Surg Off, File No, 430 Vitamins, Serial No, 2, 1942, OPEN,) 34o Ltr fr Maj F, ij« Hamman, VC, to Surg USAFICPA, subj: "Food and Nutrition Sec/ Surg Off," dtd 16 May 44» (On file CPBC Surg Off, Pile No, 320, Orgn of the Army, Serial No, 52, 1944 #1* OPEN,) 35» Memo fr Maj L, J, Stuppy, MC, to Med Insp,, CPBC, subj: "Nutrition," dtd 22 Jan 45® (On file CPBC Surg Off, File No, 430, Subsistence, Serial No, 13, #1 1945*) 36, Memo fr Maj L, J, Stuppy, MC, to Med Insp, CPBC, subj: "Complaint about Rations," 534th Amphb Tnk Bn," dtd 6 Jan 45° (On file CPBC Surg Off, File No, 430, Subsistence, Serial No, 13, #1 1945* OPEN,) 50c CHAPTER 25 Personal hygiene (History of Preventive Medicine) Personal Hygiene in the Central Pacific Area was in general satisfactory. Troops quartered in the Hawaiian Islands had adequate water supplies so that bathing and laundry was no problem. Troops stationed on the forward islands had a much more difficult time keeping clean. At first, only brackish water was available for showers and laundry. No laundry equipment was at hand, so many improvised washing machines were fabricated by the soldiers. These machines were in general of two types, (1) wind driven1 and (2) engine driven2. The wind driven machines were used early in the occupation of forward islands. An almost constant trade wind blows in many of these areas, and full advan- tage was taken of this fact. In general, a propeller was mounted on an axle shaft and a connecting rod was used to drive an agita- tor, Later, drum washers were often used, powered either by a jeep or a truck, or sometimes with a small motor salvaged from a generator set. The brackish water used in forward areas made the use of large amounts of soap necessary. This was countered in some measure by the availability in PX3s of synthetic detergents. Salt water soap was $lso furnished to the men, and was a useful item. Care of the feet presented its usual problems in this area. Early in 1942, the Orthopedic Consultant made several spot inspections in which serious deficiencies were found. A directive3 concerning the proper care of the feet was issued by HHD on 16 March 1942, following which a marked decrease in in- cidence was noted. 51 LIST OF REFERENCES Chapter 25 1* "Hundreds of Homemade Washing Machines*" Bulletin of the Army Medical Department #81* Oct 1944* p* 10* 2. Improvised Trashing machine for Field Use* Bulletin of the Army- Medical Department #75* April 1944* p* 35* 3* HHD Med 710 (Trichophytosis) 16 Mar 42* subject Trichophytosis (Ringworm Dhobie Itch) CHAPTER 26 Section I Water Supply (History of Preventive Medicine) The history of the supply of a potable water to the United States Arny in the Central Pacific Area, is closely re- lated with the history of the Anti-Biological Warfare,, Section II of this chapter covers in detail the measures taken to pro- tect the water and food supplies from sabotage or biological warfare* These measures also covered normal laboratory and sanitary measures for the protection of the food and water supplies. The Medical Department, as regards to water, is charged primarily with the responsibility of determining the sanitary quality of water supplies to troops by the Corps of Engineer* The Ehglneer5s responsibility is to furnish a sufficient quantity of potable and palatable water for the use of troops* The work of the two Departments is closely related and the cooperation between them has helped materially in pro- viding troops with a safe water. At the outbreak of hostilities with Japan in 1941* the water facilities in the Hawaiian Islands were inadequate i&o carry the load that must necessarily be put upon it. In addition to the troops in the Hawaiian Islands, the influx of thousands of war- workers made the problem of an adequate quantity of water more difficult, . The sources of water available to the Army on the Island of Oahu were four (4)* namely, the City and Suburban Water Supply Companies 5 the already developed Army supplies$ the supplies owned by the sugar plantations, and used by them for irrigation; and the undeveloped underground supplies. The Board of Water Supply of the City and County of Hono- lulu is charged with the responsibility of supplying water to the City of Honolulu and contiguous areas. The tremendous growth of the City's population has made over a 100 percent increase in water requirements since 1939. The Board had developed a long range program for both the City of Honolulu and the Island of Oahu, It was realized that with the increased water requirements, and with definite indications of salt encroachments, preliminary steps toward proper ground water control would be necessary. In 1940, a 53 commission was appointed by the governor to study the ground water problem and control the withdrawal of ground water,^ The principal sources of City Water Supplies are the Kalihi Underground System; the Nuuanu System; the Beretania System; the Kaimuki System; and the Waialae System. All of these systems draw their water from underground sources and it is pumped to reservoirs located at strategic points on the system. In addition to the above systems, the North Halawa water development project was completed in 1944. The total water supplied by the various public and privately owned water systems in the City of Honolulu has increased in the following manner; 1940, 36.9 million gallons per day; 1941, 39*9 million gallons per day; 1942, 42.8 million gallons per day; 1943, 60.0 million gallons per day; 1944, 68,9 million gallons per dayl. The two (2) factors which the Medical Department was chiefly concerned with in the City Water Supply, were the purity of the water and the chloride content of the water. The amount of infiltration from the continued deficient rainfall has been in- sufficient to supply the increased water demands and, as a result, the reservoirs in the Honolulu artesian basin are being heavily over drawn. Due to the geological structure of the artesians and basalt basins, it is necessary to maintain a definite static head of fresh water over the underlying salt water upon which all of the fresh water in the island floats. With the low artesian head prevailing in the area, the draft-chloride content relation- ship was carefully watched and regulated by controlled pumping. An illustration of this is in the Waialae Underground System, It was determined that if the pump station was operated to capacity that the chloride content increased to a point which made the water unsuitable for domestic consumption. By pumping only 50 percent of the daily designed capacity, the chloride content re- mained within normal limits. In accordance with Medical Department policy, it was required that all the water supplied by the City to Array instal- lations be chlorinated, (The regulations and procedures govern- ing the chlorination of water are discussed fully under the Anti- Biological Warfare Activities, a section of this chapter). At the outbreak of hostilities, the Suburban Water Supply Company was supplying the Kaneohe and Waimanalo Bay Areas from the Haiku Tunnel, An additional supply, known as the Luluku-Springs was available but was not being used, due to the fact that the water was contaminated and constantly showed the presence of the coli-arogenes group of organisms. With the 54 continued drought in 1944, it became necessary to connect the Luluku-Springs into the system. In order to insure the safety of this water, the Suburban Water Supply Company chlorinated it at the source and the Amy and Navy rechlorinated it at the ser- vice connections. In accordance with Ariry Regulations, the Haiku Tunnel was chlorinated continuously* In 1945, an additional supply was added to the Haiku Tunnel line by pumping the seepage from the tunnel into the pipeline prior to chlorination* The normal yield of Haiku Tunnel was six (6) million gallons per day. The rain- fall on the Haiku watershed has been approximately 60 percent of normal over the past two (2) years* The yield of the Tunnel, how- ever, has dropped more than 50 percent, due to the fact that whil* the rainfall has been over 60 percent, there had been no heavy precipitations at any period* No appreciable effect is felt on the Tunnel with less than 50 inches of rainfall per month* The Suburban Water Supply Company also supplies chlor- inated water to a number of posts, camps, and stations on rural Oahu, These are all well supplies and the yield has not appar- ently diminished. The sugar plantations on Oahu use millions of gallons of water daily for irrigation. An elaborate system of ditches carrying water for irrigation has been developed by them over a long period of time. The Army has been able uo purchase water from the plantations for use in areas adjacent to the irrigation ditches. Practically all of the water taken from the irrigation ditches is chlorinated at the "point of take", A few small in,- stallations use plantation water and chlorinate the drinking water in lyster bags, A number of slow sand-filter plants have been installed on the larger installations using irrigation water. The Waihole Ditch is the principle source of irrigation water and the Honolulu Plantation, the Ewa Plantation, and the Waianae Plantation also supply some water for Amy consumption. At the beginning of the war, Schofield Barracks was supplied by its own water system, namely, a deep well system lo- cated off the main post,, With the increase in population of the post, it was necessary to develop another source* A surface supply was developed and has been used to supplement the well supply* While this water is made safe for human consumption by chlorination, it is frequently turbid* Plans for a modern filter plant are being prepared at the present time* 55 Most of the water for the Post of Shafter is supplied by an Army deep well. Supplemental supply is provided by a connection with the Halawa System of the City Supply. The Army has also developed a number of wells on some of the smaller posts, all of which are chlorinated before use, except the well for fire protection developed in Aliamanu Crater, The fire system in the Crater is entirely independent and no cross connections exist between the potable water system and the fire protection sys- tem. The conditions existing at the outbreak of hostilities on the Islands of Kauai, Maui, Molokai and Hawaii were very similar to the conditions on Oahu* The existing water supplies were Inadequate to meet the increased demands caused by the influx of military and civilian personnel. Where possible, the existing supplies were enlarged and made available to the Army camps. As on Oahu, the county and plantation water systems were used as sources of water. Where treatment was necessary the Army or Navy put in their own treatment plants * None of the existing supplies were chlorinated until the military personnel moved in. Chlorinators were furnished the local water systems and installed for them. The chlorinators were operated by the plantations or county. The Medical Department was charged with the responsibility of seeing that the proper chlorine residuals were maintained at all timeso The Anti-Biological Warfare activities, in connection with water, were supervised jointly by the Medical Department and the Chemical Warfare Service* In several areas, where the ground water supplies were deficient, water was collected from the roofs of buildings and stored in wooden storage tanks. This water was also chlorinated and made a very satisfactory supply to augment the ground water.. All of the outer islands have felt the effect of the low rainfall during the past three (3) or four (A) years. Obtaining sufficient water on several of these islands had become a very serious problem, prior to the cessation of hostilities. The geology of the Coral Atolls is such that the water problem is practically the same on all of the atolls occupied by our troops in the Central Pacific Area. Typical of these are Canton, Christmas, and Fanning Islands. Drinking water on Canton and Christmas Islands is obtained by distillation of sea or brackish well water. Drinking water on Fanning Island is ob- tained from shallow wells. All of these supplies must be chlorinated either at the source or in Xyster bags. The Medical Department was called on to work out and issue directives on a number of special problems in which water supplies were involved. Some of these were special purification methods where amoebic and Schistosomiasis3 is prevalent and the use of marpharsen in the sterilization of dis- tilled water. The Sanitation Section of the ISth Medical General Laboratory developed a continuous flow method for treatment of ,• A field testing kit for the simple water determinations in the field and determinations of certain toxicological poisons was also developed and prepared by them. Sanitary of water supply installations were made on all the principal water supplies on the Island of Oahu except, Schofield Barracks, These surveys covered the quantity of water used, source of water, treatment plants and methods, distribution systems, and Medical Department supervision. Recom- mendations were made covering defects found in the water supply system. Follow-up inspections were made to see that these recom- mendations were carried out. The Medical Department cooperated •iv 1th the Engineering Department in solving difficult problems resulting from the recommendations. From time to time the Medical Department was called upon to inspect the various swimming areas around the Hawaiian Islands, The proper inspection of these areas required a complete sanitary survey of contiguous areas and the collection for bacterio- logical examinations of a large number of water samples. . , A number of swimming pools were built on the Island of Oahu and these were under the supervision of the Medical Depart- ment* Inspections and studies were made of these pools and recom- mendations were made as to improvements and standard procedures of operation. 57 CHAPTER 26 Section II History of the United States Army Medical Department Activities in Anti-Biological Warfare in the Hawaiian Department (History of Preventive Medicine) The History of the United States Army Medical Depart- ment in the development of protective measures against bacterial or chemical agents in the Hawaiian area is one of long considera tion and practical application of scientific knowledge. The possibility that Bacterial or Biological Warfare might be used by an enemy had been discussed and precautionary measures were taken in the Hawaiian Department prior to the onset of hostili- ties on 7 December 194-1. Sanitary inspections of military in- stallations had been intensified. Local food processing plants were more frequently inspected. The major sources of water supplies were provided with fencing and in some instances were guarded. The Commanding General, Hawaiian Department, assumed the duties of Military Governor of the Territory of Hawaii on 7 December The Surgeon, Hawaiian Department became ad- visor to the Commanding General in all matters pertaining to the health of the population of the Territory as a whole as well as to the health of the military command. The problem of pro- tection of the military and civilian population from this type o'f attack was carefully reconsidered and evaluated. Attention was focused on this subject by a false report on 7 December 194-1 that the water supply, particularly that of Hickam Field, was "poisoned". Under the authority of the military government the following precautionary measured were instituted; 1, All military personnel and all civilians over six (6) months of age were immunized with smallpox, typhoid, paratyphoid A and paratyphoid B vaccines 8, 9, 10, 11. 2. Poisons were impounded and their sale and dis- tribution kept under strict control, 12, 13. 59 3* The principal water supply systems of each island were investigated in detail and the use of fencing and guards was increased* 4o The Department Laboratory performed daily tests for some of the more common poisons on water samples from principal water supplies.- 5® The purchase of fresh milk for use in Army messes was prohibited* On the 19 June 1942, a local Honolulu Physician wrote a letter on the subject, "The next attack upon Oahu - Bullets - Bombs or Bacteria'1 The Physician sent this letter to the Commanding General, Hawaiian Department and copies to the Secretary of War, Secretary of Navy, Chief of Naval Operations, and Commander in Chief of the Pacific fleet„ On 30 June 1942, the Chief of Staff, War De- partment, directed the Commanding General, Hawaiian Department to set up the necessary organization and take measures essential to con- trol or counteract the activities which were the subject of the phy- letter*1' Steps were immediately taken to obtain all avail- able information and advice on the subject of Bacterial Warfare, and to establish a definite organization for studying, coordinating and implementing the required countermeasures* Technically trained personnel were requested from the War Department* A Lieutenant Colo- nel, Sanitary Corps, and a Captain, Medical Corps, arrived in the Hawaiian Department and were assigned to the Surgeon’s Office, Hawaiian Department on 5 September 1942* On 3 October 1942, the Surgeon, Hawaiian Department, who had been acting as the Department Commander’s advisor, was detailed AntjUBiological Warfare Officer in addition to his other duties*18 Anti-Biological Warfare Officers were designated at the Headquarters of the Hawaii, Maui, and Kauai Districts*' The period from December 1941 to April 1943 was a period of intense activity and accomplishment in the field of developing safeguards against Biological Warfare® On 14 April 1943, a very comprehensive report of the Anti-Biological Warfare program in the Hawaiian Department was submitted to 3be Adjutant General, War De- partment* Washington* D*C*20 The developments and countermeasures in effect at that time were: S Q 1* The use of fresh milk in Array messes was prohibited,, 2„ All drinking water used by troops was being chlor- inated* 1 60 3. The Military Governor had ordered continuous chlor- ination of the principal water supplies and the project was progressing favorably in spite of the magnitude of the difficulties encountered,, The water systems were numerous, varied in type and complex,, In many instances accurate knowledge of engineering data was not available and extensive liaison work with the city, county, plantation and Amy Engineers was required,. Qualified personnel skilled in the installation of chlorination equip- ment were difficult to obtain. The preparation of specifications, procurement of equipment even with an AAA priority and the shortage and shipping space all tended to make the chlorinatio^project a laborious task, The burden of the work fell on the Uo S0 Any Engineers but- considerable aid and advice in expediting the work was furnished by members of the Surgeon's staff, A system was in- stituted for checking the chlorine residual in each distribution system at two hour intervals from 0700 to 1900 and once during the night at approximately 0200o This testing not only served to insure that the chlorination equipment was operating properly but was also of value as a signal in the event of intentional contamination since the contaminating material, would cause the disappearance of the residual chlorine. 4o A method of biologically checking for x,he presence of chemical poisons in the water supply was devised and installed on the principal water systems This method utilized the "Guppy” (Lebistes reticu- latus) and the "Mosquito Fish" (Gambusia affinis) as indicators, in a small aquarium through which water flowed continuously,. 5® The Department Laboratory and laboratories at Army hospitals made daily analyses on water samples from the main water systems for chemical poisons„ 6„ After a thorough investigation, of the type and quantity of the food locally supplied to the Array,, specific control measures were placed in effect,, Ice cream5 bottled soft drinks and candy manufactu- ring plants were found to be particularly amenable to biological The Counter-Intelligence 61 Division of G-2 investigated the civilians employed in these plants. Military personnel were assigned to key positions in the plants where they could be active- ly engaged in the process of mixing the ingredients and thus prevent deliberate large seal.® contamination. These men were specially selected from the command as a whole for proficiency and past experience in the type industry to which they were assigned,, The men were transferred to Medical Department Units and placed on Detached Service,, The Veterinary Corps exercised ad- ministrative and technical supervision over these Anti-Biological Warfare enlisted inspectors0 After many months, on 11 September 1944,9 a T/0 organization, the H3th Medical. Service Go (Vet) was authorized and activated, With the activation of this unit it was possible to have all the Anti-Biological Warfare en- listed inspectors assigned to one organization for administration and duty0 In addition to prevention of intentional, contamination of the food the inspectors maintained high standards of sanitation in the plants through persistent efforts to impress upon the manage- ment and employees the importance of good sanitation,, The inspectors maintained a close laboratory check on the finished product by frequent submission of samples to the laboratory for study. 7® The Military Governor required all civilian laboratories to register,, All bacteriological laboratories were in- spected and personnel of Japanese ancestry who had had training in bacteriology were investigated by the Counter-Intelligence Division of Gr»20 Bo The civilian and military rat and mosquito control measures were intensifiedo The execution'of many of the above activities required the authority of the Military Governor, In February 19439 provision was made for the return to the proper civilian authorities of a portion of the functions performed by the military Governor, Agreement as to the continuance of the Anti-Biological. Warfare controls and such other measures vital to the health of the population was reached by a mutual exchange of letters between the Civil Governor of the.Territory of Hawaii and-the Commanding General, Hawaiian Department, 25 26 2? The General Orders Nos, 1 to l&I inclusive, were rescinded on 10 March 1943The necessary regulations covering the registration of laboratories and the control of poisons were incorporated in the Hawaii Defense Act RulesThe Office of Civilian Defense assumed the administration of the control of laboratories and poisons® Information was available to the Surgeon at all times0 The Anti-Biological Warfare efforts during the re- mainder of 1943 were devoted to the extension of the basic con- trol measures already outlined® Close liaison was maintained personal contact with the staff of the Medical Officer5 14th Naval District and with the civilian agencies concerned with various aspects of the work® In October 1943$ at the insistence of the War Department® all military personnel were immunized with yellow fever vaccine.31 Constant study and re-evaluation of the protective measures in effect was required with changes in dis- position of troops o This factor was particularly apparent on the islands of Hawaiip Maui, and Kauaip where frequent changes in unit dispositions took place® The demand for ice cream and soft drinks increased during 1943 and 1944 with the ever-mounting number of service personnel in the area® Additional plants were approved and control measures instituted® Ehlisted inspectors were .also assigned to duty in a sandwich manufacturing' plant be- cause of the large sale of sandwiches to the Array Exchange Ser- vice® At the close of the year 1944s Anti-Biological Warfare en- listed inspectors were on duty in eleven food processing plants on OahuP three on two on MauiP and one on Kauai, 3 < One inspector on duty at the small soft drink plqnt on Molokai had been withdrawn due to a marked decrease in the volume of products required by the Amy on that island® Revision of the installau- tions recommended for chlorination was required from time to time as troop areas were abandoned or new troop areas set up® By the end of 19449 the US Army Engineers had provided continuous chlorination for seventy-five installations® Many of the water systems required several chlorinators in order to provide an adequate chlorine residual® Two hour testing for chlorine residual in the distribution system® the use of aquariums for the detection of chemical poisons and the analysis of daily water samples for chemical poisons were all continued® As the war progressed and offensive forces began to stage in this area, the Garrison Force Surgeon in each case was oriented in the program as it was in operation in the Hawaiian area® Such information regarding enemy intentions as was avail- able was discussed and the possible precautions which might be A required at the new base were outlined informally„ Several letters of information and instruction were received in 1944® ™ Although the material, in these publications was based largely upon material previously available or developed in the Hawaiian 63 Area* they served as a valuable concise source of reference in the instruction of officers who had not been oriented on the subject0 As part of the effort to learn the intentions of the enemy, blood specimens were drawn from over 1000 Japanese and Korean Prisoners of war, during August 1944 at the.request of the War Depart- ment The specimens were shipped to the Director, Army Medical School, Array Medical Center for immunologic study. Pursuant to a directive from higher the Sur- geon, Central Pacific Base Command, was relieved of the appointment as Anti-Biological Warfare Officer and a Chemical Warfare Officer was 39 The Medical Department continued to exercise supervision and direction over the protection of the food and the water supplies and the immunological aspects of Bacterial Warfare,^0 The Surgeon and his staff furnished technical advice to the Bac- teriological Warfare Officer and although the Surgeon was relieved of direct responsibility, the actual amount of supervision and effort which was required remained unchanged. All formal inspections of Anti-Biological Warfare activities were made in conjunction with the Chemical Warfare Service, As of 1 January 1945* the military guards at key installations of the Honolulu Water systems were withdrawn due to the increasing demand for police personnel in forward areas. This action was taken in spite of the recommendation by the Surgeon and, Bacteriological Warfare Officer that the guards be maintain- ed*'4'" . On 12 February 1945* the control of the sale and use of poisons and the registration of laboratories ceased to be a function of the office of Civilian Defense and became a function of the Terri- torial Board of Health, This action was approved by Headquarters United. States Army Forces, Pacific Ocean-Areas, since it represented a change of policy in relations with a civilian agency. The Territo- rial Board of Health did not publish a directive on registration of laboratories. Prom December 1941 to date, there have been changes in the designation of the Headquarters directly concerned with the adminis- tration of the Hawaiian Area, The Surgeon’s Office has remained essentially the same in its organization as far as Anti-Biological Warfare is concerned throughout the change from Surgeon’s Office, Hawaiian Department, to Surgeon’s Office, Central Pacific Area on 14 August 1943 and to Surgeon’s Office, Central Pacific Base Command on 1 July 1944. With the change to Central Pacific Base Command, the higher headquarters. Central Pacific Area and later on 1 August 1944* Pacific Ocean Areas, and on 1 July 1945* Middle Pacific Areas, assumed the responsibility for overall changes in policy affecting Anti-Biological Warfare, The actual work, however, remained in the 64 Central Pacific Base Command. With the end of the war, the Anti-Biological Warfare activities are being reduced to a minimum* Certain worthwhile measures will be continued as essential to good sanitary practice. The close supervision of local food sources by frequent sanitary inspections and the chlorination of militaiy water supplies will be continued. It is doubtful that any considerable number of civilian water systems will continue to be chlorinated. There is rather widespread public opinion against it and the cost is more than many of the local systems care to assume. The mission of the Anti-Biological Warfare effort has been accomplished. There has been no instance of the use of Biological Warfare in this Area by the enemy. 65 LIST OF REFERENCES Chapter 26 1. Tenth Biennial Report of the Board of Water Supply, City and County of Honolulu, 1943-1944* on File at Medical Library, Office of the Surgeon, CPBC. 2. Ltr fr CG> U5AFPQA to the Command, subject: "Special Water Purification Procedures in Areas where Amoebic Dysentery is Prevalent," 29 Aug 1944* on File, Surg Off, CPBC, 671 (Misc). 3* . HUSAFPQA Cir No* 4* subject: "Special Water Purification Procedures in Areas where Schistosomiasis is Prevalent," 13 Mar 1943* on File, Surg Off, CPBC, 671 (Misc). 4* Ltr to Surg, CPBC, APO 958, from Surg Med Det 243d QM Bn, APO 958, subject: "Determination of Purity of Distilled Water and Marphar- sen Ampule No. 236-G-B294 G," 10 Feb 45* with 1st Ind, HQ Med Serv, CPBC, APO 958, to CO, 18th Med Gen Lab, 11 Feb 1945* on File, Surg Off, CPBC, 671 (Misc). 5„ Ltr to Surg, Hq, Tenth Array, F*om CO, 18th Med Gen Lab, subject: "Continuous Flow Methods for Coagulation, Sedimentation and Fil- tration of Water in the Field," 10 Jan 45* on File, Surg Off, CPBC, 671 (Misc). 6o Ltr£ Office of The Surgeon General, to CG, USAFCPA, subject: Sanitary Surveys of Water Supply Installations in Accordance with AR 40-205*” 18 Mar 1944* on File* Surg Off, CPBC, 720*2-1. 7. Gen Order No* 1, Office of the Military Governor, 7 Dec 1941* on File, Surg Off, CPBC. 8* Section VII, Gen Orders No. 71* Office of the Military Governor, To Ho, subject: "Control of Epidemic Disease," 7 Feb 42, on File, Surg Off, CPBC. 9o Section I, Gen Orders No. 80, Office of the Military Governor, T® Ho, subject: "Control of Epidemic Disease," 27 Feb 42, on File, Surg Off, CPBC. 10. Gen Orders No. 86, Office of the Military Governor, T. H., subject: "Control of Epidemic Disease," 17 Mar 1942,, on File, Surg Off, CPBC. 11. Gen Orders No. 97, Office of the Military Governor, T. Ho, subjects "Control'of Epidemic Disease," 17 Apr 42, on File, Surg Off, CPBC. 66 12. Section III* Gen Orders Not, 45, Office of the Military Governor, To Ho, subject: "Poisons," 27 Dec 41* on Pile, Surgeon*s Office, CPBCo 13o Section V, Gen Orders No« 89, Office of the Military Governor, To Ho, subject: "Dealers in Poisons," 25 Mar 42, on File, Surg Off, CPBCo 14• Ltr to the Command fr the CG, Hawaiian Department, subject: "Use of rations savings funds," 7 Mar 42, on File, (copy) Surg Off, CPBC, AG 123o 15» Ltr to the CO’s, Hawaii, Maui, and Kauai Districts fr CG, Hawaiian Department, subject: "Purchase of fresh milk for use in Amy Messes," 5 Mar 42, on File (copy) Surg Off, CPBC, 434° 16o Ltr to Lto Gen0 Delos C0 Emmons, fr Wo Bo Herter, MD, 342 Alex- ander Young Building, Honolulu, Hawaii, subject: "The next attack upon Oahu - Bullets - Bombs or Bacteria," 19 Jim 1942, on File, Surg Off, CPBC, 730. 17® Radio to CG, Hawaiian Department from Marshall, Gh of Staff, Washington, D„ Co 643-P, June 30, 1942, on File, Surg Off, CPBC, 730. 18. Paragraph 28, SO 276, Hq, Hawaiian Department, 8 Oct 42, on File, Surg Off, CPBC. 19* Ltrs to CG*s, Hawaii, Maui, and Kauai Districts fr CG, Hawaiian Depament, subject: "Instructions reference Anti-Biological War- fare," 31 October 1942, on File (copy) Surg Off, CPBC, 730o 20* Ltr to TAG, War Department, Washington, D0 Go, from CG, Hawaiian Department, subject: "Progress of Anti-Biological Warfare," 14 Apr 43, on File, Surg Gen Off. 21* Ltr to the Command fr CQ, Hawaiian Department, subject: "Chlori- nation of Drinking Water," 19 Nor 42, on File, Surg Off, CPBC, 671» 22• Gen Orders No. 154, Office of the Military Governor, T0 Ho, subject: "Chlorination of Water Supplies, Territory of Hawaii," 7 Hov 42, on File, Surg Off, CPBC. 23. Per paragraph 1, Gen Orders No. 37, Hqs U0 So Arny Forces, Pacific Ocean Areas, 11 September 1944, on File, Surg Off, CPBCo 24. Gen Orders No0 166, Office of the Military Governor, To Ha, subject: "Registration of Laboratories," 22 Decentoer 1942, on File, Surg Off, CPBC. 66a 2$, Ltr to Lt, Gen* Delos C* Emmons, CG, Hawaiian Department from Ingram M, Stainback, Governor of Hawaii, 7 Feb 43* on File, (copy) Surg Off, CPBC, 671. 26. Ltr to Honorable Ingram M* Stainback, lolani Palace, Honolulu, T* H,, from Lt. Gen. Delos C. Emmons, U. S. Army, Military Gover- nor of Hawaii, 7 Feb 43* on File, (copy) Surg Off, CPBC, 671* 27. Ltr to Honorable Ingram M. Stainback, lolani Palace, Honolulu, T* H., fr Lt Gen. Delos C. Emmons, U. S. Army, Military Governor of Hawaii, 20 February 1943* on File, (copy) Surg Off, CPBC, 671. 28. Gen Orders No. 13, Office of the Military Governor, T. H., sub- jects " Rescission of General Orders Nos 1 to 181 inclusive, saving clause, and effective date of General Orders Nps 1 to 14 inclusive, this office, dated 10 March 1943*" 10 Mar 43* on Pile, Surg Off, CPBC* 29. Section III, Hawaii Defense Act Rule No. 50, subject: "Relating to Hospital Laboratories and Nurses," 9 Mar 43* on File, (copy) Surg Off, CPBC. 30. Section IV, Hawaii Defense Act Rule No. 41* subject: "Relating to Medical Supplies, Photographic Supplies, and Poisons," 9 Mar 1943* on File, (copy) Surg Off, CPBC, as amended by Hawaii Defense Act Rule No. 112, subject: "Amending Rule No. 51, and Relating to Poisons," dtd 25 Jul 44, on File, (copy) Surg Off, CPBC. 31* Ltr to The Command fr CG, Hqs US Army Forces, Central Pacific Area, subject: "Vaccination of Troops against Yellow Fever," 6 October 1943* on File, Surg Off, CPBC, 720*3. 32. Memorandum to The Surgeon, CPBC, from Richard F. Davis, Major, M.D., Assistant, subject: nABW enlisted inspectors stationed in food and soft drink establishments," 28 Dec 45* on File, Surg Off, CPBC, 730. 33. Ltr to CQs? Theaters of Operations from TAG, War Departnent, subject: "Biological Warfare," 14 Feb 44, on File, Surg Gen Off, 34* Ltr to CGs, Theaters of Operations from TAG, War Department, subject: "Defense against sabotage methods of biological war- fare in a theater of operations," 20 Mar 44, on File, Surg Gen Off. 35» War Department Technical Bulletin, subject: "Notes on Certain Infectious Diseases," 20 May 1944, on File, Surg Gen Off. 66b 36. RADIO AWAR 192131Z J6TA KKDH TIVLXJ WTJ WVJN OR 574 to G-2 Pass to All Advance Intelligence Centers Richardson pass to Cincpoa Murray pass to CCMOPAC fom Bis sell WDGBI liar shall, 20 July 1944* on Pile, Surg Off* CPBC. 37. Section I Cir No. 45* Hqs United States Arny Forces* PQA, subject: "Bacteriological Warfare,” 30 September 1944* on Pile* Surg Off, CPBC. 38. Par. 12, SO 134* Hq CPBC, 11 Nov 44* on Pile, Surg Off, CPBC. 39• Par. 26, SO 137* Hq CPBC, 14 Nov 44* on Pile* Surg Off, CPBC. 40. Ltr, Hq CPBC, to limited distribution fr CG* GPBCL, subject: Bacteriological Warfare,” 3 Jan 45* on Pile, Surg Off, CPBC. 41. Ltr to Board of Water Supply, City & County of Honolulu, Honolulu, T. H., fr Elmer L. Slob, Major CMP (Acting) Provost Marshal, 14 Dec 44* on Pile* (copy) Surg Off, CPBC, 730. 42. Route Slip Correspondence* to G-2 fr Chemical Officer, CPBC, sub- ject: "Bacteriological Warfare (Reports),” 8 Jan 45* on Pile, (copy) Surg Off, CPBC, 730. 43» £oute Slip Correspondence to G-2 fr Chemical Officer, CPBC, sub- ject: "Bacteriological Warfare (Reports)," 7 Feb 45* on File* (copy) Surg Off, CPBC, 730. 44. Hawaii Defense Act Rule No. 129* subjects "Rescinding Rule No. 51, as amended and Rule No. 112, relating to Poisons,” 12 Feb 45* on Pile, (copy) Surg Off, CPBG0 45. Hawaii Defense Act Rule No. 142, subjects "Rescinding Hawaii Defense Act Rules Nos. 10, 13* 16, 21, 28, 38, 44* 45* 47, 50, 55* 60, 62, 70, 76, 79* 84, 89, 90, 94* 101* 110, 136 as amended,” dated 30 August 1945* on File, (copy) Surg Off, CPBC0 66c CHAPTER 2? Section I Sewage Disposal (History of Preventive Medicine) The disposal of human waste has been a problem since the days of the Pilgrimage of the Children of Israel from Egypt to the Promised Land, It is recorded, in the Books of Genesis, that Moses instructed the Children of Israel to go without the camp and to dig for themselves a trench and after using, to cover the same with dirt. Thus,we have a counter-part of the much used slit-trencho As man became more civilized he built for himself what we now term, “pit latrines ", With the con- gestion of population in communities, and the use of water-borne toilets, the problem of the disposal of human waste increased materially. Until the turn of the 20th Century, it was a common practice to discharge the sewage into the nearest convenient stream. As time passed on, men realized that the pollution of streams, which were later used for bathing, drinking, and irri- gation of farm lands was very detrimental. The prevention of stream pollution, with inadequately treated sewage, is extremely important on an Island, such as Oahu, and is especially perti- nent both to civilian and military establishments under the conditions existing during war times. Every effort was made to See that no sewage was discharged into streams without complete treatment, that is, primary and secondary treatment, and chlor- ination, In a discussion of sewage treatment in the Hawaiian Islands, the methods of disposal may be broken down into two (2) types: water-borne and non-water-bome sewers. The posts, camps, and stations can be broken down into permanent posts; semi-pemasnt posts; and temporary posts. The permanent posts on the Island of Oahu, with the exception of Schofield Barracks, were making use of the sewer system of the City of Honolulu, All of the city sewers dis- charged into harbors or directly into the Pacific Ocean, No effort was made to treat any of the sewage. In 1943, a Sewage Committee was appointed to study the matter of sewage treatment. 67 In September 1943* the firm of Metcalf and Eddy, Engineers of Boston, Massachusetts, were engaged to consider and to discuss sewerage problems with the Honolulu Sewage Committee0 Early in 194$, a comprehensive report was rendered by Metcalf and Eddy with recommendations for treatment of all sewage from the City of Hono- lulu in one sewage treatment plant. It was recommended that this plant be located somewhere in the vicinity of the Military Reserva- tion of San Island and be of ample capacity to treat all sewage of Sand Islandand Shafter Area, If, Metcalf and Eddycs recommendations are carried out, all of the permanent Army posts located in the Hono- lulu area will discharge their sewage through t he City system to a sewage disposal plant. Schofield Barracks and Wheeler Air Field discharge their sewage into a sewage treatment plant which consists primarily of primary sedimentation tanks, trickling filters, and final chlorin- ation, This plant was enlarged in 1944, but all of the work has not yet been completed. The Medical Department Headquarters is making a complete sanitary survey of this plant at the present time. Semi-pemanent posts, such as station hospitals, air fields, and similar organizations, were provided with sewage treat- ment plantso Some of these plants gave a fairly complete treatment consisting of Imhoff Tanks, trickling filters, and chlorination. Other small units were only provided with septic tanks and chlorin- ation. Smaller units of the temporary type were sometimes pro- vided with septic, tanks, and cesspools, discharging into more or less, an impervious soil, which covers most of rural Oahu„ In the temporary type camps, the more satisfactory type of sewage disposal was the pit latrine0 A discussion of the fly control program of the pit latrine will be given at the end of this Section, The conditions existing on the outer Islands of the Hawaiian Group were very similar to these on Oahu, with the excep- tion of the fact that there were no existing permanent posts,, A number of sewage disposal plants were constructed at various posts on these Islands„ The policy of using pit latrines on smaller out- posts was also in force on these Islands. In the Spring of 1944, the Medical Department sent a sanitary engineer to the Marshall Group to make a sanitary survey of the sewage facilities in the area of the Islands of Ebeye, Roi and Namur, Eniwetok, Parry, and the Naval Air Bases0 68 With the occupation of Ebeye Island, pit latrines were dug and their use was universal. However, owing to hard coral rock encountered in excavation, most of the pits were shallow and many are narrower than the latrine box, render- ing them unsuitable for long continuous use. None were fly- proof, These latrines were located adjacent to the beach, where- as the brackish water wells are located along the center of the Island, The distance, due to the narrowness of the Island, between the latrine and the shallow well were not over 100 yards, resulting in pollution of the wells. It was determined that part of the Island could be accommodated with water-borne sewerage. Where water-borne sewerage is impractical, concrete vault latrines were used. As on Ebeye, pit latrines were installed on Roi & Namur Islands2 but were inadequate due to the pollution of the ground water, difficulty of fly control, and lack of space for future latrines. The construction of a general water-borne sewerage sys- tem was not considered practical. The most practical solution of the problem was the construction of concrete vault latrines. It was necessary, however, to provide a means of disposing of the excreta from the vault latrines. It was possible to locate a sewer out-fall to the sea, and cart the sewage in a sewage-truck to the out-fall, and flush out to sea. A general plan for a water-borne sewage system on Hoi & Namur was developed by the 95th Construction Battalion,, There was an ingenious plan, in that it was based on the use of only those materials available locally, exclusive of concrete,, It in- cluded approximately 10,000 feet of four (4) and six (6) inch pipes, on hand, and the remainder of the system consists of approx- imately 7*000 feet of old oil drums with heads removed and a three (3) inch lining of concrete,, The disposal of sewage on Eniwetok and Parry Island's was accommodated by pit latrines and urine *T-‘ soakage pits0 This method was found satisfactory on Parry Island but, not satisfactory on Eniwetok,, It was found that concrete vault latrines would be the only satisfactory type for Eniwetok„ In a report on sewage disposal of Kwajalein the Corps of Engineers and the Medical Department recommended #the use of concrete vault latrines and disposal at sea, until such time as water-borne sewage systems could be installed,, A portion of a water-borne sewage system was installed in 1944* and the effluent is being discharged into the ocean„ 69 A joint inspection of the water and sewage facilities of the Island of Saipan was made in September 1944, by a tive of the Corps of Engineers, and of the Surgeon's Office, CPBC, This report, a comprehensive plan for a water-borne sewage system for the Island of Saipan was prepared* A part of this system has been constructed, but some difficulty has been experienced in ob- taining sufficient water for the proper flushing of water-borne toilets, The problem yet to be solved in Saipan is the obtaining of sufficient water for all needs, rather than the disposal of the water-borne sewage The Medical Department did a large amount of experimental work on the control of flies in pit latrines on the Island of Oahu0 In this area . Chrys orryal Megacethala, blue bottle fly, is the main breeder in pit latrines* The observations and results on Oahu were based on this species only. c Summarizing from a report, a brief summary of the results obtained is given below: . , "A single spraying of latrine buildings at a rate of 200 mg of DDT per square foot is not effective in a prolonged con- trol when applied at the rate of four (4) ounces per hole once per week* Two (2) ounces per hole twice a week gave a satis- factory control of emerging adults0 Four (4) ounces per hole twice a week did not give results sufficiently to warrant extra labor and material. '•Doses of less than two (2) ounces of 10 percent of DDT dust, used once a week, gave a satisfactory control of adults, DDT, either spray or dust, did not always bring a heavy in- fested latrine under control quickly enough to prevent large numbers of flies from escaping into the latrine building and beyond. nIn only a few cases did DDT prevent adult flies from emerging and escaping into the latrine buildings after the regular latrine treatments have been stopped. Three (3) weeks after treatment was stopped, there was no apparent active residual. "Paradichlorobenzene gave complete control of fly activity in latrine pits when applied twice a week at the rate of one- fourth (1/4) pound per hole. 70 "Paradichlorobenzene was outstanding in performance in these tests0 It was superior to DDT in that it completely pre- vented any fly activity, did not require equipment for applica- tion, and improved the odor of latrines in which it was used0lf CHAPTER 2? Section II Disposal of Garbage and Rubbish (History of Preventive Medicine) Prior to the war most troops were concentrated in garrison, and Array garbage and rubbish was largely disposed of by sale of the edible portions to hog raisers, and by dumping and burning of non-edible combustible and con-combustible portions on Army operated dumps and sanitary fills. Troops in congested ci- vilian areas made use of civilian facilities as was convenient under the provisions of Engineer contracts. The dispersal of troops into field positions throughout the islands on and after 7 December 1941* resulted in the creation of numbers of scattered dumps, or in the use by troops of various established village and plantation dumps. The cooperation between the Array and civilians in the solution of garbage and rubbish disposal problems has been described in Chapter 38 on extra military sanitation. In order to assure uniformly satisfactory methods of garbage and rubbish dis- posal by troops on Oahu, a special directive concerning this sub- ject was published in August 1944* Measures for garbage and rubbish disposal on the other Hawaiian Islands have followed the same general pattern as on Oahu, Most of the edible fractions of garbage are disposed of by sale to hog farmers. That which is not, and most of the nort-edible garbage and rubbish, is disposed of on dumps or sanitary fills. Jn order to reduce the amount of garbage and rubbish which had to be taken by Army units to established dumping grounds, provision was made f*or the construction by troop labor of company size incinerators,7 Many units have constructed improvised water heating facilities into the company size incinerators for shower and kitchen water. Where wood fires were used for messkit laundries some combustible matter has been disposed of in these fires, During the latter part of 1943* two eight hour, ten ton incinerators were constructed, one at Fort Kamehameha Fort Kam-Hickara area and one on the upper post area of Schofield bar- racks, The incinerator at Fort Kam has been used satisfactorily for 73 the small amount of waste which has been brought to it0 Responsible personnel at Schofield Barracks have never been satisfied with the performance of the Schofield incinerator© At the time of construction of the incinerator at Schofield Barracks, it was estimated that there were 48 tons of non-edible garbage to be disposed of dailyIt was proposed that 3 ten ton eight hour incinerators be constructed to be operated 24 hours a day0 Any surplus waste material was to be burned on one of two dumps, one in the Field Artillery area and one on East Range© After trial with the first ten ton incinerator, the Post Commander and Post Surgeon both concurred in recommending that no addi- tional incinerators be built during the emergency because of their limited capacity, and because of the excessive requirement of personnel and fuel required to operate them0 The sanitary fill or dump was recom- mended as the more practical and more economical,, A Board of Officers, consisting of representatives of the Surgeon, and Engineer, was then appointed to study the problem of garbage and waste disposal at Schofield Barracks and elsewhere,, The Board reserved decision con- cerning further construction of incinerators pending further trial, but steps were taken for the further development of the dump in the Easr Range area of the post0 It was first necessary to relocate the East Range dump to a greater distance from the 13th Replacement Depot which had been constructed since the dump had been originally established,, In 1945* the dump in the Field Artillery area of Scho- field Barracks was closed and covered over. Since that time all non- edible garbage and rubbish from Schofield Barracks has been disposed of at the East Range dump* Animal carcasses, spoiled rations, and other large amounts of matter likely to breed flies are incinerated at the tep ton incinerator0 Edible garbage has been collected from all parts of Schofield Barracks exclusive of East Range by civilian contractors0 These con- tractors have collected the garbage from the kitchen areas with their own tracks, leaving a clean garbage can and lid in place of the full ones6 Similar arrangements have not been possible for the East Range unitso The edible garbage from East Range has been acceptable to a hog farmer at some distance, but he had not had the trucks, fuel or personnel to collect the garbage. The Army has provided transporta- tion for this garbage to the hog farm by large tank truck, in order to accomplish its sanitary disposal,, Unit garbage cans have been brought by truck to a central point adjacent to the East Range dump, where the large tank truck has been loaded,, During the year 1944 - 1945* the East Range garbage transfer has been steadily improved,, It has been provided with all concrete surfaces, a recess for the tank truck to facilitate filling from garbage cans, a drainage system and grease trap to facilitate hosing down and sanitary disposal of liquid wastes, and in June,1945* a soap-steam system for cleansing garbage cans was added0 With the installation of the garbage can cleaning system, all East Range units with suitable vehicles have been required to haul edible garbage to the East Range transfer point where they exchange a full can and lid for clean ones, Eknptying and cleans- ing of garbage cans is done at the transfer point by Post Utili- ties o At other posts civilian contractors have collected edible garbage from kitchen areas* Until April 1945$ garbage and rubbish was hauled away from Array piers in Honolulu by the City and County of Honolulu under contracts The service was never entirely satisfactory, due to civilian labor shortages* In April, 1945$ special arrangements were made with the Navy whereby the Navy was responsible for the removal of wet garbage by disposal*«rat sea, and the Array was re- sponsible for removal of dry garbage and trash to incinerators 0,,r In this way, no wet garbage was placed to stand on piers, and special Array trucks were not required. On Christmas Island* edible garbage was disposed of for a time at the Island animal fam0 In general* wet garbage from coral atolls has been disposed of at sea* either by garbage scow or by dumping from a short pier where there are suitable tides to carry the garbage oute Dry garbage and rubbish have been bumedo On Kwajalein Island all units operate company size incinerators for the disposal of combustible garbage and rubbish and bring • only products of combustion to the island dump* This material is periodically pushed off into the water by bulldozerc Screened garbage can stands were widely used in the Hawaiian Department prior to December 1942* when by revision of AR 4Q~205* they were prohibited,, Since that time low wooden or concrete platforms have been generaDy used0 Beginning in 1944? more and more units have constructed concrete surfaces with drains surrounded by a concrete curb in kitchen areas to serve as combined garbage can stands* garbage can washing platforms* and messkit laundry platforms,, These installations have greatly improved sanitation in field kitchr- en areas by preventing pollution of the soil by liquid wastes0 On posts they have minimized the washing of organic matter into catch basins under the streets0 75 LIST OF REFERENCES Chapter 27 1. Ltr fr Major George H, Matsinger, SnC, and 1st Lt. James H. Reid, C of E, to CO, Ebeye Island, subject: "Sewage Disposal - Ebeye Island, Marshal Group," B May 1944, on Pile, Surg Off, CPBC, 720.7. 2® Ltr fr Major George H. Matsinger, SnC, and 1st Lt. James H. Reid, C of E to Ihe Island Commander, Roi, subject: "Sewage Disposal - Roi & Namur Islands, Marshal Group," 12 May 1944* on Pile, Surg Off, CPBC, 720.7® 3» Ltr fr Major George H. Matsinger, SnC, and 1st Lt. James H. Reid, C of E, to CO, Naval Air Base, Eniwetok, subject: "Sewage Dis- posal - Eniwetok & Parry Islands," 16 May 44* on File, Surg Off, CPBC, 720o7« 4. Ltr fr Major George H« Matsinger, SnC, and 1st Lt. James H. Reid, G of E, to CO, Hqs, APO 241* subject: "Sewage Disposal - Kwajalein Island, Marshal Group," 27 Apr 44* on Pile* Surg Off, CPBC, 720.7. 5. Memo to Surg, CPBC, fr 2d Lt. Lawrence E. Taylor, SnC, subjectj Experimental Use of DDT Insecticides in Pit Latrines (Pinal Report Including the Results Obtained in Test Series IV, V, and VI)," 24 Apr 45* on File, Surg Off, CPBC, 725® 6. Cir #23* CPA. 7. File 720.7 Serial 61 (Folder #2) Swill Disposition, 1941 (Cir. 144)* 8. File 721.5 San Rpts Schofield Bks«, 1944 (a letter dated Sept 1943 among 44 rpts.). 9® Pile 7 - 720.7 Garbage disposal 1945« Ltr to AP&SC & 1st Ind. 76 CHAPTER 28 Control of Insects (History of Preventive Medicine) During the period 7 December 1941 until the latter part of 1942, there were many urgent medical problems, and rou- tine insect control did not receive great emphasis* All troop units were expected to take mosquito control measures aoout their bivouacs, and periodic inspections were made, but the training of many of the newly organized units in the special problems of insect control was inadequate. No entomologist was assigned to the Surgeon's Office, Hawaiian Department, Adult mosquitoes were quite numerous, both during the day and night. However, considerable attention had been directed to the problem to the problem of preventing the introduction of new insect vec- tors of disease into the Hawaiian Islands, An organization for the disinsectization of military aircraft after flights origina- ting outside the Territory, had been built up by the Array with the assistance of the UoS0 Public Health Service, the Uu Se De- partment of Agriculture,' and the Hawaiian Sugar Planters5 Association, (See chapter on foreign quarantine). Late in 1942, it became evident that much of the mosquito breeding which r esulted in annoying numbers of mos- quitoes on posts and throughout the City of Honolulu resulted from standing water in bomb shelters. These shelters had been constructed in 1942, but except for practice aid raid alerts they had not been used, A directive was published calling the attend tion of commanding officers to the proper maintenance of bomb shelters o'*- In September, 1942, a request was received f rom the Commanding General, Hawaiian Antiaircraft Artillery Command, for the issue of a mosquito repellent for searchlight, sound locator, and radar crews who were located in mosquito infested areas„ The use of mosquito head nets by these troops was not desirable, be- cause of the keen uninterrupted visual and aural perception re- quiredo A quantity of oil of cintronella was purchased for the preparation of mosquito repellent creams to meet this need0 Sta- Way had been available in the Territory in 1941* on a commercial basis, but stocks were completely used up® It was not known at the 77 time that Star-Way was toxic „ When Christmas Island was occupied in late 1941, there were no mosquitoes present on the island,, Mosquitoes (Gulex quinque- fasciatus) first appeared in May 1942, probably introduced by air- craft o More attention was given to the disinsectization of air- craft arriving at the base thereafter, but the mosquitoes have main- tained themselves on Christmas Island up through 1945• Mosquito con- trol measures have been instituted without complete eradication* In late 1943* interest in mosquito control at Christmas Island was In- creased when the British Government brought in a group of filariasis infected Gilbert and Ellice Island natives to harvest the copra* At the request of the Island Commander, a trained entomologist was sent to Christmas Island to make a survey and make recommendations as to control measures*5 Following this, top feeding minnows were sent to Christmas Island, in order that they might be established in the many lagoons and ground pools* The fish arrived in good condition in May, 1944, but their present status is not known* An entomologist was assigned to the Surgeoncs Office, Hawaiian Department, 3 April 1943o In April, 1943, the Surgeon, Hawaiian Department, requested authority to conduct a mosquito survey to determine the possible pres- ence of Anopheles mosquitoes in the Hickam Field - Pearl Harbor area* This survey was considered necessary as a check upon the efficiency of the disinsectization program for aircraft-, and to provide data on conditions existing in the area should it be necessary to undertake a program of Anopheline mosquito eradication in the area* Authoriza- tion wa.s approved, and work began 19 April 1943 o No Anopheline mos- quitoes or other mosquitoes previously unknown in the Territory were found*' During the survey of the Hickam Field - Pearl Harbor area it was reported that there was more mosquito breeding in military than in civilian areas, and that septic tanks, fire barrels, and salvage yards were the worst offenders0 Based upon this information Section V, Mosquito Control Circular No* 75$ HHD, dated 8 June 19435 was pub- lished The history of this epidemic and the associated Aedes mos- quito control program in extra military areas throughout the Territory is included in Chapter ArthropocUborne Infections and Chapter 38, Extra Military Sanitation and Liaison (U0S0 Public Health Service)e In order to assure Aedes mosquito control on military reservations during the dengue fever epidemic, all commanding officers in August 78 1943.9 were directed to institute a survey and control program for the control of mosquito breeding within a radius of one- fourth mile of buildings occupied by troopsWhere civilian habitations or other premises used by civilians were within the one-fourth mile radius* troops were authorized to call upon the Territorial Board of Health for assistance. Very few cases of dengue were traced to infection in military areas on Oahu, Approximately two months after the Gilberts Campaign and the occupation of Makin Atoll by an Army garrison* a severe outbreak of dengue fever occurred involving almost every member of that garrison. Neither of the two recognized vectors of dengue fever (Aedes albopectus and Aedes aegypti) were found on Makine Two mosquitoes were present in large numbers* Culax quinquefasciatus and Aedes variegatus, In March* 1944* an en- listed medical technician was sent by the Department Surgeon to Makin Atoll to organize a mosquito control program for the garrison. This technician was exceptionally well qualified* and a comprehensive and successful program resulted,”*"0 About this same time numbers of troops began returning to the Hawaiian 1 Islands from Makin Atoll who were ill with dengue fever on arri- val, particularly Air Corps personnel. The control program, on Makin became important in reducing the danger of reintroduction of dengue virus to the Territory of Hawaii* where control measures had made great progress. To further safeguard the Terri- tory, a directive was published in March* 1944* again reminding all commanders of the necessity of continuing Aedes mosquito con- trol measures in and about troop areas,1 Troops arriving in the Hawaiian Islands from Makin by ship were put in three day quarantine* or until it was ascertained they were dengue free. It was necessary to rely on the Air Corps to maintain medical surveillance over their own personnel During this period the Aedes mosquito control program in Honolulu was being expanded to include all of the Hawaiian Islands (See Chapter 3S)0 One of the major insect control problems in the Terri- tory of Hawaii waw fly control in the many hundreds of pit latrines at training camps0 staging areas, and field positions0 The small pit latrines dug at the field positions of the many units in defense of the islands, seldom over eight feet deep, were relative- ly easy to maintain fly-free. The pit latrines provided for the larger camps, however, were provided with enormous pits, 15 to 20 feet deep and approximately 10 by 15 feet in cross section,, These large latrine pits had been provided with tight boxes and screened latrine houses, nevertheless, difficulties occurred almost at once in the control of flies in them0 The faithful application of 3-5 79 gallons of crude or waste motor oil to the pit contents each day was effective, but the latrine seats soon became soaked with black oil0 The general quality of soldier selected for permanent latrine orderly, or the equally unsatisfactory use of all company personnel as order- lies on roster made it difficult to assure continuous oiling with crude oil, or to keep sprayers in working condition for the economical use of diesel oil® Units moved in and out of these training camps frequently, and the camps were vacated for periods of time during which uhey were maintained by station complements of a few men« The large pit latrines required continuous fly control maintenance, whether they were in current use or not„ The predominant species of latrine fly in this area, Chrysomyia megacephela, has continued to breed in great numbers for 3-4 weeks after a large latrine has been left unattended*. After this period, the soldier fly (Hermetia illucens}has bred in the older feces for a longer period„ So great was the sanitary need for better fly control in the large latrines that the Department Surgeon called his consulting entomologist and directly ordered him to find a solution for the fly problem,, The result was the trial and development of the use of paradichloro- benzene* The credit for the introduction of paradichlorobenzene in- to military sanitation for the control of fly breeding in pit la- trines belongs to Major (then Captain) Franklin Sherman III, Sn C, of this Headquarters0 Considerable experimental trial with parad- ichlorobenzene in these large pit latrines followed<, The chemical was successful, economical, and so easy to apply that the simplest latrine orderly could use it„ The Department Surgeon expressed his satisfaction with the results obtained with PDB in a letter to The Surgeon General, dated 22 March Later, some limitations to the effectiveness of paradichlorobenzene were founds It was not so effective where latrine pits contained standing water, where the pits were less than six feet deep, or where a draft was created in the pit through faulty covering by the latrine houseExtensive practical trial of paradichlorobenzene in the Hawaiian Islands was not possible until 1945o Up to this time almost all paradichlorobenzene shipped to the Pacific was reserved by higher headquarters for use at ad- vanced Pacific baseso The large pit latrines for which the chemical had been developed were treated with crude oil, diesel oil, and later, 5$ DDT in kerosenec A sufficient quantity of paradichloro- benzene was available in 1945? to permit its routine use in the Hawaiian Islands* Instructions concerning procurement and use were At present both paradichlorobenzene and 5% DDT in kerosene are being used to control fly breeding in the large latrine pitSo Of the two, the paradichlorobenzene is the simpler method, provided the pits are deep, do not contain standing water, and are protected from drafts,, 80 The campaign in the Gilbert Islands had been followed by an indescribable fly problem. Adult flies were everywhere*, even to the point of swarming over food as it was being passed to the mouth, Bacillary dysentery spread through entire garrisons, the fly breeding had taken place in enemy dead*, in destroyed enemy ration dumps*, and in both destroyed enemy and unsanitated friendly latrines and garbage accumulations,, In early 1944, the Marshalls Campaign was imminent. It was to be carried out under top Navy Command (Fifth Amphibious Corps), Through Array-Navy liaison*, once again Capt, Sherman was. called upon to provide an answer. The effectiveness of sodium arsenite as a fly and maggot killer was first demonstrated to the satisfaction of the Army and Navy staff through experiments with fly-blown meat,1' Thereafter*, the development of the possibility of using sodium arsenite for for battlefield sanitation from the supply and logistical stand- points was an easy matter, Chemical warfare decontaminating trucks were selected to spray the dilute sodium arsenite solution*, and the necessary trucks and personnel were included in the opera- tion. Personnel were selected from the combat teams and garrison forces to act as burial details. These personnel were trained in the preparation of sodium arsenite solution*, the spraying of sodium arsenite from knapsack sprayers*, and the necessary precautionary measures to be taken with this violent poison. Protective lotions were prepared for the skin of personnel handling and spraying sodium arsenite,Capt, Sherman participated personally in the Marshalls Campaign to supervise the fly control work. Results were good*, and sodium arsenite has been used in all successive Pacific operations where intensive fighting has taken place on small land masses, A directive concerning the use of sodium arsenite*,”"' and two papers concerning the use of sodium arsenite under battle- field conditions are Mosquitoes did not become the problem on Kwajalein that they had been on Makin0 Kwajalein Island was completely levelled by artillery, and generally9 conditions have not been as favorable for mosquito breeding in the Marshalls as they have been in the Gilberts Debris was cleared away rapidly<, No cases of dengue occurred which were traced to infection at Kwajalein,, No extensive outbreaks of dysentery occurred at Kwajalein as they had in the Gilberts* Bedbug infestation was recognized as a serious insect con- trol problem in the Hawaiian Department in late 1942*, when an in- spection of Schofield Barracks showed bedbug infestation in a large number of units. With the frequent transfer of troops*, bedbug in- festation spread to almost all military posts. Control measures were used generally, but indifferent units were a handicap to good ones* The temporary light wooden construction used predominantly for barracks became infested with bedbugs, was difficult to fund- gate, and served as a source of reinfestation after cots, bedding, and personal effects were treated* The year around, uniformly warn climate gave the bedbug every advantage for growth and reproduction. It invaded the laundries and travelled in clean linen and blankets. It persisted on cots and blankets returned to supply rooms and Quar- termaster warehouses, and it invaded the new units to which these items were reissued* Much effort was expended to overcome this in- festation without success until there was a sufficiently intensive, Coordinated effort by all units under the supervision of a permanent detail of insect control specialists. This coordinated effort was successfully undertaken in the latter part of 1944 before DDT was available in quantities sufficient to permit its use for bedbug control. Since DDT has been available for bedbug control there has been no problem, A chronological history of bedbug control in the Hawaiian Department follows: le Bedbug control measures were left up to individual units throughout 1942 and 1943* Bedbug infestation was generalized and very little permanent progress was made<,2x All the time*honored methods of eradi- cating bedbugs were used* but the nature of the buildings and the lack of concerted afforts by all units9. frequently repeated, doomed the efforts to failure*, Large numbers of cots and mattresses were fumigated in stationary and portable gas chambers and steam sterilizers only to become quickly reln- festedo 20 In March,1944* a central Array Pest Control Section under the Array Port and Service Command, was set up to coordinate insect control measures among the various Array units and to provide technical advice and assistance where necessary*, A vigorous pro- gram of bedbug control was undertaken under the leadership of this organization,, Nevertheless, bedbug control continued to be a major problem. There were too many bedbugs on the five major Hawaiian Islands for one pest control organization to handle, and the cooperation and training of the troops in bed- bug control was not sufficient, 3* In August, 1944.) a bedbug control school was conducted on Oahu, attended by three officers from each of the 82 26 major echelons of the Central Pacific Base Commando The school occupied two days, and included demonstra- tions of fumigation with methyl bromide and hydrogen cyanide,, However, the bedbug control method stressed was the ’’Unit Clean-up Method”, the procedure for which was mimeographed and distributed at the school, The unit clean-up method was later published as a Central Pacific Base Command directive, subject: Bedbug Eradica- tion Drive, 15 October 1944* ' The unit clean-up method as applied in the bedbug eradication drive was veiy successful. However, beginning in September, 1944* the remarkable effectiveness of DDT in bedbug control was recognized in the Central Pacific Base Command, and control measures since instituted have consisted in the spraying of cots, mattresses, and barrack walls with 5$ DDT in kerosene0 Several comprehensive reports on bedbug control concerning the unit clean-up method and DDT have been included in Essential Technical Medical Data reports of the Central Pacific Base Command, Cockroaches have been a problem in the Hawaiian Islands when adequate control measures have not been taken. During the first two years of the war many units employed commercial insect control firms for cockroach control using unit funds0 With the establishment of the Army Pest Control Section in March, 1$440 this section gradu-* ally displaced the local firmsu Because of the possible danger- attending the use of sodium fluoride, DDT is used almost exclusive- ly for cockroaches and with equal success0 Much of the work of application of an insecticide is done by .insect control technicians of the Army Fbit Control Section, but troops prepare kitchens, mess halls, storerooms, and barracks in such a way that food and utensils are protected or removed, and spraying can be done rapidly. Lice have not been a problem, either in military or civilian personnele Delousing of prisoners of war has been accom- plished as required by quarantine directives, Pleas have only been a problem where an excessive number of dogs and cats have been accumulated by troops in military camps, DDT powder in talc has been effective against fleas. Bird mites are occasionally a prob- lem in buildings where Minah birds have nested in the eaves or attics. When the parent birds and young leave the nests the mites migrate down through the building in unbelievably large numbers seeking sustenance from human beings, and causing irritating bites. Treatment with standard insecticides, eradication of nests, and prevention of further nesting have been invariably successful con- trol measures, Chigger bites have not been noted. Ticks have 83 been an occasional problem among war dogs* Ant infestation has bean a frequent and very'difficult problem of no medical or sanitary im- portance* A copy of CPBG Administrative Order No, 1 (Index CPYSG 200*30), Control of Insects, 10 July 1945* is inclosed* 8 This publi- cation incorporates minor changes made in an order published 6 Feb- ruary 1945® Similar administrative orders concerning disinsectization of mail and baggage rooms and salvage tires have been reported in Chapter 40 on Foreign Quarantine* Several thousand Okinawan prisoners of war were received on Oahu from Okinawa on 13 July 1945® Immediate action was taken by the l&bh Medical General Laboratory and three malaria survey detach- ments to survey these prisoners for diseases of possible danger to the Command* Among other infections these prisoners were found to be • approximately 20$ carriers of microfilaria of Wiichereria bancrofti and malayi In the blood* The Prisoner of War Compound was situated in a rural area on Oahu where a considerable population of Culex quin- quefasciatus mosquitoes existed* The dangerous nature of this sitafiu- tion was immediately recognized* Culex mosquitoes captured while biting infected Okinawans showed 10$ infection with microfilaria Later, the complete larval transformation to the infectious larvae was observed in these mosquitoes in the laboratory* Other mos- quitoes captured at large in the prisoner compound were found to con- tain larvae on disection* Bite counts taken in the prisoner compound area were as high as 22 Culex per 10 minute period per collector* Breeding was observed to be heavy in a stream of shower and kitchen waste water which ran in an open ditch through the camp* Because of the danger to guard personnel, civilians in adjacent areas* and uninfected prisoners* energetic Culex mosquito control measures were taken* Careful individual protective measures were taken by guard personnel* The stream was sprayed with 5$ DDT in kerosene by knap- sack sprayers, and further treated by drip and ball oilers utilizing 5$ DDT in kerosene with complete success* The entire camp area and surroundings were then surveyed by a malaria survey detachment , and a few additional mosquito breeders were eradicated* The blood sur- veys were completed as rapidly as possible, and infected prisoners were transferred to one area of the camp where they were situated in tents equipped with mosquito bars* Tents, cots, and mosquito bars had been treated with 5$ DDT in kerosene. All camp tents were sprayed, and all prisoners were provided with DDT treated mosquito bars as rapidly as possible* although supervision of their use was most careful among the known infected prisoners. Brush and grass in the compound and surroundings was cut close to the ground by prisoner labor* Adult 84 mosquito resting places were determined to be beneath buildings, under bridges, along ditch walls, and in high grass, Adult resting places were sprayed with 5% DDT emulsion in water by- means of two truck-bome power sprayers,. An area of approximate- ly one mile by one-quarter mile was as thoroughly sprayed with DDT emulsion as possible for residual effect against adult mos- quitoes in harborageso Within approximately one week, bite counts taken over the entire area showed a total of only one mos- quito collected during 12 collecting periods of 10 minutes each. Precautions were taken to prevent Okinawan prisoners spreading filariasis to areas outside their compounds by limiting working hours to the period of the day when the Culex quinquefasciatus mosquito rarely bites and by requiring mosquito control in prisoners5 work areas. Except for a few experimental sprayings over military reservations or waste lands on a small scale no spraying of DDT by airplane has been carried out in the Hawaiian Islands, There is strong opinion among local civilian entomologists and planters that the widespread use of DDT in the Territory would cause catas- trophic upsets in the established biological insect balances„ The use of airplanes to spray DDT for Gulex control in the filariasis infected Okinawan prisoner compound was considered, but the idea was abandoned in respect for local civilian opinion. The control measures taken from the ground were undubtedly more time consuming than airplane spraying would have been, but were probably more effective. Headquarters, CENTRAL PACIFIC BASE COMMAND, 18 May 1%5 ADMINISTRATIVE ORDER) NUMBER 1) (Index CPYSG 204.20) THE USE OF PARADICHLOROBENZENE (PDB) FOR FLY CONTROL IN PIT LATRINES 1. General0 Paradichlorobenzene (PDB), a chemical for use in controlling flies in pit latrines, is now available for issue by the Quartermaster® 2® Technique® Since the effectiveness of PDB depends upon the formation in the latrine pits of a gas which kills all stages of the fly, latrine boxes must be as gas tight as possible® The following measures must be observed? a® All cracks and knot holes must be chinked or tightly covered® b„ Seat lids must fit tightly and remain closed when not in use® e® Fly traps must not be placed over seat holes; and if the latrine has a built-in escape to a fly trap, this opening must be closed® d0 Earth or sand must be banked around the base of the box or latrine building® “ e® The practice of "burning out” latrines and the use of oil or other chemicals must be discontinued when latrines are treated with PDB® 3g Dosage® a® PDB is applied by scattering the crystals, by hand, over the surface of contents of the pit® It is desirable that all pits be at least six (6) feet deep in order to obtain control of the fly with PDB® PDB will not vaporize under water and is therefore not effective when scattered in a pit in which the con- tents are completely covered with water® In the event that the use of PDB is begun in latrines already infested, the initial dose of PDB should be doubled0 Applications must be made twice weekly, and in the following quantities0 87 (1) Semi-permanent latrines, with covered latrine houses; (a) 12-seat latrine . . ® ® . . » ® ® 3 pounds PDB (b) 8-10 seat latrine ® ® ® ® . . „ 2 pounds PDB (c) 4 - 6 seat latrine • ••«•"••! pound PDB (d) 2—seat unit ... ® ® ® . ® ® ® 1/2 pound PDB (2) Temporary uncovered type latrine boxes; (a) 6-8-seat unit ®®. ...... .3 pounds PDB (b) 4~seat unit ......... .2 pounds PDB (c) 2-seat unit • •*•••••••! pound PDB d» The dosage of PDB required for gbod fly control may vary from that listed above, depending upon the size of the pit and the tightness of the latrine box® The larger the pit and the more loose the construction of the latrine box, the greater will be the dosage required® An inspection of the pit contents for fly maggots should be made with the aid of a flashlight each time a treatment is applied® If maggots persist during the twice-weekly application, a higher dosage of PDB is indicated® 4® Application by special detail® In each camp where pit latrines are to be treated with PDB, a special detail should be organized to apply the chemical, with the policing of latrines remaining a unit responsibility. 5. Storage of PDB0 Because PDB volatilizes at normal temperatures, it should be stored in an air tight container in a cool place® 6. Basis for requisition® Issue will be made upon the basis of twenty (20) pounds of paradichlorobenzene (PDB) monthly per one hundred (100) men. Where the above basis of issue is found to be insufficient under local conditions, requisitions for larger quantities will show a statement fully describing the circumstances underlying the increased requirement® BY command OF MAJOR GENERAL BURGIN: OFFICIAL /s/ M. W. MARSH Colonel, GSC AC of S, G-4 Wayne C® Smith Brigadier General, GSC Chief of Staff Distribution; r,Cn plus POA "O'1 less 9 & 10 Special (50 copies, Surgeon, CPBC)® 88 Headquarters, CENTRAL PACIFIC BASE COMMAND, 15 October 1944 ADMINISTRATIVE ORDER) NUMBER oooooeo) (Index 700o30) BEDBUG ERADICATION DRIVE 1, The irritation caused by even a light Infestation of bedbugs reduces vitality of men and lowers the morale of units infested. Many cases are known where clean house-keeping by certain Array units has entirely eliminated bedbug infestation. It has also been observed that such units are efficient and alert from the commanding officer down to the last man. To eliminate bedbugs entirely, it is necessary that eradication in an area at one time is accomplished so that re- infestation of the unit is less likely to occur by movement of the unit or by the transfer of men from one unit to another. The attached leaflet "Bedbugs and Their Control in the Army" was compiled to fam- iliarize all concerned with the habits and control measures which en- able a unit to find and eliminate an infestation, 2, It is directed that unit commanders explain or read this leaflet to their units and make a thorough inspection to detect any possible infestation of bedbugs, 3, If any infestation whatsoever is founds the following clean-up control measures will- be'thoroughly accomplished in a single day for the entire units a0 All bedding material such as blankets, pillows, sheets, mattresses, and all clothing will be aired in the sun, .» (1) All bedding and clothing will be shaken out, examined, and any bedbugs destroyed, (2j Mattresses will be examined and brushed with a stiff scrubbing brush in order to kil? any bedbugs or eggs present, b. Canvas cots will De folded carefully so as not to disturb the bedbugs and dipped in hot water as near the boiling point as possible for two or three minutes. Steel cots will be scalded with hot water, painted thoroughly with kerosene or disinfected with a blow torch, (The torch flame being very hot need only touch a bed- bug or egg to kill it instantly,} 89 c, Walls will be painted with kerosene or washed down with boiling water making sure that killing agent penetrates all cracks and crevices where bedbugs hide. do Floors will be scrubbed with boiling water and soap. 4« The clean-up measures will be repeated at weekly intervals for three treatments. If, at the end of that series, signs of bedbugs are evident, treatments will be continued until all infestation is eliminated. Frequent inspection will be continued in order to detect any new infestation. 5* Unit commanders will require new men joining the unit to shake out and examine their equipment for bedbugs and disinfest the equipment when necessary before entering sleeping quarters. command of Major General BURGIN: WAYNE Co SMITH, Colonel, GSC, Chief of Staff, OFFICIAL: /s/ M, W* Marsh M, W0 Marsh Colonel, GSC, A C/S - G-4 1 Incls Leaflet "Bedbugs and Their Control in the Army", DISTRIBUTION; "C" Surgeon (50 copies _ Special) 90 Incl. No. 1 to Index 700<,30 BEDBUGS AND THEIR CONTROL IN THE ARMY INTRODUCTION The crowded conditions in the Army under war conditions and the frequent movement of individual men as well as units provide ideal conditions for the propagation and dissemination of certain insect pests, This is especially true in areas where the tempera- ture is high enough x.he year round for the continuous life processes of the pest* Insects are known as cold-blooded animals and be- come sluggish and inactive as the temperature goes down, laying fewer eggs, feeding less often, and even hibernating in extremely cold weather0 On the other hand, as the temperature rises, in- sects feed more often, lay eggs faster, and finish their life cycle in a shorter time. The bedbug is such an Insect and in the Cen- tral Pacific Area where the temperature is always favorable they multiply very rapidly,. Only about six (6) weeks are required to complete the life cycle under favorable conditions0 There is a comic poem which ends with this line, nThe bedbug has no wings at all but it gets there just the sameQ 11 The bedbug depends entirely on man to scatter it from place to place. They crawl only short distances. The urge to crawl is stimulated by the odor of a person nearby on which the insects feed. The bedbug is nocturnal in habit, that is, it is active only at night ordinar- ily and spends the day resting in protected places such as in folds or seams of bedding or mosquito netting or in cracks or crev- ices of the bed or nearby walls. The female full of eggs has a particular desire to ”go places” and is ordinarily the only form which is active in day time. Thus we see that it is the female ready to lay eggs which is most likely to be carried from place to place on clothing and other articles. The crowded housing conditions and continual movement or armed forces under war conditions provide perfect conditions for the propa- gation and dissemination of the bedbug. The crowded conditions in living quarters make it necessary for the bedbug to travel only a few feet to find a luscious sleeping man on which to feed. Frequent transfers of from one man to whole units of men provide the vehicle of dissemination making it unnecessary for the bedbug to have wings. The equipment of men joining units should be inspected thoroughly so that infestation may be prevented. Units moving into quarters pre- viously occupied should be especially alert to determine if the 91 quarters had previously been infested. Units leaving quarters should make every effort to leave such quarters free from bedbugs. These are only a few of the many ways which army routing aids in disseminating bedbugs a DESCRIPTION AND HABITS The mature bedbug is a wingless brown insect about one-fourth to three-eighths of an inch long. Unless engorged with blood it is paper-thin which enables it to hide in cracks or crevices in the bed or walls. When first hatched the nymph is translucent with a yellowish tinge and feeds at the first opportunity. It molts or sheds its skin five times before reaching maturity,, which takes from A to 6 weeks in warm weather. It must feed after each molt, at 82°F to 89°F newly hatched bedbugs have lived unfed up to 18 days. At 60°F to 65°F they have lived 136 days unfed and 9 months when given a chance to engorge once. When normally fed, and laying eggs, individual bedbugs have lived from 54 to 316 days* The eggs are white, about one thirty-second of an inch long. They are oval elongate with one end constricted to a short bottle neck at the end of which the hatching nymph emerges. When first deposited the egg is covered with a mucilaginous substance which sticks to the surface on which it is laid. Prom one to five eggs are laid per day by one female, A single female has been known to deposit over 500 eggs but around 200 is probably the average. The eggs hatch in from 6 to 28 days depending upon the temperature. THE DETECTION OF INFESTATION The usual place to locate bedbug infestation is on those beds which show the disfiguring spots of excrement near the joints or crevices where the insects hide. There may also be whitish areas of eggs or egg shells. These can be seen with the naked eye, A light infestation may be discovered by searching around the tufts and seams of the mattress. However, if the bedbugs are disturbed by haphazard control measures or become more numerous they establish themselves in the walls,, behind baseboards, or in window and door casings. CONTROL MEASURES Control measures against the bedbug should be thorough and con- certed, Eradication can only be accomplished by simultaneous, thorough efforts in a whole area. These simultaneous control measures should be repeated at weekly intervals until eradication is complete. After 92 eradication is thought to be complete frequent inspections should be made and the men instructed to report the discovery of any trace of infestation. When it is thought that one is annoyed by bedbugs they can often be found by aid of a flashlight at night* and the bedbug captured for identification. SUPER-HEATING AND HOT WATER Boiling water will kill any stage of the bedbug instantly upon thorough contact. The liberal use of GI soap in the water is also recommended. Dry heat at 120°F for several hours will kill all stages. Steam sterilization of mattresses is very effective. Canvas cots dipped in a barrel containing water too hot in which to hold the hand will kill all stages of the bedbug which may be on the cot in a minute or two if the water contacts the insect or egg. The cot may be lowered into the hot water by means of a rope. The hot water must reach all crevices. Scald- ing water may be poured on a metal bed but care must be taken to hit all places the bedbugs may hide. The hollow parts of the metal frame serve as excellent hiding places and for the laying of eggs. The blow torch will clean a metal bed of infestation. The torch flame, is several hundred degrees fahrenheit, and a11 stages of the bedbug hit by the flame are .killed instantly so that the flame need not be held on coil springs long enough to affect the temper of the spring. The inside of the coil spring is most liable to contain bedbugs or eggs. The hollow parts of the frame should not be neglected. INSECTICIDES Any of the common contact insecticides will kill any stage of the bedbug but it must be remembered that the egg or bedbug must be wet with the material. The common atomizer spray gun does not throw enough material for thorough work on a large scale but if diligent work is done an individual bed and adjoining walls may be disinfested if an initial infestation is thought to be localized. It cannot be overemphasized* however* that thorough work and community effort is necessary to eliminate infestation entirely. The Quartermaster insect spray which contains lethane mixed with white kerosene is a good spray to use in wetting walls and spray- ing equipment including steel cots. All stages of the bedbug will be killed if wet with plain kerosene but the white grade kerosene should be used. The odor also has a repellant effect. Kerosene may be applied with a paint brush if a mechanical sprayer is not available. 93 FUMIGATION Where whole buildings are heavily infested and if the building can be made gas-tight a most efficient way to eliminate infestation is to fumigate with hydrocyanic acid gas, methyl bromide, or chloro- picrin. Each of these gases has its advantages under certain con- ditions* Each gas is deadly to man and should be used by persons familiar with using such a gas. The pest Control Unit of the C&U Branch of the Array Port and Service Command will aid in formulating plans for eliminating bed- bugs* It is believed, however, that with the suggestions given above the unit commander with the advice of his medical officer can rid his unit of bedbugs. 94 Headquarters CENTRAL PACIFIC BASE COMMAND 10 July 1945 ADMINISTRATIVE ORDER) NUMBER 1) (Index CPYSG 200,30) CONTROL OF INSECTS *lo Rescission, Administrative Order No0 1 (Index 200,30),, HCPBC5 subject as above,, 6 February 1945$ less inclosure 1 thereto (Leaflet "Bedbugs and Their Control in the Armyn)0 2a Technical Advice and Assistance in Control of Insects, a. An Insect Control Section, which will provide technical advice and assistance in the control or eradication of bedbugs, cock- roaches, lice, termites, and other vermin and insects, has been es- tablished in the Army Port and Service Command* The services of this Insect Control Section are available to all Army units and Include the furnishing of material, equipment, and supervisory personnel necessary in executing control and eradication measures* COMMERCIAL INSECT CONTROL FIRMS WILL NOT BE HIRED* *b. Array units desiring the assistance of this unit, will initiate a written request through channels to the Commanding General., Array Port and Service Command, This letter will give the type of pest, extent of Infestation, size and location of buildings or areas, date control measures may be taken, and any other pertinent information. For service for units needing immediate the Insect Control Section may be reached by telephoning 1S6 or Fort Ruger 696 or 1314» c, A representative of the Insect Control Section will make an inspection of the infested building or area and will make recom- mendations or arrangements for remedial action. In general, the Insect Control Section will furnish materials, such as poisons5 tools,, equipment, fumigation vaults, and supervisory personnel only0r Troops will furnish the labor necessary for moving of bedding and furniture, prepare the building or area for treatment, and provide guards to prevent unauthorized entry into buildings. d« Upon completion of control measures, the requesting authority will inspect buildings or areas treated to determine effect- iveness of control measures* If control measures were not effective, a report to that effect will be made immediately to the Commanding General, Array Port and Service Command*, *3o Insecticides and Pest Control Equipment0 Authorization for and allowances of insecticides and items of pest control equip- ment are indicated in Circular 163, WD, 4 June 1945* 4o Control of Bedbugs« (See inclosure, pages 91 to 94o) a. The irritation caused by even a light infestation of bedbugs reduces vitality of men and lowers the morale of units in- fested, Many cases are known where clean housekeeping by certain Army units has entirely eliminated bedbug infestation,, The attached leaflet "Bedbugs and Their Control in the Army" was compiled to fam- iliarize all concerned with the habits and control neasures which en- able a unit to find and eliminate any infestation* b9 If any infestation whatsoever is found* prompt control measures will be taken; *(1) Use of DDT0 DDT is the method of choice,, When DDT is available* its use for control of bedbugs is recom- mended, Allowances for troops stationed in the CPBC are as set for Pacific Ocean Areas in Circular 163, WD, 4 June 1945• Experience has shown that a single application of a sufficient amount of DDT to beds, mattresses and walls of barracks will control bed- bugs for several months, DDT is issued as a 5$ solution in light petroleum oil, (Insecticide, spray, DDT, residual effect), or as a 10% dust mixture in talc (Larvicide, DDT, powder, dusting or Insecticide, powder, louse (DDT)0 Application is as follows; *(a) Insecticide, spray, DDT, residual effect (QM Item 51-1-305) is applied by knapsack, (Engr„ Item 41-7639*400o030) continuous hand (CM Item 41-S-4105), or other suitable sprayer to beds, mattresses and adjacent barrack walls at a rate of approximately 6 gallons per 100 beds, A fine wetting spray is the most desirable type* Mattresses and beds should be set up and sprayed so that excess material not deposited on them will be deposited behind them on the walls„ Walls may be given additional treatment to a height of 6 feet, with particular attention being given to cracks and crevices0 *(b) Larvicide, DDT powder, dusting (QM Item 51-L-122) or Insecticide, powder, louse (containing DDT) (Item 51-1-173 and 1B0) can be applied by shaking from the 2 ounce can (QM Item 51-1-173) or by use of duster, powder, insecticide (QM Item 4-1-D-3755). Powder should be dusted on mattresses, particularly about the tufts, and into crevices on the beds and walls, (2) Unit Clean Up Method; When DDT is not available, the following clean up control measures will be thoroughly accomplished for the entire unit in a single day and will be repeated at weekly intervals for at least three treatments; (a) All bedding material such as blankets, pillows, sheets, mattresses, and all clothing will be aired in the sun, 1. all bedding and clothing will be shaken out, examined and any bedbugs destroyed. 2. Mattresses will be examined and brushed with a stiff scrubbing brush in order to kill any bedbugs or eggs present. (b) Canvas cots will be folded carefully so as not to disturb the bedbugs and dipped in hot water as near the boiling point as possible for two or three minutes. Steel cots will be scalded with hot water, painted thoroughly with kerosene or disinfested with a blow torch, (The torch flame being very hot need only touch a bedbug or egg to kill it instantly.) (c) Walls will be painted with kerosene or washed down with boiling water making sure that killing agent penetrates all cracks and crevices where bedbugs hide. (d) Floors will be scrubbed with boiling water and soap. c. Treatment for bedbugs will be continued until all in- festation is eliminated. Frequent inspections will be made in order to detect any new infestations. Unit commanders will require new men joining the unit to shake out and examine their equipment for bedbugs, and disinfest the equipment when necessary, before entering the barracks. 97 5<> Control of Cockroaches* a. Cockroaches are among the most annoying and objectdeni- able insects infesting Army units* They are a menace to sanitation, and result in the destruction and pollution of food* Not only may they become numerous in mess halls and latrines but also in officers1 clubs, post exchanges, hospitals, and other places where food is stored or prepared* Since they are active mostly at night, large numbers may develop in a building before they are known to exist* These pests thrive on filth and moisture and feed on food products, waste food, and even book bindings and leather* The contaminate food they touch and often cause an obnoxious odor* b* Cockroaches in this area are mainly of three species* The small tan German roach which is most common, is 3/S to 3/4 inch long, the dark brown American roach is 1 to 1 1/2 inches long and the black Oriental roach is about one inch long* The German and American roaches have Well developed wings, while the Oriental cockroach is nearly wingless* Several different kinds of roaches may infest a place at the same time* They may ne noticed around sinks, drains, plumbing fixtures, and other dark and damp places* Food is usually sought at night and it is customary for roaches to hide in crevices in the daytime or when personnel are working around areas that roaches inhabit* The German cockroach is frequently brought into the build- ing with boxes of groceriesj American and Oriental cockroaches fre- quently live in nearby sewers or other places of concealment, enter- ing the building only at night to feed* Ce Eggs are deposited in capsules of about 20 to 30 eggs per capsule* The capsules are often carried for several days pro- truding from the female;s body and are dropped in secluded places or may be found sticking to shelves or walls or even the ceiling* Upon hatching, the young appear much like the adults except they do not have wings and are much smaller* They molt severl times and feed for several months before becoming adult* This long period of feeding and development gives ample time to kill them by dusting before the young mature and begin to reproduce* •*d* All species of cockroaches may be controlled by the use of Sodium Fluoride powder and a dust gun, both of which are listed as an item of issue in Circular 163,, WD, 4 June 1945* under the follow- ing stock numberss 51~I-210, Insecticide, powder, roach| 41-IV3755* Duster,powder, insecticide* This material should be carefully dusted into all cracks and crevices in the area being treated with special emphasis on common hiding places, such as under tables, drain boards, sinks, shelves, grease traps* or other places where inspection reveals that the roaches are congregating* ec The dust kills by contact with the roaches or as a stomach poison0 In killing as a stomach poison the roaches get the dry dust on their feet and other parts of the body and clean t hese parts with the mouth parts thus ingesting the poison0 As long as the dust is dry is effective but as soon as it becomes wet and caked, it is ineffective because the roaches cannot pick it up on their feet o f0 Sodium fluoride is poisonous to man if taken internally,, Therefore, extreme care should be taken when it is being applied to see that it does not get Into foodQ All open containers of food should be removed from buildings being treatedo Care must be exercised to see that this poison is not stored with food supplies or anywhere in the kitchen where it might be mistaken for food0 It is essential thatcontrol measures be made in a regular systematic way at weekly intervals for at least the first month and one or twice a month after control measures have been established® 6 o Control of Aedes Mo a quit- oes 0 a0 Dengue fever is known to be spread only by mosquitoes of the genes Aedesa Two species,, Aedes aegypti and Aedes Albopictus are the known vectors in the Central Pacific Base Commando Both species bite habitually during the day as well as at night0 Aedes aegypti is primarily "domestic" in its breeding habits and usually limits its breeding to water in miscellaneous artificial containers, such as cans, hotties0 tires, firs buckets; or in man-made situa- tions, such as cisterns, mason or rock walls, etc05 within the area0 Aedes albopictus may be found in the same breeding places as mentioned above, but in addition is found in, water contained in coral holes, tree holes, coconut shells, lily, ape, and banana, plants0 b0 All mosquitoes require standing 'water for only ten (10) days in which to pass through the "wiggles*11 (larval) and "tumbler" (pupal) stages of their life cycle0 Hundreds of mosquitoes may be produced in water held by a neglected tin can or coconut shall® Complete control of mosquito breeding in a given area is possible if all standing water is eliminated or treated to kill the "wigglers" each ten (10) days® Oiling with kerosene or No0 2 diesel oil is most effective* and only a very thin film of oil is necessary® Permanent control can be obtained only by systematic Inspections* followed by elimination of all breeding places (water containers of all kinds) or treatment of infested standing water with a larvicide® Co Both Aedes aegypti and Aedes albopictus have a very short flight range® In appearance both are black with silver stripes0 When adult Aedes aegypti and Aedes albopictus mosquitoes are dis- covered it may usually be assumed that their breeding places are 99 within 100 - 150 yards0 do All major echelons and separate unit commanders will require that inspections be made to determine presence of mosquito (Aedes) breeding in areas under their control* and that measures be taken to eliminate breeding places where found0 Aedes control must be a continuing process,, Commanders concerned will be alert to prevent Aedes mosquito breeding in the vicinity of military installa- tions 0 Liaison with civilians will be made directly or through the Territorial Board of Healths 7o Control of Culex Quinquefasciatus Mosquitoes0 a9 Culex quinquefasciatus is a yellow and brown* predominantly night-biting mosquito present in the Central Pacific Base Commando It is the chief nuisance mosquito in the Hawaiian Islands and is a potential vector of filariasis0 b0 The Culex quinquefasciatus mosquito has an estimated flight range of several mil.es 3 The number of adults in any area is deter- mined by the distance and heaviness of the breeding* the prevailing winds* and the presence of local harborages* such as high grass* depressions in the ground* or other cool.* moist places out of the wind0 Heavy breeding of this mosquito occures in polluted standing or slowly running water* such as sewage effluents* shower or kitchen wastes* street catch basins* wastes from piggeries* or in marshy pasture lands which are polluted by the droppings of animals„ Breeding is curtailed or controlled by fish* by any rapid* turbulent movement of water* by the dressing of stream banks and clearing of vegetation so as to allow for more rapid movement or for wind turbu- lence* and by spraying or drip oiling0 c. All possible effort, will be directed toward the control of the potentially dangerous and annoying Culex mosquito. All maj$r echelon and separate unit commanders will require that inspections be made to determine the presence of Culex mosquito breeding in areas under their control or in waste waters discharged from their areas. Control measures will be taken to eliminate breeding places whenever practicable. Necessary liaison will be maintained with civilians and other adjacent reservations* either directly or through the 100 Territorial Board of Health<, BY COMMAND OF MAJOR GENERAL BURGIN; WAYNE C, SMITH* Brigadier General* GSC* Chief of Staff OFFICIAL; /s/ Mo Wo Marsh Mo Wo MARSH Colonel* CSC* AC of S* G-4, 1 Incl: (same inclosure as stipulated on page 90) pages this incl0 numbered 91 Leaflet* "Bedbugs and Their Control to 94 o in the Am$r (attached to Adm 0 No0 1* 200e30* 6 Feb 1945o) DISTRIBUTION: "C" plus AFMIDPAC distribution "C" (less 9 & 10) Special (50 copies* Surgeon* CPBC) *Changed LIST OF REFERENCES Chapter 28 lo Ltr, Hq Hawaiian Depto to CO* Station Complements and Arny Air Bases* subjects "Maintenance of Bomb Shelters*" dtd 27 Nov 42, File Noo 72.5ol* Mosquitoes* Hq Hawaiian Depto, Off of Dept Surg, 1941. 2o Ltr fr CO, 98th CA (AA) to CG, Hawaiian -AA Cored, subject: "Issue of Mosquito Repellent" dtd 2 Sep 42, File No0 72$ol. Mosquitoes, Hq Hawaiian Dept* Off of Surg, 1941° 3, Memo fr Maj Ro Wo DuPriest to the Dept Surg, subjects "Mosquitoes at Birch," dtd 5 Mar 43, File No<, 725d? Mosquitoes, Serial No* 1, Surg Off* CPA, 1943o 4* Memo, subjects "Mosquitoes at Birch (Statement)f, Ibido $o Rpt, subjects "Mosquito Survey of APO 915" by Benjamin Freeman, Capt, SnC to Med Insp* Surg Off, CPA, dtd 28 Feb 44* File No» 725, Insects (Secret) Serial No0 10, Surg Off, CPA, 1944° 6o Ltr* subjects "Receipt of Mosquito-Eating Pish," to CG, Hq CPA, fr Surg* APO 915* Ibido 7o Rpt to Dept Surg, subjects "Search for Anopheline Mosquitoes in the Hickam Field and Pearl Harbor areas" by Franklin Sherman III, Capt, SnC, dtd 29 May 43* File No® 725d, Mosquitoes* Serial No„ 10, Surg Off, CPA, 1943* 8o Cir Noo 75* Hq Hawaiian Dept, Section V, subjects "Mosquito Control" dtd 8 Jun 43* File No0 725d, Mosquitoes, Serial No0 13, Surg Off, CPA, 1943o 9* Immediate Action Ltr, subjects ’’Dengue, Hq Hawaiian Dept" to Dis- tribution "A", dated 12 Aug 43* Pile No0 710, Dengue, Serial No„ 26, Hq Hawaiian Dept, Off Dept Surg* 1943 (Secret)o 10* Rpt to Med Insp* CPA, subjects "Mosquito Survey and Control Pro- grams at APO 459” by Bernard Eo Weening, Pfc0, Med Det Surg Off, Pile Noo 725, Insects, Serial Noo 11 (Secret) Hq, Surg Off, 1944* 11* Cir Noo 42, Hq CPA, subjects Dengue Control, dtd 13 Mar 1944* Section IIIo 12 <, Ltr to TSG, US Army, subjects "Use of Paradichlorobenzene in Pit Latrines" by Edgar King, Brig Gen, USA, Surg, CPA, dtd 22 Mar 44* Pile No® 441 ol. Drugs, Poisons, Serial No0 16, Hq Surg Off, CPBC, 1944o 102 13. Cir No. 42, Hq USAF, POA, subject: "Sanitation" dtd 25 Sep 44.. 14. Adm Order No. 1, Hq CPBC, subject: "The Use pf Paradichlorobenzene (PDB) for Ply Control in Pit Latrines" dtd 18 May 1945$ Incl lo 15* Rpt to Surg, CPA, APO 958$ subject: "Destruction of Maggots in Decomposing Meat" by Franklin Sherman III, Capto, SnC, dtd 1 Jan 44* File 725$ Insects, Serial No. 3 (Secret) Surg Off, Hq CPA, 1944. 16. Ltr fr Commander in Chief, POA to Island Commanders, subject: "Ply Control with Sodium Arsenite as a Means of and Training Personnel For" dtd 7 Jan 44$ Pile No. 725$ Insects, Serial No. 5 (Secret) 1944$ Surg Off, CPBC. 17. Cir No. 33$ Hq US Army Forces, POA, subjects "Use of Sodium Arsenite for Ply Control, dtd 16 Sep 44° 18. Draft of Article for Publication, subjects "Special Sanitary Problems Following Battle" by Franklin Sherman III, Capt, SnC, dtd 7 Aug 44$ Pile No. 461, Publications, Serial No. 101, Surg Off, 1944. 19® Ltr to CG, USAFICPA from A. Go Downing* QIC Burial Development, subjects "Report of Burial" dtd 16 Feb 44$ Pile No. 293$ Ptmerals and Gra ves. Serial No0 2, Surg Off, CPA, 1944. 20. Rpt to Surg, APO 241, subjects "Mosquito Situation on Porcelain and Other Islands of South Sector" dtd 26 Feb 44, by Franklin Sherman III, Capt, SnC, File No0 725, Insects, Serial No. 9 (Secret) Surg Off, CPA, 1944. 21. Ltr to CO, Port Hq APO 957, subject: "Infestation-Bedbugs" dtd 15 May 43$ File No. 725.1, Bedbugs, Serial No. 2, Surg Off, CPA, 1943. 22. Ltr to all Unit Commanders and Battalion Surgeons, subjects "Con- trol of Bedbugs" dtd 19 May 43 by CO, 106th Infantry, APO 27, File No. 725.1, Bedbugs, Serial No. 3, Surg Off, CPA, 1943° 23® Memo, Surg to Dept QM, subjects "Material for Fumigation and Bedbug Spray" dtd 28 Jul 43$ File No. 725ol, Bedbugs, Serial No0 6, Surg Off, CPA, 1943. 24. Cir No. 44, Hq USAF, CPA, subjects "Control of Insect Pests" dtd 16 Mar 44$ File No0 725<>1, Bedbugs, Serial No. 4$ Surg Off, CPA, 1944. 25. Memo to the Surg, CPA, subjects "Bedbug Control Activities of Pest Control Section, AP&SC" no date, by H. L. Meltzer, Lt. Col., MC, and Planklin Sherman III, Capt., SnC, Pile No. 725.1, Bedbugs, Serial No© 6, Surg Off, CPA, 1944. 102a 26. Cir No. 26, Hq CPBC, subject: "Insect Control" dtd 4 Aug 44, File No. 725.1, Bedbugs, Serial No. 7, Surg Off, GPA, 1944* 27. Adm Order No. 1, Hq CPBC, subject: "Bedbug Eradication Drive" dtd 15 Oct 44, Incl 2• 28. Adm Order No. 1, Hq CPBC (Index CPYSG 200.30) subject: "Control of Insects" dtd 10 July 45, File No. 725* Insects, Serial No. 16, Surg Off, CPBC, 1945* Incl 3* 29. Ltr to the Surg, HAMEDPAC, subject: "Filaria Infested Mdsquitoes" dtd 20 Jul 43* fr CO, 18th Med Gen Lab, APO 957, File No. 725, Insects, Serial No. 4 (Secret) Surg Off, CPBC, 1945* 102b CHAPTER 29 Control of Rodents (History of Preventive Medicine) - Interesting historical facts concerning rats and plague in the Hawaiian Islands have been summarized as followsjl 1. First case of human plague appeared in the Hawaiian Islands in the Chinese section of Honolulu on December 12, 1899° It is significant that in November of that same year* plague was reported at Kobe, Japan. 2« Maui experienced its initial case in January 1900* and in February 1900, it has spread to Hawaii. It was not until May 1901 that plague was introduced on Kauai. 3. On Oahu cases were reported every year (save 1909) until July 1910 since which time neither hu- man or rodent plague has been identified. 4o Maui had nine (9) human cases in 1900, and then none appeared until 1930u Since then, there had been six (6) cases* four (4) in 1932 and the last in December 1937. \ , „, Rodent plague has been observed on Maui since 1931o There have been only thirty-eight (3&) cases identified in which the last was on October 31st, 1942. 5o On Hawaii human cases appeared yearly with few exceptions (1901, 1902, 1916/ 1931, 1932) until 1935. Since this time only one case had been confirmed on December 23d 1939. Rodent plague has been observed every year without exception since 1907, the greatest number of infected rodents, 129, being observed in 1939. Seventy- nine (79) this year to date. 6. Kauai had four (4) cases in 1901, and nine (9) in.1902. There were two (2) cases in 1906, but none has been observed since. No records of infected rodents were obtained, but in 1936 - 1937 a survey was accomplished to include 8,508 rats, all of which were found to be non- inf ectedo (U„ S0 Public Health Service recognizes standards 103 of $,000 noninfected rats in order to state an area to be free of plague.) 7. No records of human or rodent plague on Molokai, Lanai, Niihau or Kahoolaws. 2 a v ery informative pamphlet prepared by the Rat and Mosquito Control Section of Honolulu Chamber of Commerce, states that it costs approximately $'2.00 a year to feed a rat. There are an estimated one hundred thirty million (130,000,000) rats in the United States. In addition, it is estimated that the value of material destroyed or damaged by rats is ten times as great. In other words, it is esti- mated that the annual costs of maintaining the normal rat population of the United States amounts to the staggering sum of two billion six hundred million dollars ($2,600,000,000). In Hawaii, there are four distinct species of rats namely, the Norway or brown rat (Rattus norvegicus) the black or house rat (Rattus alexandnnus), the gray or roof rat (Rattus Rattus Rattus) and the Hawaiian rat (Rattus hawaiiensis). The different species of rats have many choices of habitats: fields, burroughs, surface depressions, rock piles, dense brush, trees, and man’s own premises. Control measures listed are as follows; 1. Ratproofing 2. Trapping 3. Poisoning 4. Shooting 5. Gassing 6. Natural enemies Rats are carriers of some of man’s worst diseases, namely: bubonic plague, endemic typhus fever, infectious jaundice, trichinosis, rat bite fever, and amebic and bacillary dysentery as well as eleven species of internal parasites which also occur in man. Some animal diseases transmitted by rats are hog cholera, fowl tuberculosis, swine erysipelas and probably foot and mouth disease. On 21 April 1942, tentative proposals for rat control were outlined, presumably by the Surgeon, Headquarters Hawaiian Department, in an unsigned memorandum as follows:3 The attached copy of an inspection report by the Division Supervisor, Mr. Schultz, raises the question again of the necessity for specific arrangements for a positive system of rat control. The very large number (several thousands) of small buildings, portable type, which will 104 be required, the necessity for locating them in numerous different places and under very varying conditions, tacti- cal and otherwise, makes it out of the question to ad- here closely to the building code which was devised for quiet times and to construction which could be proceeded with at relative leisure. At a conference this date with Colonel Marston, G-4, it was agreed that so far as possible his Department would have buildings placed twenty inches off the ground, particularly in inhabited areas such as the City of Honolulu, that he would return our recommenda- tion with a directive pointing out the necessity for the rat control, following which we are to organize such rat control agency as seems necessary and to develop it as circumstances change„ It is further proposed that we prepare a directive for department publication making organization commanders responsible for keeping a close watch for rats, exterminat- ing them to the greatest extent practicable with the facili- ties possessed by uhe organization, having in mind that their primary mission is tactical, and further placing the responsibility on them to report the presence of rats when- ever numbers are at all large and their own facilities are inadequate to estimate them0 It is proposed to assign an officer to my office as rat control officer or some equivalent title who will develop a well trained group of enlisted inspectors who can go from place to place to assist in the location of rat harborageso It is further proposed that the actual work of exterminating the rats where it involves labor such as lifting buildings, etc0, be largely done by groups of civilian laborers0 It is further contemplated that all Surgeons of the major echelons will be instructed through tactical channels in this matter* The provisions of this to apply to the entire Department. It may be necessary to have this rat control section as an independent section of the office and not under the Medical Inspector* Decision on this as time passes* This memorandum may be regarded as the beginning for the mili- tary rat control program in the Hawaiian Department» On 10 May 1942s a was issued and signed by the Depart- ment Commanders Subject: Rat Control Within Organization Areas, This 105 publication, the basis of the rat control program in the Hawaiian Islands, is reproduced as follows; 1* a* Rats constitute a major potential health menace in this department* Rats infested with plague have recently been found in certain areas in Hawaii and Maui* Even under normal conditions it is difficult to prevent an undue increase in their numbers. Under present conditions the prevention of such undue in- creases is possible only by the most unremitting vigil- ance on the post of every military organization. b0 With the wide dispersion of troops and the necessity for uhe use of many small prefabricated buildings which often must be set up near or on the ground, numerous ideal harborages for rats are being created. 2, It is directed that a* All tait floors and prefabricated buildings be raised enough from the ground to make inspections possible beneath ,hem0 be Grass, weeds, rubbish be cleared from the immediate vicinity of all floors and buildings in so far as such action will not interfere with camouflage* Co Commanding officers of all units will re- quire frequent inspections to determine presence of rats in or about military installations * dc Eradication of rats and rat harborages will be attempted by all units when found and if unsuccessful, report will be made to this Headquarters stating the nature of the problem* ec Great care will be exercised in the storing of food so as to make it unavailable for rat consumption. f* Edible garbage will be kept in tightly covered containers?where possible, edible garbage will be removed* All garbage and rubbish not removed by contract, must be burned or otherwise satisfactorily dis- posed of daily* Accumulation of refuse will not be allowed to occur* 106 g, Lumber, boxes, etc, will not be stored under or against buildings and will be raised from the ground so that inspection is possible under and about them. h6 Any existing before being occupied by troops, will ue closely inspected inside and out for rats, for evidence thereof,, Such inspection will include every closed space, such as that between ceilings and roofs. i. Additional precautions have been prescribed for certain areas on the islands of Maui and Hawaii in separate letters to the Commanding General of respective districts. This letter was received in the Surgeon’s Office on 12 May 1942, and on that date, Colonel Elliott Ge Colby, MC, was placed in charge of the Rat Control Program for the Surgeon’s Office, In a letter to members of the Rat and Mosquito Control Committee, Chamber of Commerce of Honolulu, the chairman, inclosed a an intensive rat eradication program, A copy of this pro- posed program is attached as [Enclosure 2„ The meeting of the Rat and Mosquito Control Committee on 6 May 1942 mentioned on the foregoing letter was attended by members of the Territorial Board of Health, one member from the Hawaiian Sugar Planters’ Association and two representatives of the Array, The Rat Control Officer made a of this meeting to the Depart- ment Surgeon in a letter. Subject, Rat Control, 7 May 1942, and submitted the following recommendations: a. That the Array assist in every way in the clean-up campaign on the island of Oahu and that similar campaigns be organized on Hawaii and Maui, b. That the Arny supply trucks and men during the early part of this campaign if the City and County of Honolulu are ynal?le to handle the situation rapidly enough themselves. c. That enlisted men be trained in rat-trapping and poisoning in order to take over the work in the dock areas on the three islands which are now being done by the Territorial Board of Health, d0 That additional enlisted men be trained in rat- trapping and poisoning so that their services will be immediately available in case an extensive rat eradication campaign becomes necessary, due to the findings of plague infected rats in any of the harbor areas in the Territory, e. That a directive be issued ty the Commanding General., Headquarters Hawaiian Department, covering measures to be taken immediately by Army personnel for the eradication of rats and rat harborages on Army control areas. f0 That more attention be given to the inspection of shipping between Hilo, Hawaii; Kahului, Maui; and Honolulu, Oahu; in order to prevent possibility of bringing plague, from those areas. go That arrangements be made to assist the City and County of Honolulu in securing the shipment of the pump for use at the Kaena Point Dump from San Francisco to Honolulu, It is understood that it has been at the San Francisco dock for a considerable period of time. h. The USED make available certain material and supplies which may be needed for rat proofing of the more important installations in the Territory of Hawaii, The following directives? were sent to the Commanding General, Maui District and to the Commanding General, Hawaii District in letter, subject, Plague Infected Rats; a0 Raise all temporary housing above the ground so that all areas are open for inspection, and are sufficiently elevated to permit access for cleaning whenever practicable. b. Allow no refuse, grass, or weeds to accumulate under or about buildings as far as is consistent with camouflage. c. Cause frequent inspections to be made for rats in and about all buildings and institute measures taken for their destruction,. If unable to eradicate rats, this fact will be reported to this Headquarters0 d. Direct all Army personnel report at once to the Plague Laboratory or Board of Health Office, Wailuku, Maui, (Hilo, Hawaii) if dead rats are found in or about Array 108 installations in the plague infested area0 These rats are not to be handled by Army personnel but covered when found until picked-up by the Territorial Board of Health authoritieso Secure details from Plague Laboratory of Protection of personnel from dead rodents pending collec- tion by the Laboratory,, f‘ On 9 May 1942 the Rat Control Officer submitted a letter to the Department Surgeon, subject. Training in Rat Control, This letter made the following recommendations: a0 That fifteen (15) enlisted men be assigned for a period of ten days to receive rat control training. At least two of these men should be non-commissioned officers. b0 That this proposed -Draining program be conducted by Mr, R, E, Doty of the Hawaiian Sugar Planters' Associa- tion, c0 That the training be practical in type with the posts of Ft. Armstrong and adjoining dock area being used for inspection,, trapping and poisoning0 d0 That the fifteen (15) enlisted men be assigned to Ft, Armstrong on special duty, and housed and fed there during the ten-day period. e. That one, two and a half-ton truck for the use of these men throughout the ten-day period be provided. This proposed program was approved by the acting deputy Chief of Staff, on 15 May 1942, On 26 June 1943*. the Surgeon noted in a route slip to G-l, subject. Rat Guards on Cables of Piers, that neglect in the use of rat guards on cables holding ships at piers was widespread and recommended immediate action by proper police authorities to en- force this law. Inspection of tie lines for ships docking at Hono- lulu Harbor showed that only 50$ of the ships were using rat guards on tie lines. Consequently, the Surgeon was directed to write a letter to the Port Commander, by the Adjutant General, This letter which was mailed on 29 June 1942 was addressed to Captain of the Port of Honolulu, and called attention to the neglect of the use of rat guards and requested corrective action. As a result of this letter, steps were taken to furnish each shipmaster with instructions regarding use of rat guards. 109 On 13 April 1942, the attention of the Surgeon was requested by the Territorial., Commissioner of Public Health in a communication concerning the construction of temporary buildings at a level at least twenty inches above the ground in order to prevent rat infestation. This matter involved the Territorial Building Code, The Surgeon urged compliance with the building code and the acting Chief of Staff recommended that the Engineer construct all Theater of Operation buildings with the clear space of twenty inches under the building for purposes of in- spection and elimination of rat harborages and that the Surgeon prepare a suitable directive to the Command, directing all Com- manders to have frequent inspections for rat infestation and to establish a Rat Inspection Station and Eradication Service from men in his Commando In order to carry out this program, an appropriation of $30,000 was made available to the Department Engineer, Hawaiian Department, for Rodent Control Work0 Of this amount $18,000 was made available to ground forces facilities, and $12,000 for air forces facilities* A letter dated 30 May 1942, subject. Rodent Control Funds, stated "that these allotments have been prepared by a detailed study of the requirements of your Department which has taken into consideration the balance of funds on hand from the fiscal year 1942 funds* Therefore, it should be understood that the funds herein mentioned are to be used for personnel and all equipment and supplies except those which are the technical nature, for example, microscope, and special laboratory apparatus which will be procured from Medical and Hospital Department Funds as required*" ° Althought these funds were assigned to ohe Engineer, subsequent communication between Engineer and Surgeon, transferred these funds to the Office of the Surgeon,, Since appropriation of funds for the rat control program had been approved and allctted, steps were taken to secure necessary poison and traps. In a addressed to the Territorial Commissioner of Health, the Surgeon requested recommendations regarding the purchase of poison. In Commissioner recommended the use of Rat Nip or Sence, both of which were phosphorous compounds, and thallium sulfate. He recommended a stock of poison of about 6,000 lbs0 and a 100 to 200 lbs, of thallium sulfate. The request by the Surgeon for 12,000 lbs0 of phosphorous base rat poison was submitted to G-l; and, also, that 25,000 traps costing approximately 50j/ apiece would be provided,, The 12,000 lbs, of phosphorous rat poison was received on the 16th of July 19420 Purchase of rolled oats with thallium sulfate for rodent control, was made on 11 August 1942 and equipment for trapping and prebaiting was also purchased,, In an early r eport, apparently a weekly report., 1,543 rodents were killed at Fort Huger and adjacent vicinity. This was made by the group of enlisted men which had been delegated to carry out the rodent control program under the Rat Control Officer, The Rat Control Program had now been set in motion. Necessary materials and personnel had been supplied and funds had been alloted, a definite program had been outlined, and progress had been initially made in killing rodents. All this had been accomplished in three to four months, A series of reports were made by the rat control section, and in one instance at Schofield Barracks with the use of 255 traps, 1108 rats were caught daily. In a to the Surgeon dated 11 June 1942, sub- ject: Rat Control Program, the Rat Control Officer reviewed the situation regarding personnel and the Rat Control Program, As noted previously in this program, sixteen men were being trained for rat control work, although the responsibility for rat control on Array posts was delegated to the Post Commanders, In paragraph 2 of this memorandum, the Rat Control Officer remarked that "recent survey of posts such as Ft, Shafter and Ft, Armstrong indicates that t-he rat population is so high that ordinary trapping methods will do no good. Poisoning by the pre-bait system is the only method which at present appears feasible. This must be done by trained men and must be repeated at intervals of two to three months, or possibly oftener," The Rat Control Officer then made the following recommendations: a, Eight(8) men of the sixteen (16) men including one Sergeant be kept directly under the control of the Department Surgeonss Office, These men would be used on the larger and would be held responsible for inspection, poisoning, ad- vice in trapping, rat proofing and clean up campaign of military installations. b0 That the other eight (8) men be returned to their station, and be used by the Surgeon of each of the higher units as in- spectors of all stations and Camp sites, These men would do rat eradication work at the smaller installations, but would refer the large problems which they discovered to the men pre- scribed under (a) above. Co That the necessary equipment consisting of prebait stations, both poison and unpoisoned oats, be obtained and turned over to the Sergeant in charge of the unit operating 111 out of the Surgeon’s Office, This section would then be responsible for the equipment, and for the rat eradication work on the various larger posts. d, The section operating out of the Department Surgeon!s Office should be given the responsibility of inspection and rat eradication in the harbor area. This is necessary due to the fact that the Territorial Board of Health is unable to operate in the harbor area under present condition. On 20 April 1942, a member of the Public Health Committee of the Chamber of Commerce of Honolulu, wrote a to the Executive to the Military Governor, subject: Control of Rats, In this letter the author spoke of the necessity for rat control, and appended a list of fifteen suggestions, entitled "Householders Program for Rat and Mosquito Control", This list of fifteen points for householders is considered a very practical compilation of measures for rat control, and is given as Inclosure No, 3« On the 2nd of September 1942, the Surgeon for the Maui Service Command, sent a letter to the Surgeon, Hawaiian Department, Headquarters, Ft, Shafter, subject: Rat Re Plague, This letter called attention to the fact that in the last ten years, six persons had ac- quired plague in the Maui District, resulting in five deaths, and requested information regarding iramunicsation against plague, and the advisability of immunizing military personnel on the Island of Maui, The first indorsement to this letter is as follows: Records in this office show that plague rats have been found dead and trapped on Maui from time to time for the past eleven years, with the human cases of plague as noted in basic communication, the last being in 1937o There is no evidence known to this office to show that the situation with regard to plague-infected rats is essentially different on Maui than it has been in the past eleven years. The presence of troops, of course, demands that every precautionary measure be exercised to prevent harborage of rats in and around camps and billets, and contact of troops with rats. In view of the above it is not believed that a serious threat of exposure to plague exists on Maui, within the mean- ing of the communication referred to in paragraph No. 1, Therefore, immunization of military personnel on Maui against plague is not considered indicated at this time. 112 Recommend that measures directed in letter, Headquarters Hawaiian Department, 10th of May 1942, Medical file No, 725*1, subject: Rat Control Within Organization Areas, and Letter Headquarters Hawaiian Department, to Commanding General, Maui District, 8th May 1942, subject: Plague-Infested Rats, be applied diligently,, Plague vaccine is on approved acquisition from this depart- ment and will be available at the 5th Medical Supply Depot as soon as it can be furnished from the mainland. If any unusual circumstances should arise on Maui in regard to this problem this headquarters should be informed promptly. In a later report to the Department Surgeon from the Surgeon, Maui District, two rats were reported as plague-infested. These rats were trapped on 26 September and 29 September 1942, respectively. The matter of a suitable rat poision continued to be a problem. In a dated 18 September 1942, to the Commanding Officer of the Department Laboratory, the Surgeon for the Maui Ser- vice Command, mentioned that the supply of thallium sulfate was very low, and suggested the use of pulverized glass. The Commanding Officer, Department Laboratory, in an indorsement to this letter mentioned that the effect of ground glass was entirely mechanical, and might be re- jected by the rats if too large in particle size or be noneffective if too small, and since he had no rats to experiment with, could not determine proper effect of glass. He suggested the use of Red Squill as a rat poison. The letter was referred to the Rat Control Officer who stated that thallium sulfate poisoned rolled oats were still avail- able from the Pacific Guano and Fertilizer Company although the supply was not large. The Rat Control Officer stated that arrangements were being made to procure zinc phosphide as a rat poison which was de- clared superior to thallium sulfate by the Hawaiian Sugar Planters’ Association. The Hawaiian Sugar Planters’ Association stated that Red Squill was entirely inadequate for use of the rat poison. In a separate memorandum,-*-0 subject: Rat Poison, signed by the Rat Control Officer, but undated and without address, it was stated that thallium Sulfate was becoming scarce and expensive, costing about $17,50 a pound. Paragraph 2 of this memorandum stated; Experimental work by HcS0PoA. shows that zinc phosphide is more toxic than thallium, kills quicker and becomes harmless when left in the field for a few days. This chemical may be procured from the Oldbury Electric Chemical Co., 113 22 East 40th St,, New York, for approximately $1,00 a lb. It is prepared by mixing in a ratio of 1-200 with rolled oats, A typical formula would be one twentieth of a pound zinc phosphide, one quart com oil, twenty pounds rolled oats. The zinc phosphide should be mixed with the com oil and then with rolled oats shaking it on to the oats out of a can such as a pint myonnaise jar with holes punched on the top. Zinc phosphide is a dangerous poison, and should be handled with care by the person mixing it with the oats. Thirty miligrams of zinc sulphide will kill a rat weighing one kilo, two and two tenths pound, in approximately eight hours. In a subsequent communication with G-4S subject; Purchase of Rat Poison, dated 2? September 1942, the Rat Control Officer re- quested the purhcase of one eighty-pound can of zinc phosphide for use in rat poisoning, a supply which was considered adequate for six months under normal conditions* This purchase was approved* In connection with the training of men for rat control work, a rather comprehensive papem' on the subject: Rats and their Control, dated 24 September 1942, was compiled by Major Charles B* Perkins, M,C,, and is given as Inclosure No* 4e This paper is divided into important subjects such as. General Habits of Rats, Evidence of Infestation, Control Measures, Prebaiting System, Precautions, and Recommendations and Suggestions,, A very important part of this paper is contained in paragraph 7* Prebaiting System, which was found to be an effective measure in the control of rats. In Paragraph 75 the detailed instructions day by day for handling prebait system is given, and is considered valuable for general use by all rat control officers* IS The report of rat control activities by the rat control section during the period IS September 1942 to 3 October 1942, was submitted on 3 October 1942, and listed the following measures; 1, Prebaiting stations placed (unpoisoned) 400* 2, ” " n (poisoned) 212, 3e Total amount of unpoisoned oats consumed 76,50 4. Total amount of poisoned oats consumed 13.02 5« Total number of rats killed by poisoning 1982, 6, Total number of rats killed by trapping 48, Recommendations were made in this report concerning elimina- tion of rat harborages. This report was sent as an inclosure to a latter, subject; Rat Control, to the Commanding Officer, Ft, Shafter. 114 by Command of Lt0 General Emnons, directing that recommendations of the report be carried out, and that a similar rat control campaign be carried out on the post within two monthsa 19 In a communication 7 to the Surgeon, Hawaiian Department, on IB September 1942, subject; Treatment of Plague, the Surgeon of the Maui Service Command requested information concerning the use of sul- fathiazole in the treatment of plague0 The request was forwarded to The Surgeon GeneralSs Office, which called attention to Circular Letter No. 56, SGO, 9 June 1941» The following revision regarding the treat- ment of plague were noted; Sulfathiazole by mouth as follows; Initial dose, 4 grams, subsequent doses 105 grams every four hours day and night until temperature has been normal for seven days. In fulminating cases sodium sulfathiazole may be tried intravenous route. Subsequent doses 0.03 grams per kilo, five (5) percent colution in sterile dis- tilled water. 0.06 gram per kilo given slowly by the intravenous route. Subsequent doses 0.03 grams per kilo, five (5) per cent solution every six hours. Change to oral dosage as soon as possible. The use of sulfadiazine in man has not yet been recorded, but in mice it is more effective than sulfathiazole and less toxic. In a rat control activity dated 20 October 1942, the following summary of rat control activity on the north shore on the Island of Oahu by the Rat Control Section, during the period of 6 October 1942 to 17 October 1942 inclusive is as follows; 10 Prebait stations placed (unpoisoned) 194« 20 Prebait stations placed (poisoned) 194o 3o Total amount of unpoisoned oats consumed 22„ 4<» Total amount of poisoned oats consumed 12<,25 5<» Total number of rats killed by poison 1084* 6, Total number of mice killed by poison 2024a 7o Total number of rats killed by trapping 16, 2i * A comprehensive report entitled r,Lethal Dose Studies in Cages” was forwarded to the Rat Control Office by the Associate Agriculturist, of the Hawaiian Sugar Planters5 Association. These experiments were carried out by the H.S.P.A. to determine the efficiency of various rat poisons compared to thallium sulfate. A chart entitled "Comparative Effectiveness of Some Poisons Ex- pressed in Per cent,” gave the following information: 115 1. Strychnine 10c81 per cent 2. Arsenic 15o2 per cent 3o Ratmort 18o0 per cent 4» L-Tcx 18o4 per cent 5t Rat Nip 30% 31*6 per cent 6, Red Squill Powder 40.9 per cent 7« Rat Nip 40$ 73•5 per cent 8. Zinc phosphide 96.9 per cent 9. Thallium sulfate 96.6 per cent An important part of the rat control program consisted of laboratory tests and examinations on suspected rats. The Territorial Board of Health had taken the lead in this matter and had established laboratories on Oahu, Maui, and Hawaii, and with the cooperation of the Army, a laboratory was set up on the Island of Kauai in Novenv- ber 1942. The purpose of the laboratories was to diagnose plague in rats, and the procedures consisted of autopsy, and gross examination of the rats with all suspicious pathological lesions further checked by smears or by guinea pig inoculation, or both. Culture work was not recommended by the Territorial Board of Health as an added precaution against the accidental or even intentional spread of the disease, A culture of the organism is not necessary in the diagnosis of plague. All rats which were found dead or trapped were submitted to the laboratory for examination, and reports were made by the labora- tory giving the following information:22 io Identifying number 2„ Date 3o Feces 4« Exact location where rodents were found* 5* How obtained, that is, trapped, found dead or killed. 6„ Condition when received,, 7o Subcutaneous injection. Br, Lymphatic glands, buboes or other lesions. 9» Liver 100 Spleen 11o Pleural effusion 12o Purulent focci 13o Provisional diagnosis of gross lesions 14, Provisional diagnosis from smears Army personnel were employed in these rat laboratories, and vrorked in cooperation with the personnel of the Board of Health, 23 A Headquarters Hawaiian Department letter dated 12 December 1942 subject: Rat Control, directed the establishment of a thorough and 116 sustained program of rat control by all military organizations, and provided for a training program for personnel in rat control. This letter directed measures for the elimination of rat harborages, for the starvation of rats, for poisoning by the prebait method, for the handling of dead rats, and provided the necessary equipment for trapping and handling rats. As a result of this letter, appointed officers and enlisted men from various posts and camps attended an Array training course in rat control. The training schedule for the rat control school included lectures, field trips, moving pictures, demonstrations in prebaiting, and other control measures and discussion periods. Inspection of ship docking in Honolulu showed that of the tWenty-one vessels inspected, only two of the ships had the rat guards on all hawsers, and the attention of the Port Commander was again drawn to this matter* This inspection made on 16 April 1943* and indicated that during the war, there* was little success in main- taining rat guards on ships3 lines* In May, another inspection of ships In Honolulu Harbor was made to determine the number of rat guards in use* Ten vessels were inspected having sixty-one hawsers. Of this number only fifty-four per cent had adequate rat guards, and there were no ships with adequate rat guards on all of the hawsers* These inspections were continued but a large percentage of ships continued to dock without proper safeguard for rat control. 26 In a report by the rat laboratory of the Chamber of Commerce, Island of Oahu, the following information was given con- cerning the number of rats recorded by the laooratory by species. 1* Rattus alexandrinus 10? males, 144 females* Total 251 2* Rattus rattus rattus 33 males, 70 females* Total 103 3« Rattus novegicus 25 males, 52 females* Total 77 4o Rattus hawaiiensis 18 males, 13 females* Total 31 Grand total of the rats examined in the laboratory for the month of April 1943 being 462* Examinations of these 462 rats revealed no Pasteurella Pestis bacilli found microscopically or macroscopicallye In a report from the laboratory for the month of October 1943* a total of rats were examined* No Pasteurella Pestic bacilli were found in any of the rats submitted to the laboratory0 According to the U* S, Public Health Service, examination of rats without evidence of Pasteurella Pestis is indicative of plague-free conditions* It was noted in a report by the Hawaiian Sugar Planters' Association and the Consolidated Report of Rodent Control of the District Surgeon on Hawaii, that dried coconut is a veiy effective bait for rats although no one particular bait will trap all rats. It is found to be good practice to vary baits from time to time. In addition to the conventional methods employed in the eradication of rats on the ground, other means were employed to attack rats nesting in trees. Use of the Chemical Warfare Service flame thrower was tried, but this proved dangerous and not too effective, A better method was the use of shotguns which were almost a hundred percent effective, A Circular, subject: Shooting Rats from Nests in Trees with Shotgun, was subsequently prepared. This circular was later published under the title, Rat Elimination, 3 January 1944, Headquarters U. S6 Army Forces, CPA, Circular No, 2, Other methods of rat control are noteworthy. Biological control has been attempted from time to time in the Hawaiian Islands by the introduction of such animals as owls, dogs, cats, and the mongoose,, None of these animals has been particularly successful in eradicating the rats. The mongoose, which is a natural enemy of the rat, is a diurnal animal, and the rat is a nocturnal animal. The mongoose was introduced in the Hawaiian Island in 1883. The only notable effect on the rat population has been the shift in the species ratio of rats present. On the islands not having mongooses, the Norway rat comprises from ninety to ninety-five per cent of the rat population. On islands where the mongoose is present, the Norway rat is found in the smallest number. Among the chemical methods used for rat control, poison gas, generally hydrocyanic acid, is used in gassing burrows and nests on the ground. 28 Training in rat control was continued for the duration. Under the direction of the Medical Inspector's Office, Central Pacific Base Command, a course consisting of lectures, and field work in trapping, poisoning, shoting, gassing and inspection was given to various units and divisions. No new or unusual developments in the rat control program were reported during the latter part of 1944 or until the end of the war. No epidemics of rat-borne diseases occurred. 118 RATS AND PUBLIC HEALTH The presence of rats in a community is a constant menace to the health of the peoplee The rat contributes no earthly good but does a lot of ham, Perhaps no other animal on earth lives with less justification* It not only lives and raises its family at the expense of man and other animals, but in its pursuit for the essen- tials of life, it transmits disease to both man and animal and de- stroys food, buildings and merchandise* Rat life persists in a community because of man5s indiffer- ence and tolerance* There is too much of that "let George do it" attitude* Pardonable this may be during normal times, it is unpatriotic and dangerous to assume this attitude when one3s country is at war* Hawaii has a rat problem* Our equable climate, the practical absence of natural enemies, abundance of natural food and inaccessible harboring places, and a general lack of interest in rat control among the population are some of the chief factors which bring this about* This problem has been complicated by recent concentration of troops and defense workers which constitutes virgin soil for rats to plant their disease germs and the necessity of building up a reserve of food and supplies furnish the rates with additional sources of food* It is impossible to exterminate a biological species* But rats can be controlled and rendered innocuous if every resident of a community would take cognizance of the danger and initiate proper measures for their suppression* Governmental agencies, civic and health organizations, and volunteers may be able to stem an epidemic but the job of preventing such an epidemic rests with the people* Therefore, solution of the problem lies largely in the interest and cooperation individual citizens take in maintaining a year round rat control program* To insure the success of such a program, it behooves the general public to have a clear understanding of the habits of the rat and to familiarize themselves with the approved methods of rat control* REASONS FOR RAT CONTROL Rats are carriers of some of mancs worst diseases, namely: Bubonic plague, endemic typhus fever, infectious jaundice, trichinosis, ratbite fever, and amoebic and bacillary dysentery, as well as eleven species of internal parasites which also occur in manG Some animal diseases transmitted by rats are hog cholera, fowl tuberculosis, swin erysipelas, and probably foot and mouth diseasec Incl 1 119 No local figures are available showing monetary losses caused by rats, but it must be large, for it is common knowledge that rats: 1, Destroy cultivated grain as seeds, sprouts, or after harvesting. 2, Destroy merchandise stored and in transit, 3, Destroy books, leather, harness, gloves and cloth, 4, Destroy fruits, vegetables, and peanuts, 5, Kill chickens, turkeys, ducks and pigeons, 6, Eat enormous quantities of eggs, 7, Kill wild birds and song birds, 8, Attack seeds, plants, and flowers, 9, Damage buildings by gnawing wood, pipes, walls, and foundations, 10, Kill lambs and pigs, 11, Have gnawed holes in dams and started floods, 12, Have started fires by carrying off, and gnawing on, matches and electrical wires, 13o Have eaten holes in mail sacks and eaten valuable mall, 14, Have nibbled at ■ohe ears, noses and toes of infants in cribs. Have attacked and killed man in deserted mines. According to U, S, Public Health Service figures, it costs approximately $2,00 a year to feed a rat. There are an estim- ated 130,000,000 rates in the United States — one rat to each human population. The annual cost of feeding rats in the United States would therefore amount to $260,000,000, In addition, the value of material destroyed or damaged by rats is ten times as great. In other words, the annual cost of maintaining the normal rat popu- lation of the United States amounts to the staggering sum of $2,600,000,000s Before rat poisoning was practiced in Hawaii, an estimated 20 per cent of the sugar crop was destroyed by rats each year. Since the adoption of prebaiting by plantations, this damage has been reduced to less than one per cent. The pineapple industry has record of damages done to its crops in the fields by rats. The coffee industry suffered annual losses estimated to be $75*000 for many years. 120 SPECIES OF RATS IN HAWAII, There are four distinct species of rats in Hawaii, namely; the Norway or brown rat; the black or house rat; the gray or roof rat; and the Hawaiian rat. (From Bureau of Biological Survey Recordsby H. J, Spencer), Rattus norvegicus (the Norway or common brown rat) This rat is the largest of the four represented species, attaining a weight averaging 10 to 12 ounces 5 specimens weighing 16 to 18 oz, are taken frequently. The combined length of the body and head is 8 to 10 inches, and the tail averages an additional 7 to 9 inches in length. The body of the Norway rat is heavy and rather clumsy; the tail is stout and covered with large, coarse scales like skin. The fur is of a coarse texture, which adds to the general impression of a chunky rough appearance. The ears are small in compari- son to the large body and head, and the pads of the soles of the feet are also relatively small. The species has a characteristic number of mammae - 12 in all, 3 pairs located on the chest and 3 toward the groin.. The general color of the fur is so varied that no attempt will be made to describe it. In some specimens the appearance is like that of the gray rat and oftentimes they are mistaken for one another,The characteristics of the species given above are gener- ally used for identification, with no particular consideration for color. Rattus rattus rattus (the black rat) The black rat is smaller than the Norway rat, its average body length being 5 to ? inches and the tail measures 6 to 8 inches0 The general appearance of this species is striking. It has not the repulsive aspect of the Norway rat nor does it convey the impression of filth and disease usually connected with the sight of a rat5 rather it has the attractive appearance of a squirrel, particularly when seen scampering about in the trees. The contour of the body and head of the black rat is graceful and slender. The head is in proportion with the size of the body, with a sharp muzzle. The tail is slender, and always longer than the combined length of the body and head. The ears and pads of the soles of the feet are relatively large in this species. The species is characterized by $ pairs of mammae, 2 on the chest and 3 toward the groin, The fur is of fine, soft texture, ranging in color from smoky gray to jet black. 121 Rattus rattus alexandrinus (the gray rat) This rat is a sub-species of the black rat. Its physi- cal characteristics is identical with those of t he black rat ex- cept that its cast of fur is brownish-gray. Rattus hawaiiensis (the Hawaiian rat) This rat is the smallest of the four species. It is very often mistaken for a mouse or sometimes even reported as an immature gray of Norway rat. The average body weight of this rat is 2 or 3 ounces. Its average body length is 4 to 5 inches and the tail measures ..an additional 4 to 5 inches. The coloration of the haw&ii- ensis is distinctive of the species. Stone describes him as follows: ''Above he is cinnamon brown or russet shading into cinnamon buff on the sides and light buff or buggy white below, strongly mixed with black hairs on the back and sides. Feet nearly white above, and whole underside of the hind feet dark.n A fifth rodent present in the Hawaiian Islands is the mouse (Mus rausculus) so commonly known that it hardly needs describ- ing, It is the smallest rodent inhabiting Hawaii, seldom exceed- ing one-third to one-half of an ounce in weight. The general body form is slender. The ears are moderately large, and the tail is about as long as the combined body and head - frequently longer, rarely shorter. The general color is dusly gray above with a darker slate hue towards the middle of the back and ashy gray be- neath, This species has five pairs of mammae, 3 on the chest and 2 toward the groin. HABITAT, BURROWS AND NESTS The different species of rats have many choices of hab- itats and Hawaii abounds in a variety of natural dwelling places to suit each type of nest - in the fields, in burrows, surface depressions, rock piles, dense brush, and trees, as well as man's own premises. The Norway rat has, through the ages, been considered to be to a large extent parasitic on man? wherever man dwells, his nest will be found under chicken houses, stock and feed bams, privies, and even in raan3s own home when conditions permit. That part of the premises most abounding in filth is this rat's natural habitat. In Hawaii, the clemency of nature and the agricultural crops cultivated by man have led the Norway rat to broaden his usual manner of living. He may be found not only around man's dwelling place but also far removed from human habitations. 122 carrying on a life similar to that of any field rodent0 He is, in the Islands, a particular menace to sugar cane, pineapples, and other minor and local argicultural crops0 The Black, and Gray rats nest in trees of nearly all -varieties,the tops of shrubbery, dense brush and grassy slopes, rock piles, or in attic or other accessible portions of build- ings . The nests are usually constructed of materials typical of the area, grass probably being preeminent. Cfoicken feathers and the like are used when available. The location of the nest usually indicates considerable forethought as to inaccessibility to enemies and numerous avenues of retreat0 The Hawaiian rat is seldom found in close proximity of buildings and is not known to live other than in burrows. Gulches, grassy slopes, and other waste lands are particularly suited to their methods of livelihood, but the species is found in practically every field locality in which rat abound. Their burrow systems average 3 to 4 feet in length, with generally but 1 or 2 entrances. The depths of the burrow average 12 to 15 inches. Nests are built of masses of loosely woven grass blades, and is on one main line of the burrow system, permitt- ing the rat to retreat from enemies or control measures in either direction of the burrow. GENERAL HABITS OF RATS. Rats are active at night <> They prefer narrow, concealed and out-of-the-way routes which they habitually use0 Their repeated travel over such places leaves behind the tell-tale black markings so characteristic of rat runways 0 These marks are made by the oil and dirt left behind from the rat’s fur and are most helpful in tracing rat runs which usually lead from the nest through the open- ing through which entrance is gained into the building and the lo- cation of the food supply„ For a home, rats like a secluded, dark and well-protected place,preferably one in close proximity of an easily accessible food supply. This accounts for their establishment within our houses and buildings where kitchens and pantry insure them an in- exhaustible supply of food, while double walls, spaces between floors and ceilings, boxed-in fixtures, etc. furnish them ideal nesting places. These favorable conditions, abundant food supply and protection against adverse weather conditions and natural enemies, are conducive to the breeding of more and larger litters. 123 Rats can walk along telephone and electric wires with perfect ease and balance. These with vines alongside buildings and overhanging branches are commong avenues of approach to build- ings. They can jump two feet high, swim half a mile in rough water, dig two feet into the ground, and climb smoothly painted pipes up to three inches in size, any opening larger than one-half inch will admit most rats. Galvanized iron lighter than 18 gauge, lead sheets and pipes, light aluminum sheets, and zinc sheets are no bar to the sharp teeth of the rat. EVIDENCE OF INFESTATION The signs of rat infestation are those produced by the rats themselves. They are as follows? lo Droppings 2. Runways, 3® Tracks and tail marks 4o Gnawing o 5. Live rats (actually seen by the inspector) 60 Dead rats 7* Nestso 8. Rat odor* Droppings .-According to Williams of the U.S.P.H.S., this is the most constant sign of rat infestation and the one on which inspectors most rely. Like that of other rodents, the excreta of the rat is in small firm masses. These are rod-shaped, straight or slightly curved, with rounded ends. In size they vary from l/4 inch long by 1/16 inch in diameter to 3/4 inch long by 1/4 inch in diameter. Nearly always they are quite dark or black in color. When freshly passed they are soft enough to be squeezed out of shape and often have a glistening, wet appearance. Within two or three days they dry and become hard. Later the surface becomes dull. Very old ones are dust or dirt, covered, and may be discolored. The size, consistency, number, and even the color of drop- pings may vary considerably with variations of food. Rats under observation have been noted to pass as few as 30 and as many as 180 droppings in 24 hours. In general., grain as food produces relative- ly few while the more moist foods, and those with much roughage, produce more and often larger droppings. Rat droppings are passed singly at relatively frequent intervals. Consequently, though they may occur in considerable quantities within small areas, their arrangement is haphazard; they are not seen in small piles or grouped together, as is the case 124 with some of the other rodents0 They will be found wherever the rats roam, which is everywhere, but will be in greater numbers along their runways, near their harborages, and in secluded cor- ners* They will be found in greatest numbers in places seldom cleaned or disturbed* The size of the various pieces of excreta will determine whether family life is present and litters of young are being reared. It is seen then that it is possible to learn three valuable things through uhe examination of the excreta foundc First, whether the infestation is an old one or one of recent origin. Second, from the quantity and location, the probable extent of the infestation. Third, from the various sizes of excreta, whether families of rats are being reared,. Runways*-All colonizing animals establish runways* These are merely the usually traveled routes from one frequently visited locality to another* The constant passing of many individuals, each leaving a mark, finally produces a well-worn track, obvious to any eye and often giving a great deal of information to the experienced one* The body of the rat is dirty and the hair a trifle oily, so that wherever it rubs against a wall, cimbs a pipe or angle iron or swings under an obstruction, it leaves a dark mark* These marks are built up and extended by the constant passage of rats, the runway finally becoming clearly delineated* An experienced observer will detect a runway used by but few ratsj runways used by many are plain to the most unobserving, though the unknowing nay not realize their significance* Runways are of the utmost importance to the rat proofer, since they show him where to place a barrier and where the harborage that must be closed or removed is located,, Tracks and Tail Marks,,-Like any other animal, rats leave tracks$ that is they leave tracks on soft surfaces* The most im- pressionable surfaces are found in dust collected on surfaces of beams, railings, shelves, pipes, floors, etc* On these the rat leaves a literally tell-tale trail, for the trail of its tail is as characteristic as the marks of the 4-toed paws* In light dust the marks of the toes may be quite clear* On such a surface the dragging tail may also leave an irregular wavy line, though this is not constant and is often a broken track* The rat drags its tail only part of the time, usually only when moving slowly* Rat tracks on the surfaces over hard bases generally show the marks of the separate toes, but tracks in thick dust or bulk grain are usually only regularly spaced little pits or craters* On white-painted 125 pipes, footprints are very clear and sharp. Gnawings.-Rats gnaw for three purposes, viz, to cut through an obstruction between one inclosure and another, to cut into a food container (actual or expected), and to eat. The first includes cutting a way into harborages out of spaces in which the rat may be caught, and through partitions or similar barricades. The second comprises cutting into cargo or stores containers. The third in- cludes cutting through the outer shell of some foods as well as their actual eating. Gnawing is always purposeful; it seldom even appears to be at random. In fact, as a rule, it is quite obvious what the rat was trying to accomplish. Live Rats Seen,-If live rats are seen by the inspector in the course of his inspection, infestation is obvious. Dead Rats,-Old, dried carcasses of rats are definite signs of past infestation, but do not constitute evidence of present in- festation, Bodies of rats which have recently died indicate present infestation, but are not positive evidence. If partly eaten, how- ever, as is often the case, there is little doubt of the present of live rats. Rats partly eaten by cats are badly mangled; those eaten by other rats are more cleanly handled, often the greater part of the viscera having been reached through a single hole through the body wall. Nests ,,-In most cases, rat nests are well hidden and lo- cated inside of protective harborages. In consequence of such location, nests are not always seen during the course of ordinary inspection. As a rule, they need not be searched out, unless other evidences of rat life are confusing so that the in- spector finds it necessary to check against the presence of nests and other signs inside of harborages. In and near the nests are places where one expects to find fresh droppings. The presence only of old droppings about the nests is evidence that the rat in- festation has disappeared or that the nest has been abandoned. RatsJ nests may be constructed of almost any soft material, the rat is not at all particular in this respect. It is common to find a much larger collection of material than is necessary for the construction of the nest. In many cases this represents old nests, successively built one on top of the other. In other instances, however, it is a protective and secretive maneuver, the nest being in the center and accessible only through a single narrow opening. Sometimes the nest is simply hollowed out in an already existing collection of soft material, such as a bag of rags, a box of old paper, an old mattress or pillow, etc. 126 It is sometimes easy and at other times quite difficult to determine whether nests are old or recente An old nest is generally somewhat out of shape, while a new one is neatly rounded out and pressed on the inside0 The age of droppings nearby is a guide, as is sometimes the apparent age of the materials entering into the structure and of remains of food scattered about0 Young rats in a nest obviously denote recent construction as well as the presence of parents0 Rat Odoro--The odor of rats is distinctive and character- istic o It is of a must character, but, like all odors, cannot be described accurately enough to be recognized therefrom. Unfortunate- ly, it tends to persist for a considerable period after the rats are gone, so that it cannot be classed as a positive indication of their presence. It is of value, however, as often giving to the inspector information that rats have been present, and thereby intensifying his search for other evidence. Individuals vary considerably as to the acuteness of the sense of smell, and hence, vary in perception of this' sign. REPRODUCTIVMESSo The reproductiveness of rats is limited by food supply and opportunity for nesting and- harbcringo Well-fed rats living in com- fortable, protected nests breed oftener and produce larger litters0 Rats reach maturity between 100 to 120 days5 the gestation period is 21 5 to 7 litters are produced in a years and litters vary from 5 to 10 young ones3 Many estimates as to the number of progeny from one pair of rats in a given period have been made0 Following are some; 1 pair win produce 800 in a year0 1 pair will produce in a year0 1 pair will produce 3509000c,000 in three years,, 1 pair win produce 340 s 369c, 9599 1.52 in five years 0 CONTROL MEASURES Control measures against rats ares lo Ratproofingo 20 Trapping o 5» Poisoningo 4o Shootingo 5e Gassing* 60 Natural enemies From the standpoint of rat control,, rat proofing may be defined as the elimination of food and shelter for rats0 Put it in another way,, it means making food and shelter inaccessible to rats is the essential aim of ratproofing0 The modem trend in rat control is toward ratproofingo Pood and shelter are essential to all animals0 When the rat is deprived of these essentials it will leave to seek more favorable environments elsewhere,, This is precisely what ratproofing aims to accomplish,, By denying rats admission to our homes and depriv- ing them of food through proper storage and disposal.« they are forced to move away from our homes and buildings0 Theartner away' rats are from the human population the less the chance of contact and thus the danger of contracting rat-borne diseases is minimi2,ed0 Since fleas are the transmitting agents of plague and typhus fever from rats to human a very important point to keep in mind is that rats under arid near buildings carry more .fleas than rats away from buildings0 Some common faults found about homes which attract rats or encourage harborage ares 1* Holes in roofs, wallsp floors., and around pipes (> 20 Open fascia, ventilators,, louvers, skylights, flues and chimneys0 3v. Overhanging branches and vines 0 lo Overhead wires - electric, telephone, and radio0 5o Insufficient clearance under buildings 0 60 Improperly constructed basements and cellars. 7o Accumulations of rubbishy rocks, firewood,, lumber , tin cans, junk, and odds and ends (in yard., under house, and in attic) Bo Burrows in stone walls, around cesspools, and under concrete or stone floors0 9o Uncovered or improperly covered garbage cans* 129 10o Exposed feed for poultry and other domestic animals0 11, Faulty storage and disposal of food and feeds« 12* Unprotected trees bearing fruits and edible seeds. 13, Ungathered windfalls,, Ratproofing of buildings consist of (1) the elimination of actual rat harborage, (2) the protection of enclosed spaces that form harborage, and (3) the protection of buildings so that rats cannot Invade them. Harborages fall under three general heads; (l) structural, (2) incidental, and (3) temporary. Examples of structural harborage and double walls, enclosed spaces between floors, and ceilings, and beneath basement floors, or those that rest flat on the ground. Enclosed stairways, boxed in beams and pipes, improperly constructed loading platforms, and ele- vator pits are some other common rat harborages0 Incidental harborages apply to those harborages which result from the installation of non-ratproof fixtures, furniture, and equipment which is incidental to the operation of the building and its subdivisions0 Such harborage is ordinarily found in boxed-in bases or enclosed spaces in, above, or behind fixtures0 Shelves, counters, desks, show-cases, filing cabinets, and plumbing fixtures are frequently found to provide harborage. Temporary harborage is a type of harborage that generally results from carelessness and general, lax sanitation. Such harbor- age is found in the mass storage of materials or supplies, rubbish heaps, old furniture, odds and ends piled in cellars, attics, and closets, etc. Any such material if left undisturbed for several weeks can and will be used for homes by the rats. From the descrip- tion of temporary harborage, we can see that this type of harborage is frequently due to negligence and can be eliminated easily. In the cases of stored merchandise and or supplies, generally, a satis- factory schedule for the removal or turnover can be arranged that will prevent harborage. The most common source of food for rats around homes is the open garbage can. Cans with tight fitting covers should be employed. The garbage then should be collected regularly and dis- posed of through incineration or burial. Garbage dumps should not be allowed. Food storage in homes should be in ratproof closets or metal containers with tight covers to render it inaccessible to 130 rats0 Food for poultry and other domestic animals should be stored in ratproof storerooms or metal binsc Spillage and uncon-v sumed feed should not be allowed to remain exposed overnight to ' nourish rats but swept up or collected and disposed of in such a manner that rats cannot reach them* Some trees, like the coconut, date, and algaroba, besides providing nesting places for rats also supply them with food in the form of their fruits. To protect fruit trees and others which bear edible seeds, a band of metal at least ten inches wide should be nailed around the trunks at least three feet from the ground. If* windfalls are gathered each evening and kept out of reach of rats, a frequent source of rat food is eliminated. Careless and promiscuous scattering or throwing of uneaten lunches and so forth about school and playgrounds, candies and peanuts in theaters, carcasses of animals and fowls in vacant lots, only help rats to an easy living. Rats are not particular; they eat anything regardless of its state of freshness or decay0 Food stores, restaurants, and food warehouses should pay special attention to the storage of food so rats cannot get it. Slaughterhouses should exercise care in disposing of their wastes beyond the reach of rats, TRAPPING Trapping is a good means of eliminating rats provided a large number of traps are employed. Care is required in the selection of bait and placement of traps. The snap trap is generally accepted as the better type of trap to use. The cage trap is un- satisfactory because rats are too smart and usually shun such a sus- picious-looking contraption. No one single bait will catch all rats* Fruits, nuts, meatss fresh or smoked, fish, dried shrimp, and vegetables offer a variety of baits which may be useda One may either prebait, that is, put several kinds of baits on unset traps to find out which particu- lar bait is taken more freely, then adopting that bait, or he may set his traps with one bait and after he has caught all the rats he can, switch over to another bait, and so on, thus rotating the kinds of bait used« Dried coconut meat has been found to be a very good bait for all localities and conditions* —. Traps should be set in the evening to avoid their being accidentally tripped and thus, lose their usefulness*, A delicate set is required because the reaction of rats is very fast* Since rats usually follow the wall in moving from one place to another. 131 traps should be placed about an inch from the wall with the trigger parallel to it. This allows maximum trapping area and permits free approach from either directions. Traps should be properly anchored or staked down, otherwise rats which have not received a fatal blow may drag the traps away with them. To insure maximum efficiency from traps, frequent inspections should be made to keep them clean and moving parts working freely. Steel traps may be used with or without bait. They should be placed in known runways, along walls, on top of beams, and in the rat's path as he runs out from behind boxes, stoves,and other hiding places. POISONING The use of poison bait while more effective than trapping must be employed with caution. Most rat poisons are toxic to humans and domestic animals. Ther is also the chance of rats dying in in- accessible places and creating a stench before they are discovered. If one has to use poison, follow strictly instructions on the pack- age, place the bait out of reach of children and animals, and have antidote for the poison handy and within easy reach. Following are basis for practically all rat poisons 1. Barium carbonate. 2. Phosphorus. 3. White arsenic. 4# Thallium sulphate. 5* Strychnine. 6. Red Squill. Prebaiting.-The rat sometimes prefers certain types of foods. It is usually time well spent to pre-bait for several days before the poison is put out - one time a cereal, next time a meat, and then next, trying fuits and vegetables. The bait getting the best reception is the bait that will probably be more effective to use with poison. Unpoisoned bait is placed in containers and ex- posed for several days until the rats have been accustomed to visit- ing and feeding at these stations, then poisoned bait is substituted. The rats returning the following evening will unsuspiciously eat a lethal dose. For a poisoning campaign to be successful, all other sources of rat food must be protected. Food in the kitchen must be 132 well protected; garbage cans will be covered; and premises thoroughly cleaned of any rat food except the poisoned bait0 SHOOTING Rat nests in trees are usually shot down with a.,shot gun* Shooting within the city limits is prohibited by law and a regular hunting license is required to shoot rats* GASSING Rats in burrows are killed with a poisonous gasD This work should be done by an experienced person or a professional fumigator* Following are common fumigants used: 1* Hydrocyanic acid gas, 20 Calcium cyanide,, 3 o Carbon bisulphide 4. Carbon monoxide* 5* Sulphur dioxide, 6. Chloropicrine 7, Methyl bromide Gassing kills the fleas on the rats and in the nests thus eliminating the transmitting agents of rat-borne diseases* Natural Enemies Natural enemies of the rat are few on these islands* The mongoose was introduced from Jamaica in 1S83 to kill off rats by the sugar plantations* It has not met with success because there are still as many rats now as before its importation, the reason being that the mongoose is active during the day while the rat only ventures out at night* The two seldom meet, therefore, the mon- goose cannot destroy very many rats* Owls are present here, but they cannot detect or catch rats with such luxuriant vegetation under which to hide and escape* Some cats and dogs are good ratters but they are in the minority* Therefore, too much reliance should not be placed upon them although they are useful to a limited extent in suppressing rats in homes and buildings* 133 HANDLING DSAD RATS Any rat found dead or killed should be sprayed with kerosene before being handled although in the absence of plague, little risk is involved in handling dead rats. They may be buried two feet below ground, burned with other rubbish, or taken to the city incinerator in an ordinary Manila paper sack or paper box. 134 Port Regulations Following are port regulations formulated under international Treaties; 1. If a vessel is from a plague port or if rat life is found on board, the following precautionary measures are required; A, Rat guards on all lines Be Only one gangway with a watchman, Ge At night, there must be a light over gangway, 2, If a vessel is from a plague port and over 5 rats are estimated on board, fumigation* is mandatory, 3© If a vessel is not from a plague port but over 12 rats are estimated on board, fumigation is mandatory. CHAMBER OF COMMERCE OF HONOLULU HONOLULU, HAWAII, U, S0 A, April 29, 1942, To members of Rat and Mosquito Control Committee Oahu Health Council Public Health Committee Chamber of Commerce of Honolulu Honolulu, T,H, Gentlemen; At the last meeting of the Public Health Committee of the Chamber of Commerce, the question of rat control was brought up. Some of the members of the committee seemed to think that in view of the fact that we are at war, our committee is not doing as much as it might o With this in mind I have asked Mr, Lee to draw up a plan for an intensive rat eradication campaign. This plan is en- closed herewith and will be the principal subject- of discussion at our next meeting. May 6, 1942, at 10;30 a, at the office of the Ua S, Public Health Service, Room 208, Federal Building, Honolulu, To Hc Very truly yours. John H, Linson, M, D, Chairman, Rat & Mosquito Control Committee, Enel, #2 137 OUTLINE OF A RAT ERADICATION CAMPAIGN FOR HONOLULU I, Divide city into units, lt Four zones of as nearly equal area as possible. A, Subdivide zones into 15 equal districts, a. Each district under one trapper, a. Sets 120 traps.daily, a. Sets out poisoned baits. B, Two supervisors to each zone, Co Two trucks and a driver to each zone, 2, Headquarters, * ; A, ■ Office, a. One director, a. In full charge of campaign. b. Three clerks, b. Segregate reports and compile data, B. Laboratory, a. Four to six laboratory technicians, (Depending upon size of rat catch) a. Segregate rats into species and sexes, a. If deem desirable, dissect rats, II, Inform public through newspaper, radio, and other channels re 1, Presence of an acute rat problem in city, 2, Danger connected with existence of such a rat problem, (Rat-bome diseases) 3, Economic losses to be expected to support a large rat population, (Destruction to property, food, merchandise, and livestock) 4, Importance of rat control in connection with national defense, (Conservation of health and national resources) 5, Stress cooperation and total support necessary to success, III. Eliminate rat harborages, 1, All types of hiding and nesting places, 2, First attack those easily corrected, such as accumulations of rubbish, firewood, old lumber, rocks, bottles, tin cans,'junk, odds and ends, 3, Have free garbage collection for limited time to help eliminate harborages and encourage active participation, IV. Gut off food supply, lc Install tight covers for swill and garbage cans, 2„ Provide proper storage for food and feed, (Rat- proof storerooms and metal containers) 139 V. Eradicate existent rat population. 1. By trapping. 2. By poisoning. VI. Rat-proof buildings. 1. Seal up or screen openings in homes and business buildings and otherwise rat-proof property, VII. Encourage all year trapping. 1. Possible distribution of traps used in campaign gratis. VIII. Establish headquarters for 1. Dissemination of information and advice 2. Enforcement of existing regulations. 3. Conduct of educational program, 4. Check on increase or decrease in rat population through trapping* poisoning* and shooting. 140 It is pretty well agreed among sanitarians, health officers, and others experienced in rodent control that if perma- nent results are to be expected, rat-proofing must receive prime consideration and made part of such a program. The principle underlying rat-proofing is that rats, like other animals, must have food and shelter. If these two essentials of life are denied them, they either will have to move out or remain and starve. Rat-proofing does not simply mean the exclusion of rats from buildings of all types, but also includes elimination of hiding and nesting places and cutting off of food supply. Harborage is necessary for rearing of a family and protection while food is essential for subsistence. Of these two essentials, harborage seems to be the prime factor. All other con- ditions being equal, it is reasonable to assume that the maximum rat population a given area is able to support is governed by the number of available harborages and the accessible food supply. Therefore, by eliminating all harboring places and rendering food supplies inaccessible, rat life in any locality will be made untenable. The program to follow is made up of two parts, (1) rat-proofing and (2) reduction of existent rat population. The city is divided into four equal zones which are in turn subdivided into fifteen districts. Allowing one-third of the city to be composed of inaccessible areas, such as valleys, gulleys, wastelands, and mountain ridges, which estimate is very conservative, there remains 36,096 acres to be covered. Each district will have an area of o01&6 acres. To cover such will require one trapper with 120 traps thirty days. It is desirable to have the campaign completed within a month, if possible, cer- tainly not over two months. This will require 60 trappers, 7,200 traps, 8 supervisors, 8 drivers, and 8 trucks. Since the life of a rat trap is rather short, it will require at least 25,000 traps for the campaign. Covering a district twice will require 60 days or twice the number of trappers, supervisors, driv- ers, trucks, and traps„ One director, three clerks, and from four to six laboratory technicians round up the balance of the personnel. At the start of the campaign, the public should be informed through newspaper and radio, as well as other channels, regarding: 1* Existence of an acute rat problem, 2, Diseases rats are able to transmit to man and livestock, 3o Damage and destruction to food, merchandise, livestock and property, 4. Importance and bearing upon present defense program, 5, Need of cooperation and total support to insure success 141 The first step is to eliminate as many as possible, all existing harborages* It is proposed that harborages requiring minimum effort and little or no material to correct be taken care of first, such as accumulations of rubbish, firewood, old lumber, rocks, junk, bottles, tin cans, and odds and ends which have been found to exist in 42.83$ of the premises inspected. People are not apt to make necessary corrections if they involve much work and expense. However, other types of harborages should not be neglected. In this connection, if free garbage disposal service is given for a limited time during the campaign, many harborages would be eliminated and active participation would be stimulated. In an average home, uncovered or improperly covered swill can constitute the chief source of accessible food for rats. The number of premises guilty of this violation amounted to 49*94$ of all premises inspected. The correction of this one condition alone will go a long way in discouraging rat infestation about homes. Proper storage of food and feed in rat-proof storerooms and metal containers should not be overlooked. After as many as possible of existing harborages are eliminated and principal sources of rat food are protected, men are set out with traps and poison bait to reduce the existent rat population. The next move is to get householders to rat-proof their homes or put them in condition unattractive to rats. Business buildings should be treated in like manner. Figures show that 19.89$ of buildings in residential districts inspected have holes in roof, walls, floors, and around pipes and 21,93$ have open fascia, unscreened louvers, ventilators, and skylights through which rats can gain entrance. As a rule most of these defects may be remedied by the owners themselves with a little time and material found at hand* This phase of the work should be empha- sized and pushed as the resulting corrections will break the close association between rat and man. Another point to remember is that rats breeding in and under buildings harbor more fleas than those breeding outside and away from buildings. The last step in the program is to encourage year round trapping among householders 0 This may be done by giving away traps used for the campaign gratis. There are approximately 40,000 builcU ings in the city* If each one keeps a trap set, the rat eradication potentiality would be enormous. It would play a tremendous part in keeping the number of rats down. 142 After the campaign, headquarters should be established where the public can go for information and advice in solving rat problemso A staff of trained inspectors should be maintained to enforce rat control regulations0 With a rat-proof city as the ultimate goal, plans for new buildings should be closely scrutinized to eliminate structural conditions capable of affording harbors for rats. Existing old buildings which are beyond repairs and con- stitute harbors should be condemned and demolished. In any endeavor involving the public, education is in- dispensable* The people should be informed of new facts and con- stantly reminded of the subject to keep them conscious„ Data relative to the increase or decrease in the rat population is important in public work. They serve as a measuring stick in the evaluation of current rat control work and practices and a guide to the planning of future programs. There is one drawback to ary rat eradication campaign except under stress of an epidemic0 The public see that work is being done for them and will therefore do nothing toward keeping down the rat population at the reduced low level but sit back and wait for the start of the next public eradication campaign* How- ever, this can be overcome to a large extent by requiring com- pliance either by strict enforcement of existing regulations or through a military order* Householders?5 Program for Rat and Mosquito Control 1« Garbage cans shall be securely covered* (Loose covers will not do. ) 2. Rubbish cans and waste paper boxes shall not contain food stuffs, 3o Food particles shall not be left on streets or other property, unless in covered containers* 4® Attic and basement shall be cleared of all but essential materials* 5o Droppings from fruit trees shall be removed from the ground daily and placed in covered containers. 6. Waste materials shall be disposed of through approved sources with a view to cleanliness and salvage. 7o Overgrowth of grass or weeds will not be tolerated. Vegetable and produce gardeners and private gardeners shall dis- pose of refuse daily or have refuse placed in covered containers, 9® Broken screens, where materials permit, shall be repaired, 10. Doors and windows to attics and basement, especially outside doors and windows to attic and basement shall be kept closed unless screened* Ho Investigate outer walls of buildings for elimination of holes in building walls and foundation bases by patching, filling, etc, 12o Remove as far as practicable all tree branches overhanging which closely approach the building structure. 13e Attention shall be given to all overhead wiring entering build- ings. Metal guards on wires, metal plates fastened to outer walls where wires enter the buildings are recommended. 14. Empty bottles, cans, pails, buckets, etc®, on the premises shall be turned bottoms up or hung under cover. 15„ Water in outside containers shall be stocked with mosquito fish, rain pools on private property shall be dried up as quickly as possible, moving water shall be kept free of heavy growth. Rain drains on buildings shall oe kept clean. Regular inspection by the household is a requisite. Incl, 3 145 HEADQUARTERS HAWAIIAN DEPARTMENT Office of the Department Medical Inspector Fort Shafter, T, H, 24 September 1942, RATS AND THEIR CONTROL 1. REASONS FOR RAT CONTROL; Rats are carriers of some of man!s worst diseases, namely: Bubonic plague, endemic typhus fever, infectious jaundice, trichinosis, ratbite fever, and amoebic and bacillary dysentery, as well as eleyen species of internal parasites which also occur in man. Some animal diseases transmitted by rats are hog cholera, fowl tuberculosis, swine erysipelas, and probable foot and mouth disease. No local figures are available showing monetary losses caused by rats, but it must be large, for it is common knowledge that rats: (1) Destroy merchandise stored and in transit. (2) Kill domestic fowl, (3) Destroy fruits and vegetables, (4) Damage buildings by gnawing wood, pipes, walls and foundations. 2. HABITAT. BURROWS AND NESTS; The different species of rats have many choices of habitats - in the fields, in burrows, surface depressions, rock piles, dense brush, and trees, as well as man;s own premises. The Norway rat, has, through the ages, been considered to be to a large extent parasitic on man; wherever man dwells, his nest will be found. That part of the premises most abounding in filth is this rat*s natural habitat. The Black and Gray rats nest in trees of nearly all varieties, the tops of shrubbery, dense brush and grassy slopes or rock piles. The nests are usually constructed of materials typical of the area, grass probably being preeminent. The location of the nest usually in- dicates considerable forethought as to the inaccessibility to enemies and numerous avenues of retreat. Incl. 4 3. GENERAL HABITS OF RATS; Rats are active at night. They prefer narrow, concealed and out-of-the-way routes which they habitually use. Their repeated travel over such places leaves behind the t ell-tale black markings so characteristic of rat runways. These marks are made by the oil and dirt left behind from the ratJs fur and are most helpful in tracing rat runs which usually lead from the nest through the open- ing through which entrance is gained into the building and the lo- cation of the food supply. For a home, rats like a secluded, dark, and well-protected place, preferably one in close proximity to an easily accessible food supply. Rats can walk along telephone and electric wires with perfect ease and balance. Vines alongside buildings and overhanging branches are common avenues of approach to buildings. They can jump two feet high, swim half a mile in rough water, dig two feet into the ground, and climb smoothly painted pipes up to three inches in size. Any opening larger than one-half inch will admit most rats. Galvanized iron lighter than IS inch gauge, lead sheets and pipes, light aluminum sheets and zinc sheets are no bar to the sharp teeth of the rat. 4o EVIDENCE OF INFESTATION: The signs of rat infestation are those produced by the rats themselves. They are as follows: (1) Droppings, (2} Runways 0 (3) Tracks and tail marks „ (4) Gnawlngc (5) Live rats (actually seen by the inspector). (6) Dead rats, (7) Nestsa (8) Rat odor. Droppings - are the most usual sign of rat infestation and the one on which inspectors most rely. They are nearly always quite dark or black in color. When freshly passed they are soft enough to be squeezed out of shape and often have a glistening, wet appearance. Within two or three days they dry and become hard. Later the surface becomes dull. Very old ones are dust or dirt covered, and may be discolored. Runways - All colonizing animals establish runways. These are merely the usually traveled routes from one frequently visited locality to another, The constant passing of many in- dividuals ? each leaving a mark* finally produces a well-worn track obvious to any eye and often giving a great deal of in- formation to the experienced one. The body of the rat is dirty and the hair a trifle oily* so that wherever it rubs against a wall* climbs a pipe or angle iron or swings under an obstruction, it leaves a dark mark. These marks are built up and extended by the constant passage of rats* the runway finally becoming clearly delineated. An experienced observer will detect a run- way used by but few rats; runways used by many are plain to the most unobserving* though the unknowing may not realize their sig- nificance, Runways are of the utmost importance to the rat proofer* since they show him where to place a barrier and where the harborage that must be c3.osed or removed is located. Tracks and tail marks - Like any other animal, rats leave tracks $ that is, they leave tracks on soft surfaces,, The most impressionable surfaces are found in the dust collected on surfaces of beams,, railings, shelves, pipes, floors, etc. On these the rat leaves a literally tell-tale trail, for the trail of its tail is as characteristic as the marks of the A-toed paws. In light dust the marks of the toes may be quite clear. On such a surface the dragging tail may also leave an irregular wavy line, though this is not constant and is often a broken track. The rat drags its tail only part of the time, usually only when moving slowly. Eat tracks on impressionable surfaces generally show the marks of the separate toes, but tracks in thick dust or bulk grain are usually only regularly spacedlittle pits or craters. On white*-painted pipes, foot-prints are very clear and sharpo Gnawing - Rats gnaw for three purposes, viz. to cut through an obstruction between one inclosure and another, to cut into a food container (actual or expected) and to eat. Gnawing is always purposeful; it seldom even appears to be at random„ In fact, as a rule, it is quite obvious what the rat was trying to accomplish. Nests - In most cases* rat nests are well hidden and located inside of protective harborages. In consequence of such location* nests are not always seen during the course of an ord- inary inspection. Rat°s nests may be constructed of almost any soft material—the rat is not at all particular in this respect„ It is common to find a much larger collection of material than is necessary for construction of the nest. In many cases this repre- sents old nests successively built one on top of the other* In other instances, however, it is a protective and secretive maneuver, the nest being in the center and accessible only through a single narrow opening,, Sometimes the nest is simply hollowed out in an already existing collection of soft material, such as a bag of rags, a box of old paper, an old mattress or pillow* Rat odor - The odor of rats is distinctive and character- istic It is of a musty character, but, like all odors, cannot be described accurately enough to be recognized therefrom* Unfortunate- ly, it tends to persist for a considerable period after the rats are gone. so that it cannot be classed as a positive indication of their presence0 It is of value, however, as often giving' to the inspector information that rats have been present, and thereby intensifying his search for other evidence,, Individuals vary considerably as to the acuteness of the sense of smell, and hence, vary in perception of this sign0. 5« REPRODUCTIVMESSs The reproductiveness of rats is limited by food supply and opportunity for nesting and harboring* Well-fed rats living in comfortable, protected nests breed oftener and produce larger litter So Rats reach maturity between 100 to 120 days $ the gestation period is 21 days5 5 to 7 litters are produced in a yearj and litters vary from 5 to 10 young ones* 6(> CONTROL MEASURES Control measures against rats ares (1) Rat proofing* (2) Trapping* (3) Poisoning* (4) Shooting* (5) Gassing* (6) Natural enemies* Prom the standpoint of rat control, rat proofing may be defined as the elimination of food and shelter for rats* The modern trend in rat control is toward rat proofing. Food and shelter are essential to all animals* When the rat is deprived of these essentials it will leave to seek more favorable environ- ment elsewhere* This is precisely what rat proofing aims to 150 accomplish,, The farther away rats are from the human population the less the chance of contact and thus the danger of contracting rat-borne diseases is minimized. Since fleas are the transmitting agents of plague and typhus fever from rats to human beings, a very important point to keep in mind is that rats under and near buildings carry more fleas than rats away from buildings. Trapping - Trapping is a good means of eliminating rats provided a large number of traps are employed. Care is required in the selection of bait and placement of traps. The snap trap is generally accented as the better type of traps to use0 The cage trap is unsatisfactory because rats are too smart and usually shun such a suspicious looking contraption. No one single bait will catch all rats, A few of the better baits are bacon rind, fruits, vegetables, fish and candy. Dried coconut meat has been found to be a very good bait for all localities and conditions. The best method to follow in trapping is to use one type of bait until you catch all the rats you can and then switch to another type of bait, and so on, thus rotating the kinds of baits used. Traps should be set in the evening to avoid their being accidently tripped and thus losing their usefulness. Since rats usually follow the wall in moving from one place to another, traps should be placed about an inch from the wall with the trigger parallel to it. This allows maximum trapping area and permits free approach from either direction. Traps should be properly anchored or otherwise rats which have not received a fatal blow may drag the traps away with them. To insure maximum efficiency from the traps, frequent inspections should be made to keep them clean and moving parts working freely. Poisoning - The use of poison bait while more effective than trapping must be employed with caution. Most rat poisons are toxic to humans and domestic animals. The poison found to be the most successful in and around the army camps on the Island of Oahu was THALLIUM SULPHATE treated oats, 7o PREBAITING SYSTEM: 1st Day - Place l/4 lb, (about one cupful) of clean, unpoisoned rolled oats at each station. Number each station and keep a record of its location, treatment, etc. 151 4th Dav - Inspect all stations* Refill the pans with fresh, unpoisoned oats if they are empty or much of the oats has been eaten, or soiled by rats. Any soiled oats removed must be put in a bucket and not dumped near the station or left lying around. Nothing but clean oats must be left, 6th Day - Remove all of the oats, clean the pans and clean up any oats the rats may have spilled around the pans. Then place one cupful of clean, poisoned oats in the pans. Also keep a record of the amount of unpoisoned oats taken by the rats -at each station, 9th Day - Inspect all stations. Weigh or estimate the amount of poisoned oats left in each pan, which will indicate how much has been eaten and roughly tell how many rats have been poisoned, NOTE; One pound of thallium treated oats at a concentration of 1-200 is sufficient to kill about 150 good sized rats. Three grams of this oat mixture will kill one rat, (453o60 grams = 1 lb,) Ml*60 - 151 3 8* PRECAUTIONS; a* Don’t handle the poison, b0 Keep poison supplies locked up* c, Keep the oats dry, Rats won’t eat oats that smell mouldy* d* Don’t touch dead rats without rubber gloves* 9* RECOMMENDATIONS AND SUGGESTIONS; a* 100 ft, between prebait stations, b, One man can take care of approximately 100 prebait stations* Co A notice should be placed in the daily bulletin stating that no extra policing will be done during the period of rodent control, d, Camp or territory to be worked should be divided into equal sections. Each section should be inspected by the man assigned for possible rat harbors. CHARLES B. PERKINS, Major, M, C, 152 LIST OF REFERENCES Chapter 29 1. Memo to The Dept Surg, subject: "Data on Human and Rodent Conpiled by Major A. F. Scheele, MC. Pile Ho. 729.5# Rat Control, Serial No. 82, 1942, Hq Hawaiian Dept, Off of Surg, 2« "Rats and Their Control," published by Rat and Mosquito Control Committee of the Chamber of Commerce of Honolulu, T. H. 1943• Incl #1 Reprinted under title "Rats and Public Health" in File No. 729.5, Hat Control, Serial No. 43* Hq Hawaiian Dept, Off of Dept Surg 1943• 3. Off Memo, 21 Apr 42, Pile No. 729*5* Hat Control, Serial No. 2 Hq Hawaiian Dept, Off of Dept Sung, 1942. 4. Ltr fr Off of Dept Comm, subject "Rat Control Within Organiza- tion Areas,V1 Distribution CD & F, dtd 10 May 42, Pile No. 729.5* Rat Control, Hq Hawaiian Dept, Off of Dept Surg, Serial No. 5, 1942. 5* Ltr to members of Rat and Mosquito Control Comittee, John H. Linson, MD, 29 Apr 42, Incl No. 2, File No. 729.5* Rat Control, Serial No. 7, Hq Hawaiian Dept, Off of Dept Surg, 1942. 6. Ltr to Dept Surg, subject "Rat Control" by Col. Elliot G. Colby, 7 May 42* Hq Hawaiian Dept, Off of the Surg, File No. 729.5* Rat Control, Serial No. 7* 1942. .•7. Ltrs to CG, Maui District and Hawaii District fr Hq Hawaiian Dept, Off of Dept Comir, dtd 8 May 42, subject, "Plague Infected Rats," Pile No. 729.5* Rat Control, Hq Hawaiian Dept, Off of the Dept Surg, 1942, Serial No. 7. 8. Ltr to Dept Engr, subject "Rodent Control Funds" dtd 30 May 42, fr 1st Lt. H. L. Lewis, Assistant, Repairs & Utilities Br, Constr Divn, Pile No. 729#5* Rat Control, Hq Hawaiian Dept, Off of the Surg, 1942, Serial No. 16. 9« Ltr to Dr. M. F. Haralson, Terr Commissioner of Health, subjects "Rat Poison" fr Col Edgar King, Dept Surg, dtd 26 Mar 42* Hq Hawaiian Dept, Off of the Surg, Pile No. 729.5 Rat Control, 1942, Serial No. 19• 10, Ibid. 152a 11 o Memo to Colo Colby fr Jameat Co Koch* Tech 4th Grade* dtd 7 Aug 42, Hq Hawaiian Dept* Off of the Dept Surg* File No® 729o5* Rat Control. Serial No0 35„ 12o Memo to Colo King* subject: "Rat Control Program!' dtd 10 May 42 fr Colo Eo Go Colby* Pile No0 729®5* Rat Control, Hq Hawaiian Dept* Off of Dept Surg* Serial No® 43° 13. Ltr fr Forrest Jo Pinkerton* M0D0 to Colo Thomas Ho Green* subject: "Control of Rats"-dtd 20 April 1942* File No0 729o5* Rat Control, Hq Hawaiian Dept* Off of lie Surg* Serial No0 45> 1942* Incl #3« 14o Ltr fr Lto Colo Mo Ro Bradner to Colo King* subject: "Rats Re Plague*" File No, 729®5> Rat Control* Hq Hawaiian Dept, Off of the Surg* Serial Ko0 50* 1942» 15o Ltr fr Lto Colo Mo Ro Bradner to Lt0 Colo P» P» Green* File No0 729<>5j Rat Control, Serial No0 53* Hq Hawaiian Dept* Off of Dept Surg, 1942o 160 Memo, subject: "Rat Poison," File No0 729o5* Rat Control* Serial Moo 54* 1942* Hq Hawaiian Dept, Off of Dept Surge 17o "Rats and Their Control," Major Charles B0 Perkins, MC, File No* 729<>5s Hat Control, Serial Koe 60* Hq Hawaiian Dept, Off of Dept Surg* 1942o Incl: No0 4<> 18o "Report of Rat Control Activities" by Clyde WD Evans* Tech 5th Grade* File No0 729°5* Rat Control*. Serial No0 62* Hq Hawaiian Dept* Off of Dept Surg* 1942o 19o Ltr fr Lto Colo M0 R0 Bradner to Colo Edgar King* subject: "Treat- raent of Plague," dtd IB Sep 42* File No0 729»5* Rat Control, Serial Ho0 65* Hq Hawaiian Dept* Off of Dept Surg, 1942o 20o "Report of Rat Control Activities" Clyde W<, Evans, Tech 5th Grade, File Hoo 729o5* Rat Control, Serial Ko0 67® 21, "Lethal Dose Studies in Cages," Ro Ec Doty, Associate Agriculturist, Hawaiian Sugar Planters Assn,* 1942, File No0 729o5, Rat Control, Serial No0 69* Hq Hawaiian Dept* Off of Dept Surg, 1942o 22o "Rodent Plague Record," File No0 729«5* Rat Control, Serial Noe 73* Hq Hawaiian Dept* Off of Dept Surg, 1942<, 23® Ltr, Hq Hawaiian Dept, Distribution Dc, subject: "Rat Control" dtd 12 Dec 42, File No0 729<>5* Rat Control* Serial No, 82, Hq Hawaiian Dept, Off of Dept Surg* 1942o 152b 24. File No. 729*5* Rat Control, Serial Nos. 14 & 15* Hq Hawaiian Dept, Off of Dept Surg, 1943« 25. Memo to Med Insp, Hawaiian Dept, subject: "Inspection of Ship Hawsers for Hat Guards," by H. L. Meltzer, Major, MG, File No. 729*5* Rat Control, Serial No. 31 Hq Hawaiian Dept, Off of Surg, 1943* 26. Ltr, (No Subject) by S/Sgt Louis D« Mulhall, File N0o 729«5* Hat Control, Serial No. 34, Hq Hawaiian Dept, Off of Dept Surg, 1943. 27* Report of Experiments 53* 54 and 55* Hawaiian Sugar Planters1 Assn, 25 Jun 1943* File No. 729*5* Rat Control, Serial No. 62, Hq Hawaiian Dept, Off of Dept Surg, 1943* 28. Memo to Lt. Col. H. L. Meltzer fr Clyde W, Evans, Tech 3d Grade, File No. 729*5, Rat Control, Serial No. 26, Surg Off, Hq CPA, 1944. 152c CHAPTER 30 Immunization (History of Preventive Medicine) The status of immunizations on 7 December 1941 was as follows s lo When war reached the Hawaiian Department on 7 Decem- ber 1941, the immunizations which had already been required for all military personnel in the Depart- ment were smallpox, typhoid-paratyphoid fevers, tetanus and yellow fever, 2, Smallpox and typhoid-paratyphoid immunizations were required for all troops by AR 40-215» 3. Immediate Action Letter, WD, Adjutant General5s Office, AG ?20o3 (1-10-41) M-A-M, subjects Vaccina- tion ot troops against yellow fever, dated 30 January 1941, had been received by the Commanding General, Hawaiian Department, to the effect that all military personnel now stationed in the tropical regions of the Western Hemisphere, including Panama and Puerto Rico would be vaccinated against ye11ow fever. It was not clear whether this requirement referred to the Hawaiian Department, Inquiry was made to the War Department by letter dated IB February 1941« The War Department replied by radio, dated 29 March 194V3 that ‘»it is not intended that troops in Hawaiian Department be vaccinated against yellow fever at this time11 but that it was desirable that vaccine be stocked in the Hawaiian Department, In May, 1941, Immediate Action letter. War Department, Adjutant General9s Office, AG 720.3 (4-17-41) M-WPD-M, subjects Vaccination of Troops against Yellow Fever, dated 9 May 1941, was received by the Commanding General, Hawaiian Department, to the effect that all military personnel and civilian Army employees stationed in tropical regions, including Bermuda would be vaccinated for yellow fever. It was not clear whether this requirement referred to the Hawaiian Department, and inquiry was made by radio, dated 7 June 1941 Radio reply from the War Department, dated 10 June 1941,0 stated that "troops in 153 Hawaiian Department arerequired to be vaccinated against yellow feverc rt In compliance with uhe radio directive, vaccination of all troops for yellow fever was directed by letter to all subordinate commanders, dated 16 August 1941J During the interval between June and August, 1941, the necessary yellow fever vaccine was requisitioned and received from the mainlando A test group of 110 men were immunized against yellow fever at Schofield Barracks in July, 1941, under the supervision of a board of medical officers. Experience gained in the immunization of this test group was used in preparing instructions contained in the letter directive of 16 August, No civilians were vaccinated against yellow fever. 4, Immunization of all Hawaiian Department troops against tetanus during the period 1 June - 1 August 1941 was required by War Department radio to Commanding General, Hawaiian Department, dated 11 April 1941,° These immunizations were directed in the Hawaiian Department by a letter to subordinate commanders, dated 8 May A number of urticarial reductions to tetanus immunization were experienced at first, and it was directed that adrenalin be ready when tetanus immunizations were being given0 Records of tetanus immunizations and stimulating doses were embossed on identification tags. Tetanus immunizations were offered to civilian Army employees on a voluntary basis0 To insure that all military personnel in the Hawaiian Department had completed required immunizations against smallpox, triple typhoid, tetanus, and yellow fever, the Commanding General, on 5 December 1941, directed that an immediate recheck be made by an officer of the Medi- cal Corps of all service records of soldiers and immunization records of officers of the command, Reports received from the various echelons after 7 December 1941 showed some deficiencies, all of which were corrected* Authority for the voluntary immunization without charge to civilian Array employees against smallpox and typhoid-paratyphoid fever was reguested by letter to The Adjutant General., dated 30 Sep- tember 1941. Approval was given by the War Department in a radio dated 21 October 19410 Smallpox and typhoid-paratyphoid fever immunizations were given to all civilian Array employees who were 154 willing to accept them. Compulsory Smallpox and Typhoid-Paratyphoid Fever Immu- nizations for Military Personnel and Civilian Army Employees was undertaken in December, 1941; In compliance with paragraph lb (4), AR 40-215, dated 4 March 194D, The Commanding General, Hawaiian Department, directed that all military personnel and civilian Array employees be immunized or re-immunized against smallpox and typhoid- paratyphoid fevers, except those satisfactorily immunized within the twelve previous months, 3 14 Compulsory Smallpox and 'lyphoid-Paratyphoid Fever Immu- nizations for all Civilians in the Territory was undertaken begin- ning in February, 1942; There began a program of compulsory immu- nization against smallpox and typhoid-paratyphoid fevers of all civilians in the Territory of Hawaii, by order of the Commanding General, Hawaiian Department, the Military Governor of the Territory, This subject is more fully covered under Chapter 40 of this history, subject; Civil Public Health, By the end of the year 1942, it was estimated that approximately 90$ of the civilian population of the Territory of Hawaii had been vaccinated against smallpox and typhoid-paratyphoid fevers. Yellow fever vaccination hepatitis occurred in large numbers of military personnel arriving on transports from the U, S0 mainland in early March, 1942, Additional cases developed among these newly arrived personnel in the Hawaiian Islands, The disease closely simulated infectious hepatitis (catarrhal jaundice) and, therefore, was considered to be contagious,' By 23 April 1942, a total of 1136 cases had already been With the large number of military cases there was considerable alarm that the disease would become widespread among the military personnel and civilians of the Territory, Strict epidemiological control was exercised, insofar as knowledge of the disease existed at the time. Arrangements were made in advance for the inspection of incoming personnel as they disembarked from transports, ° Newly arrived troops were placed in working quarantine, and physical inspections were made as often as twice daily to detect and isolate early cases of jaundice. Particular attention was given to the detection of cases among food handlers, as the disease was assumed to be trans- mis sable through the gastro-intestinal tract. All recognized cases were hospitalized and screened by mosquito bars or other- wise from mosquitoes, flies, and other insects,1' Immediate action was taken to set up special temporary hospitals apart from the established hospitals% first to provide for the large number of hepatitis cases apart, from other patients, and second, to 155 18 clear established hospitals for possible battle casualties0 The Territory was under imminent danger of Japanese attacks, Between 1 March and 1 August 1942, there occurred 4465 cases of hepatitis with a peak of 1857 cases during the month of March® The hepatitis rate for the Hawaiian Department during the year 1942 was 45«1$ compared with rates for 1943 and 1944 of 0o5 and 0o3 respectively0 Hepatitis Cases by Months - Hawaiian Department, 1942 J cUTU.Sl’y ueooooooooooooo 0 F©bl,U3.I,jr ,0,000000000,0 0 March,,000,0000,000000 288 Aprllosoeooooooeuooooo 1857 Msy 0,0000,000000000000 933 June000,00000000000000 821, July” oooooooooooooooooo 563 August oooooooooooooooo 77 September,00000000,000 37 October oeoeoooooooooeo 25 November00,00,00000000 13 December,,000000000,0, 10 Total 462T At the request of The Surgeon General investigation was made of the lot numbers of the yellow fever vaccine previously received by these hepatitis cases on the mainland. In 551 cases where the lot number could be quickly determined, r esult-s were as follows:^ Lot No, Gases 335 OOOOOOOOOAOOOOO# 215 331 oooooooooooooooo 234 367 © o o o o ooooooooooo 12 334 .OOOOOOOOOOOOOOOO 8 340 oooooooooooooooo 12 219 oooooooooooooooo ? 330 oooooooooooooooo 3 350 oooooooooooooooo 2 338 0900000000000000 3 329 oooooooooooooooo 1 336 oooooooooooooooo 1 322 oooooooooooooooo 1 321 oooooooooooooooo 1 156 The above information was transmitted to The Surgeon General within a few hours by radio,, "Questionnaires for use in connection with cases of jaundice without known cause," received from The Surgeon General, were reproduced in number, completed and returned*, In compliance with War Department radio, dated IS April 1942, all stocks of yellow fever vaccine supplied by the laboratory of the International Health Division of the Rockefeller Foundation with the Hawaiian Department were destroyed. Yellow fever vaccination for military personnel in the Hawaiian Department was revoked by immediate action letter, War Department, Adjutant General!s Office, AG 720,3 (6-22-42) M3-SPGAiPS-M, subjects Vaccination of troops against yellow fever, dated 29 June 1942, and by letter. Office of The Surgeon General. subject; Vaccination against- yellow fever, dated 29 June 1942 A single stimulating dose, one cc of tetenus toxoid, to be given one year after the completion of the initial immunization, was directed for all military personnel of the Hawaiian Department by letter, dated 3 June 19420^-** A second complete series of typhoid-paratyphoid fever immunizations was required for all military personnel in the Hawaiian Department who had received only one previous series. This was directed by letter, dated 5 July 1942 The second series was directed to be given one year after the initial series* This policy had the approval of The Surgeon General, The practice of t he utilization of a yearly intradermal injection of l/lO cc triple typhoid vaccine for the maintenance of immunity to the typhoid-paratyphoid fevers was noh approved A review of copies of the "Questionnaire for use in connection with cases of: jaundice without known cause" showed numerous deficiencies in the recording of yellow fever vaccine lot numbers within the command* A letter directing correction of these deficiencies was sent to all subordinate commanders, dated 14 August- 19420 Inspections of immunization registers and service records of various units in January, 19439 showed that deficiencies in the completion of immunization records were numerous and widespread throughout the commando Circular No0 14, Hq Hawaiian Department, 23 January 1943$ ' was published directing that commanding officers institute a thorough check of immunization records and take necessary steps to correct existing errors, omissions, and discrep- ancies. 157 The number of employees of the United States Engineers Office on Oahu in early 1943 was approximately 17,000, By order of the District Engineer this large body of civilian Array employees was immunized against tetanus and reimmunized against smallpox and typhoid-rparatyphoid fevers during 1943« A small number of employees had been previously immunized against tetanus, These individuals were given a stimulating dose one year after the initial serieso Vaccination of military personnel of USAFICPA against yellow fever had been discontinued since 1942, at which time yellow fever vaccination had been directed by the War Department to be re- served for military personnel stationed in or passing through yellow fever endemic areas. In October, 1943* the Commanding General, USAFICPA, directed that all military personnel under his command be vaccinated against yellow fever, except for those previously so vaccinated, ' This was done upon the recommendation of the Assistant Secretary of War, as a counter-measure against the possible introduction of yellow fever into the Territory as an offensive weapon by the The civilian population was not vaccinated, but 600,000 doses of yellow fever vaccine were requisitioned and stored on Oahu for a rapid immuni- zation of all civilians in case of emergency. The Commanding General, USAFICPA, was assured by the Assistant Secretary of War that yellow fever vaccine now produced by the Arny had no icterogenic properties. To test the potency of the yellow fever vaccine used on military personnel 97 specimens of blood were drawn from personnel one month after vaccination and submitted to the Rockefeller Foundation for determination of protective antibodies. Annual revaccination of all military personnel and civilian Arny employees subject to service with the Army by means of a single stimulating dose of 0,5 cc of triple typhoid vaccine administered subcutaneously was directed by Section I, Cir- cular No, 143* Hq USAFICPA, dated 9 October 1943* This directive was published in compliance with Changes Noc 6, paragraph 10c(2), AR 40-210, dated 30 August 1943» After several years in which no human cases of plague occurred in the Territory 11 fatal cases of human plague occurred in the Hamakua District of Hawaii between March,, 1943 and April, 1944„ Immunizations were made available to the civilian population of the District on a voluntary basis in April, 1944* and approxim- ately of the population was immunized. Following the immuniza- tion program only 2 cases of human plague occurred, both fatala One occurred in a nonimmunized person. The other case occurred in an immunized individual 14 months after immunization. This case 158 survived for over a month of illness, dying of peritonitis follow- ing internal rupture of a bubo. At autopsy no plague bacilli could be recovered. Stimulating doses of plague vaccine were made avail- able in July, 1945* and the percentage of immunized population was brought up to approximately 90%, No military camps have been lo- cated in the Hamakua District, The other plague endemic area in the Hawaiian Islands, the Makawao District of the Island of Maui, has contained numerous military personnel, however, no human plague has been .reported from Maui since 1937, and very few rodent plague cases have been found. No immunizations for plague have been given to military personnel for reason of duty in the Hawaiian Islands, and no military cases of plague have occurred. In the Makawao District of Maui a vigorous rat control program was carried out, both by the Army and the Territorial Board of Health with the assist- ance of the U, S, Public Health Service, In order to eliminate the necessity for sending individual immunization instructions to each unit alerted for overseas movement within and from the Central Pacific Area, prior to operations in the Gilbert Islands, standing immunization requirements were published in HQ USAFICPA, Standing Procedure for Overseas Movement of Troops with- in' and from the Central Pacific Area035 This publication, short title; "CPA-POM” was revised and kept as nearly up-to-date as poss- ible for the period of the war0 After 1 July 1944, this publication became "CPBC-POM" of the Central Pacific Base Commando Immunization requirements for overseas movement of troops within and from the Central Pacific Area and Central Pacific Base Command were considered to be the same as for troops proceeding overseas from the U0 S0 main- land. On this basis, a repeat smallpox vaccination was required if the individual had not been so vaccinated during the preceding nine months, and a stimulating dose of tetanus toxoid was required unless there had been prior immunization within six months. The smallpox revaccination requirement was maintained until early 194$, when at the direction of Headquarters USAFPOA, smallpox was re- quired only once every three years regardless of movement forward. The r equirement of an additional tetanus immunization on movement forward was discontinued on revision of CPBC-POM dated 29 January 194$, on the basis of TB MED 114, subject; Immunization, dated 9 November 1944# Beginning in January 1944, typhus immunization was re- quired for all personnel in attack and garrison forces taking part in the establishment or occupation of new advanced bases in the Central Pacific Area0 This immunization was required because of the uncertainty of medical intelligence concerning the prevalence of typhus fever in the Japanese Mandated Islands* and particularly 159 because of the large number of troops Involved in these operations on small land mass areas. It was understood that there was very little evidence that the standard Array typhus vaccine available gave protection against endemic or mite-borne typhus. This require- ment for routine typhus immunization of all personnel of attack and garrison forces was maintained until February* 1945, when instructions concerning typhus immunization were again made on individual unit movement orders. Typhus vaccination was never thought necessary for troops on duty in the Hawaiian Islands* Fanning* Christmas* Can- ton, and the Gilbert Islands, In accordance with War Department radiogram No, WX-31833, dated 4 May 1944, a Headquarters USAFICPA directive was published to subordinate commanders 17 May 1944, to the effect that yellow fever vaccination will be considered adequate if administered not more than 4 years and not less than 10 days prior to entry into or passing through an endemic area,3? All prisoners of war held within the Central Pacific Base Command were required to be immunized against smallpox* typhoid-para- typhoid fevers, and tetanus, with reimmunizations, according to the same dosages and schedules as required for AUS personnel,, Smallpox and typhoid-paratyphoid immunizations were required under provisions of Article 13, Geneva Convention of 1929* and for the protection of the command* Tetanus immunization was indicated as a protective measure for the individual and to simplify treatment in case of injury, Vaccination against yellow fever was revoked for all military personnel in Pacific Ocean Areas by Section V, Circular Noo 91* Headquarters USAFPOA, dated 12 June 1945» It was directed by the Commanding General* USAFPOA, that 500*000 doses yellow fever vaccine be maintained in storage in the Central Pacific Base Commando 3° In secret letter, AG ?20o3 (11-14-44) 0B-S-E-SPM0T-M20, subjects Immunization for troops moving overseas* dated 20 November 1944, the War Department required immunization of all troops moving to Pacific Ocean Areas for typhus* cholera* and plague. Prior to 20 November, these immunizations had not been required for troops of the Central Pacific Base Command, Furthermore* there was no indication for them. Officers and enlisted men returning to the Central Pacific Base Command from rest and recuperation leaves and furloughs were held up at Ports of Embarkation to complete these immunizations. Immediate action‘was taken to correct this situa- The "requirements were revoked in late January,^ 160 To date no case of human or animal rabies has been known in the Hawaiian Islands, Territory of Hawaii quarantine laws pro- hibited the introduction of dogs and cats into the Territory without a period of quarantine. The provisions of Change No, 2, paragraph 30, AR 55-485, dated 7 January 1944, prohibiting the carrying of pets or mascots on U, S„ Army transports or at War Department ex- pense gave additional insurance that rabies would not be introduced to the Territory,, Strong command attention was given zo quarantine requirements and responsibilities. However, with the large numbers of Army, Navy, and Marine Corps personnel staging in and passing through the Territory, there could be no assurance that rabies-in- fected animals were not being introduced. For this reason, it was directed that in all cases of animal bite where the animal could not be identified and properly observed, the patient receive the Pasteur treatment for rabies as promptly as possible. The necessary vaccine for this purpose was procured and stored. Beginning in June, 1945, a brief mild epidemic of Influenza B occurred among the civilian population of Honolulu, and to a less extent on outlying islands. Relatively few military personnel be- came infected. As a precautionary measure certain Medical Department personnel in epidemiological, administrative, and supply work, and those in contact with patients were immunized with Array influenza vaccine. The benefit of this immunization could not be determined, as the outbreak quickly subsided. Immunizations were accomplished 26 June 1945» To eliminate confusion as much as possible, and to keep all elements of the Central Pacific Base Command informed concern- ing the frequently changing immunization requirements of the Central Pacific Base Command and higher headquarters, directives summarizing immunization requirements were published and revised as necessary. Two series of directives resulted, a series of r evisions to Head- quarters CPBG, Standing Procedure for Overseas Movement of Troops within and from the Central Pacific Base Command, a series of currently up-to-date annexes to Headquarters CPBC trative Order No, 1 (Index CPYSG 204*80) subjects Immunization^ Benefits of the Immunization Program were as follows; la Smallpox? No civilian or military cases occurred within the Hawaiian Department, Central Pacific Area, or Central Pacific Base Command during the duration of the war* (During the years 1932-1945 there have been 4 civilian cases of smallpox, 3 in 193B and 1 in 1940)* 161 2* Typhoid Fever; No case occurred among military personnel* The typhoid immunization program for civilians’took place throughout the year 1942* Following this immunization program civilian typhoid fever cases were markedly induced, as shown in the table below* Of the 121 cases re- ported in 1942, over 70 cases occurred in an outbreak from a Honolulu public school cafeteria before the immunization program was begun* Civilian Typhoid Fever Gases Territory of Hawaii 1940 eonoooooooooaooeooooooooaoeoooo 5 6 CaS6S 1941 oooooooooooeoonooeooooooooooooo 69 CaSSS 1942 0*000*0*00000000000000*0000*000 121 CaSCS 1943 oeo.oo.oo.ooooooooooooooooooooo 9 CaS6S 1944 00 OOO OOOO OOOOOOO O 0 9 0 0 0 OOOOOOOOO 5 cases 1943 ooo.ooooooo.ooooooooo.oooooooo* 7 CaS 6S 3. Tetanus; No military cases occurred throughout the war* There was no program for the tion of civilians for tetanus* The incidence of tetanus among civilians during the years 1940-1944 was as follows; Civilian Cases of Tetanus Territory of Hawaii Date No0 of Cases Noo of Deaths 1940 009000 0 0 25 O O 0 0 O 0 •....•Not available 1941 09000900 23 0 O O O O 0 o o o o o a Not SiVSnlsibl© 1942 00000000 30 • O O O O 0 O 0 O O 0 o S 1943 00(100000 17 O O 0 0 o o 7 o o o o o e ( 1944 oooooooo IS 0 0 0 9 0 0 « O 0 O 0 0 fe 1945 oooooooo 15 O O 0 o o o 0 0 O 0 o o 10 4. Yellow Fevers There was no known exposure to yellow fever* There was no known introduction of a yellow fever patient nor of infected mos- quitoes* Yellow fever immunizations were given upon the recommendation of the Assistant Secre- tary of War as a protective measure against the possible use of yellow fever as an offensive weapon by the enemy* 162 5, Typhus Fever: There was no known exposure to the virus of epidemic typhus fever, Tophus immunizations were given only to individuals of attack and garrison forces staging to take part in the establishment of new Central Pacific bases, A number of cases of endemic typhus fever occurred among military personnel who had been vaccinated against typhus fever. In general, it appeared that these cases were milder. Often more than 6 months had elapsed between typhus immunization and illness. 6. Plague: Among military personnel immunizations were given only to individuals of certain units scheduled for operations in certain forward Pacific areas, and to a few enlisted Medical Department technicians working for the Territo- rial Board of Health in plague control labora- tories., No cases of plague have occurred among military personnel. 7o Cholera: There was no known exposure of military personnel to cholera. Immunizations were given only to individuals of certain units scheduled for operations in certain for- ward Pacific areas. No cases of cholera have occurred among military personnel. 163 LIST OF REFERENCES Chapter 30 1. Note: Number one (1) not used as reference number here* 2, Ltr to TAG, Washington, D, C,, subjects "Vaccination of Troops Against Yellow Fever" dtd 18 Feb 41 by Dept Surg, Pile No* 720,3, Vaccination, Immunization, and Inoculation (known hereafter as VI&I), Serial No, 7, HHD, Office of the Dept Surgo Radiogram - War Dept to CG, Hawaiian Dept, Pile No, 720,3 (Secret), Immunization, Serial No, 3, HHD, Off of Dept Surg, 1941-43° 4* Immediate Action Ltr fr TAG to all CGs, subject: "Vaccination of Troops against Yellow Fever," dtd 9 May 41> Pile No<> 720,3 VI&I, Serial No, 23, HHD, Off of Dept Surg, 1941° 5. Radiogram dtd 7 Jun 41 fr CG, Hawaiian Dept to TTG, Pile No, 720,3, Serial Ho, 3, Immunization (Secret,), HHD, Off of *Dept Surg, 1941- 1943° 6, Radiogram dtd 10 Jun 41, War Dept to CG, Hawaiian Dept, Pile No, 720.3, Immunization (Secret), Serial No, 3, HHD, Off of Dept Surg, 1941-43° 7« Ltr, Hq Hawaiian Dept to Distribution "A", subjects "Vaccination of Troops against Yellow Fever," dtd 16 Aug 41, Pile No, 720,3, VI&I, Serial No, 65, HHD, Off of Dept Surg, 1941° 8, Radiogram, War Dept to CG, Hawaiian Dept dtd 11 Apr 41, File No, 720.3, VI&I, Serial No, 19, HHD, Off of Dept Surg, 1941° 9* Ltr fr Hq Hawaiian Dept to Distribution "A", subject: Active Immunization against Tetanus by Vaccination with Tetanus Toxoid," dtd 8 May 41, Pile No, 720,3, VI&I, Serial No, 21, HHD, Off of Surg, 19a» 10, Ltr fr Hq Hawaiian Dept to Distribution "G", subject: "Status of Immunization" dtd 5 Dec 1941, Pile No, 720,3, VI&I, Serial No, 130, HHD, Off of Surg, 19a° 11, Ltr to TAG, Washington, D, C,, subjects "Voluntary Immunization of Civilian Employees against Smallpox and Typhoid-paratyphoid Fever," dtd 30 September 1941, fr Hq Hawaiian Dept, Pile No, 720, 3, Immunization, Serial No, 4 (Secret), HHD, Off of Dept Surg, 19a-43° 164 12o Radiograms, War Dept to CG, Hawaiian Dept, Ibid. 13® Ltr fr HHD to Distribution "B", subject: "Immunization of Civilian Employees," dtd 22 Dec 41, File Mo. 720.3, VI&I, Serial No. 134# HHD, Off of Surg, 1941° 14o Memo fr HHD to "F", File Mo. 720.3, VI&I, Serial M0. 136, HHD, 1941 o 15® Radiogram fr CG, Hawaiian Dept to VSG, Washington, D. C., dtd 23 Apr 42, File Mo. 710, Jaundice (Hepatitis) Serial No. 20 (Secret), HHD, Off of Dept Surg, 1942-43® 16. Radiogram fr Hq Hawaiian Dept to COs of Hawaii, Maui, and Kauai, dtd 3 Apr 42, File Mo. 710 Jaundice (Hepatitis) Serial Mo. 10 (Secret), Hq Hawaiian Dept, Off of Surg, 1942-43® 17. Radiogram fr Hq Hawaiian Dept to COs of Hawaii, Maui, and Kauai, dtd 28 Mar 42, File Mo. 710, Jaundice (Hepatitis) Serial Mo. 3 (Secret) Hq Hawaiian Dept, Off of Dept Surg, 1942-43. 18. Radiogram, Hq Hawaiian Dept to CO, Hawaii District, dtd 2 Apr 194*2, File Mo. 710, Jaundice (Hepatitis) Serial No. 6 (Secret) Hq Hawaiian Dept, Off of Surg, 1942-43® 19o Radiogram, Hq Hawaiian Dept to TSG, Washington, D. C., dtd 29 Apr 42, File Mo. 710, Jaundice (Hepatitis) Serial No. 21 (Secret) Hq Hawaiian Dept, Off of Surg, 1942-43® 20. Ltr fr War Dept, to GGs, subject: "Vaccination against Yellow Fever," dtd 29 Jun 42, File No. 720.3, VI&I, Serial No. 110, HHD, Off of Surg, 1942. 21. Ltr fr Hq Hawaiian Dept to Distribution "F", subject: "Tetenus Toxoid Stimulation Dose," dtd 3 Jun 42, File No. 720.3, VI&I, Serial No. 103., HHD, Surg Off, 1942. 22. Ltr fr Hq Hawaiian Dept to Distribution "D", subject: "Vaccina- tion against Typhoid Fever" dtd $ July 1942, File No. 720.3, VI&I, Serial No. 112, HHD, Surgeon, 1942® 23® 2d Indo, Surg Gen to Dept Surg, dtd 28 Jun 1942, File No. 720.3, VI&I, Serial No. 105, HHD, Off of Dept Surg, 1942. 24® Ltr, Hq Hawaiian Dept to Distribution "A», subject: "Records of Yellow Fever Vaccination," dtd 14 Aug 42, File No. 720.3, VI&I, Serial No. 114, HHD, Off of Dept Surg, 1942. 164a 25® Cir No® 24, Hq Hawaiian Dept, subject: nImmunization Records,” 23 January 1943, Pile No® 720®3, VI&I, Serial No® 2, HHD, Off of Surg, 1943 26® Memo to Dept Surg, dtd 6 Mar 43 fr Surg, Engineer’s Office, File No® 720„3* VI&I, Serial No® 7, HHD, Off of Surg, 1943® 27® Ltr, Hq USAFICPA to Distribution ”C”, subject: ”Vaccination of Troops against Yellow Fever,” dtd 6 Oct 1943* Pile No® 720.3, VI&I, Serial No® 14* HHD, Off of Surg, 1943* 28-33® Pile No® 020 Assistant Secretary of War (Secret) HHD, Surg, 1943® 28® Ltr to CO, HHD, fr Asst Sec’y of War, Serial No® 5V File No. 020, as above 8 July 1943 <> 29® Ltr to Asst Sec'y of War fr CO, Hawaiian Dept, Serial No® 5, Pile No® 020, dtd 5 Jim 43® 30® Ltr to Asst Sec’y of War fr CQ, Hawaiian Dept, Serial No® 12, File No® 020, 20 Jul 1942® 31® Ltr to Gen Richardson fr John M® Hall, Serial No® 13, Pile No. 020, dtd 15 Aug 43o 32® Ltr to Asst Sec’y of War fr CG, Hawaiian Dept, Serial No. 14, File No® 020, dtd 6 Sep 43® 33® Ltr to CG, Hawaiian Dept fr Asst Sec’y of War, Serial No® 16, File No® 020, dtd 7 Oct 43® 34® Cir No® 143, Hq CPA, subject: ”Reimmunization against Typhoid and Paratyphoid Fevers,” dtd 9 Oct 43, Pile No® 720.3, VI&I, Serial No® 15, HHD, Off of Surg, 1943® 35® "Standing Procedure for Overseas Movement of Troops within and from the CPBC," Hq CPBC, Pile Ref AG 370.5, 1 Nov 44® 36® Ltr, Hq CPA, to Distribution C, subject: "lyphus^Innoculations," dtd 20 Jan 44, Pile No® 720®3, VI&I, Serial No® 6,;HCPA, Off of Surg, 1944o 37® Ltr, Hq CPA to Distribution C, subject: "Vaccination of Troops against Yellow Fever," dtd 1? May 1944, Pile No. 720.3, VI&I, Serial No® 12, HCPA, Surg Off, 1944® 38® Radiogram, CG, PQA to CG, CPBC, dtd 15 Jun 45, Pile No. 444®2, Vaccines, Serial No® 1, Hq CPBC, Surg Off, 1945® 164b 39. Messageform, CG, CPBC to CG, POA, dtd 3 dan 45, File No. 720.3, Immunization, Serial No. 3* Hq CPBG Surg Off, 1945* 40. Messageform, CG, POA to CG, CPBC dtd 2 Feb 45, File No. 720.3, Inmunization, Serial No. 3* 1945* 41. CPBC-POM, 1 Nor 44. 42. Changes in CPBC-POM, 1 Nov 44* dtd 29 dan 45. 43. Changes in CPBC-POM, 1 Nov 44* dtd 20 Feb 45. 44« Changes in CPBC-POM, 1 Nov 44* dtd 20 Jul 45. 45. Hq CPBC Adra 0 No. 1 (Index 204.80) Immunization, dtd 29 dan 45* 46. Hq CPBC Adm 0 No. 1 (Index 204.80) Immunization, dtd 25 Feb 45* 47. Hq CPBC Adm 0 No. 1 (Index CPYSG 204.80) Inmunization, dtd 27 dul 45« 48. Figures for comnunicable diseases among civilians fr Territory of Hawaii Board of Health. Figures for Military cases from records of Surgeon’s Office, CPBC. CHAPTER 31 Intestinal Infections (History of Preventive Medicine) • During the year 1941* there were no serious epidemics in the Hawaiian Department; however, there were several outbreaks of food poisoning and dysentery which were quickly brought under con- trol 0^ Bacillary dysentery is endemic in the Territory of Hawaii, and sporadic cases have appeared from time to time,. The following outbreaks of bacillary dysentery, all of the Flexner type, occurred among military personnel during 1942 1, 40 cases in one battery on the island of Hawaii,, 2, .140 cases in one company and its associated personnel on Oahu „ 3„ 400 cases in the Army task force stationed at Canton Islands, In addition to the 400 cases diagnosed by stool culture at Canton Islands 225 other individuals at the station had symptoms of dysentery during the course of the outbreak* but positive stool cultures were not obtained* For t he most part this was believed due oo the fact that adequate laboratory facilities were not avail- able at the station at the onset of the outbreak so that many cases had time to recover and become free of the organisms before stool cultures could be made0 In each instance of a dysentery outbreak* recognized control measures were applied and the response t o these was gratifyingc Occupation of Baker Island in 1943 was accompanied by an outbreak similar to that which occurred in 1942 when a garrison was established on the coral atoll at Canton* Experience indicated that dysentery, which was endemic in the Central Pacific Area, might be expected whenever a coral island was occupied unless ade- quate sanitary control measures were immediately taken* It was often difficult to build fly proof latrines because of t-he sandy nature of the terrain. On Canton Island this problem was solved by construction of impervious concrete pits which were emptied by means of portable cesspool pumps c The contents of the pit were then emptied into the sea in areas where there was an offshore 165 current* Epidemics were invariably due to a combination of a Carrier in the command, faulty latrine construction, and the pres- ence of large numbers of flies* Control of epidemics was brought about by stool examina- tions (by the rectal swab technique) of all members of the command; elimination of carriers by treating all positive cases with sulfa- guanidine; and effective fly control*3 When outbreaks of bacillary dysentery occurred, field bacteriological teams were sent to the spot to perform rectal swab cultures on all personnel in affected , units for the identification, isolation, and treatment of carriers. It was the policy in the Central Pacific to assume all cases of diarrhea to be bacillary dysentery until proved otherwise, and all diarrheas were hospitalized for study and treatment. Out- breaks tended to occur only under field or combat conditions. For the control of bacillary dysentery emphasis was placed upon the indoctrination of troops in the necessity for individual discipline in the sanitary disposal of fecal wastes and garbage for the control of flies. The use of sodium arsenite was developed for the control of fly breeding under combat conditions, in latrines, shattered eneiry ration dumps, and dead on the battle field. The importance of food-bome infection was Use of DDT and paradichloro- benzene in fly control is discussed in another chapter. An outbreak of Salmonella Newport infection occurred in a company of military police following the ingestion of roast tur- key, dressing and gravy on Christmas day 1944* The Christmas dinner had been prepared over field ranges and investigation showed that several hours elapsed between the time of preparation of some portions of the dinner and the time of ingestion. There were a total of fifty-three cases from a company strength of approx- imately 140* Of these cases positive stools were found in eighteen (16). The organism was identified as Salmonella Newport, group C; VI, VIH, e, h - 1, 2, 3* Four asymptomatic carriers of Salmonella Newport were also discovered in the organization; three of these were mess personnel and included the Mess Sergeant. This was the first outbreak of dysentery due to Salmonella Newport in this area. 5 Cases of amebic dysentery consisted mostly of asymptomatic carriers, A number of these were found through a survey of the personnel of two field hospitals which returned from Saipan for rest and recuperation in 1944. It is doubtful that very many cases or carriers of amebic dysentery had the origin of their infection within the geographical limits of the Central Pacific Base Command, Carriers were also discovered among troops who arrived in the Central 166 Pacific from Puerto Rico in the summer of 1945» During the early months of 1945* there were approx- imately thirty patients transferred to hospitals of the Central Pacific Base Command with the diagnosis of schistosomiasis. These patients had been stationed on the Island of Leyte in the Philippines, Most of them had been attached to an Engineer Battalion and an Infantry Division, where constant exposure to fresh water ponds and streams was unavoidable. Repeated examin- ations of the stools were necessary before a positive diagnosis could be made in many cases. Special sedimentation techniques for the concentration of Schistosoma japonicum ova proved helpful in making the diagnosis, A persistent eosinophilia was frequently the only positive finding until numerous stool examinations proved the presence of schistosoma ova,' Sporadic, cases of acute' infectious hepatitis occurred within the geographical limits of the command, A number of these cases occurred among troops recently arrived from the con- tinental United States, A total of 337 Army and Marine cases of hepatitis were evacuated from Saipan to Central Pacific Base Command hospitals during 1944# All of these Saipan cases were mild and no fatalities occurred/1' During late 1944 and early 1945 cases of hepatitis were hospitalized from other forward Pacific areas such as the Philippines and Ryukyus, Gases of local origin were never present in sufficient numbers to be of serious consequence. In 1942, over 4500 cases of jaundice occurred following yellow fever vaccination. These were classified in the Hawaiian Department as acute infectious hepatitis and were included as communicable diseases on the Form No, 86 ab report. However, in view of later findings concerning the etiology of this type of jaundice, these cases should not be considered infectious hepa- titis and should not be included as communicable diseases. Approximately, 4000 prisoners of war from Okinawa arrived on Oahu after June, 19450 The group was examined for blood and stool parasites9 Examinations of stools proceeded slowly and was not completed at the time of the cessation of hostilities. In August, 1945* 739 (£9$) #32 stools examined were positive for one or more parasites. Hookworm was the most common helminth found; others included Strongyloides, Ascaris, and Trichocephalus, Among the protoza found in the group were Endameba histolytica, Endameba coli, and Endolimax nana,^ 167 Intestinal Disease d Rates per Thousand Per Annum 1942 1943 1944 1945 Common Diarrhea 10.99 8.32 16,65 12.78 Dysentery, bacillary and carriers 3.61 3.14 2.43 2.06 Dysentery, amebic 0.07 o.os 0.44 3.10 Bacterial Food Poisoning * * 0,87 3*76 Dysentery, unclassified 0.55 0.22 0.10 0.10 Paratyphoid fever 0,03 0.01 — Typhoid fever —— —— 0.01 — Hepatitis infectious 45.10 0.55 0.54 2,33 Schistosomiasis 0.01 ~— ...» 0.54 Hookworm -«• 0.04 1.07 * Not a reportable disease 168 LIST OF REFERENCES Chapter 31 1, Annual Report for the Calendar fear 1941, Hq Hawaiian Dept, Off of Dept Surg, File Med 319*1, 11 May 42, 2* Annual Report for the Calendar Year 1942* Hawaiian Dept, Med Dept Activities, File, Med 319,1, 1942, Hq Hawaiian Dept, Off of Dept Surg, 3® Annual Report for the Calendar Year 1943, Med Dept Activities, Hq U. So Arny Forces, Central Pacific Area, File: Surg 319,1, 1943, On File Surg Off, CPA, 4, Annual Report, Calendar Year 1944, Med Dept Activities, Central Pacific Base Command, File: CPYSG 319,1, 1944* on File, Surg Off, CPBCo $, Essential Technical Medical Data, CPBC, April 1945* File Ho, 350.0$, Hq Surg Off, CPBC. 6, Essential Technical Medical Data, CPBC August 1945* File No, 350,0$, Hq Surg Off, CPBC, 7, Essential Technical Medical Data, CPBC March 1945, File No, 350,0$, Hq Surg Off, CPBC0 8, Monthly Statistical Health Reports, (WD, MD, Form 86ab) On File, Surg Off, CPBC, CHAPTER 32 Infections of the Respiratory Tract and Infections Transmitted by Discharge from the Respiratory Tract (History of Preventive Medicine) Common respiratory diseases were the leading communicable diseases in the Central Pacific both before and during the war* Rates for the respiratory diseases and diseases transmitted by dis- charges from the respiratory tract are shown in Table I, below* TABLE 1-Respiratory Diseases Diseases 1942 1943 1944 1945 Common Respiratory Diseases 33.45 74.92 58.34 121.35 Pneumonia, primary atypical 3.63 4.36 3.40 8.04 Influenza 3.65 0.95 2.84 3.62 Pneumonia, primary 3.29 1.82 0.89 1.14 Mumps 1.62 1.82 1.18 3.64 Measles 0,66 0.09 0.40 3,76 Measles, German 1.42 0.82 0.40 2.30 Tuberculosis 0.62 0.76 0,65 1.91 Streptococcus Sore Throat 0,01 —-— 0.93 2.41 Ghickenpox 0,07 0.14 0.04 0.92 The rates shown above for the first eight months of 1945 we re probably not true rates, but were very nearly double the actual figure. With the breakdown of the Central Pacific Area on 1 August 1944, and the establishment of the Central Pacific Base Command and Pacific Ocean Area Headquarters on Oahu, strength figures were based on the assignment of units to one or the other echelon. How- ever, all hospitals on the island of Oahu were Central Pacific Base Command hospitals, and no discrimination was made between the hos- pitalization of patients assigned to CPBC or P0A. The following are some of the factors which contributed to give falsely high admission rates for CPBC, First, there w'ere almost as many -Droops assigned to P0A (later known as Array Forces Mid-Pacific) within CPBC geographical confines as there were CPBC troops. The P0A troops included the Air Force units, troops assigned to the IX Corps, the Tenth Arny, and 169 other replacements staging in the Hawaiian Islands but not assigned to the Central Pacific Base Command* Such troops were admitted directly to CPBC hospitals, and their admissions were totalled with the admissions of CPBC troops0 However, when the total admissions were divided by the figure of the CPBC strength, a hospital admission rate approximately double the true rate was the result* In many instances troops evacuated from forward areas to CPBC hospitals as admissions by transfer, were found to have or to be carriers of communicable diseases, such as hook- worm, malaria, bacillary or amebic dysentery during their hospital stay or subsequent to discharge to units within the Central Pacific Base Command* Such communicable diseases were charged against CPBC rates* Troops admitted to CPBC hospitals from transports arriving from the mainland or from forward areas were charged as direct admissions to CPBC hospitals, and contributed to the CPBC rates* Communicable diseases developing within the Command within the normal incubation period of arrival from other areas belonged in this category* In June 1943 a sudden increase in the incidence of respira- tory infections was noted in the civilian population on Oahu* This was followed shortly by a slight increase of the same disease among military personnel* The epidemic consisted chiefly of nasopharyn- gitis but occasional cases were diagnosed as influenza* (The same disease was considered influenza among civilians)* All cases re- sponded to symptomatic treatment and were returned to duty in a few days* The annual admission rates for upper respiratory in- fections per thousand per annum, for military personnel in this area for the month of June, July, and August were 92, 95$ and 82 respectively* This disease ceased to be a problem by the first of September when the incidence returned to normal* The mean monthly rate for the rest of the year was 75 per thousand per annum*^ Influenza was not ordinarily a reportable disease in the Territory of Hawaii* Because of an apparent increase in the in- cidence of respiratory disease clinically diagnosed as influenza, the President of the Territorial Board of Health required the dis- ease t© be reported as of 16 June 1945o Forty-eight cases had been reported to the civilian population of Honolulu within 48 hours after the disease became reportable* Arrangements were made by the Surgeon ©f the Central Pacific Base Command with civilian authori- ties to obtain blood specimens and throat washings from civilian cases diagnosed as Laboratory studies carried out at the 18th Medical General Laboratory indicated that the disease occurring among civilians was influenza B* This was determined by examining acute and convalescent blood specimens for the presence of antibodies against influenza type A and B* The same laboratory also isolated influenza B virus from throat washings of a civilian patient When 170 immvik Adalttlon* to CPBC Botpltals Proa 17 Juno thru IT July 1948 it became apparent that influenza B was occurring, a directive was published by Headquarters USAFP0A,5 requiring hospitalization of any patient with respiratory disease and reduction of contacts by allow- ing a minimum of 75 square feet of floor space per person. Follow- ing the publication of this directive, there was an immediate and marked in crease in the number of hospital admissions for respiratory diseases, (See chart on following page). The number of civilian cases reported as influenza declined the first week of July 1945, and the directive mentioned above was rescinded 9 July 1945, Follow- ing that time, the number of military admissions for respiratory dis- ease decreased. It was not possible to state the exact number of actual influenza cases in military personnel. Only forty-five cases were reported as influenza during a five-week period ending 29 June 1945* Many cases were reported as "nasopharyngitis", "upper respira- tory infection", or "fever of unknown origin". Medical officers were reluctant to diagnose "influenza" without a serologic basis 1 for diagnosis, and it was not convenient or practicable to carry out laboratory tests to confirm such a diagnosis on all patients which were hospitalized as "flu1* suspects. The disease was mild in most cases and known complications were not a prominent feature of this epidemic. Clinically, the pneumonia observed during this epidemic resembled the atypical variety, and it was believed that the pneumonia was coincidental and not secondary to influenza. The introduction of captured prisoners of war to the Hawaiian Islands was cause for concern in preventing communicable diseases« Stool surveysp mass roentgen examinations of the chest, and blood examinations were carried out whenever indicated0 A chest survey by means of i+ x 5 inch single photofluoro- graphic film was conducted on Italian prisoners of war during the months of April and May 194$» A total number of 1980 subjects were examined by this sur- vey o Findings in the survey were as follows? Essentially negative OOOOOOOOOOOOOOOOOOOOOOOOOOOOODO 1,921 (Including completely calcified and sharply defined fibrotic lesions of minimal extent) Pulmonary tuberculosis•ooooooooooooooooeooooooo»& o o 30 Non-tuberculous pulmonary disease0ooooo«0oooooeooo<. 6 Pleural Changes OOOOOOOOOOOOOOOOOOOOCOOOOOOOOOOOGOO© 9 Cardiac contour variations suggesting pathologic ChangeS oooooooooooooooooooooooooooooooooooooooo 11 Rib anQBialieS oooooooooooooooooooooooooooooooooooooo 3 TOTAL 1,980 171 The thirty prisoners diagnosed roentgenologically as having pulmonary tuberculosis were hospitalized for further study to determine the extent of activity. 172 LIST OF REFERENCES Chapter 32 1. Monthly Statistical Health Reports (WD, MD, Form No. 86ab), On file, Hq Surg Off, CPBC. 2. ETMD, CPBC, July 1945, file CPYSG 350.05, on Pile, Hq Surg Off, CPBC. 3. Annual Report, Med Dept Activities, Central Pacific Area, 1943, Pile Surg j>x9.1, on File, Hq Surg Off, CPBC. 4. ETMD, CPBC, June 1945, File CPYSG 350.05, on Pile, Hq Surg Off, CPBC. 5. Ltr, HUSAFPOA, POYSG 710.67, 24 June 1945, subject: "Control of Respiratory Disease," To: Distribution "A" (Oahu only). 6. Ltr, HCPBC, CPYSG 720,3 , 9 July 1945, subject.: "Control of Respiratory Disease," To: Distribution "A" (Oahu only). 7. ETMD, CPBC, August 1945, File CPYSG 350.05, on Pile, Hq Surg Off, CPBC. CHAPTER 33 Venereal Diseases (History of Preventive Medicine) The venereal disease rate fell from 14 d cases per thousand per annum in 1941 to 3«79 cases per thousand per annum for the first eight months of 1945p (Chart- I)„ Venereal disease was never a major problem in the Hawaiian Islands, but the rate fell to an all time low during the period of the war0 The factors responsible for the ex- tremely low Hawaiian Department rate were not all known, but some of them included interest in the diseases since 1860$ a clinic in opera- tion since 1921! regulation of prostitution! a moderate control pro- gram since 1937s the insular nature of the area; a polyglot population, many of whom lived in slums % disparity in numbers between men and women, importation of large numbers of single male laborers, first for plantations then for war work| a high social breakdown rate, and later a large population increase at the outset of the war„ While all of these factors may not directly relate to the presence or absence of venereal disease, many of them normally reflect scenes in which venereal, disease is quite prominent e Following the outbreak of war and the establishment of martial law in the islands, the normal con- ditions of life changed sharply* A curfew and blackout became effective0 Prohibition was instituted and was absolute for several months, follow- ing which moderate relaxation occurred,. Many women were evacuated from the Territory while men were imported for the Services or war work* The entire civilian population was registered and finger printed, ana travel between outlying islands and the Mainland was placed under ab- solute control0 The number of white prostitutes declined and recruit- ments of new operations became difficult o1 During the first five months of the year 1942, the venereal disease control activities of the Hawaiian Department followed the ordinary policies which had existed in the past* These included edu- cation regarding prevention and control of venereal disease, monthly physical inspections to detect the presence of venereal disease and the reporting of cases to the military police who attempted to pick up infected women and send them to private physicians for treatment* On 21 May 1942, the Office of the Military Governor, Honolulu, T0 He, issued General Order No0 107, Section I of which, outlined the control of communicable disease in the Territory of Hawaii, and applied particularly to the control of venereal disease* Close cooperation between the Army, Navy, and the Territorial Board of Health was achieved 173 in the enforcement of the provisions of this General Order* A medical officer was appointed venereal disease control officer for the Depart- ment to coordinate the activities of the three services. Venereal disease control activities following the issuance of General Order No* 107 were as follows; Reporting by special messenger to the Territorial Board of Health of all contacts were made within 24 hours after diagnosis of the disease* The Territorial Board of Health energetically followed up all of these contact' reports and as a result a large number of in- fected women and men were quickly placed under treatment* An intensive drive was carried out by both military and civilian police in the pick-up and examinations of all street walkers to determine whether or not they were diseased* All recalcitrant patients who did not take adequate treatment* and infected prostitutes who had not been reported by their private physicians or those still infected after having been pronounced cured by their private physicians, and street walkers were hospitalized under military control* r C An effective educational program was carried out through- out the entire Command with the use of training films as well as films supplied by the Territorial Board of Health* the distribution of educa- tional literature* and monthly lectures to all Commands stressing the importance of prophylaxis* Venereal disease control activities were carried on under General Order No* 107, Office of the Military Governor* until 10 March o 1943/ when there was a return of many activities to civilian authorities,, Control of communicable disease was one of the functions returned to the Territorial Board of Health* Prior to 10 March 1943, the regula- tions of the Territorial Board of Health* especially those pertaining to the control of Venereal disease* were rewritten and made law by order of the Governor of the These new regulations were as effective in operation as was the operation of General Order No* 107o They were adequately enforced by civilian authorities* Close coopera- tion continued to exist between the venereal disease control officers of the Array, the Navy, and the Territorial Board of Health* Principal activities carried out by the armed forces in venereal disease control during the year 1943, were as follows;* Hospitalization of all acute venereal disease cases among the armed forces until they were considered noninfectious* Adequate contact reporting by Medical Officers assigned to venereal disease treatment in all Army hospitals„ These reports were 174 VENEREAL DISEASE Rates per thousand per annum HAWAIIAN DEPARTMENT, 1936 THROUGH AUG. 1943 CENTRAL PACIFIC AREA, SEPT. 1943 THROUGH JULY 1944 CENTRAL PACIFIC BASE COMMAND, AUGUST 1944 THROUGH AUGUST 1945 CHART I sent by special messenger to the venereal disease section of the Territorial Board of Health within 24 hours after diagnosis was made0 The Territorial Board of Health with the aid of well-trained personnel promptly located named suspects0 When the persons were located, they were examined at the venereal disease clinic of the Territorial Board of Health, and if found infected, all cases were hospitalized until cured, with the exception of a very few individuals whom it was felt could be trusted to carry out ambulatory treatment, The picking-up of questionable women at bars, dance halls, and similar places of amusement was continued by civilian and mili- tary policee Women so detained were sent to the venereal disease clinic of the Territorial Board of Health for examination. An extensive prophylaxis program was placed in operation,, Four large prophylactic were operated in downtown Honolulu by the Arngro One was operated by the Uc S„ Navy0 Data available Indicated that an increase in the prophylactic rate was an actual increase in the number of prophylactics taken per exposure,, An educational program was actively continued. Training films of the U, S, Public Health Service were in constant use. Two posters on the subject of prophylaxis, giving the address of stations and other information, were prepared and 5$000 of each were posted throughout the Commando Locations of all prophylactic sta- tions were shown on passes, A large variety of venereal disease publications from the U, S0 Public Health Service were kept in all prophylactic stations and approximately 500 of these publications were taken by men each month, A pamphlet on gonorrhea was prepared and 60,000 copies distributed to the Command as well as over 100,000 U, S, Public Health Service pamphlets on venereal disease control. The supply of literature and printing of pamphlets and posters was made possible through cooperation with the venereal disease control section of the Territorial Board of Health who pro- vided the necessary ftmds. At the onset of the coordinated program, diagnostic and treatment were amply provided for servicemen in the several Army and Navy Hospitals, The facilities for civilians con- sisted of, a moderately interested but extremely busy group of medi- cal practitioners | a small number of whom were interested in the a score of ‘’house doctors” responsible for the medical care and examination of prostitutes in the city, most of whom were conscientious, careful, qualified practitioners, others of whom were indifferent or incompetent to diagnose contagious venereal diseases government physicians in thirty-six districts of the Terri- tory who were responsible for the care of communicable disease and 175 the indigent sick| and the Board of Health Clinics« In the city of Honolulu5, the Board of Health Palama Clinic was adequately equipped to handle the diagnostic and treatment loads in the area, as were the Board of Health clinics in Hilo, Hawaii, and Wailuku, Mauio Treatment was accomplished in accordance with current War Department directives, but the policy of treating gonorrhea on a duty status as indicated in TB MED 96 published in September, 1944, was not followed in the Central Pacific Base Command until July, 1945* The venereal disease rate had always been so extremely low that such treatment seemed unnecessary,. For example, the total rate for locally contracted cases of all venereal diseases for the month of March, 1945, was 0*25 cases per thousand per annum* With such a low rate, it was obvious that venereal disease did not con- tribute very much to the noneffective rate* Therefore, it seemed preferable to continue to treat gonorrhea in hospitals rather than to risk the exposure of contacts to cases of venereal disease which might be infectious,. Furthermore, with only twenty-six cases of gonorrhea in a two month period there was no strain placed on hospital bed facilities*° However, following publication of Section III, Circular No* 3, Medical Treatment of Gonorrhea, Headquarters, USAPMIDPAC, 9 July 1945 , the duty status treatment of gonorrhea was instituted* All cases of new gonorrhea were treated by hospitals as outpatients except those in whom an accurate diag- nosis could not be made immediately* Such cases were hospitalized until the diagnosis was made* Treatment consisted of 200,000 units of penicillin, given intramuscularly in four 50,000 unit doses spaced two hours apart* It was recognized at the outset of this program that cer- tain infected promiscuous individuals had to be removed from the community if they were to be kept from exposing others® General Orders 10? provide! the services of Army Provisional Hospital #3 for hospitalization1 of patients deemed necessary by the health department* This provision of hospital facilities for civilians was an indubitable aid in the reduction of disease rates*1 Early in July,1942, the first patient was admitted to any army section of the hospital* At that time known professional pros- titutes who had their own private physicians were not hospitalized as it was the feeling in the community that professional prostitutes could be handled adequately as outpatients, as had been done in the past* In September 1942, it became apparent that professional as well as clandestine prostitutes needed to be hospitalized* The "house physicians” were asked to hospitalize their infected clients at any private hospital in the city, but following hospitalization 176 their patients were to be examined by the Board of Health Palama Clinic prior to "going back on the fXoor0" There waft-a sudden in- flux of infected professional prostitutes into private hospitals0 This large influx of an undesirable type of patient into already overcrowded hospitals made it imperative that other bed facilities be founds following which arrangements were made for private wards adjacent to Army wards in the Kuakini Hospital. These wards were opened 4 January 1945 During the year5 sixty-three patients were admitted to the Army Provisional Wards and fifty-three to the private wards of the hospital. The exact number of professional prostitutes hospitalized prior to January9,1943.0 is not known but was probably in the neigh- borhood of forty.“ Prostitution ; flourished in Hawaii with little or no regu- lation until 1929o Between 1929<, anc* the time of the war5 prostitution continued to exist on a somewhat smaller scale than was common to many mainland communities0 New operators were difficult to obtain and with the great influx, of menp the average time of each exposure was reduced 3-6 minutes0 Some of the bordellos were of the parlor type*, others were merely cribs in which the landlord or madam rented rooms to tljie girls on a dally basis j most of these were located in the slumso Early in 1942c, a study was made by the health department of sources of new venereal infection reported by service men? over seventy-five per cent of which came from regulated, inspected houses of prostitution. Twenty per cent of prostitutes examined had gonor- rheas fifteen per cent had syphiliSj, and sixteen per cent of those examined for chancroid had chancroid.8 Early in 1942P when soldiers received an increase in pay5 the prostitutes increased their prices from $3®00 to $4o00. This drew interesting comments from certain columnists and was the source of much ribald conversation*, but the price was finally forced down to fo.OO.1 An attempt was made to set up a brothel for officers in an exclusive residential area* One of the finer homes in the city was rented by prostitutes and a select trade was being established when the neighbors protested to the police* The house was closed forthwith*^ An attempt was made by the Police Department in the autumn of 1942P to drive the prostitutes out of certain residential areas; As the girls claimed to be essential to the welfare of the community and armed forces* they insisted that this attempt to drive them back 177 to their brothels was against the Bill of Rights and so they struck,, On 31 August 1942* the prostitutes in all houses except three went on strike* and the houses remained closed until 21 September 1942® In the few houses which remained open* business became so good that the girls were overwhelmed,, In one place* at the normal closing hour of 1500* the military police found approximately 185 men lined up to visit five girls0 The strike was also an expression of in- dignation of the harsh tone of the Venereal Disease Campaign in the newspapers„ On 21 September 1944* the houses of prostitution in the city of Honolulu were closed* Those in other parts of Oahu and the other islands had been closed previously at various times0 The civil police made every effort to discourage clandestine prostitution and the establishment of call houses* The most noticeable effect was in the reduced use of prophylactic station where 51*735 prophylac- tics were given in Army stations in August, and 31*435 in September, the following three months dropped to 156,297* and 286 respectively*' Prior to the closing of the houses thirty to forty per cent of the venereal infections in the area were contracted elsewhere than in the Territory of Hawaii, or were considered "off shipping”® Whereas, after the houses were closed, 60-70$ of cases were '’off shipping”* There were no startling immediate change in Array rates because they were already so low*10 During the days when prostitution was widespread* every effort was made to develop adequate prophylaxis1 facilities for the community® Early in 1942* there were but two Army prophylaxis sta- tions in Honolulu* both of which were off the beaten path and neither did a great volume of business® In February* 1942* the Navy opened a station in the red light district and following this the two out- lying Army stations showed a sharp decline in their volume® Eventu- ally* when the Amy opened stations in the red light district* the volume of business of the outlying stations dropped to such a point that they were finally abandoned® When stations were established, the volume of business increased sharply®-1- During the early part of 1942* when there was a large influx of troops* the prophylaxis rate fell® With the addition of new facilities in July of that year* the rate sharply increased but in September during the three-week strike of the professional prostitutes* the rate dropped to almost zero® With the resumption of prostitution the rate continued to go up® In January 1943$ the Territorial Health Department was authorized to publicize the availability of a Navy Prophylaxis station to civilians® At that time one of the daily news- papers made mention of this fact on its front page and another on its editorial page® After that the Array also granted similar per- mission and attempts were made to publicize the availability of both Army and Navy stations to civilians® In addition to prophylaxis 178 { ri< -A f«lat &» i iiAieui-Pcx; "LoXKAJtd jLbjf.MmJiLi stations, the individual prostitutes were expected to administer prophylaxis to their customers0 A study of the type of prophy- laxis administered showed that in all instances it was inadequate and in some instances it was actually dangerous in that the solutions used were old and improperly or septic ally handled,, In May, 1943, with opening of two new Array stations and the remodel- ing of the Navy station, prophylaxis was no longer permitted at houses of prostitution, and extensive use was made of placards directing all men to use prophylaxis stations* A sharp increase from about 12,000 prophylaxes in May 1943 to over 25,000 occurred with a significant increase in the proportion of civilians using such prophylaxis facilities,1 As mentioned above, the most striking immediate result of closing the houses of prostitution was the reduction in the number of prophylactics given. This trend continued during the remainder of the war, (See Chart II and Table I), Prior to 1942, sporadic efforts had been made toward a lay educational program in the Territory, but the press and radio were not particularly responsive to these efforts. As late as May, 1942, the newspapers carried all releases submitted by the health depart- ment excepting those pertaining to the venereal diseases. In June, of that year, the Hawaii Health Messenger, a publication of the Board of Health, presented the venereal disease picture to its mail- ing list of physicians, social agencies, and health-minded laymen* and shortly thereafter the Hawaii Magazine, a small independent pub- lication, carried two articles on the subject. At the request of a prominent Honolulu physician, Honolulu’s afternoon newspaper reprinted one of the latter articles on its editorial page. Following that, several hundred inches of news release, editorials, letters to the editor, and special articles appeared in all of the Honolulu papers. It was particularly interesting to note that after the papers once started they were willing to publish practically everything released concerning the disease. One of the most effective educational procedures carried out was that of distributing over 50,000 each of the U0 S, Public Health Service pamphlets concerning venereal disease to the Armed Services by methods of distribution which assured that the pamphlets were quickly and effectively scattered., A letter was sent from the Commanding General;s Office to the Commanding Officer of each large command, with a sample pamphlet stating that the pamphlets were beiog given to the unit surgeons 0 Distribution was made through medical channels by command orders all men were ordered to read the pamphlets and to be prepared to answer questions about them,,1 179 TABLE I Prophylactic Treatments Given to Array Personnel on Oahu, T0Ho, by Army Pro Stations 1* 12&2 m2. im Jan 1802 7347 19503 113 Feb 1810 7487 16870 73 Mar 2349 7888 18414 £5 Apr 2657 7340 19771 66 May 3588 8336 21243 44 Jun 2895 • 12938 ’ 21088 31 Jul 4654 18022 19773 41 Aug 5897 15485 20785 Sep 3648 19924 12819 Oct 6381 22014 S5 - Nor 7401 19815 153 Dec 7234 19754 162 TOTAL 50316 166350 170666 453 180 Considerable use was made oi movies both among the armed services and for civilian groups. No record was kept of the showing to Array or Navy personnel0 but over 60 groups of civilians saw Board of Health Films during the period. Radio stations on the Island of Oahu presented U, S, Public Health Service venereal disease recordings, and the , recordings were later used by stations on Kauai and Hawaii,1 Prior to the closing of the houses in the fall of 1944, nearly every newspaper carried articles concerning the problem of prostitution in Honolulu, A serologic survey of colored troops in the Central Pacific area was initiated in June, 1944 File AG 704do To: Distribution "An and "Bo" On file: Hqs, Surg Off, CPBCo 7o Ltr, Subj, Dengue, Hqo HoDo, 2 Sept 1943* Files AG 704d (Dengue) (Med), To; Comdrs of all Districts, and Arrcy Task Forces, On file: Hqs, Surg Off, CPBCo 8o Ltr, Subj, Dengue Fever, Hq, USAF Central Pacific Area, 12 Sep 43, Files AG 710, To; Distribution "Ao" On file; Hqs, Surg Off, CPBCo 9» Ltr, HUSAFCPA, Subj, Dengue Fever, file AG 710, 24 Sep 1943* To; Distribution "Ao" 10o Ltr, HUSAFCPA, Subj, Dengue Fever, file AG 710, 28 Dec 43* To; Distribution "A" (Island of Oahu only)0 11o Essential Technical Medical Data for CPBC, June 1945° On file: CPBC, Surg Offo 12o Ltr, Subj, Dengue, Hq, CPBC, file; CPYSG, 710, 9 Jun 45* To; Distribution "Co" On file: Hqs, Surg Off, CPBCo l3o Annual Report, Med Dept Activities, Central Pacific Base Comd, CPYSG 319ol* 1944, On file: CPBC Surg Off0 14o Monthly Statistical Health Reports—(T©, MD Form No0 86 ab) On file: Hqs, Surg Off, CPBCo l5o Essential Technical Medical Data for CPBC, Aug 1945, On file: Hqs, Surg Off, CPBCo 188 16. Ltr, SubJ, Pllariasis in Okinawa Prisoners of War, Pile CPYSG 710, Hq, CPBC, 26 July 194-5* To: CG, Array Port & Serv Comd, Copy on file: Hqs, Surg Off, CPBC. 17. Message form, Subjs Testing of Prisoners of War for filariasis, files 0291--CPACS, Chief of Staff, CPBC, 25 Jul 1945* To: CG, AP & SC, On files Hqs, Surg Off, CPBC. 18. Effect of Penicillin on Experimentally Produced Plague in Guinea Pigs, Bernard Witlin, Sc D., and Charles L. Wilbar, Jr., M.D.J. Lab and Clin Med 30, 237, 1945* 19* Ltrs, Territory of Hawaii Board of Health, Tos Hqs, CPA, Attn: Surg, 4 Jun and 26 Jul 45* On files CPBC Surg, 710 Plague, #31* CHAPTER 35 Miscellaneous Infections (History of Preventive Medicine) Poliomyelitis; From the beginning of the -war until April 1943* no cases of poliomyelitis occurred among military personnel, although forty-three cases occurred among civilians on Oahu during the same periods In March 1943* poliomyelitis became unusually prevalent in the civilian population, sixty- six civilian cases occurring during the remainder of the year (March tc October)0 There were four cases of poliomye- litis among military personnel on Oahu during the months of April-June, The Kuakini Hospital (later an annex to Tripler General. Hospital) hospitalized the military cases® The Army assisted civilian authorities in the establishment of a poliomyelitis hospital, in 1943* operated by the Office of Civilian Defense* This assistance included the use of Drinker respirators which were subject to immediate r ecall if needed by military personnel® The Kenney method of treatment was used with good results® The Command was notified of the outbreak and instructed to take generally accepted preventive measures which were enum- erated® Since June,1943, no further cases of poliomyelitis were seen among troops until 1945* when eleven cases were evacuated from Leyte to Oahu in January and February, and two cases were taken off transports from the mainland in August® Yaws? The Navy imported twenty-one Ellice Island natives to Canton to work as laborers in May of 1943» Yaws was noted among these natives and following a request from Headquarters Central Pacific Area, further importation of native laoorers to that station was discontinued® All infected natives were treated with arsenicals by Army medical officers as a means of preventing dissemination of the disease. No ease* occurred in military personnel® In Decent- ber, the British government imported forty-one infected male natives to Christmas Island for the purpose of working copra plantations® These were treated and rendered noninfeetious® Examinations were made to discover other communicable diseases in the group and steps were taken to protect the Command®! Leprosy2 This disease is present in civilians in the Central Pacific Area but was not of military importance* Lactures and clinics were conducted for medical officers who might enter leprous areasFour cases of leprosy in military personnel were reported in 1942 and one in 1944*x These cases were in local men who were inducted into the Army from the Hawaiian Islands* Presence of the disease was not recognized prior to induction* 189 LIST OF REFERENCES Chapter 35 lo Annual Report, Med Dept Activities, CPA, (1943), Piles Surg 319.1, On File: Hq Surg Off, CPBC. 2. Monthly Statistical Health Reports, WD, MD Form No« 86ab„ 190 CHAPTER 36 Nutritional Diseases 1« Calorie Deficiencies,- The overall food supply in the Hawaiian area during the war was in general adequate to main- tain normal weight among the troops„ On some of the forward is- lands, however, the monotonous r,BH ration diet caused inadequate caloric intakes in some instances0 During the first two months after occupation of Makin atoll, (early 1944) it was observed by a medical officer that there were many instances of weight losvses of 5 to 10 pounds among the garrison. Monotony of field ration "B", alleviated only by neglig- ible issues of fresh food, was cited as the principal cause, to- gether with early shortages ef sugar, coffee, flour, baking powder and canned fruit and vegetables0 When increases in these items and fresh foods were received, the ration became more palatable and most of the weight losses were regained,, No vitamin deficiencies were an issue of two vitamin tablets daily per man was instituted in the third week of occupation, x In a report- cohering feeding conditions on APO 241, Kwaj ale.ks from 1 February to 5 May 1944 another medical officer observed that weight loss was the raid during that periodo Inade- quate appetite was attributed chiefly to monotony of the "S'1 ration, particularly the limited variety of meat components and the unpopularity of the canned siew0 Spam and chili & beans 0 Poor preparation and serving of food also contributed, and the menu was considered not well suited for field use0 The early provision of ice-making equipment was recommended, as well as the assignment of a nutrition officer to large garrison forces to supervise the cooking and serving of foodo^ 2a Vitamin and Mineral Whether or not there were adequate amounts of specific nutrients in the rations through- out the command remained uncertain during the war The use of vitamin capsules in forward areas would have tended to prevent any widespread incidence of specific vitamin deficiency even if the ration had furnished insufficient amounts*, Prior to June 1945 no analysis was made of the dietary as actually consumed to determine whether the vitamin in- take was low enough that specific deficiencies might be likely in any considerable proportion of the troops*. At that time estimated intakes of thiamin, riboflavin and calcium by troops served by one depot (APO 957) on Oahu were found to average slightly below the 191 National Research Council standards, but not sufficiently low that ©vert symptoms might be expected,4 Sanitary Reports occasionally stated that the diet of cer- tain units was lacking in vitamins, but no conclusive demonstration of deficiency symptoms was made* In a few instances information suggestive of minor deficiencies was reported, but no data on the dietary intake nor on controlled response to vitamin therapy was includedo In August 1942, a station hospital reported that a decreased healing time for minor cuts and injuries had been observed when vita- min capsules had been used the troops for several weeks, and that susceptibility to infection was also lessened*5 In August 1943;? a battalion surgeon reported that capillary fragility was demonstrated in 22$, and marked sponginess of the gums in 26$ of a sample of his troops« He attributed this to inadequate ascorbic acid in the consumed ration, but no data on the actual ascor- bic acid intake were provided,, Measures were taken to instruct mess personnel in methods of food preparation to preserve ascorbic acid values o0 \ Request was made in November 1943 for supplemental vitamins to be issued to an infantry regiment on Oahu, The r egimental surgeon stated that the dietary had been variable for the past two years, averaging barely adequate as to vitamins and consistently inadequate in calciumo He felt that optimal nutritional supplies were advisable to further recovery from injury or illness in troops going into battle. Ho data were presented on the actual dietaiy intake of rita- mins and minerals by the troops 01 In May 1944* the surgeon at APO 241, Kwajalein, reported the appearance ©f swelling and bleeding of the gums and neuritis among the troops of that area, and considered it likely that it was due to the limited variety of foode A 90 day supply of multivitamin capsules for all personnel was forwarded,® In June eye symptoms attributed to riboflavin deficiency vras reported in patients at the 156th Station Hospital on Kauai, photophobia, a feeling of grit in the eyes, blurring under close work, headaches, and proliferation of the limbus plexus into the cornea. The cases were said to respond to riboflavin although no controlled trials were reported,° In April 19459 a nutritional survey of troops on Hawaii by a team from the SGO revealed no classical deficiency syndromes, and there was a low incidence of signs commonly attributed to malnutrition. The biochemical status of the subjects was good and their dietary intake was only slightly below National Research Council standards in calcium and riboflavin, ® 192 HEADQUARTERS UNITED STATES ARMY FORCES CENTRAL PACIFIC AREA OFFICE OF THE SURGEON APO 95S In reply refer to (Surg) 23 May SUBJECTS Nourishment of Personnel at an Advance Base, TO: The Surgeon, Central Pacific Area0 1, The ration provided the garrison at Makin Atoll, during the first two (2) months, was the type r,Bn tropical field ration. Only a negligible quantity of fresh foods were issued. Two (2) vitamin tablets daily per man were issued to all personnel, beginning about the third week ashore. This was a very monotonous diet and many men did not eat sufficient to maintain their normal weight. As a result, there were numerous instances ©f weight losses of 5-10 pounds per man. The greatest lack in this ration seemed to be short- ages of sugar, coffee, flour, baking powder, and canned fruit, and vegetables. Action by the Island Commander resulted in increases in all of these items. Due to the warm, humid, monotonous climate, a concentrated diet rich in fats and proteins is not nearly as appealing as one with a preponderance of carbohydrates. 2, After the first two months, fresh foods, meat, eggs, butter, fruit and vegetables were received and a much more palatable ration was issued. Most ©f the weight losses mentioned were re- gained at time time. 3, In general the nourishment and weight of all personnel in the command was good at the time of departure of the undersigned. There were never any evidences of vitamin deficiencies. s/ William E„ Strozier t/ WILLIAM £« STROZIER, Lieutc Col05 M0 Co, Assistanto A TRUE COPT: /s/ Charles D0 Buss CHARLES Do BUSS 1st Lt, SnC 193 SUBJECT? Weight Loss in Forward Area, MEMO TOs Col, Gates, lo The undersigned was at APO #241 during the period 1 Feb - 5 May 44« 20 During this period my weight dropped from 19S# to 186#, Since my return I have gained 4#, Weight loss was the rule at this area and can be attributed to the following factors*, ac Initial Dehydration, b, Loss of appetite and consequent small meals due tos Do Unpalatability of rations, a)0 The C and K rations eaten during the first 15 days were not at all palatable. Biscuits of the K ration and the meat and vegetable stew and hash of the C ration were the biggest offenderso A hearty meal cannot be eaten of these components, b}0 In the B ration, practically all the components except the stew, spam and possibly chili and beans were very popular when prepared with some imagination by the mess personnel (the three components mentioned are never popular, although spam can be pre- pared so that it is at least edible). It was noted though, that even in what was considered an exceptionally fine mess (2nd Prov„ Stn, Hosp,), those, who ate there consistently complained of monotony. Food warmed up and served sloppily is the biggest factor in poor eating, 2)0 Unsuitability of the menu. The menu prepared for our use m which basis the ration was issued, was not made up by a person familiar with field or tropical conditions. Items were on the menu which either could not be prepared in the field or if they could a man could not easily use his mess kit to eat it (examples soup; needs the canteen cup*, which must then be washed before used for the drink, and no man likes to get up in the middle of a meal to wash a cup for his coffee). The menu frequently had an overbundance of carbohydrate foods. The heaviest meal was usually at noon, when the heat of the day made appetites poor, 3)o Monotony of the ration was the biggest fault; due to pilfering perhaps of canned chicken and ham soon after the garrison forces were landed. Spam, corned beef, hash and stew and chili and beans were the principal meat components - just a little chicken or ham would have relieved the monotony, A noticeable increase in morale was evident after about IB April, when enough fresh food was available for one fresh meal a day, including fresh meat* 3« Recommendationss (See also Veterinarian Report on APO #241*) \ ' • / ac Increase palatability of K ration, especially biscuits, b0 Eliminate C ration hash and stew and substitute something a man can chew on* Co A competent food and nutrition officer, familiar with all the items of the B ration, and familiar with field cooking, be assigned to large garrison forces to actively supervise the cooking and serving of food. In other words, an officer with the imagination and ability to make ordinarily monotonous foods palatable and "exciting". d„ Early and adequate ice making machines for icing of drinks. All Navy and Marine units on the main island were equipped to start of/ with reefers or large iceboxes, and two of these units had chip and snow ice making machines* Needless to say. Army personnel, including myself, were loud in our exclamations of wonder as to why the Army couldn't have the same things* s/ J0 F« Mo t/ JOSEPH F. MAGUIRE, Major, MC* A TRUE COPY; s/ Charles D0 Bass,, CHARLES Do BUSS 1st Lt, SnC 196 HEADQUARTERS CENTRAL PACIFIC BASE COMMAND Office of the Surgeon APO 956 IB August 1945 SUBJECT: Nutritional Analysis of CPBC Menus, TO % Surgeon Central Pacific Base Command APO 956 1„ In accordance with verbal request, nutritional analyses were made of the rations planned and issued at APO 957 for the month of June 1945o 2e As compared to the recommended allowances of The Surgeon General’s Office, the rations planned were adequate In all specific nutrientso The rations as actually issued, however, fell below the recommended standards in calcium Vitamin B]_ and vitamin B2o This was due to lack of acceptance by organizations of the full amounts of certain foods, notably evaporated milk, flour and vegetables, 3o Two measures currently under way will improve the nutritional situation: a, A new CPBC 15-day menu is being formulated which will incorporate new recipes to make certain foods more acceptable to the men, b. An active educational program at the School for Bakers and Cooks is stressing proper food preparation and the importance of using the full allowances of essential foods, 4® Since a new CPBC menu is being prepared, and since adequate surveys of the present menu have been obtained, it is suggested that the QM, CPBC, be notified that the submission of issue records for analysis may be discontinued for the present. Close liaison is being maintained with the Subsistence Officer, CHARLES D„ BUSS 1st Lt0 Sn, Co Nutrition Consultant 1 Incls Rat ion Analys is, APO 957, June 45. 197 HEADQUARTERS central pacific base command OFFICE OF THE SURGEON APO 958 RATION EVALUATED As Issued, June 1945 ORGANIZATION APO 957 FOOD CLASSES PER AVERAGE RATION -- AS As Pounds per Man per Day Planned Issued Meats 967 .353 (Pork) (.Ill) (.030) Eggs (fresh equivalent) 187 .177 Milk products (liquid equivalent) 739 .679 Butter 070 .067 Fats, other 075 ,066 Grain products .608 Legumes, dry .059 Sugars .313 Vegetables, leafy, green and yellow.... .294 Tomatoes .162 Citrus fruits 353 .326 Potatoes, white '.750 .631 Vegetables, other 329 .218 Fruits, other 339 .319 Fruits, dried 0& .025 TOTAL 5.909 4.797 NUTRITIVE VALUES PER MAN PER DAY— Corrected for estimated edible garbage loss of 10j£ AS AS Recommended Planned Issued Allowances Energy, Calories 4430. 3550. 3500. Protein, grams 132. 107. 70. Fat, grams 133. 16$. Carbohydrates, grams 549. 420. Calcium, grams 9 .7 .8 Phosphorous, grams 1.9 1.6 Iron, mgms 21. 12. Vitamin A, Int. Units 8360. $000. Vitamin mgms ...i... 3.0 2.2 11 " n (corrected)* 2.3 1.7 1.9 Vitamin B2, mgms 2.1 H u w (corrected)* 2.3 1.8 2.1 Nicotinic Acid, mgms 32. 2$. 11 n n (corrected)*,.., 26. 20. 19. V itamin C, mgms 150 117. n w n (corrected)* 105 89. 7$. *Corrected for probable preparation and cooking losses. COMMENTS: 1. The "As Planned" ration represents the food offered to the organizations; the "as Issued" represents the food accepted, 2. The considerable proportions of each food class that were not accepted by organizations at time of issue are reflected in the lowered nutrient intakes of the "As Issued" ration. The intakes of calcium, vitamin fl and vitamin B2 are below the amounts recommended by The Surgeon General. 199 LIST OF REFERENCES Chapter 36 1. Ltr to the Surg, USAPTCPA, fr Lt Col Y/m. E. Stozier, MC, subj: "Nourishment of Personnel at an Advanced Base,” dtd 23 May 44» (Incl No. 1) 2. Memo to Col K. H. Gates, MC, Deputy Surg, USAFPOA, fr Maj J. F. Maguire, MG, subj: "Weight Loss in Forward Area," undated. (Incl No. 2) 3. Address by Lt Col H. L. Meltzer, Me, CPBC Med Insp, undtd. (On file CPBC Surg Off, File No. 430 Subsistence #1, Ser. No. 28, page 8, 1945, OPEN) 4. Ltr to the Surg, CPBC, fr 1st Lt C. D. Buss, SnC> Nutrition Consul- tant, subj: "Nutritional Analysis of CPBC Menus," dtd 18 Aug 45» 5. Ltr to Hawaiian Dept Surg fr Maj Tell Nelson, MC, CO of First Sta Hosp, Station 634, subj: "Report on Use of Multi-Vitamin Capsules," dtd 18 Aug 42o (On file CPBC Surg Off, File No. 430, Subsistence, Ser. No. 9, 1942 #1, OPEN) 6. Ltr to Hawaiian Dept Surg fr Capt H. H. Zinneman, MC, Bn Surg, 102d Engr (C) Bn, APO 27, subj: "Avitaminosis Among Enlisted Person- riel," dtd 5 Aug 43o (On file CPBC Surg Off, File No. 441 Vitamins 1943, Ser. No. 11, OPEN) 7. Ltr to CG, 27th Inf Div, fr Col L. A. Bishop, CO, 105th Inf, subj: "Dietary Deficiencies," dtd 12 Nov 43- (On file CPBC Surg Off, File No. 430, Subsistence, Ser. No. 29, 1943, OPEN) 8. Ltr to the CO, APO 241, fr Lt Col B„ A. Nichol, MC, Surg, “subj: "Multivitamins Capsules," dtd 5 May 1944. (On file CPBC Surg Off, File No. 400.312, Requisitions-Marshalls, Ser. No. 14, FY 1944, APO 241, SECRET) 9» Ltr to CO, 156th S. H., APO 962, fr Maj E. P. Danforth, MC, Chief EENT Serv, subj: "Vitamin Deficiency in Troops," dtd 23 Jun 44» (On file CPBC Surg Off, File No. 400.312 Kauai District, Ser. No. 134, 1944, OPEN) 10. Ltr to CG, USAFMIDPAC, fr Maj W. B. Bean, MC, et al., subj: "Nutrition Survey in Arif Forces Middle Pacific," dtd 16 July 1945* (In MIDPAC Surg Off, File No. 430, Nutrition Survey Report in AFMIDPAC, 1945, OPEN) 200 CHAPTER 37 Environmental Disease (History of Preventive Medicine) There has been no significant incidence of environmental diseases in the Central Pacific* The climate is moderately warm and comfortable with very little variation. Cases of heat stroke and heat exhaustion have been very rare and have only occurred as a result of strenuous exercise in the direct sun. Cases of severe sunburn are not uncommon, but they occur only as a result of in- discretion in sun bathing. Cold injuries have been nonexistent. CHAPTER 38 Extra Military Sanitation and Liaison Activities (USPHS)* (History of Preventive Medicine) Section Is Headquarters Hawaiian Department (7 December 1941 to September 1943)« On 7 December 1941, the Territory of Hawaii was placed under martial law. The Commanding General, Hawaiian Department became the Military Governor of Hawaii. Full martial law over the Territory existed until March 1943, at which time certain civilian functions, including matters of civilian public health, were returned to the civilian government. During the period 7 December 1941, to March 1943, the Hawaiian Department Surgeon was responsible to the Military Governor of Hawaii for the investigation and determining of all factors which affected the health of civilians as well as military personnel, and for recommending and supervising measures for the control of disease and the provision of adequate medical care for the entire Territory. The magnitude of this responsibility was tremendous. The Territory had been attacked by the Japanese without warning« The land mass was small, and military personnel and civ- ilians necessarily worked in intimate contact with one another. The civilian population was over half Japanese, among them many eneiry aliens or individuals of dual, American and Japanese citizen- ship* Medical facilities were not adequate to care for the military and civilian casualties which could be expected in event of enemy invasion. Both Array and civilian hospital facilities to be ex- panded, blacked-out, and splinter-proofed* Materials, supplies, and personnel for the construction and operation of hospitals be- came critical, and decisions as to priorities had to be made. Troops previously in garrison moved to field positions largely on privately owned land, and satisfactory sanitary expediencies for them had to be provided and supervisedc Troop reinforcements arrived in large numbers to defend the Territory, and military camps and medical facilities expanded rapidly, particularly on the Islands of Hawaii, Maui, and Kauai. A large number of troop lacked training in field sanitation, and any deficiencies in either civilian or military sanitation affected both0 The United States Engineering Department hired large numbers of civilian 203 employees and established camps for feeding and housing them. The Office of Civilian Defense required supervision, and frequent inspections were necessary to insure that adequate provision had been made for civilian evacuation, housing, food and medical care in event of enemy attack or epidemic. Food and water supplies had to be protected against accidental or enemy contamination. Problems in waste disposal and mosquito and rat control developed because of labor shortages. For a period, private incinerators could not be used and large dumps could not bum through che night hours because of black-out restrictions. Dependents of military personnel and other civilians had to be evacuated to the mainland. Civilian Army and Navy employees began to arrive from the mainland to swell the City of Honolulu, Restaurant and rooming facilities became over crowded, and many temporary facilities opened with in- experienced operating personnel and inadequate equipment® The Territorial Board of Health was unable to adequately inspect and supervise these establishments without assistance from the Arny, Close liaison was necessarily maintained with the Territorial Board of Healtn, The rapid growth in the population of the City of Hono- lulu, with the introduction of numerous war workers and military personnel on pass who crowded restaurants and rooming houses, resulted in many sanitary problems. The staff of sanitary .in- spectors of the Territorial Board of Health became greatly under- manned, Many of the older inspectors of the Board of Health were alien Japanese who were now restricted in their activities, Every effort was made by the Board of Health to hire more in- spectors, but men with the necessary experience could not be found. It became evident that Army assistance was necessary if adequate sanitation was to be maintained. Upon the recommendation of the Surgeon, Hawaiian Department, a detachment of Medical Department enlisted men were placed on detached service to the Territorial Board of Health for sanitary inspection of civilian restaurants, rooming houses, and for other general purposes. These enlisted men were first given a course of instruction in sanitation by Medical Department officers, and then were placed with the civilian in- spectors of the Board of Health for practical experience* Approximately thirty of these technicians began routine inspection work in Honolulu in September 1942, Although the number of these inspectors ha£ gradually been reduced, and replacements have been added from time to time, this Army service has continued through September 1945o In March, 1943, when responsibility for the pro- tection of public health was transferred back to the civil govern- ment, a special request was made by the Civil Governor to the Commanding General, Hawaiian Department, for the retention of the 204 Army sanitary inspectors with the Board of Health for as long as the military situation would permit. In August 1944* when the 114th Medical Service Cotapany was activated, these sanitary techr- nicians were transferred from detached services from many different Medical Department units to the Table of Organization of that or- ganization, For the duration of full martial law the work of the Army sanitary inspector was very effective. Insanitary restaurants and rooming places were charged stiff fines by the Provost Courts, After March 1943s "the work of the sanitary inspectors in civilian establishments became largely educational, as convictions in civilian courts have been very hard to obtain® The rapid increase of Array, Navy and civilian defense work personnel on the Island of Oahu during the early part of the year 1942, greatly increased the demand upon the already over-faxed garbage and rubbish disposal facilities of the City and County of Honolulu,, To make matters worse, many employees of the City and County left their jobs to take defense jobs offering higher pay0 Black-out regulations had restricted the use of private incinerators and the burning of the large City and County dumps 0 These factors contributed to a generally prevalent insanitary situation on civilian properties, and resulted in increased breeding of flies, mosquitoes, and rodents* Particularly important was the definite increase in the rat population in Honolulu,, With the ever present menace that plague might spread to Honolulu from endemic foci on the Islands of Maui and Hawaii, this was considered a most dangerous situation,, Upon the recommendations of the Surgeon, Hawaiian Department, a complete study of the problem was undertaken by all interested military and civilian agencies0 As a result of this study, there was published Section II, General Orders No0 122, Office of the Military Governor, dated 1 July 1942 The use of private incin- erators by householders was encouraged with certain restrictions0 Regular garbage and rubbish collection service was provided,. All collected garbage and rubbish was to be disposed of by Incineration at the City incinerator or by hauling by railroad to the City’s remote dumping ground near Kaena Pointe Certain authorized dumps were established throughout rural Oahu, and it was directed that only these authorized dumps be used© These dumps were properly maintained, provision was made for burning and marked with signs reading ’’Official Rubbish Dump - By Order of the Military Governor”0 Necessary publicity was given to the locations of these dumps0 The Array contributed a pro rata share of the cost of preparation and maintenance of dumps and incineration facilities, according to Army use0 The disposal of suitable wet garbage to hog farmers by both military organizations and civilian establishments was encouraged. 205 The effect of General Orders #122 was a marked improvement in sanitation. Considerable work had to be done in cleaning up in- sanitary accumulations of rubbish at unauthorized locations. Much of this work was done by Army details. Many of the authorized dumps had large accumulations of unbumed combustible material which could not be burned during one daylight period. Special arrangements were made for burning these large accumulations on specified moonlight nights, after which burning during daylight was sufficient. In addi- tion to the remote dump location, a dumping site was located in the vicinity of Honolulu for the emergency disposal and burning of rubbish which could not be hauled in any one day by the railroad. Large amounts of rubbish of all kinds still remained in the backyards and vacant lots of the City of Honolulu, The civilian popu- lation was busy with war work, many leaving for work before dawn and returning to their homes after sunset. The rubbish collection trucks of the City of Honolulu were working at full capacity. Upon the recommendation of the Surgeon, Hawaiian Department, Section I, General Order #137, Office of the Military Governor, dated 11 Septem- ber 1942, was published, providing for a city-wide clean-up. The Army provided extra trucks and prisoner labor for the collection of the large amounts of extra rubbish brought to the curbstones. All householders were required to clean-up under penalty of fine not to exceed |100„00, So successful was this clean-up campaign that it was impossible to collect all the rubbish brought to the street dur- ing the month period allotted, -and Army assistance was continued for an additional two weeks. Amy liaison with civilian agencies in connection with gar- bage and rubbish disposal has continued. In 1943, General Orders #122 was rescinded, along with the return of responsibility for other public health matters to the civil government. Neverthe- less, the general scheme for Army-Civilian cooperation in the dis- posal of garbage and rubbish has continued in effect. In order to safeguard the sanitation of the various water- sheds on the Island of Oahu and to inform newly arrived troops of the regulations concerning entry into watersheds, Hawaiian Depart- ment Circular #132, 2? December 1942, was revised as Headquarters, Hawaiian Department Circular #43, dated 31 March 1943 and given wide distribution. The latter directive was again revised to include the other Hawaiian Islands and was republished 5 January 1945, as Head- quarters, CPBC, Administrative Order #1 (Index 700,90),* The Army has cooperated closely with civilian public health officials in the control of plague and rodents. 206 Plague was introduced to the Hawaiian Islands in Decem- ber 1899, as part of a large epidemic originating in China and spreading to India in one direction, and to Manila, Honolulu, and San Francisco in another,, From Honolulu, the disease spread to the principal parts of Hawaii, Maui, and Kauai during the succeed- ing five months* By 1906, evidence of both human and rodent plague had died out on Kauai, and by 1910, the disease had dis- appeared from Oahu,' Plague has remained endemic, however, in one area on Maui (Makawao-Paia) and another on Hawaii (Hamakua District), Sporadic cases of human plague have occurred. Since 1910, plague control in the Hawaiian Islands has been limited to these two areas. Prior to the war, plague control activities were carried on under the supervision of the Territorial Board of Health, with the financial assistance of the U, S, Public Health Service, the Hilo Shippers5 Wharf Committee, the Maui Quarantine Tax Fund Commission, and the Voluntary Tonnage Funds of the Chamber of Commerce of Honolulu, In 1941 the Board of Health had 68 full time personnel in anti-plague work. Of these the Board of Health provided funds for the employment of 39* the U, S, Public Health Service 14, and the other agencies 15• During the period of complete martial law, 7 December 1941 to March 1943, the Office of the Military Governor had co- ordinated Army and civilian activities in a clean-up of the City of Honolulu, and in a program for garbage and rubbish disposal for the Island of Oahu, The Territorial Board of Health had con- tinued its plague control program on the Islands of Maui and Hawaii, The clean-up on the Island of Oahu, particularly around Honolulu Harbor, had been considered as a protective measure against the introduction of plague into Oahu from the foci on the Islands of Maui and Hawaii, During the years 193&-1942 on Maui, and 1940-1942 on Hawaii, there were no cases of human plague reported, although the Territorial Board of Health found the continued presence of rodent plague. During March 1943, two cases of human plague occurred in the Hamakua District of the Island of Hawaii, The direct responsibility for the public health of the Territory had already been returned by the Military Governor to the Civil Governor, Nevertheless, the Commanding General, Hawaiian Department, in a letter to the Governor of the Territory, dated 3 April 1943, emphasized the importance of increased plague control activity on the Hawaii and offered whatever cooperation was necessary, ° During the next few months the plague control program was increased with the financial assistance of the Office of Civilian Defense, Fifteen additional personnel were employed for each of the plague More emphasis was placed upon rat control in and around human habitations in the Hamakua Dis- 1 trict, A third case of human plague occurred in the Hamakua District in April, a fourth in May, and a fifth in August. In August the Office of Civilian Defense announced that it could not continue financial support of the program much longer0 On 17 September 1943, the Commanding General, Hawaiian Department, wrote The Adjutant General, Washington, Dn C„, fully explaining the emergency and urging that representation be made t@ the Civil Governor t© provide additional anti-plague work be made available to him promptly, and that action be taken to insure continuation of a vigorous anti-plague campaign in the Territory of Hawaii' This letter was answered on 27 September to the effect that 'The Surgeon General had been informed of the situation and was making the necessary representations to the United States Public Health Service and the Department of the Interior,, The necessity for an Aedes mosquito control program for the Territory as a safeguard against the introduction of yellow fever was also referred to the War Department at about this same time, The solution reached in Washington was to set up United States Public Health Service, District No, 10, Terri- tory of Hawaii, for the coordination of Army and civilian activities and to provide United States Public Health Service personnel and funds as necessary for both a satisfactory rodent and Aedes mosquito control programo10 The Senior Surgeon for the new District arrived in the Territory in November 1943, and a specialist, in rodent and plague control in February 1944o A complete study of the rodent and plague situation on Maui and Hawaii was accomplished, and radical changes in the program resulted,, The Hamakua plague campaign force was doubled, with the expansion of personnel from 45 to 93 employees0 The Office of Civilian Defense continued to support the program until June 1944, the Civil Governor provided funds through September 1944, and the United States Public Health has provided the funds through September 1945« A total of 11 human plague cases had occurred in the Hamakua District of Hawaii by April 1944, at which time the majority of the inhabitants were given immuniza- tions against plague. From April 1944, through September 1945, there -have been only two additional human cases, A tabulation of human and rodent plague cases by years is shown below; Plague Cases in Hawaiian Islands Year Maui Human Rodent Hawaii Human Rodent 1941-42 0 1 0 54 1942-43 0 7 4 157 1943-44 0 8 7 63 1944-45 0 ’I 2 31 208 During the fiscal year 1944-45, the personnel employed in plague control activities were as follows: Hawaii 8? Maui 49 Oahu 6-20 Kauai 7 A total of 339,535 rodents were retrieved during the fiscal year 1944-45: Hawaii (Hamakua District) 151,800 Hawaii (Hilo) $9,789 Maui 60,505 Kauai 4$,$29 Oahu 21,912 Total 339.535 Along with changes made in the rodent control program, more adequate facilities were set up on Hawaii for the accurate bacteriological diagnosis of plague and for the isolation and treatment of cases. The necessary supplies and apparatus for the improvement of the plague laboratory at Honokaa, Hawaii, were loaned to the Territorial Board of Health by the Array, Two Army laboratory technicians were assigned to institute the necessary bacteriological work under the direction of the County Health Officer®11 The services of an Array pathologist were provided to accomplish the necessary autopsies„ In addition to this assist- ance, the Array has provided 50 gallons of dimethyl phtnalate and 2000 two-ounce cans of insecticide powder for the protection of personnel working on the plague control program in the endemic area® The Array has provided additional personnel for the operation of plague laboratories on the Islands of Oahu and Kauai® The purpose of these laboratories has been to examine all rodents brought in for evidence of plague infection® Many thousands of rodents have been examined, but none have been found infected with plague on these islands® On Oahu, the Army has provided one enlisted technician, and on Kauai, one pathologist and two technicians, part time® An Army rat trapping crew has been provided for the necessary assistance to the Territorial Board of Health in a rat control pro- gram for Honolulu Harbor, This crew consisted of four enlisted men from October 1943* through April of 1944* In May 1944, the crew was increased to ten enlisted men. This service has been continued 209 up through September 1945« The history of the dengue epidemic in the City of Hono- lulu has been fully described in CPBG ETMD reports to The Surgeon Generalo A program was jointly set up by the Territorial Board of Health, the Honolulu Chamber of Commerce, the U0 Se Public Health Service, and the Army* For most of the period of the epidemic, one epidemiologist visited and conversed with all reported civilian and military cases0 Often whole neighborhoods of unreported cases were discovered through the exchange of information between patients and the epidemiologist or visiting nurses. In the majority of cases the source of infection could be guessed with some accuracy* Usually the source of infection was outside the home premises, in one of the known foci of dengue infected mosquitoes in Honolulu0 Information on several cases in a neighborhood often lead to the discovery of foci of dengue in neighborhood stores and the discovery of cases in the storekeepers8 families* All this information was reported to the mosquito control organization, and intensive breeding surveys and disinsectizations were accomplished in accordance with the epidemiological leads, Army nurses played a large role in the control program, substituting for the overworked public health nurses in almost all home visits to dengue patients,, These nurses contributed materially to the working out of the epidemiologic picture, In revisiting the patients during convalescence the nurses were able to complete the individual case records upon which statistical data concerning the duration of disease , symptoms and signs were compiled* Dengue fever had broken out so explosively in Honolulu despite considerable control effort, there was continued concern in 1943-44 that it would spread to other towns and villages0 During the latter part of November 19435 three cases of dengue occurred in the town of Wahiawa, Oahu* The source of infection of these cases was probably Honolulu, nevertheless it appeared possible that secondary foci would be set up« A regular Aedes control pro- gram was established for Wahiawa in November 1943s continuing through March 1945» Wahiawa was considered especially important to the Array because of the large numbers of military personnel frequent- ing the town from Schofield Barracks* No definite secondary foci of infection have ever occurred in Wahiawa, despite a considerable number of imported cases from Honolulu* It is not clear what factors operated to prevent this* Temperatures frequently drop below 70°F in Wahiawa during the night* This may have been a factor* One secondary focus did occur on Kauai* Three or four secondary cases of dengue occurred in the area of Eleele-Hanapepe-Pt* Allen, Kauai, during November and December 1943• Vigorous breeding control measures and 210 spraying of insecticide in infected neighborhoods resulted in an end of new cases0 All travelers to the other Hawaiian Islands from Oahu were educated by the airlines as to their responsibility in preventing the spread of dengue virus0 In early 1943* the Air Corps began setting up camps on Kauai, Maui* and Hawaii as well as Oahu, for the recuperation of combat fliers0 Many of these fliers were returning by air travel from the Gilbert Islands where dengue was epidemico The possible effect of the arrival of these airmen on the various islands appeared to be of more concern in the spreading of the dengue virus to susceptible mosquito and human populations than civilian travel* With the arrival on Oahu of three colored medical sanitary companies in February 1943* it became possible to extend the Aedes control program to all of rural Oahu and to Kauai, Maui, and Hawaii0 Two of these companies were trained in Aedes mosquito control by officers of the U0 S0 Public Health Service working with the Territorial Board of Health on dengue control (the third company was trained in rodent control by the Surgeon, Hq USAFICPA, for rodent control on military posts and piers)* After a sufficient amount of class-work* the Aedes control personnel were given practical training by assigning a few of them to each of the Honolulu Aedes control inspectors for several days of routine inspecting* Before being sent to another island, Aedes control personnel were assigned to work an area in rural Oahu for a week9s period, where their work was carefully supervised* The one dis- advantage to the use of the sanitary comparer personnel in Aedes mosquito control work has been their color* This has been in no way connected to any inadequacy in the quality of their work, but solely because Aedes control inspectors must usually meet the lady of each house and enter the house to inspect for interior breeders (statis- tics show that one-quarter of all Aedes breeding places are inside dwellings)0 There has been a certain amount of prejudice against and fear of negroes even in the Hawaiian Islands* Nevertheless, these troops proceeded with their work without too much complaint, except on the Island of Maui* On Maui there was sufficient com- plaint by civilians for the Commanding General of the Maui District to order the program discontinued in July 1943o Except for the one small secondary focus of infection on Kauai, no other foci occurred outside Oahu* There was a case in the City of Hilo which was im- ported from Oahu, and vigorous prophylactic measures were taken in the neighborhood, including a careful survey of all Hilo for Aedes breeders* Six cases of dengue were reported from Hana, Maui* but careful appraisal resulted in the decision that they were cases of simple nasopharyngitis* As the original medical sanitary companies have been assigned to combat other companies have been received from the mainland and trained to continue the work, however, the number of companies available for use in the Hawaiian Islands has gradually declined® The Aedes control program on Hawaii, which was begun during March 1944, was discontinued during September 1944o The program on Kauai, which was begun late in March 1944, was discontinued during November 1944® The program in rural Oahu has been continued up through September 1945® Some of the contributions of the Army to the dengue and Aedes control efforts were as follows:1^ 1, In August 1943s five enlisted mosquito control technicians and three (3) Chemical Warfare Service decontamination trucks and their crews for a week’s periodo 2« In September 1943, fifty (50) additional enlisted personnel for Aedes mosquito control inspections0 3» From September 1943* until April 1944* the services of a medical officer as epidemiologist0 4o In October 1943, additional enlisted personnel and 14 light truckso A smaller number of trucks had been loaned beginning in September0 5» In November 1943, additional enlisted personnel to a total of 68„ 6« Beginning in November 1943, 6 Army nurses„ Nurses were relieved from duty with the Board of Health in proportion to the decline in dengue cases0 One nurse remained until January 1945« 7o In December 1943, additional enlisted personnel to a total of 86, 8„ For the year, 1944, enlisted personnel as follows: 212 Rural Period Honolulu Oahu Kauai Maui Hawaii Total (a) 1-15 January 1944 95 95 (b) 15-31 January " 95 95 (c) 1-15 February ,f 99 99 (d) 15-29 February 11 99 99 (e) 1-15 March 11 78 78 (f) 15-31 March " 146 58 41 43 57 345 (g) 1-15 April " U6 58 41 43 57 345 (h) 15-30 April " 132 58 41 43 57 331 (i) 1-15 May « 140 58 41 43 57 339 (j) 15-31 May « 148 58 41 43 57 347 (k) 1-15 June 11 U8 58 41 43 57 347 (1) 15-30 June » 90 58 41 43 57 289 (m) 1-31 July " 85 63 41 43 57 288 (n) 1-31 August H 85 109 41 0 57 292 (o) 1-30 September'* 84 77 40 57 258 (p) 1-31 October " 77 77 40 194 (q) 1-30 November 11 77 77 40 194 (r) 1-31 December n 74 77 151 9. For the year 1945, enlisted personnel have been as follows: Period Honolulu Rural Oahu Total (a) Januaryl945 79 44 123 (b) February 1945 7S 4 82 (c) March n 77 46 123 (d) April " 69 69 (e) May M 67 60 127 (f) June M 65 60 125 (g) July " 64 60 124 (h) August n 70 60 130 Until August 1944, all military personnel on duty with the Territorial Board of Health to carry out the Aedes control pro- gram had all been made available on detached service from various Medical Department units on an emergency basis. These Medical Department units had their respective missions to perform and were handicapped by the absence of the large numbers of personnel on detached service. The Board of Health had made every effort to recruit civilian personnel to replace the military Aedes control inspectors, but without success. In January 1944, the Commanding 213 General, USAFICPA, had requested authorization from the War Depart- ment to form a special sanitary battalion of Array personnel to support the Territorial Board of Health*1'' A proposed T/O & E for this special sanitary battalion was attached to the letter of request. The battalion provided an organization to which the Array enlisted personnel already on duty with the Territorial Board of Health as sanitary and dengue inspectors could be assigned,, It also pro- vided additional personnel for rodent control and expansion of the Aedes control program for rural Oahu, and the Islands of Hawaii, Maui, and Kauai* The need for an extensive Aedes mosquito control program had been the subject of numerous letters between the Command- ing General, USAFICPA, and the Assistant Secretary of War, particular- ly in connection with the possible use by the enemy of yellow fever as an offensive weapon* 14 15 16 In October 1943> the United States Public Health Service, l)istrict No* 10, Territory of Hawaii, was set up. It was the plan of the War Department that the Senior Surgeons assigned thereto could achieve a solution to the problems of mosquito and rodent control in the Territory*1' Decision as to further action of the War Department was deferred pending study of the problems in the Territory by the newly appointed Director, United States Public Health Service, District No* 10,18 Report of these studies was submitted 1 January 1944, * including outlines of proposed programs for mosquito and rodent control. It was stated by the Director, USPHS District of Hawaii, that "in neither case, however, has it appeared even remotely possible that these expanded programs can be operated by the Terri- torial Board of Health through assistance now available from the Public Health Service, since personnel for the operation of the pro- grams are not available in the Territory through civilian employment channels*al° Nevertheless, the request for a special sanitary battalion made by the Commanding General, USAFICPA, in his letter to the Adjutant General, dated 1 January 1944* was disapproved by 1st indorsement thereto, dated 2 February 1944, with the advice that further investiga- tion be made into the possibilities of procurement from civilian sources on the mainland of the required labor to support the proposed program. It is believed that every effort was made by the Territorial Board of Health with the assistance of the United States Public Health Service to obtain civilian personnel for this work, however, it has been necessary for the Array to continue to provide personnel for the con- tinuation of the Aedes control program. The problem of continuing Army support to the Territorial Board of Health for sanitation and Aedes control in Honolulu was solved in August, 1944, with the activation of the 114th Medical Service Company*20 21 Personnel so long on detached service from Medical Department units of the theater for the purpose of carrying on this work were absorbed by T/0 of the 114th Medical Service Company, The Public Health Committee of the Chamber of Commerce of Honolulu is an active public agency in the Territory, controlling 214 considerable funds for the support of worth while measures for the betterment of health. These funds result from a voluntary tax collected on a tonnage basis from all vessels using Honolulu Har- bor. A representative of the Hawaiian Department Surgeon has worked closely with this committee since 19 A2# In 1944-> the Hono- lulu Chamber of Commerce began to foster committees for the study of problems of post-war health planning. At the request of the Chamber of Commerce a representative of the Surgeon, CPBC, was appointed as a member of two subcommittees, the subcommittee on Mosquito Control and the subcommittee on Rodent Control of the Post-War Planning Committee of the Chamber of Commerce.22 As a result of the work of the subcommittee on Mosquito Control a plan was drawn up for a post war Aedes control organization for the Territory, this organization to be entirely supported and operated on a civilian basis and to relieve the Army supported organization. According to this plan the Aedes control organization would operate as a separate division of the Bureau of Sanitation of the Territorial Board of Health on a biennium budget of 1268,056.00.23 The major Aedes control activity would take place in Honolulu, with a small program in Hilo. It was considered that these cities would be the most likely points of entry of Aedes-borne diseases into the Terri- tory, According to the plan, the Honolulu organization would serve as a mobile force to proceed to any area in the Territory and set up prompt Aedes control measures, wherever necessary. It is expected that this plan will be presented to the Civil Governor of the Terri- tory during early October 194-5, with the hope that it will receive his support through a large Contingency Fund under his control. The next meeting of the Territorial Legislature will take place in 194-7. The presentation of this plan to the Civil Governor is timely, since the Army will probably be unable to provide Army personnel for Aedes control in Honolulu very much longer with the radical reduction in critical point discharge scores. The new plan provides for only 23 inspectors with additional foremen, but it is expected that cer- tain new Aedes control techniques involving the use of DDT, developed during the present program, will allow considerable saving in man- power, 24- In January 1944* the Surgeon, Headquarters USAFICPA, brought to the attention of the Commanding General the existence of a number of grossly insanitary rooming houses in the City of Honolulu which were serving Army and Navy enlisted personnel on pass. Sanitary inspections of these establishments showed crowding of cots tightly against one another in basements, the use of cots by two men, the provision of soiled bed linen, bedbug and cockroach infestation, and filthy surroundings and toilet facilities. High prices for the overnight rental of such facilities prevailed, due to 215 the scarcity of accommodations in Honolulu. Similar action was taken by the Surgeon, 14th Naval District, in notifying the Commandant, 14th Naval District, Complaint was made of these con- ditions in an exchange of correspondence between the Commanding General, USAFICPA, and the Civil Govdmor of Hawaii in February, 1944, in which it was noted that the Territorial Board of Health was taking action to correct the deficiencies.xt was reported by the Military Police that even with all of the established recreation facilities such as Array Navy YMCA, The Recreation Center at Fort DeRussy, and the USO Club on King Street in Honolulu, plus the insanitary tenements, many enlisted men walked the streets or slept on porches for want of accommodationsc To meet this need the Army, in May 1944, opened a hotel for enlisted men in Honolulu sufficient for the accommodation of 325 Further action in connection with the tenements was not taken by the Amy, The Navy established a continuous program of inspection of these places by the Shore Patrol and published lists of approved and disapproved establishments for the guidance of Navy personnel. In 1945, the Nayy arranged with the United States Public Health Service, Dis- trict of Hawaii, for the spraying of certain of the approved es- tablishments with DDT spray as a protection against bedbugs. It was the opinion of a sanitary officer of the that the program of surveillance of these establishments by the Share Patrol was of definite benefit to Navy personnel and of some assistance to the Navy venereal disease officer. A Joint Army-Navy Disciplinary Control Board was established in Honolulu in February 1945• The original members of t he board were appointed by SO 37, HQ USAFPOA, 6 February 1945• The first meeting of the board was held on 14 February 1945* The investigations leading to complaints considered by the Board were carried out by various different agencies. The military police furnished a large share of the evidence on prostitution and on exorbitant prices charged by amusement centers and concessionaries, A Joint Board investigating team was set up to inspect restaurants, tattoo parlors, barber shops and other establishments where sanitary inspections were considered necessary. The investigating team consisted of a sanitary officer from the 14th Naval District Medical Office, a medical officer from the Medical Inspector's Section of the Surgeon's Office, GPBC, and the Supervisor for Sanitation for the Island of Oahu of the Territorial Board of Health, Several meetings of the board were held to plan a course of action. It was felt that the most pressing need was to bring prices in line in amusement areas and to suppress clandestine prostitution. After investigation by military personnel, the Board recommended and the Commanding General, USAFPOA, and the Commander in Chief, POA, placed 37 Amusement Centers and 15 hotels and rooming houses off limits as of noon, 3 March 1945o This move caused consider- able comment in the local press, and news stories., editorials and letters 216 to the editor were published. The Territorial legislature was in session at the time and proposals were introduced upon the floor to investigate the cause of the action by the military. Several protest meetings were held by the owners of the affected estab- lishments. The desired clean-up and lowering of prices was ob- tained fairly rapidly. Establishments were placed back on limits after the board had satisfied itself, generally by personal in- spection, that reasonable prices had been established in amuse- ment centers, and that adequate supervision was present to suppress prostitution in rooming houses. Shortly after this, a campaign to clean up the restaurants and eating places frequented by military personnel was started. The investigation team visited each restaurant referred by the Territorial Board of Health or other sources as insanitary and inspected it. Deficiencies were pointed out to the owner orally, and the request made that the deficiencies be remedied. Most owners were willing to close up and clean up. Some were uncooperative, in which case a report was made to the Joint Board. The Board then recommended that the establishment be placed "off limits”. In the meantime, the Board of Health wrote a letter to the owner of the uncooperative establishment citing deficiencies and requiring them to be corrected. After an establish- ment had met Board of Health requirements, and was operating for civilians, it was again inspected by the joint team. If the sani- tary conditions were satisfactory, the recommendation was made by the team to the Disciplinary Board that the establishment be again placed on limits. The Board then recommended to the Commanding General, USaFPOA, and Commander in Chief that the establishment be placed on limits. The Joint Team also inspected installations selling foodstuffs, mainly baked goods, to the Services, Standards were set up for tattoo parlors, and excellent cooperation was obtained. No attempt was made to clean up barber shops. The Board of Health has no sanitary regulations for them. 217 FEDERAL SECURITY AGENCY U. S. PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report August 1945 I. Monthly Summary A. Dengue Fever Cases—Non-military Cases acquired within Territory 0 Cases "off-shipping” 0 B. Control Program—Territory-wide (as covered in this report) No. of premises inspected 53,917 No. of preiaises breeding Aedes 1,022 Total personnel engaged in program 165 News of the definite conclusions of war with Japan did not materially affect the program except for a loss of man-days. It is expected that the program will be continued on the present scale until the major redeployment of troops in the Pacific has been completed. II. Control Activities in Honolulu A, Inspection Activities The city-wide Aedes breeding index in Honolulu was 1.7$ on August 15 and 1*2% ~on August 31. At the end of August, 3 zones had indexes above 5% and 7 zones had indexes above 3%* The Aedes breeding indexes for the 20 critical zones vary as follows: (Zone 25D was dropped from critical zone list,,) 0.0$ - 0*5% — 12 0.6 - 1.0 — 4 1.1 - 1.5 — 4 \ Following is a summary of the August inspection activities: No. of premises inspected 45,695 No. of premises breeding Aedes 641 Aedes breeding index on August 31 1*2% No. of inspections per man-day 45.1 Incl. 1 B, Special Work 1. Larviciding Activities a. Motorcycle larviciding unit The following mosquito breeding places were sprayed with 317 gallons of diesel oil with the motorcycle larviciding unit: catch basins and storm drains 15940 ground pools 45 cesspools 4 ditches and streams 16 swamps 4 bomb shelters 2 pillboxes 2 fishponds 2 b. Larviciding by inspection foreman The following mosquito control places were larvicided with 36 gallons of diesel oil by the inspection foreman during Augusts catch basins and storm drains . B ground pools 22 cesspools 4 ditches and streams 1 fishponds v 2 c. Power larviciding The Power Sprayer was used to larvicide Pauoa and Pukoi streamso Ninety-five gallons of diesel oil were usedc Two new Hardie power-spraying units were received from Malaria Control in War Areas, Atlanta, Georgia,, These units are expected to make the power larviciding activities more efficient and dependable, 2, Clean-fUp Activities The clean-up detail from the 760th Medical Sanitary Co, continued to cover certain sections of the city on a house-to-house basis collecting all tin cans, bottles, and other potential breeding containers. In carrying out this activity, 192 man-days work were expended and 64 loads of containers were removed from the areas covered. 220 In addition to the above clean-up activities, 13 loads of containers were removed from premises in abating 18 referral slips0 117 old tires were collected for dis- posal 3, Special Activities a0 Fish stocking 7 fishponds were stocked with mosquito fish b0 Roof gutters 7 roof gutters were cleaned and repaired c0 . Inspection of USED Base Yards and Waterfront Areasa Records of regular Inspections of USED Base Yards and Waterfront areas were lost when the regular inspector was transferred,, The Surgeon :s Office of the Army Port, and Service Command responsible for mosquito breeding in the USED Base Yards received a considerable amount of DDT0 Assistance and instructions have been pro- vided by this office for the most practical use of DDT in the Base Yards * Present operations call for t he spraying of all stored equipment and places - where water might collect, with 5% DDT kerosene spray0 Only that equipment which cannot be restacked so it will not hold water is being treated. All tarpaulins used to cover equipment are being treated also. At least, 02 cf a gram of DDT is applied per square foot of area treated, During August, 3 Base Yards were covered using 30 gallons of the DDT spray, d. Rock-hole and tree-hole filling During the month of August, 118 rock-holes and tree-holes were filled with cement0 C0 Cooperative Program with the Board of Health, Bureau of Sanitation, Sanitary Inspection Division0 During the month of August, 8$ referrals were submitted covering sanitary defects noted by the mosquito control inspectors to the Bureau of Sanitation, Inspection Division, for abatement„ During August, 72 referrals were abated by the Sanitation Divisions Inasmuch as the Board of Health has lost many of its sanitary inspectors, the back-log of referrals submitted to be corrected has increased. 221 D, Drainage Improvement, At our instigation, the City and County of Honolulu Road Department constructed an 18 inch drain in 700 feet along Makini Street to Campbell Avenue, Previously, a natural storm-drain from Diamond Head flowed across a city block from Makini St, creating a prolific Culex breeding spot. While this was normally a dry run, weekly drainage from the Pt, Ruger swimming pool maintained a continuous problem. £• Personnel Field Total Amgr (Average) 67 70 U.S, Public Health Service 21 30 Total —m 100 During the past three months, there has been a considerable turnover in the ranks of the Army personnel assigned to the Honolulu program. During this period, 34 men were lost and 33 gained with 23 lost during August and 29 gained in August. These were given complete technical and field training. Of the number of men lost, three were supervisors; six, foremen; and four, assistant foremen. III Rural Oahu Personnel—60 Inspection activities were continued in rural Oahu by the detachment assigned to the Dengue Mosquito Control Program from the 76Oth Medical Sanitary Company. As noted under the clean-up activities of the Honolulu program, 192 man-days were expended by the clean-up detachment in Honolulu, The follow- ing is the summary of the inspection activities for the period July 16-31 and the month of August, July 16-31, 1945 July 16-31, 1945 No. Prem. Aedes Man-Days Town Prem. . Breed. Breed. in Insp, Aedes Index Field Aiea 506 1 0.1 19.0 Ewa 1,078 15 1.3 28.5 Haleiwa 201 4 1.9 8.0 Kailua 328 4 1.2 11.0 Kaneohe 229 7 3-0 10.0 Lanikai 246 2 0.8 6.0 Pearl City 263 5 1.7 10.5 Wahiawa 1,939 16 0.8 51.5 Waialua Walnanalo 185 1 0.5 5.0 Waipahu ... 1.399 4 0.2 50.0 Totals 6,394 59 — 199.5 August 1-31, 1945 Town Noo Prem„ Aedes Man-Days Preaio Breed* Breed* in IngPo Aedes Index Field. Aiea 1,285 4 0.3 46o 5 Ewa 1,244 6 0o5 33.0 Haleiwa 642 3 0.5 23.5 Kailua 622 6 1.0 22o0 Kaneohe 415 12 2.9 23.0 Lanikai 466 3 0.6 u.o Pearl City 539 12 2.2 21.0 Wahiawa 1,539 13 0.8 4io0 Waialua 1,818 6 0.3 52o0 Waimanalo 376 3 0.8 12.0 Waipahu 1,444 12 0.8 45.0 Totals 10,390 80 nnmrm 330.0 IV. Hilo, Hawaii Program Personnel—-5 Regular control activities on the Hilo Program are tabulated as • follows for the month of August: s NOo of premises inspected 2,832 No. of premises breeding Aedes 301 Aedes breeding index on July 31 10«6$ Culex breeding index 1.7$ • No. of containers inspected 11,594 NOo of containers breeding Aedes 671 General container Aedes breeding index . 5 <>8$ V. Public Education A. School Program Conferences were held with the Department of Public Instruction Health Section on the preparation of material for mosquito lectures by the Public School System0 B0 News Releases During the month 7 column inches of English and 4 column inches of foreign language news articles appeared in local papers. 223 VI* Entomological Work A. Light traps mosquito collections The report from tne quarantine officer covering the Use of the five light traps on loan from Malaria Control in War Areas for the month of July "was received,, Traps were located at the Kalihi Leprosy Investigations Laboratory,, Ekahanui Gulch, Kaneohe, Ewa Air Station, and Hickam Field, In all areas, a consistent catch of Culex quinquefasciatus was made* B* A field trip was made by the Assistant Sanitarian (R), David D, Bonnet, on ?/ednesday, August 27, with Major Webb of the ISth Medical General Laboratory and Capt0 Wirth, USPHS Quarantine Division to Mta Kaala,;' the highest mountain on the Island of Oahu, This mountain rises to an elevation of 4,040 feet and has a large amount of standing water in the ancient crater near the summit „ No adult mosquitoes or mosquito breeding was observed at this elevation, and it is doubtful that the three species found in the Territory of Hawaii ewr ranged to that altitude* G* The mosquito control laboratory at the request of Surgeon5s Office, GPBC, has undertaken to provide larval and adult Aedes aegypti and Aedes Albopictus to the entomological section of the IBth Medical General Laboratory, POA, under Major Webb for starting cultures and experimental purposes* D« Routine Activities 1, Approximately 650 mosquito larvae samples collected by the inspectors on the program were examined and identified* 2* Approximately 25,000 phenothiazine strips were prepared during the month* Respectfully submitted. /s/ Arve H0 Dahl Arve H, Dahl P0 A, Sanitary Engineer (R) i/c Dengue Mosquito Control 224 FEDERAL SECURITY AGENCY U0 So PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report, July 1945 I* Annual Summary for 1944-1945 Fiscal Year During the 1944-1945 fiscal year the Dengue Mosquito Control Program in the Hawaiian Islands was continued to maintain a safe Aedes mos- quito population to prevent a recurrence of the 1943 epidemic. Sporadic cases of dengue fever were reported throughout the year, all occurring in Honolulu, However, due to the low Aedes aegypti and Aedes albopictus populations, no general outbreak occurred® The following statistics have been summarized for the years No« of dengue cases * 25 Total no® of premises inspected 922,778 Total no, of premises breeding Aedes 11,238 Total nc0 of tree holes filled 17*325 Total no, of rock holes filled 5*343 Total no, of truck loads hauled by cleanup crews 661 Monthly Summary A0 Dengue Fever Cases—Non-military Cases acquired within Territory 1 Cases rloff-shipping” 0 B. Control Program—Territory-wide (as covered in this report) No, of premises inspected 51*068 Noo of premises breeding Aedes 878 Total personnel engaged in program 158 Ill, Control Activities in Honolulu A0 Inspection Activities The city-wide Aedeg breeding index in Honolulu was 1*1$ on July 15 and 1«1? on July 31• At the end of July, 4 zones had indexes above 5$ and 7 zones had indexes above 3$„ The Aedes breeding indexes for the 21 critical zones vary as follows; 0.0% - 0*5% — 11 0(»6 — X«0 — 5 1.1 — 1.9 —* 5 Following is a summary of the inspection activities: No, of premises inspected 45*523 No. of premises breeding Aedes 507 Aedes breeding index on July 31 1,1^ No, of inspections per man-day 41 *8 B, Special Work I, Larviciding Activities a0 Motorcycle larviciding unit The following mosquito breeding places were sprayed with diesel oil with the motorcycle larviciding units catch basins and storm drains 1*906 ground pools 43 cesspools 8 ditches and streams 19 swamps b bomb‘shelters L pillboxes 2 fishponds 3 A total of 425 gallons of diesel oil was used in these larviciding activities,, Any body of standing water is referred by the inspectors to this larviciding unit. This unit then takes care of this referral until the problem is corrected and needs no further larviciding. Until correction is made, visits are made every 12 days, b. Power larviciding The Power Sprayer was used to larvicide the (Dili Rd, ditch, Sheridan St, ditch and the Akolea Rd, ditch twice during the month. 100 gallons of diesel oil were usedo 2* Adult Spraying Activities Only premises around the one reported case of dengue were sprayed using Sure-shot sprayers containing Pyrocide 20 propelled by Freon gas0 3* Clean-up Activities The clean-up detail from the 760th Medical Sanitary Company was used to cover certain sections of zones which have been showing an increase in breeding. They have covered these areas on a house-to-house canvass collecting all tin cans, bottles and other potential breeding containers. In carrying out this activity, 440 man-days were expended and 89 loads of containers were removed from the areas so covered. 226 In addition to the above clean-up, 2? loads of containers were removed from premises in abating 30 referral slips* There are still a great number of old tires in the city of Honolulu and during the month of July, 134 were collected and disposed of* 4* Special Activities a8 Fish stocking One fishpond was stocked with fish b. Roof gutters Six roof gutters were cleaned and repaired c* Inspection of USED base yards and waterfront area Complete inspection of 58 USED base yards were madec Aedes breeding was found in five yards 38 complete inspections were made in the waterfront area and no mosquito breeding was found* Two medical corpsmen assigned to the Surgeon3s Office of the USED were given training in AEDES mosquito control with special emphasis on methods and procedures used in covering the USED base yards* d0 New warehouse A prefabricated building, 163 x 40®, was received from the U.S* Army for use by the Dengue Mosquito Control Program* This building was set up on the property of the Territorial Board of Health garage* It will be used as a storage ware- house and special crew operations center* A total of 22 man-days were expended in erecting this warehouse and pre- paring it for operations* Co Co-operative Program with the Board of Health, Bureau of Sanitation, Sanitary Inspection Division Under this co-operative program 40? referrals have been submitted since the program was started to the Bureau of Sanitation Inspection Division0 Approximately 50% of these have been abated* This figure is considered quite satisfactory inasmuch as there is a lag of approximately 3 to 6 weeks in obtaining correction of the referrals0 D„ Court Case on Mosquito Control The first court case solely on a violation of mosquito control ordinance. Section 73 of the Rules and Regulations of the Board of Health, Territory of Hawaii, occurred in July* The offense was based upon the establishment of an Aedes mosquito breeding place by improper construction of an ice storage house. Water drained through the floor and collected in a pool in which Aedes mosquitoes bred. In addition to the above offense, six other instances where Aedes mosquito breeding was found on the premises were used as evidence, These instances were recorded upon the householder notices of which a copy is kept on file and served as court evidence. The fine imposed by the court consisted of |25oOO and 15 day sentence suspended for 13 months with orders to clean-up his premises immediately. E, Elimination of Mosquito Breeding on the Waialae Golf Course For some time a normally dry run, Kapakahi Stream, has been a running stream due to effluents from many hog farms. The effluent ponded along the flat dry run providing excellent habitat for the breeding of Culex quinquefasciatus, A meeting was held June 28 with 26 hog "farmers of the Kapakahi district at which methods of proper disposal of their wastes were discussed. The methods recommended involved the use of their pig-pen washings for irrigation purposes in the field each farmer maintained for the growing of fresh grass for his animals. Two methods used were (1) main ditches with laterals and (2), contour ditches 2-1/2 feet deep. Mosquito breeding on the premises is controlled by the great amount of lime spread upon the ground and in the water to keep down odors and fly breeding. F, Personnel Field Total Army 61 64 U0Stt Public Health Service 20 TOTAL a " 93 ~ 17. Rural Oahu Personnel— 60 Inspection activities were continued in rural Oahu by the detachment assigned to the Dengue Mosquito Control Program from the 760th Medical Sanitary Company,, Following is a summary of the inspection activities for the first 15 days of July„ (A report- on activities for the period July 16-31 has not been tabulated in time for this report-e) 228 No, Prem0 Aedes Man-Days Prem„ Breed, Breed, in Town Ingj)o Aedes Index Field Aiea 436 9 2,0 15 Haleiwa 211 4 1„8 9.5 Kailua 366 5 1*3 13.0 Kaneohe 209 8 3.8 IloO Lanlkal 2 43 1 0o4 6.0 Pearl City 319 7 2.1 9.5 Waialua 443 2 0.4 11.5 Wainanalo 191 ii. 4o0 zuh§ 39 79.5 In addition to the above activities, the clean-up crew which is a part of the entire detachment was used on the Honolulu Programs V, Hilo, Hawaii Program Personnel—5 Regular control activities on the Hilo Program are tabulated as follows for the month of Julys NOo of premises inspected 3«12*7 No* of premises breeding Aedes 362 Aedea breeding index on July 31 „ Ho6/6 No* of premises breeding Culex 0 Culex breeding index 0% Noa of containers inspected Noa of containers breeding Aedes 828 General containers Aedes breeding .Index No0 of inspections per man-day 4X®1^ In addition to the regular Inspection activities, 10? rock and tree holes were permanently corrected by filling and 3 ground pools ware filled with sande Vic Public Education Ac School Program Since all schools in the Territory of Hawaii closed during June there is no monthly report covering this activity* Dis- cussions are being carried on with the Department of Public Instruction to determine what course this activity shall take during the next school yeare 229 In reviewing the program for the past fiscal year,it is signifi- cant to note the amount of work in the schools participating in this program. Students in 49 schools on the Island of Hawaii and 21 schools on the Island of Maui participated. The follow- ing is a summary of all the inspections made during the year by the students? Hawaii Maui No. of students reporting No. of wet containers found No, of containers with wrigglers 663 268 143,206 47,320 23,054 35,984 8,269 B. News Releases During the month 10 column inches of English and 5 column inches of foreign language news articles appeared in local papers. VII, Entomological Work A, DDT Investigations Control of Aedes Breeding in Vine Bowls One test not previously reported consisted of the addition of 1 cc of DDT in 95$ Ethyl alcohol which was added to one pint of water in a vine bowl. This is equivalent to a dosage 5 times that which has been recommended by laboratory experiment. The only treatment occurred on March 1 and the vine bowl has been periodically tested to determine the residual kill of Aedes albopictus fourth instar larvae. On March 27, April 3, April 11, April 20, May 11, June 1 and June 11 the larvae were killed within 24 hours. On July 20 the vine bowl did not kill introduced larvae. This is a residual period of approximately 20 weeks. The test was not primarily to determine the residual time but to observe the effect upon the Philodendron plant growing in the vine bowl. The plant continued to grow and showed no different growth than did the control which was kept under the same conditions without DDT, The control plant was tested simultaneously with the experimental container and in each of the above-mentioned dates the larvae remained alive. B. Routine Activities 1, Approximately 500 mosquito larvae samples collected by the inspectors on the program were examined and identifiedo 2o Approximately 54,000 phenothiazine strips were prepared during the month. Respectfully Submitted, /s/ Aire H* Dahl Arve Ho Dahl PoAo Sanitary Engineer (R) i/c Dengue Mosquito Control 230 FEDERAL SECURITY AGENCY U, S, PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report June 1945 I o Monthly Summary A, Dengue Fever Cases—Non-Military Cases acquired within Territory—7 Cases "off-shipping”—0 B, Control Program—Territorywide (As covered in this report) No, of premises inspected 52,392 No, of premises breeding Aedes 921 Total personnel engaged In program 156 C, School Program The June report from the County Health Officer on the Island of Hawaii and the May and June reports from the Acting Health Officer on the Island of Maui covering the school mosquito control program are summarized as follows s No« of students reporting 16^26# No, of wet containers found 25*68? No, of containers with wrigglers 7*075 Details of these reports will be found under V9 Public Educa- tions of this report. II, Control Activities In Honolulu P, A, Sanitarian (R) Bertram Cross,, who was formerly supervisor of the Honolulu has been transferred to the position of Acting Health Officer of the Island of Kauai as of June 2S 1945• The duties formerly performed by Mr, Gross will be handled by P0 A0 Sanitary Engineer (R) Arve H„ Dahl assisted by Assistant Sanitarian (R) David D„ Bonnet, Seven more positive cases of dengue were reported during the month of June in Honolulu, Special inspectional and adult spraying pre- cautions as noted in the May narrative report were continued. 231 Complicating the dengue picture was the occurrence of a flu epidemic in which a good many of the symptoms have been similar to those of dengue. Inasmuch as some dengue cases may have been reported as flu, spray activities have been continued wherever adult Aedes mos- quitoes have been found. The last two positive cases were reported on the 14th and l?th of June* A, Inspection Activities The citywide Aedes breeding index in Honolulu was 1,4$ on June 15 and 1*3?" on June 30, At the end of June,, 3 zones had indexes above 5$ and 9 zones had indexes above 3$, Zones 25-D and 25-E were added to the list of critical zones inasmuch as one of the positive cases of dengue occurred in Zone 25-E and many military personnel frequent these two zones. The Aedes breeding indexes for the 21 critical zones varied as follows? 0o0$ - 0,5$ — 7 0«6 - loO — & 1*1 = 1 © 9 —° 5 4 *5 — 1 Following is a summary of the inspection activities? No, of premises inspected 44<,&50 No, of premises breeding Aedejs 6,19 Aedes breeding index on June 30 1*3$ No, of inspections per man-day 41*3 B, Special Work 1, Larviciding Activities A change was made during the month of June in the method of handling larvicidal problems. The checking and oiling of all places requiring regular larviciding were put on the list to be handled by the motorcycle larviciding unit. The following mosquito breeding places were sprayed with diesel oil with this units catch basins-—>746 ground pools—>30 cesspool s-~—22 ditches and streams—14 swamps— bomb shelters-—>1 pillbox— 1 A total of 270 gallons of diesel oil was used in all larviciding activities, 232 The motorcycle Servi-car which has been used up to this time on the program broke down beyond repair during the month. The temporary loan of a machine was made from the U. S, Coast Guard, It is hoped that a permanent replacement can be made of the old unit within the next two months. 2, Adult Spray Activities Special emphasis was placed on the activity in order to minimize the danger of possible secondary cases of dengue. Pyrethrum sprays have been used almost exclusively for this work, a, Outdoor spraying A total of 333 premises were sprayed, using 400 gallons of pyrethrum emulsion spray. The Hardie orchard type sprayer was used for this work. b. Inside spraying Approximately 100 homes were sprayed with sure-shots using Pyrocide 20 propelled by Freon gas. One school containing 92 rooms, and 2 theaters containing 722 and 1,087 seats respectively, were also sprayed, using Pyrocide 20 diluted with 3 parts of kerosene using an atomizing nozzle and a power sprayer. 3. Clean-up Activities Due to the great number of containers placed in the cemeteries on Memorial Day, the first week in June was used to remove all tempo- rary containers from the cemeteries. Both clean-up crews were used on this activity.' A total of 37 loads of containers were removed from the 30 cemeteries taken care of. Letters were written to the caretakers in advance requesting that the containers be stacked by access roads in order that they could be picked up without delay. When the pick-up was made a special squad combed each cemetery, removing all additional temporary containers that could be found. In addition to the above clean-up, 7 loads of containers were removed from premises in abating 14 referral slips; 13 loads of containers were removed from vacant lots. 4. Special Crew Activities a. Fish stocking Eight fish ponds were stocked with fish. 233 b. Roof gutters Thirty-two roof gutters were cleaned and repaired, c, Inspection of USED base yards and waterfront area Complete inspections of 30 USED base yards were made, Aedes breeding was found on 5 yards. Thirty-eight complete inspections were made in the waterfront area and no mosquito breeding was found. G. Personnel Field Total Army 62 65 U,S, Public Health Service 18 26 Total 80 91 D. Co-operative Program with the Board of Health* Bureau of Sanitation* Sanitary Inspection Division0 Efforts have been made to coordinate the activities of the dengue mosquito control organization and the sanitation inspectors of the Board of Health,, Under an agreement reached in conference with Mr, B, J, McMorrow* Director* Bureau of Sanitation and Mr, George Robert- son* Division Supervisor* Oahu* a coordinated program for abating both sanitary and mosquito problems was worked out0 A directive was issued by Mr, McMorrow covering this agreement0 The following main points were included in his directives lo ''Dengue mosquito control inspectors* during their premise-to- premise inspections* will observe premises for the following insanitary conditions; overflowing cesspools* improperly covered cesspools* leaking plumbing and broken sewers* heaps of garbage or rubbish on private premises and improper garbage containers at food handling establishments„" 2, "Whenever one or more of these conditions is observed* the in- spector will refer them, to the Oahu inspection staff," This section provides for the handling of these referrals* abatement by the sanitation inspector and notification of the mosquito control section of the abatement of these nuisances. This section will include difficult problems of mosquito control which require the issuing of abatement orders by the Board of Health and provides for quicker abatement of these problems. It will assist the sanitation inspectors by minimizing the area he must travel in order to locate the common sanitaiy nuisances, 234 3, Any general complaints regarding mosquitoes shall be referred to the Officer in Charge of the dengue mosquito control. This program has been in operation since May 1. To date a total of 242 referrals have been submitted to the sanitation inspectors,, of which 145 have been abated. III* Rural Oahu Program Personnel—60 Inspection activities were continued in rural Oahu by the detachment assigned to the dengue mosquito control program from the 760th Medical Sanitary Company, The following is a summary of the inspection activities: No, Prem, Aedes Man-Days Prem, Breed, Breed, in Town Lisp, Aedes Index Field Aiea 922 17 2,8 32.0 Ewa 1368 8 t3 35.5 Haleivra 407 10 2,3 17.5 Kailua 644 15 .9 23.0 Kaneohe 454 17 2.7 22.0 Lanikai 464 12 1.2 12,0 Pearl City 720 14 1.4 24.0 Waialua 835 10 .8 24.0 Wahiawa 2310 26 1.1 56.0 Waimanalo 375 2 13«0 Waipahu 1S61 id'isr 150“ 1.4 315.0 The three inspections! teams have been kept at full strength by making replacements from the clean-up crew. This arrangement was made to maintain regular inspectional cycles even though several inspectors may be absent from one crew due to sickness or pass, A high caliber of work has been performed by this entire detail. The clean-up crew removed 4 loads of containers from cemeteries in rural Oahu and took care of 4 clean-up referrals during June, The balance of the craw!s time was utilized in Honolulu on similar work. IV« HilOj, Hawaii Program Personnel—5 Regular control procedures on the Hilo program were inaugurated during June following the completion of the training of the 4 new inspectors. 235 Transportation was assigned to the unit by the County Health Officer in order to facilitate the inspectional operations. The following is a summary of the inspectional activities for the month of Junes No, of premises inspected I, 732 No9 of premises breeding Aedes 210 Aedes breeding index on June 30 12,1$ No, of premises breeding Culex 4 Culex breeding index 0,20$ No, of containers inspected 75336 No, of containers breeding Aedes 3&5 General container index 5*0$ V, Public Education A, School Program The following table is a summary of the reports from the Island of Maui for the months of May and June and for the Island of Hawaii for the month of Junes Hawaii June Maui Maj June No, of schools reporting 49 19 H O No, of students in the 4th grade and up H.071 7,198 4,063 No, of students reporting 7* 90S 5,306 3,054 No, of containers found 13 <> S69 8n 008 3,810 No, of containers with wrigglers 4a664 r,626 785 Container breeding index 33*6 20,3 20.5 Container breeding index for previous month 32,0 26,4 20.3 B, News Releases During the month 53 column inches of English and 27 column inches of foreign language news articles appeared in local papers. It is the aim of the publicity section to have at least two articles a week on mosquito control in each of the two main Honolulu papers which receive territorywide distribution. VI, Entomological Work A, DDT Investigations A series of 5 coca-cola bottles were treated continuously over a period of three weeks with DDTe These bottles were taken to the 236 local coca-cola bottling works for refilling. It was found that during the washing, sterilizing and filling process all traces of DDT were removed. B, Routine Activities 1, Nine hundred mosquito larvae specimens from all sections of the city were examined and identified. 2. Approximately 21,500 phenothiazine strips were prepared for use in the Honolulu Control program. C, A New Jersey light trap was placed in operation at the Kalihi laboratory during the latter part of June. This trap is approximately 3 miles from John Rogers Airport and the Naval Air Station, Honolulu. It is being operated in conjunction with the Quarantine Division of the U, S. Public Health Service. D, An hour's talk on dengue and other insect— borne diseases in Honolulu was presented to the officers of the 18th General Medical Laboratory, Uo So Army. This talk was well received and was followed by a dis- cussion of the general situation in Hawaii, Respectfully Submitted, /s/ Arve H, Dahl Arve H. Dahl PoA« Sanitary Engineer (R) i/c Dengue Mosquito Control FEDERAL SECURITY AGENCY U. S. PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report May 1945 I, Monthly Summary A. Dengue Fever Cases—Non-military Cases acquired within Territory—2 Cases "off-shipping"—0 B. Control Program—Territorywide (As covered in this report) No, of premises inspected 54,669 No, of premises breeding Aedes 920 Total personnel engaged in program 161 C. School Program The May report from the County Health Officer on the Island of Hawaii and the April report from the Acting Health Officer on the Island of Maui on the school mosquito control program are summarized as follows: No, of students reporting 15,22? No, of wet containers found 27,522 No, of containers with wrigglers 8,257 Details of these reports will be found under V, Public Education, of this report. II* Control Activities in Honolulu The importance of Aedes mosquito control activities in Honolulu were re-emphasized with the occurrence of two proven cases of dengue noted as acquired in the Territory of Hawaii, Following the report of these two cases special precautions were taken which included spraying the inside of premises and places where the patients visited during the infectious period of the disease. The exterior of premises surrounding the cases were also sprayed for adult kill. In each case special investigations were made for larval breeding and intensified larval inspections were made by the inspection crews in each particular zone. This policy has been carried out with each dengue suspect as soon as reported, whether proven or not. 239 During the month of May final checks on the use of DDT as a larvi- cide for Aedes mosquito control were made and one crew was equipped with applicators using a suspension of DDT, Details of this method will be found under VI, Entomological Work, of this report. A, Inspection Activities The citywide Aedes breeding index in Honolulu was 1,8$ on May 15 and 1,3$ on May 31* At the end of May, 12 zones had indexes above 3$ and 6 zones had Indexes above 5$* The Aedes breeding indexes for the 19 critical zones varied as follows: .0$ - ,5$ — 8 .6 - 1.0 — 3 1.1 - 1.5 — 5 1*6 - 2.3 — 3 Following is a summary of the inspection activities: No, of premises inspected 48,942 No, of premises breeding Aedes 789 Aedes breeding index on May 31 1.3$ No, of inspections per man-day 44o5 B, Special Work 1. Larviciding Activities The following mosquito breeding places were sprayed with . diesel oils catch basins—24 ground pools—20 ditches—9 pillboxes—6 bomb shelters—4 cesspools—3 The motorcycle Servi-car was used to larvicide 282 catch basins, 2, Tree and Rock Hole Filling A total of 752 tree holes were filled, of which 21 or 2,7$ were found breeding. Two hundred forty-nine rock holes were filled, of which 12 or 4»8$ were breeding. In addition, 25 bamboo stumps and 183 pipe holes were filled, 3* Clean-up Crew A total of 16 loads of containers were collected and hauled away, of which 7 were from the Central district, 1 from the Kapahulu district and 8 from the Lanakila district. 240 The 760th Medical Sanitary Company clean-up crew which returned to work on May 17 cleaned out the badly overgrown Pauoa Stream between Vineyard and Lusitana Streets, Twelve loads of containers were removed from this stream. x 4. Fish Stocking Twenty barrels and one fish pond were stocked with mosquito minnows during May, 5. Inspection of USED Base Yards and Waterfront Area Complete inspections of 37 USED base yards were made, AEDES breeding was found 16 times. Forty couplete inspections were made in the waterfront area, Aedes breeding was found 2 times, C, Personnel Field Total Army 67 67 Chamber of Commerce 2 4 U, S, Public Health Service 19 29 Total 88 100 Ill, Rural Oahu Program Personnel—60 The 760th Medical Sanitary Company resumed inspection activities in rural Oahu on May !?• Three inspectional teams were formed and operations expanded to cover towns on windward Oahu, namely, Kaneohe, Kailua, Lanikai and Waimanalo0 The following is a summary of inspection activities in rural Oahus No. Prem, Aedes Man-Days Prem, Breed, Breed, in Insp. Aedes Index Field Aiea 386 6 1.5 13 Ewa 865 14 1.6 25 Haleiwa 200 2 1.0 7.5 Kailua 374 11 2o9 16 Kaneohe 246 9 3.6 9 Lanikai 205 10 4.8 7 Pearl City 49 2 8 1.6 12.5 Waialua 504 4 o? 13 Wahiawa 950 1? 1.8 19 Waimanalo 174 4 2.2 6.5 Waipahu 812 16 1*9 21 Total 5208 • 101 149.5 241 IV, Hilo, Hawaii Program Personnel—1 Inspectional activities were carried on by the foreman during the month of May. Four inspectors were recruited and will report for duty on June 1 for training and regular inspectional work under Mr, Munro. Following is a summary of inspectional activities for the month of Mays No, of premises inspected 519 No. of premises breeding Aedes 30 Aedes breeding index on May 31 V, Public Education A, School Program The following table is a summary of the reports from the Island of Hawaii for the month of May and the Island of Maui for the month of Aprils Hawaii Maui MSJC April No, of schools reporting No. of students in the 4th grade 49 21 and up 12,658 8,204 No, of students reporting 9,004 6,223 Per cent of students reporting 71* 75* No. of containers found 17,764 9,758 No. of containers with wrigglers 5,679 2,578 Container breeding index 32,0* 26PU% (Container breeding index for previous month) 32.7* 22.3* B, News Releases During the month 10-1/2 column inches of English and 5 column inches of foreign language news articles appeared in local papers. VI. Entomological Work A, DDT for Aedea Mosquito Control It is hoped that DDT will prove to be the ideal larvicide for Aedes mosquito control. Laboratory and field tests using DDT have been run on the mosquito control program. The following is a report of preliminary tests to determine satisfactory methods of application. 242 In order to minimize damage to water-holding plants, it was decided to avoid hydrocarbon solvents and to utilize the DDT in emulsion form. Initially, an emulsion of DDT containing approximately 1$ of Vatsol was used to stabilize the emulsion* It was found, however, that solutions of Vatsol alone would kill plants. Consequently, this form of solution was limited, A subsequent test utilizing DDT in alcohol indicated that no damage occurred in the plants which are constant sources of Aedes mosquito breeding* These tests are summarized below; A vine bowl containing approximately one-half pint of water was treated with 1 cc, of 1-1/2$ DDT in alcohol* The water in the vine bowl was tested at regular intervals by observation of the mortality after 24 hours of introduced larvae. After 4 months the kill remained at 100$, The vine growing in the bowl has shown no adverse effects, A control of vine bowl showed no mortality. Pineapple lilies, spider lilies and ape plants were treated at the base of each leaf and no adverse effects were found on the plants after one month. Tests of breeding in the pineapple lilies were carried out similar to the above test and 100$ mortality was obtained after 4 months. A 55 gallon barrel was treated with 1 cc, of l-l/2$ DDT in alcohol and although first instar larvae were observed after 20 days, fourth instar larvae were not observed until 44 days after treatment, A control barrel contained all stages of larvae on all dates of observation. A series of tin cans were similarly treated and 100$ control was obtained through 4 months of observation. The only adverse effect was the presence of extensive corrosion in the tin cans treated with DDT, The observations of residual effect are being continued. The method of application that was decided upon was the use of an Eagle #66 Super Oiler which enables the operator to apply a control dosage of approximately 1 cc. The solution that is applied consists of a suspension of 6 grams of DDT dissolved in 400 cc, of 95$ Ethyl alcohol mixed with approximately 1600 cc, of water. This gives a final concentration of ,003 grams per cc. After mixing, this suspension is milky in color and finely dispersed. However, on standing the suspension produces large, soft flucculent particles which partially settle out. This flucculent precipi- tate does not interfere in the use of the applicator and tests to deter- mine kill and residual effect have shown this suspension to be satisfactory. A preliminary trial of the use of these applicators by the inspectors was , made in the Buckle Lane area of zone 8-B, The applicator and the methods set up have appeared satisfactory on the basis of this preliminary trial. No difficulty was experienced due to failure of the guns to operate. No containers were encountered which could not be treated. Treated containers have been observed and no breeding has been found after being deliberately left containing water after treatment* All evidence at hand points to the present method as a highly practical means of utilizing DDT in the control of Aedes mosquitoes, ' The only limitation to date is the high toxicity of DDT to fish$ hence fish ponds and fish bowls are not treated. 243 All other water containers* wet or dry, natural or artificial* are being treated with approximately 1 cc, of the suspension per pint of water. Bo Rainfall Data Included with this report is a graph showing the average rainfall in inches for each week from February 16, 1944 to April 17, 1945. On the same sheet is graphed for the same period the citywide Aedes breeding index for the periods ending the first and fifteenth of each month and the total man-days worked semi-monthly. This is a continua- tion of the previous graphs presented in the narrative reports of December 31* 1943 and April 30, 1944 with the total man-days worked semi-monthly graph added. VII, Miscellaneous A, Manpower Reference is made to the total man-days worked semi-monthly curve on the rainfall-Aedes breeding index graph included with this report. It is significant to note that there has been an approximate 40 per cent reduction since August 1944. Special efforts are being made to increase civilian personnel* the number of which have also declined, along with the number of military personnel assigned to this program. However* the supply of adequate civilian personnel is still limited* according to the Civil Service Commission* and no great increase in personnel from this source is anticipated. Respectfully submitted. /s/ Arve H, Dahl Arve H, Dahl P0 A, Sanitary Engineer (R) i/c Dengue Mosquito Control 244 mrinmwtffgwiE }] :.;Kainfaui. in nche.s , r#t l i: yi r TnTffRT ttl-H-Wr-— : moNouj^i— Index II Ra>NFAUU in . HONC UIl I mmiismwm FEDERAL SECURITY AGENCY U, S„ PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report April 1945 X. Monthly Summary A. Dengue Fever Cases—Non-military Cases acquired within Territory—0 Cases 11 off-shipping"—0 B. Control Program—Territorywide (As covered in this report) No, of premises inspected 38,724 No, of premises breeding Aedes 604 Total personnel engaged in program 102 C. School Program ’ Reports from the County Health Officer on the Island of Hawaii on the school mosquito control program are summarized as follows: No, of students reporting 8*893 No, of wet containers found 19,250 No, of containers with wrigglers 6*303 A more detailed report on the school program will be found under V* Public Education* of this report. The report on the Maui School Report was not received in time to be included. II. Control Activities in Honolulu A. Inspection Activities The citywide Aedes breeding index in Honolulu was 1,2$ on April 15 and 1.7$ on April 30. At the end of April* 6 zones had indexes above 3$ and 2 zones had indexes above 5$° The zones having indexes above 5$ are located in Nuuanu Valley and the Upper Fort Street area. The Aedes breeding index for the 19 critical zones at the end of April varied as follows: 0.0$ - 0.5$ — 8 zones - 0o6£ - 1.0$ — 4 " 1.1$ - lo5$ — 5 " 1.6$ - 2.5$ — 2 0 Following is a summary of the inspection activities: No, of premises inspected 38*404 No, of premises breeding Aedes 587 Aedes breeding index on April,30 1.7$ No, of inspections per man-day 46,2 B, Special Work le Larviciding Activities The power sprayer was used to larvicide the swamp next to Lanakila School and King and Liliha Streets, In addition, the following mosquito breeding places were sprayed with diesel oil: . storm drains—22 ground pools—18 bomb shelters—14 ditches—8 pillboxes—-6 fish ponds—3 swamps—2 cesspools—2 The motorcycle Servi-car was used to larvicide 915 catch basins, 2, Insecticide Spraying The power sprayer was utilized in spraying seven premises in the Kapahulu district, 3* Tree and Rock Hole Filling A total of 6?4 tree holes were filled, of which 37 or 5.4$ were found breeding. One hundred eighty-six rock holes were filled, of which 6 or 3«2$ were breeding. In addition, 35 bamboo stumps and 16 pipe holes were filled, 4* Clean-up Crew A total of 16 loads of containers were collected and hauled away, of which 4 were from the Central district, 4 from the Kapahulu district and 8 from the Lanakila district, 5 • Fish Stocking Seven barrels, 5 fish ponds, 1 swamp and 1 ditch were stocked with mosquito minnows during April, 246 6. Inspection of USED Base Yards and Waterfront Area Complete inspections of 23 USED base yards were made, Aedes breeding was found 10 times. Thirty-two complete inspections were made in the waterfront area, Nc Aedes breeding was found, C, Personnel Field Total Army 69 69 Chamber of Commerce 2 4 U. S. Public Health Service 19 28 TOTAL 90 101 III. Wahiawa and Rural Oahu Programs These two programs were consolidated towards the end of March to be operated under the ?60th Medical Sanitary Company, On April 1 an urgent military need arose which necessitated the transferring of this company to other work. It is anticipated that they will be returned to this program to continue the Wahiawa and rural Oahu programs on or about May 15. IV* Hilo. Hawaii Program Personnel—1 Mr. Arthur Munro, foreman of the Hilo mosquito control project, carried on regular inspection activities as a part of his train- ing* From April 9 through April 14 Mr. Munro was given special training.in Honolulu in preparation for hiring the inspection crew for the Hilo program. It is anticipated that Mr, Munro will train these inspectors under the supervision and direction of P. A. Sanitary Engineer (R) Bernard B. Berger, County Sanitary Engineer. Following is a summary of inspection activities for the month of April: No, of premises inspected 320 No, of premises breeding Aedes 1? Aedes breeding index 5»3% V, Public Education A, School Program Only reports from the schools on the Island of Hawaii are available on the school Mosquito Control Day conducted in cooperation with the Department of Public Instruction on the 247 Islands of Hawaii and Maui during the month of April. The following table is a summary of the reports from all schools reporting: No. of schools reporting 44 No, of students in 4th grade and up 12,110 No, of students reporting £,£93 Per cent of students reporting 73$ No, of containers found 19,250 No, of containers with wrigglers 6,303 Container breeding index 32.7$ (The container breeding index for March—35•9$) B. News Releases During the month 32 column inches of English and 16 column inches of foreign language news articles appeared in local papers. VI. Miscellaneous A. Entomological Experiments were continued on the use of DDT for Aedes mosquito control. Respectfully submitted, /s/ Arve H, Dahl Arve H. Dahl P.A, Sanitary Engineer (R) i/c Dengue Mosquito Control FEDERAL SECURITY AGENCY U, S. PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report March 1945 I. Monthly Summary A* Dengue Fever Cases—Non-Military Cases acquired within Territory—2 Cases "off shipping"—0 B, Control Program—Territorywide (as covered in this report) No, of premises inspected 65,647 No, of premises breeding Aedes 850 Total personnel engaged In program 158 During the month of March control activities were expanded to include six towns in rural Oahu and Hilo, Hawaii, C, School Program Reports from the County Health Officers on the Islands of Hawaii and Maui, on the school mosquito control program, are summarized as follows; Number of students reporting 14,949 Number of wet containers found 31*185 Number of containers with wrigglers 9* 813 A more detailed report on the school program will be found under VI, Public Education of this report. II. Control Activities in Honolulu A. Inspection Activities The citywide Aedes breeding index in Honolulu was 1,6% on March 15 and 0*9$ on March 31« At the end of March, 8 zones had indexes above 3% and 5 zones had indexes above 5%, The location of zones having indexes above 3% are as follows? one in upper Kalihi Valleys three in Nuuanu Valley above Judd Streets and one in Manoa Valley behind the University, 249 The Aedes breeding index for the nineteen critical zones at the end of March varied as follows; 0,0$ - 0.3$ — 15 zones 0.6$ - 1,0$ — 3 11 1.6$ 1 " Following is a summary of the inspection activities; Ne.of premises inspected 57*278 No. of premises breeding Aedes 732 Aedes breeding index on March 31 0.9$ No. of inspections per man-day 52.6$ B. Special Work 1. Tree and Rock Hole Filling A total of 50? tree holes were filled, of which 10 or 2$ were found breeding. One hundred forty-one rock holes were filled, of which 6 or 4$ were breeding. 2. Larviciding Activities The power sprayer was used to larvicide swamps on Kalauokalani Way and Kalakaua Avenue, back of the Church of the Crossroads, back of 625-B Waiakamilo Road and a stream on Aukoi and Oili Roads, In addition, the foil own- ing mosquito breeding places were sprayed with diesel oil; ground pools—23 catch basins—16 ditches—9 cesspools—B bomb shelters—4 fish ponds—4 The motorcycle Servi-car was used to larvicide 73& catch basins. 3. Insecticide Spraying The power sprayer was utilized in spraying the area around Royal Hawaiian Hotel* An area bounded by Kapalama Canal, School Street, Palama Street and King Street which consistently contained a high number of secondary breeders was also sprayed. Approximately, 1,135 gallons of insecticide were used. 250 4. Clean-up Crew A total of 6 loads of containers was collected and hauled away, of which 1 was from the Central District, 2 from the Kapahulu District and 3 from the Lanakila District, The clean-up crew of the 760th Medical Sanitary Company detailed for mosquito control cleaned out 900 feet of a tributary to Kapalama Canal, hauling 12 loads of containers to the dump. On Pauoa Stream 400 feet of ditching in the stream bed were cleaned and 4 loads of containers were hauled away, 5. Fish Stocking Twenty-one barrels and 5 fish ponds were stocked with mosquito minnows during February, 6. Inspection of USED Base Yards and Waterfront Area Complete inspections of 29 USED base yards were made, Aedes breeding was found six times. Seventy-six complete inspections were made of the waterfront area. No Aedes breeding was found. C, Personnel Field Total Array 77 77 Chamber of Commerce 2 4 Uo S„ Public Health Service 19 30 Total 9S 111 III. Wahiawa Program Personnel—4 The citywide Aedes breeding index in Wahiawa was 0,6$ in mid-March, and 0,4$ at the end of the month. Following is a summary ©f the inspection activities for March; No, of premises inspected 1*642 No, of premises breeding Aedes 9 Aedes breeding index on March 31 0,4$ No, of inspections per mart-day 43•! 251 IV, Rural Oahu Program Personnel—42 The training of the 760th Medical Sanitary Company in dengue mosquito control was completed on March 3- Control operations in rural Oahu were started on March 5 with control crews in Waipahu and Aiea, Forty- two men have been assigned to work on the dengue mosquito control pro- gram to form three inspection crews of eight men each, leaving eighteen men for special activities to include larviciding, clean-up and other activities as needed. The clean-up crew was assigned temporarily to take care of a back log of specific clean-up jobs in Honolulu, The following is a summary of the inspection activities carried on in the towns listed in rural Oahu: Prem, Aedes Prem. Breed, Breed, No, Insp. Insp, Aedes Index Per Man-Day Aiea 1254 18 0.9 26 Ewa 1601 5 0.2 47 Pearl City 816 15 0.4 17 Waipahu 189V 11 0.4 32 Waialua 158 — — 45 Haleiwa Totals 226 8 3.5 20 V. Hilo. Hawaii Program Personnel—1 The foreman hired for the Hilo program has been carrying on regular inspection activities as a part of his training. The following is a summary of the results of his inspection activities carried on under the direction of P„ A, Sanitary Engineer (R) Bernard B, Berger, County Sanitary lihgineer: February 15-28 March No, of premises inspected 127 479 No, of premises breeding Aedes 14 3S Aedes breeding index 11,0^ 7.9% VI. Public Education A. School Program The school Mosquito Control Day being conducted in cooperation with the Department of Public Instruction on the Islands of 252 Hawaii and Maui were carried out as planned on the first Friday of March, The following table is a summary of the reports from all schools reportings Hawaii Maui March Feb. March No, of schools reporting 45 12 21 N©„ of students in 4th grade and up 12,565 3,415 8,061 No, of students reporting 8,954 2,376 ' 6,095 % of students reporting 71* 69* 75* No. of containers found 20,956 4,179 10,229 No. of containers with wrigglers 7,528 995 2,285 Container breeding index 35.9 23.7 22,3 As the first summary report for Maui was not in at the time the February narrative report was written, the results are included in the foregoing table. B, Film Two copies of the film ’Miss Skeeter Goes to Town” were received from the "Malaria Control in War Areas" office in Atlanta, Georgia, Local comments by health officials are to the effect that this picture is one of the best health films yet made. Arrangements have been made to send this film to public schools through the Director of Health Education of the Board of Health, The program was inaugurated by showing the film at a preview of health depart- ment films given for the Department of Public Instruction and other community organizations interested,, To date the film has been shown to four schools having an approximate enrollment of 1,260 students. Other showings have been at the Kapahulu Health Center in Honolulu and the Rat and Mosquito Control Committee of the Honolulu Chamber of Commerce, C, News Releases During the month 40 column inches of English and 20 column inches of foreign language news articles appeared in local papers. D, Radi® A local radio station broadcast in its daily news program included the occurrence of the two dengue cases in Honolulu as. soon as they were reported by the Board of Health. 253 VIII, Miscellaneous A. Entomological Work Experiments were continued to determine the factors which must be known before DDT can be used as a larvicide on routine inspection activities, B, Kahuku, Oahu Survey A request was received for information r egarding the Aedes mosquito population near the Kahuku Air Strip, In a special survey made on March 22, 169 premises were inspected and no Aedes breeding was found. It was learned that this area had not had a prolonged rain since December 1944* As a result, containers which ordinarily could be expected to contain water were dry. Respectfully submitted, /s/ Arve H, Dahl Arve H. Dahl P, A, Sanitary Ihgineer (R) i/c Dengue Mosquito Control 254 FEDERAL SECURITY AGENCY U. S. PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report February 1945 I. Monthly Summary A. Dengue Fever Cases—Non-Military Cases acquired within ’Territory—0 Cases "off shipping"—0 B. Control Program—Territorywide (As covered in this report) No, of premises inspected 54,804 No, of premises breeding Aedes 578 Total personnel engaged in program 122 Regular control activities during the month of February were limited to the Island of Oahu, Inspection activities were carried on only in Honolulu and Wahiawa, The figures quoted above for the control program do not include the results of the school Mosquito Control Day, Results of the fourth complete report on the Island of Hawaii will be found under IV, Public Education, of this report. II. Control Activities in Honolulu V\ A, Inspection Activities The citywide Aedes breeding index in Honolulu was 1,2$ on February 15 and 0.9$ on February 28. At the end of February, 3 zones had indexes above 3$ and there were no zones with indexes above 5$« The 19 critical zones in Honolulu are being worked on a 10-12 day cycle while the average inspection cycle for the remaining 58 zones is somewhat less than 24 days. Inspection results for the month of February show .that the breeding index for the 19 critical zones was 0.5$ while that for 53 of the non-critical 255 zones was 1,2$, Following is a summary of the month’s activities: No, of premises inspected 52,476 No. of premises breeding Aedes 566 Aedes breeding index on February 2B 0,9$ No, of inspections per man-day 49*3 B, Special Work 1* Tree and Rock Hill Filling A total of 1,503 tree holes were filled, of which 21 or 1,4$ were found breeding. Five hundred sixty-eight rock holes were filled, of which 4 or 0,7$ were breeding. In addition, 331 upright pipes were filled,, 2, Larviciding Activities The power sprayer was used to larvicide swamps on Damon Estate in Moanalua Gardens and Damon Tract near D* Road; the stream next to Waialae Golf Course; and the area near 462 Hobron Lane, back of Lanakila School, Kam Highway, Middle Street and Sheridan Street, In addition, the following mosquito breeding places were sprayed with diesel oil: ground pools—14 storm drains—12 cesspools—11 ditches—3 3, Storm Drain and Catch Basin Larviciding The motorcycle (Servi-car) which has been laid up for repairs for the past few months was placed in operation during February to larvicide catch basins, storm drains, etc. The spraying is accomplished by means of a regular spray can shut-off nozzle supplied by a rubber hose from the 25-gallon pressure oil tank mounted above the rear axle of the machine. Approximately 15 gallons of oil are added to the tank and pressure is obtained by using com- pressed air at service stations. The main section covered is between the waterfront and Beretania Street from Fort Street to Ward Street in which there are approximately 600 storm drains and/or catch basins to larvicide, a great many of which continually hold water. Other sections of the city which have similar problems will be covered in a minimum of time with this machine. During February 570 storm drains were larvicided. 256 4. Roof Gutters The roof gutters on 13 premises were corrected during the month. 5• Clean-up Crew A total of 32 loads of containers were collected and hauled away, of which 7 were f rom the Central District, 3 from the Kapahulu District and 22 from the Lanakila District, 6, Fish Stocking Five fish ponds, two swamps and ten barrels were stbcked with mosquito minnows during February, 7* Inspection of USED Base Yards and Waterfront Area Complete inspections of 29 USED base yards were made, Aedes mosquitoes were found 3 times. Fifty-three complete inspections were made of the waterfront area. No Aedes breeding was found, C, Personnel Field. Total Army 78 78 Chamber of Commerce 3 6 U. S, Public Health Service 23 34 TOTAL 104 118 Ill, Wahiawa Program Personnel—4 The citywide Aedes breeding index in Wahiawa was 0,5% in mid-February, No Aedes breeding was found for the latter part of February, This is the first semi-monthly period in which no Aedes breeding was found since the start of the control program and reflects the fine spirit of cooperation from the householders in that community. Following is a summary of the inspection activities for February: No, of premises inspected 1,131 No, of premises breeding Aedes 5 Aedes breeding index on February 28 No. of inspections per man-day 32.5 257 IV. Public Education A. Hawaii School Program During the month of February the school Mosquito Control Day was extended to 11 schools in the Kona district on the Island of Hawaii, P. Ac Sanitary Engineer (R) Arve H. Dahl spoke to each school, explaining the problem of Aedes mosquito control and the participation of the students in the program. These schools participated in the February Mosquito Control Day, Out of the 12,720 students above the fourth grade, 9,247 turned in a report on the fourth Mosquito Control Day on the Island of Hawaii. Of 22,24-0 containers found containing water, 8,054- contained wrigglers, giving a container breeding index of 36,2$, as compared with 28,6% for January. In analyzing the results, it is observed that this increase was due to two things; (l) the high container breeding index in the Kona schools, which was 45.5$, and (2) a slight increase in many schools, due, undoubtedly, to increased rainfall on the island. B. Maui School Program The school mosquito control program was extended to 22 schools on the Island of Maui during February, Assistant Sanitarian (R) Wendell R. McCool and P. A, Sanitary Engineer (R) Arve H, Dahl visited the island to inaugurate the program. Talks were given to each school, explaining methods of Aedes control and the plan for the participation of all students above the fourth grade in the program, C. News Releases During the month 52 column inches of English and 30 column inches of foreign language news articles appeared in local papers, V. Miscellaneous A, Entomological Work The efforts of the entomological staff are being directed towards determining the most efficient methods of using DDT on regular inspectional programs for the control of Aedes mosquitoes. Applications in powder as well as liquid form is being considered. 258 B, Control Program in Hilo, Hawaii A foreman has been hired for the purpose of establishing an Aedes mosquito control program in Hilo, Hawaii, He is receiving preliminary training from P.A. Sanitary Engineer (R) Bernard B. Berger, County Sanitary Engineer, Respectfully submitted, /s/ Arve H. Dahl Arve H. Dahl P, A. Sanitary Engineer (R) i/c Dengue Mosquito Control FEDERAL SECURITY AGENCY U. S. PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report January 1945 I, Monthly Summary A, Dengue Peye* Cases—Non-military Cases acquired within Territory—0 Cases "off shipping"—0 B. Control Program—Territorywide (As covered in this report) No. of premises inspected 55,323 No, of premises breeding Aedes 757 Total personnel engaged in program 163 Regular control activities during the month of January were limited to the Island of Oahu, Inspection activities in rural Oahu were suspended on January 20 when the 719th Medical Sanitary Company was reassigned for training for duties in forward areas. On the Island of Hawaii, the third complete monthly school Mosquito Control Day was held on the first Friday of January, Results of this control activity will be found under V, Public Education of this report. II, Control Activities in Honolulu A, Inspection Activities The citywide Aedes breeding index in Honolulu was 1,B$ on January 15 and 1,2$ on January 31. At the end of January, 6 zones had indexes above 3$ and 2 zones had indexes above 5%. Following is a summary of the month*s activities: No, of premises inspected 50,536 No, of premises breeding Aedes 724 Aedes breeding index on January 31 1*2$ No, of inspections per man-day 47*3 261 B, Special Work 1. Insecticide Spraying The power sprayer was utilized in spraying USED base yard No, 7, a junk yard near the Kapalama Canal and an area on Liholiho Street. 2. Tree and Rock Hole Filling, One thousand nine hundred sixty-nine tree holes were filled, of which 32 or 1.6$ were breeding. One hundred thirty-nine rock holes were filled, of which 7 or 5% were breeding and 425 upright pipes and 63 bamboo stumps were filled. 3* Larviciding Activities The power sprayer was used to larvicide the following swamp areas: Kalakaua and Kalauokalani Avenues, between Makaoe and Makanoe Lanes, Kapiolani Boulevard next to Kalakaua Homes, along Kalauokalani and Kapiolani Boulevard and along Date Street; the following ditches were also larvicided; on Rycroft Street, on Kona and Piikoi Streets, on the 1300 block on Houghtailing Road, at Kapiolani Boulevard and Ward Avenue, on Oili Road, at Waialae Golf Course and on Sheridan Street, A total of 3&5 gallons of diesel oil was used to larvicide these areas. 4. Roof Gutters The roof gutters on 5 premises were corrected during the month, 5• Clean-up Crew A total of 33 loads of containers were collected and hauled away, of which 2S were from the Lanakila district, 4 from the Central district and 1 from the Kapahulu district, 6, Fish Stocking Four fish ponds and two catch basins were stocked with mosquito minnows during January. 7* Inspection of USED Base Yards and Waterfront Area Complete inspections of 27 USED base yards were made, Aedes mosquitoes were found breeding 14 times. Sixty-one complete inspections were made of the waterfront area, Aedes breeding was found once. 262 C. Personnel Field Total Army 79 79 Chamber of Commerce 3 6 U, S* Public Health Service 23 • 34 TOTAL 105 119 D. Report of Honolulu Supervisor In the preceding two months, personnel shortages caused a serious extension in the number of days required for each inspection cycle in all areas. At a conference with the Officer in Charge, it was deemed advisable to concentrate inspections on certain critical areas where an outbreak of dengue fever would be considered most likely to occur. These areas were selected on the basis of (a) population concentration, (b) occurrence of dengue cases during the 1943-44 epidemic, and (c) areas most visited by military personnel who might be a source of infection. Nineteen critical zones were selected, which will be inspected on the regular 10-12 day cycle. The remainder of the zones will oe inspected on ex- tended cycles, the number of calendar days varying with the available manpower. The elean-up crew devoted most of its time to systematic house-to- house clean-up in two large critical zones in the Lanakila district where persistent breeding in artificial containers has occurred. In the future, the elean-up crew will be utilized more for routine work of this nature, the value of which has been adequately shown by the lowering of indexes in the zones mentioned. III. Wahiawa Program Personnel—4 The citywide Aedes breeding index in Wahiawa was in mid-January and *6% at the end of the month. Following is a summary of the inspection activities for January: No. of premises inspected 2,231 No. of premises breeding Aedes 13 Aedes breeding index on January 31 ,6$ No, of inspections per man-day 43*4 During the month of January Aedes mosquitoes were found breeding only in artificial containers—barrels, tubs, tin cans and ant cups. 263 IV, Rural Oahu Program Personnel—40 The rural Oahu program, which has been carried on by the 719th Medical Sanitary Company, was terminated on January 20 when the Company was reassigned for training for duty in forward areas. During the first part of January part of the personnel was taking part in other required training. As a result, the maximum number of workers during the month of January totaled 40, A total of 3*056 premise inspections were made during the first half of January, of which 20 were found breeding Aedes, giving an index of , .6$. Following is a list of the Aedes breeding indexes as of January 15: Town Aedes Breed, Index Town Aedes Breed, Index Aiea 1.3 Pearl City o2 Ewa .5 Waialua <>5 Haleiwa 2,7 Waipahu o5 The 719th elearv-up crew activities were confined to Pearl City, making a complete clean-up of all vacant lots. Several breeding junk piles were removed. In all, 20 loads of cans, bottles, etc, were hauled to the Pearl City dump. This crew also larvicided 2 large swampy areas in Pearl City using Quartermaster DDT-kerosene larvicide in a power sprayer with excellent results on Culex breeding. V. Public Education A. Hawaii School Program Excellent results of the third school Mosquito Control Day held on the first Friday of January show an encouraging continued interest. The report for January reveals that 71$ or 7* 468 of the students above the fourth grade reported., A total of 13*355 containers were found, of which 3*£16 were breeding, giving a container breeding index of 28.6$ as compared with 30.3$ in December, B. News Releases During the month of January, 36 column inches of English and 24 column inches of foreign language news articles appeared in local papers, C. Magazine Article The January issue of the Hawaii Farm and Home magazine, which has a Territorywide circulation of over 12,000, carried a two-page article 264 of the dengue mosquito control program. Mr, Donald Burum, Editor of the magazine, attended the complete course given regularly to new employees and soldiers assigned to the program. This article is the result of his attending this course. Besides emphasizing the purpose and value of the program, street markings, house markings and the uses of various pieces of equipment in the inspector’s kits are all illustrated fully with diagrams and photographs. D, Talks A lecture on dengue mosquito control was given to the junior and senior classes of Queen’s Hospital Nursing School by Assistant Sanitarian (R) David D, Bonnet on January 30, Charts of the Aedes breeding cycle, live larvae and adult mosquito samples, as well as various types of plants and containers which are common mosquito breeding places in Hawaii, were used by Dr, Bonnet to illustrate his lecture. In conclusion, the Aedes aegypti control film was shown. VI. I&itomological Work The following material is abstracted from the reports of Assistant Sanitarian (R) David D. Bonnet: A. Effect of DDT on Plants It is well known that many types of larricides used in mosquito control are detrimental to plants, A few preliminary experiments have been performed and more are underway at the present time, to determine the effect of different DDT concentrations on various plants. Three species of plants in Hawaii which collect water in the axils of the leaves and which have been serious sources of mosquito breeding are being tested. Common Name Scientific Name Ape or Elephant Ear Alocasia sp., probably a variety of Alocasia macrorrhiza Schtt, Spider Lily Crinum asiaticum Linneaus Crinum giganteum Andrews Pineapp]e Lily Billbergia thyrsoidea Van Martins The first speej.es, Alocasia, or ape, has been tested with large con- centrations of DDT applied directly to the Axils of the plant in alcoholic solution and in emulsion form with Vatsol, In addition, controls were set up using straight alcohol and straight aqueous solution of Vatsol, In no case has there been observed any ill effects on the plant up to the present time (30 elapsed days). Trials are now being made on the other species. 265 B. Laboratory During this month the identification of samples has been continued but on a modified scale. Complete identifications are being made on all samples from the 19 critical zones. The samples from the other zones are examined to insure correct field identification but the examinations to separate Aedes aegypti from Aedes albopictus are not made. The total number of samples handled by the laboratory during January was 950. Mr. Douglas Worcester, assistant at the laboratory, resigned to accept a position with the Territorial Board of Agriculture and Forestry as Plant Quarantine Inspectior of Maui. VII. Analysis By Type of Containers Inspected and Contalners Found Breeding Aedes in Honolulu The following figures for the last quarter of 1944- and the entire year of 194A are analyses of various types of actual and potential Aedes breeding places, ranked according to importance and showing the per- centage which each type of container assumes of the totals October-November-December 19LL Containers Inspected (Wet Only) Containers Breeding 1ZE® No, % of Total Type No. % of Total 1 Animal Drinking 1 Others 1,172 25.7 Troughs or Pans 218,818 42*6 2 Tin Cans, Pans 883 19*4 2 Flower Vases, 3 Flower Vases, Vine Bowls 83,547 16.3 Vine Bowls 555 12.2 3 Barrels, Buckets, 4 Lily Plants 527 11.6 Jars, Tubs, Tanks 39,546 7o7 5 Barrels, Buckets s A Tin Cans, Pans 35,430 6.9 Jars, Tanks, Tubs 466 10.2 $ Others 32,175 6.3 6 Bottles 368 8.1 6 Bottles 29,063 5*7 7 Ape Plants 207 4.5 7 Lily Plants 19,749 3.8 8 Ant Cups 163 3.6 8 Fish Ponds 16,423 3o2 9 Animal Drinking 9 Ape Plants 15,025 2o9 Troughs or Pans 82 1.8 10 Ant Cups 10,982 2 o 1 10 Tires 76 1.7 11 Ditches, Ground 11 Fish Ponds 39 .9 Pools 6,399 lo2 12 Ditches, Ground 12 Tires 3,737 o7 Pools 10 .2 13 Catch Basins 1,874 .4 13 Catch Basins 3 .06 14 Cesspools 443 .1 14 Cesspools 1 .02 Total Containers 513,211 Total Containers 4,552 . 266 As noted in the November 1944 monthly narrative report in the analysis of containers for October-Noveaber-December 1943 and July-August-September 1944, the most numerous types of potential breeders are still not the greatest source of mosquito breeding. The importance of other or unusual breeding containers has in- creased, In line with this trend, emphasis is now being placed upon the location and elimination of hidden and unusual breeders. Respectfully, /s/ Arve H0 Dahl Arve H, Dahl P, A, Sanitary Engineer (E) i/c Dengue Mosquito Control FEDERAL SECURITY AGENCY U„ S, PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report December 1944 I* Monthly Summary A, Dengue Fever Cases—Non military Cases acquired within Territory—0 Cases "off shipping”—0 B, Control Program—Territorywide (As covered in this report) No, of premises inspected 61,46# No0 of premises breeding Aedes 793 Total personnel engaged in program 192 Regular control activities during the month of December have been limited to the Island of Oahu, On the Island of Hawaii the second complete monthly school Mosquito Control Day was held on the first Friday of December, Results of this con- trol activity will be found under VI, Public Education, of this report, II9 Control Activities in Honolulu Ae Inspection Activities The citywide Aedes breeding index Honolulu was 1,6$ on December 15 and 1,2$ at the end of December, At the end of December, 10 zones had indexes abcve 3$ and 5 zones had indexes over 5$® Following is a summary of the month’s activities; No, of premises inspected 46,#97 No, of premises breeding Aedes 695 Aedes breeding index on December 31 1,2$ No, of inspections per man-day 38.2 269 Bo Special Work 1, Insecticide Spraying The power sprayer was utilized in spraying 15 premises in the Kapahulu area and 51 premises in the Waikiki area„ 2, Tree and Rock Hole Filling One thousand one hundred thirty-three tree holes were filled, of which 53 or 4»6$ were breeding. Six hundred forty-five rock holes were filled, of which 21 or 3«.2$ were breeding and 630 upright pipes were filled, 3, Larviciding Activities during December, The following mosquito breeding places were treated with diesel oil: storm drains—70 ground pools—17 ditches—12 manholes—12 cesspools—5 bomb shelters—>4 gun mount—1 well—1 The power sprayer was used to larvicide swamp areas in back »- of Lanakila School, Kalakaua Housing, Church of the Cross- roads, Sheridan Street and Coolidge Street, 4» Roof Gutters The roof gutters on 11 premises were corrected during the month, 5 o Clean-up Crew A total of 50 truck loads of containers were collected and hauled away, of which 29 were from the Lanakila district, 15 from the Central district and 6 from the Kapahulu district 6, Fish Stocking Six fish ponds were stocked with mosquito minnows during December, 270 7. Inspection of USED Base Yards and Waterfront Area Complete inspections of 23 USED base yards were made, Aedes breeding was found 5 times. Seventy-four complete inspections were made of the water- front area. No Aedes breeding was found, C, Personnel Field Total Array 74 74 Chamber of Commerce 1 4 U. S, Public Health Service 23 36 TOTAL 98 114 D, Report of Honolulu Supervisor Assistant Sanitarian (R) Bertram Gross reports the following: Phenothiazine strips prepared by the entomological staff are fulfilling a definite need in the control program. Water- proofed pint jars filled with phenothiazine strips were sus- pended from all water spigots in Nuuanu Cemetery with instruc- tions for their use placed on each jar. Inspections to date show that nearly all visitors to the cemetery are making use of these strips in flower vases and urns, as requested. Envelopes containing phenothiazine strips have been distributed to certain hotels where interior breeding has been persistent. Each envelope contains twelve phenothiazine strips 1/2M x 1” with instructions as to their use stamped on the envelope. The manager of each hotel was requested to see that t,he occupant of each room received the strips together with a mimeographed educational form letter bearing the hotel's endorsement of suggestions made for the curtailment of breeding places in water plants and flower vases. To date, results have been ex- cellent, no interior breeding having been found by the inspectors Similar envelopes are now being distributed to premise occupants by inspectors in certain critical zones in the Waikiki areas. It is planned to eventually distribute pheno- thiazine strips throughout the entire city through the zone inspectors, E, Chamber of Commerce Expenditures for Calendar Year 1944 During calendar year 1944 the Chamber of Commerce of Honolulu, from its public health funds, expended approximately 271 $44*950.00, of which approximately $35*000.00 was allocated through the Rat and Mosquito Control Committee and $9,950.00 was allocated through the Public Health Committee, specific- ally for dengue mosquito control. The Rat and Mosquito Control Committee budget has been an annual expenditure for combined rat and mosquito control activities and represents primarily expenditures for salaries. However, during the past year approximately $12,990.00 were made available for gratuities for military personnel assigned to the mosquito control program. The gratuities were distri- buted according to an approved schedule based on the period of service on the program and the type of duty carried by the individual. The funds of the Public Health Committee on mosquito control were budgeted for salary items, repair and maintenance of auto- motive vehicles, printing and other items. The Public Health Committee and the Board of Directors of the Chamber of Commerce have approved a budget for the first six months of calendar year 1945 in the amount of $4,300.25, ex- clusively for dengue mosquito control. III. Public Health Service Expenditures for the Quarter Year October- December Month Salaries Supplies and Miscellaneous October $85111o99 $227.33 $88.55 November 7* 93% 50 416.48 December 70&2?e46 _25£OL. 146.49 23,878.95 996790^ 235.04 GRAND TOTAL—$25,110.89 The grand total for the period July through September was $22,532.22. IV, Wahiawa Program. Personnel—4 The citywide Aedes breeding index in Wahiawa was in mid- December and V6%~at the end of the monthe Following is a summary of the inspection activities for December; No. of premises inspected 1*679 NOo of premises breeding Aedes 13 Aedes breeding index on December 31 06$ No0 of inspections per man-day 31o2 272 V, Rural Oahu Program Personnel—73 During the last half of November a total of 3,339 premise inspections were made in rural Oahu, of which 26 were found breeding Aedes mosquitoes, giving an Aedes breeding index of During the month of December a total of 5,214 premises were inspected, of which 33 were found breeding Aedes mosquitoes, giving an Aedes breeding index of 96%0 Following is a list of Aedes breeding indexes as of December 31: Town Aedes Breed, Index Town Aedes Breed, Index Aiea 1.2 Pearl City —m Ewa — Waialua o3 Haleiwa 3.5 Waipahu .4 All work in rural Oahu has been carried on by the 719th Medical Sanitary Company* Due to a shortage of officers in the company to supervise field operations, it has not been possible to carry on control operations in towns on the windward side of the island, VI, Public Education During the month of December, 45 column inches of English and 25 column inches of foreign language news articles appeared in local papers. In addition. Assistant Sanitarian (R) Wendell R, McCool reports the following concerning the mosquito control educational program on the Island of Hawaii: Since the start of the coordinated school mosquito control pro- gram on the Island of Hawaii, two control days have been reported by the 33 schools participating. The percentage of students reporting results continues to be high with 67% reported in December, The latest reports for the month of December show that 7,685 students found 5,296 containers, of which 4,628 were breeding, giving a container breeding index of 3093%* This represents a reduction in the number of containers found and over 30% decrease in the number of containers found breeding since the first report in November, This program is carried on by the stu- dents after school hours and reports inspections of their own homes and yards. In making the inspections, the students are instructed to destroy or remove all containers in order to eliminate future trouble. Succeeding control days are expected to 273 show a further decrease, both in numbers of containers found and the amount of breeding taking place, VII, Entomological Work The following material is abstracted from the reports of Assistant Sanitarian (R) David Dc Bonnets 1, Experiments with DDT Certain experiments in the use of DDT have been performed and many others are projected. The emphasis has been upon the use in local control problems rather than a duplication of experi- ments performed in other areas. Since one of the biggest con- trol problems in the Hawaiian Islands involves the control of breeding in lily plants, ape plants and tree holes, it is necessary to find a method of treating these plants which will not harm the plants but will give lasting control. The high toxicity of DDT in low concentrations promises to be a possible solution. Tests are therefore being done on the effect of different concentrations on local vegetation involved in mos- quito breeding, 2, Preparation of Phenothiazine Strips The laboratory has undertaken the preparation of phenothiazine strips for the use of the control program. The method of preparation has been a modification of that used in other areas and has proven satisfactory. The formulae used in the preparation is as followss 1 lb, phenothiazine (Thiodiphenylamine) 1/2 ozo clear gelatin 1/4 oz, Vatsol Sufficient water to liquify and to paint. This quantity is sufficient to make up approximately 9,OCX) square inches or 18,000 strips (1/2" x 1"), Each strip has an approximate dosage of 0o025 gram. One strip placed in a quart of water would give an approximate dosage of one to 40,000 if all phenothiazine were to go into the solution. It is questionable if the concentration ever reaches more than one to 60,000, 39 Minimum Amount of Water to Support Aedes Albopietus Larvae Development, It has been claimed that mosquito larvae, under conditions where a minimum amount of water is present in the container, can complete their life cycle and emerge. To test this statement twelve Aedes albopictus larvae of various instars were placed under observation in a covered Petri dish, 3-l/2n in diameter. The dish contained a layer of four pieces of filter paper saturated with water and several chopped leaves of nut grass. Two days after introduction the larvae were all alive$ most of them had wriggled under the leaves or into the folds of the top filter paper where slightly more water was available. On the third day, one larva pupated but died and three managed to molt. By the fourth day four larvae had pupated and all but one died. This pupa alone survived and it emerged as a male one week from the start of the experiment, It would seem that tree holes, containing a water-saturated mass of leaves and trash and but a few cubic centimeters of water, are capable of supporting the albopictus life cycle, VIII, Miscellaneous A, The Effects of Variations in Rainfall on Mosquito Breeding Indexes Over a period of one year, a study has been made of the Aedes breeding indexes in fifteen zones located in the vicinity of ten of Honolulu8s rainfall stations. The rainfall stations are located at various points throughout the city in such a manner as to give a wide variance in seasonal and annual rainfall. In general, the following observations have been made: (1) Higher breeding exists in areas of greatest rainfall, (2) Small and sometimes moderate increases in rainfall have not greatly affected the Aedes breeding index, (3) One week of high rainfall proceeded and followed by low rainfall has not seriously affected mosquito breeding, (4) Three or four weeks of moderate to high rainfall usually have produced an increase in mosquito breeding, (5) Areas which normally had low rainfall have not shown proportionate increases in Aedes breeding after a period of higher rainfall, as had areas of normally high rainfall, B0 Personnel Pe A, Sanitary Engineer (R) Arve H0 Dahl reported during the latter part of the month to replace P, A, Engineer (R) Wesley 275 E0 Gilbertson, who is returning to the Headquarters Office of Malaria Control in War Areas in Atlanta, Georgia for reassignmento A continued shortage of inspection personnel, both civilian and military, has lengthened the average inspection cycle to about three weeks0 Respectfully, /s/ Arve H0 Dahl Arve Ho Dahl P0 Ae Sanitary Engineer (R) i/c Dengue Mosquito Control 276 FEDERAL SECURITY AGENCY U. S„ PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report November 1944 I• Monthly Summary / A, Dengue Fever Cases—Non-military Cases acquired within Territory—0 Cases ’’off shipping"—0 B, Control Program—Territorywide (As covered in this report) No. of premises inspected 83,028 NOo of premises breeding Aedes 958 Total personnel engaged in program 199 II. Control Activities in Honolulu A. Inspection Activities The citywide Aedes breeding index in Honolulu was l„C/o on November 15 and \02% at the end of November. Thus it has remained in the neighborhood of 1% since the middle of September. At the end of November, 11 zones had indexes above Z% and 4 zones had indexes over 5%a Following is a summary of the month’s activities; No. of premises inspected 68,428 No. of premises breeding Aedes 775 Aedes breeding index on November 30 102% No. of inspections per man-day 41.1 B, Special Vfork 1. Insecticide Spraying The power sprayer was utilized in spraying Dewey Court and a portion of the Niumalu Hotel in the Waikiki area. 2. Tree and Rock Hole Filling 277 One thousand three hundred eighty tree holes were filled, of which 47 or 3.4$ were breeding, 358 rock holes were filled, of which 12 or 3.3$ were breeding and 555 upright pipes were filled, 3. Larviciding Activities during November The following mosquito breeding places were treated with diesel oil: storm drains—55 manholes—12 ground pools—10 ditches—7 cesspools—4 bomb shelters—2 The power sprayer was used to larvicide swamp areas on Sheridan Street and near Kalauokalini Way, 4* Roof Gutters The roof gutters on 17 premises were corrected during the month, 5. Clean-up Crew A total of 106 truck loads of containers were collected and hauled away, of which 27 were from the Lanakila district, 10 from the Central district and 6 from the Kapahulu district.. Five hundred thirty-one old tires were disposed of, 6« Fish Stocking Eight fish ponds were stocked with mosquito minnows during November, 7, Inspection of USED Base Yards and Waterfront Area Thirty-five complete inspections of USED base yards were made, Aedes breeding was found in eight containers located on five different yards. Seventy-eight complete inspections were made of pier and dock areas. Aedes breeding was found once, C. Personnel Field Total Army 77 77 Chamber of Commerce 2 5 U« S. Public Health Service 26 40 TOTAL 105 ’ 122 278 D, Report of Honolulu Supervisor Assistant Sanitarian (R) Bertram Gross, who was designated as Supervisor of the Honolulu mosquito control program recently, reports the following: Observations made during the period September 6 to November 30, 1944 revealed (1) a need for more adequate and constant supervision of zone inspectors,, special crew workers and fore- men, (2) that more intensive inspections and corrective measures are indicated for certain well-defined areas where Aedes breeding has occurred consistently over extended periods of time. To date, various changes have been made in field procedures, chief of which follow: (1) Referral slips covering special situations, which were formerly handled by the foremen, are now followed up by special crews or by the district supervisor. (2) Foremen have been instructed to be in the field at all times, assisting, instructing and correcting zone inspectors. (3) Assistant foremen work as zone inspectors, assuming a supervisory capacity only when the foreman is absent. (4) A foreman and his crew now work as a group in one zone. When that zone has been completed the men move as a unit to the next zone in the assigned territory. In this manner it is possible for the foreman to maintain closer supervision of his men. Formerly each zone was assigned to a single inspector. (5) Foremen are being checked daily as to their.efficiency and competency. (6) Special Crew foremen are required to turn in a daily route sheet each morning. m (?) The nucleus of a ’’Mother Foci” squad has been established and will be expanded. ’’Mother Foci” is a term applied to a well-hidden breeding place which is continuous, and thus ’’seeds” the area with mosquitoes. These mosquitoes find their way to miscellaneous temporary breeding containers. III. Public Education During the month of November, 94 column inches of English and 50 column inches of foreign language news articles appeared in local 279 papers. In addition. Assistant Sanitarian (R) Wendell R. McCool reports the following concerning the educational program on the Island of Hawaii; . In cooperation with Mr. Orsn E, Long, Superintendent of the Department of Public Instruction and Mr. Tate Robinson, Director of Health Education for the same department, arrangements were completed for a coordinated school mosquito control program in the schools on the Island of Hawaii. Conferences were arranged by the County Health Officer with the three supervising principals on Hawaii and with representatives of the private schools. A total of 38 schools were included in the program with 10 more to be added when the coffee picking season on the Kona side of the Island is completed. One day each month, the first Friday for most schools, is being designated as ’’Mosquito Control Day.” A report form has been prepared on which the students record the number of water-filled containers dis- covered around their own homes and yards and also the number found which contain mosquito wrigglers. Totals are tabulated by room and by school and forwarded to the Health Officer on the Island for final tabulation. The results of the first after-hours inspection by the students of these schools show that over 70$ of the students reported; that over 20,000 water-filled containers were eliminated; and that more than one- third of them contained mosquito wrigglers. To inaugurate the program, the schools were visited by two members of the dengue control staff. The students from the fourth grade and up were assembled and an explanation given of the program for controlling the day mosquito. The life cycle and potential breed- ing places of the dengue carrier were covered. Two 15-minute radio programs and 12 spot announcements over the local radio station were sponsored by the Hilo Chamber of Commerce during the 10-day promotional period. At a leter date the 10 schools closed will be visited and the program outlined to the students. Results of the first Mosquito Control Day are very satisfactory and reflect a fine spirit of cooperation on the part of the students of Hawaii. IV. Wahiawa Program Personnel—4 The citywide Aedeg* breeding index in Wahiawa was 0,8$ in mid- November and 2,3$ at the end of the month. One of the three 280 inspectors was unable to work during a major portion of the month. Following is a summary of the inspection activities for November: No. of premises inspected 2,029 No. of premises breeding Aedes 31 Aedes breeding index on November 30 2.3$ No, of inspections per man-day 39.2 Towards the end of the month the clean-up crew from the 719th Medical Sanitary Company took care of a large accumulation of referral slips covering clean-up activities throughout the city, V. Kauai Program Personnel—4-0 The 719th Mosquito Control Detachment was transferred from Kauai during November, During the first half of the month a total of 7,191 premise inspections were made, on which 125 were found breeding aedes mosquitoes. Following is a list of Aedes breeding indexes as of the termination of the active control work on Kauai: aedes Breed aedes Breed Town Index Town Index Eleele 1.1 Koloa 3.8 Hanalei 8.1 Koloa Mill - Hanaraaulu .8 Lihue 2.8 Hanapepe .7 Makaweli .5 Huleia Camp 3 2.1 Nawiliwili 3.2 Kalahoe .6 Port alien 1.2 Kapaa .5 Puhi 2.6 Kapaia 2.9 Wahiawa .2 Kealia 1.4 Wahiawa Camp 2 .7 Kekaha .4 Waimea .9 Kilauea 2.9 When control activities began on Kauai, the indexes ranged up to approximately 30$, with an island-wide average of approximately 15$ In the above summary it will be noted that the community with the highest index in mid-November was Hanalei with 8.1$, the next highest was Koloa with 3.8$, During the last period only 1.7$ of all premises inspected on Kauai were found to have Aedes breeding. Efforts are being made to urge the general public to maintain low mosquito breeding conditions as they now exist. Newspaper articles to that effect have been published and possibly a school program may be inaugurated later. 281 VI. Rural Oahu Program Personnel—73 During the first half of November a total of 5,380 premise inspec- tions were made in rural Oahu, of which 27 were found breeding mos- quitoes . Following is a list of the Aedes breeding indexes on November 15: Town Aedes Breed Index Town Aedes Breed Index Aiea <.2 Laie 3.5 Bwa .3 Pearl City .2 Haleiwa - WaiaTua .6 Kahuku - Waimanalo .7 Kanoehe 1«4 Waipahu - Kailua o7 VII. Entomological Work The following material is abstracted from the reports of Assistant Sanitarian (R) David D, Bonnet, 1, Pyrethrum Spray Tests A series of tests were conducted to determine the effective- ness of various mixtures of pyrethrum extract in the Milwaukee sure-shot sprayers as used on the program. Conditions were set up so as to closely approximate normal conditions in spraying a house. In a room with a volume of 1,750 cubic feet, with a spraying time of 5 to 6 seconds, the following concentrations were found satisfactory: Amount of Amount of Amount of Pyrocide 20 Kerosene Liquid Gas Trial 1 300 cco 0 12 oz. 3 100 cc. 200 cc, 12 oz. 4 150 cc. 150 cc. 12 oz o In trial 2 with 75 cc. of Pyrocide 20 and 225 cc. kerosene, a satisfactory kill was not achieved with 6 seconds spraying time, but when this ms increased to 10 seconds it was satis- factory* Observations were made at 5 minutes after spraying at which time the cages were removed to another room. Additional observations were made at 15 minutes and at 24 hours. 282 2. Hybridization From time to time various authors have reported attempts to cross different species of mosquitoes. In only a few of these attempts have successful crosses been reported. Weyer (1936) and Roubaud (1941) successfully crossed Culex pipiens with Culex quinquefasciatus. Toumanoff (1937) (1930) reported successful crosses between Aedes aegypti and Aedes albopictus in Indo-China while attempts to cross Aedes albopictus from Calcutta with Aedes aegypti from Indo-China were unsuccessful. Similarly, Simmons, St. John and Reynolds (1930) were unsuccess ful in crossing these species with races from the Philippines. Hoang Tich Try (1939) reported that male aegypti and female albopictus crossed readily in small cages and at unfavorable times of the year. All the progeny resembled albopictus. Connall (1925) attempted to cross breed Aedes aegypti with Aedes luteocephalus and Aedes longipalpus in Africa but with negative results. Attempts to cross Aedes aegypti females and Aedes albopictus males have been successful in Honolulu in two instances and all the offspring through two generations have resembled Aedes aegypti. The fact that both males and females 'are produced by this cross, would indicate that this is not a case of partheno- genesis, if sex is determined in mosquitoes by a chromosome mechanism similar to that shown for Drosophila. Furthermore, since the generation is fertile-, it would seem to indicate that the different chromosomes compatible. In order to demonstrate the existence of true hybrids, slides are being prepared of the larvae and of the salivary gland of adult and of aegypti and albopictus females and males. If there is an obvious difference in size or shape of the chromosomes in the two species the difference should be demonstrable in the hybrids. Furthermore, back crosses between the hybrids and the species of the male parent should bring out the presence of such chromosomes. Male terminalia are being prepared in the hope that there will be observable differences in the hybrid condition. Double-screened cages were used. 3. Flight Range of Albopictus The studies of the flight range of Aedes albopictus are prac- tically complete and it is now planned to review and analyze the data collected. A report will be made of the results. 4. Oviposition Requirements of Aedes albopictus From time to time it has been suggested that the large hordes of Aedes albopictus that are found in the rain forest perhaps 283 do not need a blood meal in order to lay eggs. A test of Aedes albopiotus females in the laboratory indicates that a blood meal is required for oviposition. No eggs were obtained from females fed on raisins or sugar water, whereas females given a blood meal readily laid eggs. Fertilization by a male is not necessary for oviposition and females, which were given a blood meal but were isolated from males, laid eggs which were sterile. VIII• Analysis by type of Containers Inspected and Containers Found Breeding Aedes in Honolulu Following is an analysis of the various types of actual and potential Aedes breeding places ranked according to importance and showing the percentage which each type of container assumes of the total. For comparison, the figures for the period October-November-December 1943 and the figures for the period July-August-September 1944 are shown. October-November-Dec ember 1943 Containers Inspected (Wet & Dry) Containers Breeding Rank type % of Total Rank , Type % of Total 1 Bottles 36,0 1 Lily Plants 23.8 2 Tin Cans, Pans 15,2 2 Tin Cans, Pans 15.1 3 Lily Plants 13.1 3 Bottles 12.7 4 Ape Plants 10.7 4 Flower Vases 5 Barrels, Buckets, Vine Bowls 11.4 Jars, Tubs, Tanks 7,0 5 Barrels, Buckets, 6 Flower Vases, Jars, Tubs, Tanks 10.5 Vine Bowls 5.2 6 A.pe Plants 7.2 7 Animal Drinking 7 Others (miso.) 6.2 Troughs or Pans 4.8 8 Ant Cups 6.0 8 Others (misc.) 2.3 9 Tires 2.5 9 Tires 2.1 10 Animal Drinking 10 Ant Cups 1.6 Troughs or Pans "1.5 11 Fish Ponds 0.7 11 Fish Ponds 1.1 12 Ditches, Ground 12 Catch Basins 1.1 Pools 0.6 13 Ditches, Ground 13 Catch Basins 0.6 Pools 0,8 14 Cesspools 0,1 14 Cesspools 0.1 TOTAL 100.0 TOTAL 100.0 284 Containers Inspected (Wet Only) Containers Breeding Rank Type % of Total Rank Type % of Total 1 Animal Drinking 1 Others (misc,) 19,5 Troughs or Pans -3 o 00 2 Flower Vases, 2 Flower Vases, Vine Bowls 17,3 Vine Bowls 19 * 7 3 Lily Plants 16,2 3 Barrels, Buckets, 4 Tin Cans, Pans 11,6 Jars, Tanks, Tubs 6,9 5 Barrels, Buckets, 4 Ape Plants 4,7 Jars, Tanks, Tubs 10.4 5 Tin Cans, Pans 4,4 6 Bottles 8.2 6 Lily Plants 4,2 7 Ant Cups 6.3 7 Others (misc.) 3,6 8 Ape Plants 6,3 8 Bottles 3.2 9 Animal Drinking 9 Ant Cups 2,3 Troughs or Pans 1,8 10 Fish Ponds 1,2 10 Tires 1,1 11 Ditches, Ground 11 Fish Ponds 0.71 Pools 0,9 12 Ditches, Ground 12 Catch Basins 0,5 Pools 0,31 13 Tires 0.5 13 Catch Basins 0,25 14 Cesspools 0.1 14 Cesspools 0,03 TOTAL 100.0 TOTAL 100 o0 July-August-September 1944 It will be noticed that the most numerous types of potential breeders are not the greatest sources of mosquito breeding., A comparison of the two sets of figures also shows that control activities produce a differential effect in that useless containers are eliminated as sources of mosquito breeding more easily than the semi-useful, useful and decorative containers» Interior breeding places are also diffi- cult to reduceo A study of the two quarter-year periods between those mentioned above, shows that a gradual change has been taking place, in which the types of containers at the top of the lists were reduced and succeeded usually by the next most numerous typeso Respectfully, /s/Wesley E. Gilbertson Wesley E. Gilbertson P. A. Engineer (R) i/c Dengue Mosquito Control 285 FEDERAL SECURITY AGENCY Uo S. PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report October 1944 I o Monthly Summary A0 Dengue Fever Cases—Non-military % Cases acquired within Territory—2 Cases "off shipping"—0 Bo Control Program--Territorywide (As covered in this report) Noo of premises inspected 108,705 NOo of premises breeding Aedes 1,261 Total personnel engaged in program 241 II. Control Activities in Honolulu A, Insecticide Spraying Houses sprayed--! Garages sprayed--! Bo Inspection and Indexes The citywide Aedes breeding index in Honolulu was loO/Z on October 15 and at the end of October. The increase took place in the Central and Kapahulu districts. Four zones had indexes over and two zones had indexes over 5% at the end of the month. Following is a summary of the month’s activities: No. of premises inspected 77,516 No. of premises breeding Aedes 877 Aedes breeding index on October 31 1.1% No. of inspections per man-day 43.3 Co Special Crews 1. Trouble Shooting Crew Insecticide spraying activities were minor during the month of October. Tree holes filled numbered 2,488, of which 92 or 3.7/£ were found breeding. Rook holes filled numbered 287 2,290, of which 178 or 1*1% were found breeding. When the tree and rock hole filling activities were inaugurated about ten months ago it was found that the tree holes had a higher percentage of breeding than the rock holes*. How- ever, during the past month the reverse was true. Upright pipes in the ground which were filled numbered 496. 2. Larviciding activities during October The following mosquito breeding places were sprayed with diesel oil: storm drains—28 ditches—7 cesspools—6 v streams—3 , ground pools—3 . manholes—1 bomb shelters—2 Larviciding activities were covered principally by knap- sack sprayers, with the exception of a swampy area along Kapiolani Boulevard, for which a power sprayer was used. 3. Clean-up Activities A total of 61 truck loads of miscellaneous containers were removed by the clean-up crew in covering 154 referrals. These were divided among the districts as follows: Centra 1--52, Kapahulu—42 and Lanakila—23. In a program inaugurated in October to.eliminate useless old tires, a total of 1,548 tires were disposed of. In each case the serial number of the tire was recorded and the signature of the householder obtained on the referral slip. 4o Fish Stocking Eleven fish ponds were stocked with mosquito minnows during the month of October. 5. Inspections of USED Base Yards and Waterfront Area Twenty-seven inspections were made of USED base yards. Aedes breeding was found 9 times on 5 yards. Culex breed- ing was found 9 times on 6 yards. Seventy-four inspections were made of docks and piers in the waterfront area, Aedes breeding was found 4 times on 3 piers and Culex breeding was found 10 times on 4 piers. 288 Under the direction of the Medical Officer of the Base Command Construction Department, a responsible individual has been designated at each base yard to correct mosquito breeding conditions* The responsible person is to check the yards between inspections by the mosquito control inspector and will accompany the inspector when the check inspection is made* Do Personnel Field Total Army 77 77 Chamber of Commerce 2 5 Uo Su Public Health Service 29 42 TOTAL 108 124 Since the activation of the 114th Medical Service Company (Sano), several of the arry personnel previously assigned to mosquito control duty have been released for duty at the company head- quarters.. This reduces the number of army personnel assigned to the work in Honolulu the lowest since last October* It is anticipated that additional manpower will be assigned to the company soon for mosquito control duty* E« Public Education During October plans were made for the inauguration of an exten- sive mosquito education program on the Island of Hawaii to be conducted through the public schools* The program was arranged in cooperation with the Department of Public Instruction through Mr, Oren B„ Long, Superintendent, Department of Public Instruc- tion, Mr, Tate Robinson, Director of Health Education and the Supervising Principals on the Island of Hawaii, Mrs, Emma P* Giacometti and Messrs* Cecil K. Dotts and Ernest de Silva* Various educational materials were reproduced in quantity for distribution to the teachers and students* In Honolulu 33 column inches of English and 16 column inches of foreign language news appeared in local newspapers during October. Fo Refuse Collection Plan for Piggeries in the Kapahulu District Since the inauguration of mosquito control, some difficulty has been experienced because of mosquito breeding conditions in the vicinity of piggeries located in the Kapahulu district of Honolulu* The accumulations of tin cans and other receptacles are excessive at these establishments because the hog raisers collect garbage from food handling establishments throughout the city for hog feed* The City-County Refuse Collection 289 Department has not provided refuse collection at these establishments because of the excessive accumulations and because they are located on private roads. In cooperation with the sanitation supervisor, a plan has been worked out whereby the area is divided into four sections: upper Oili, lower Oili, Kahala and Kapakahi. In a meeting with the hog raisers it was decided that one or two individuals would be responsible for collection of garbage and refuse once a month for each section. For each section individual arrange- ments were worked out concerning assessing the various partici- pants in the plan. By arrangement with the City-County refuse disposal plan the usual dumping fee has been waived so that the piggeries may dispose of these accumulations without charge, III. Public Health Service Expenditures for the Quarter Year July- September Month Salaries Supplies & Equipment July August #6,107.66 8,495.32 #344.76 September 7,233.21 353.27 #21,834.19 #698.03 GRAND TOTAL—$22,532.22 The grand total for the period April 1 through June 30, 1944 was $26,244.91. IV. Wahiawa Program. Personnel—4 The Wahiawa citywide Aedes breeding index was 1,1% in mid-October and 1.3% at the end of the month. Following is a summary of the inspection activities for the month of October: No. of premises inspected 2,442 No. of premises breeding Aedes 32 Aedes breeding index on October 31 1.3% No. of inspections per man-day 47.2 During October lily plants were the most numerous type of Aedes breeder. Next were interior breeders (flower vases and vine bowls) and miscellaneous large containers (barrels, tubs, tanks, jars, buckets)o 290 V. Kauai Program Personnel—40 During the period September 16 through October 31 a total of 18,745 premises were inspected on the Island of Kauai. Of these, 298 were found to be breeding Aedes mosquitoes. Following is a list of the Aedes breeding indexes as of October 31i Aedes Breed Aedes Breed Town Index Town Index Eleele — Koloa 1.7 Hanalei 5.0 Koloa Mill - Hanamaulu 1.6 Lihue 3.1 Hanapepe - Makaweli .9 Huleia Camp 3 1.0 Nawi liwili 4.8 Kalaheo 2.6 Port Allen - Kapaa .5 Puhi - Kapaia 1.1 Wahiawa - Kealia .9 Wahiawa Camp 2 1.4 Kekaha .6 Waimea 1.6 Kilauea 2.8 Additional work reported from Kauai included the weekly spraying of ditches and ground pools which were breeding Culex mosquitoes in the vicinity of ah army hospital; a ditch at Hanapepe and spotty breeding areas in the area where the detachment is quartered. A ground pool in Waimea was filled, requiring 18 truck loads of sand, A taro patch in Waimea was stocked with mosquito fish. VI, Rural Oahu Program Personnel—73 ✓ During the month of October a total of 10,002 premise inspections were made in rural Oahu communities on which 54 were found breeding Aedes. Work was reinaugurated in windward Oahu communities during the month. During the last half of October one-half of all breeding containers were found to be in the miscellaneous large container group (barrels, tubs, tanks, jars, buckets). The next most numerous breeder was interior containers such as flower vases and vine bowls. 291 Following is a summary of the Aedes breeding indexes as of the end of the month: Aedes Breed Aedes Breed Town Index Town Index Aiea .1 Laie 4.4 Ewa * 2 Pearl City; .1 Haleiwa 6 5 Waialua .6 Kahuku - Waimanalo - Kaneohe 1.1 Waipahu .3 Respectfully, /s/Wesley E. Gilbertson Wesley E. Gilbertson P* A. Engineer (R) i/c Dengue Mosquito Control 292 FEDERAL SECURITY AGENCY U0 S, PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report September,1944 I, Monthly Summary A, Dengue Fever Cases Cases acquired within Territory—3 (civilian) Cases "off shipping"—1 (civilian) B. Control Prograa—Territorywide (As covered in this report) Number of premises inspected 123, $4-3 Number of premises breeding Aedes 1,444 Total personnel engaged in program 305 II. Control Activities in Honolulu A, Insecticide Spraying Houses sprayed—26 Garages sprayed—S Others—2 B, Inspection and Indexes The citywide Aedes breeding index in Honolulu was 0.4$ on September 15 and 1.0$ at the end of the month. The increase in mosquito breeding was general over the whole city but rela- tively higher in the Lanakila district. Seven zones had in- dexes over 3% and 2 zones had indexes over 3% at the end of the month. Following is a summary of the monthfs activities; No, of premises inspected 79*369 No. of premises breeding Aedes 604 Aedes breeding index on September thirtieth ' l,0j£ No. of inspections per man-day 47*2 293 C, Special Crews 1® Trouble Shooting Crew In addition to insecticide spraying activities, the trouble shooting crew filled 2,OSS tree holes with cement, of which 13 or 0,4$ were breeding, 243 rock holes, of which 34 or 1,4$ were breeding and 29 upright pipes, 2, Larviciding activities during September included 61 storm drains, 14 ditches, 10 cesspools, 6 swamp areas, 4 streams, 2 bomb shelters and one swimming tank, 3* Roof Gutter Work The gutters of 159 residences were inspected, of which 6S were cleaned, 12 repaired, 6 perforated and one removed. Four roof gutters were found breeding Aedes mosquitoes, 4, Clean-up Activities Sixty-three truck loads of miscellaneous containers were removed from 135 premises. About two-thirds of the work was done in the Central district, 5, Fish Stocking Nine fish ponds and 7 ground pools were stocked with mosquito minnows, 6, During September, 74 inspections were made on docks, piers and buildings on the waterfront area and 4& inspections were made of USED base yards, Aedes mosquitoes were found breed- ing four times in the waterfront area and ten times in the USED base yards. This information was forwarded each time to the responsible persons in charge, A special effort is being made by the Medical Department of USED to take care of their problem, D, Personnel Field Total Army 84 84 Chamber.of Commerce 4 7 U S Public Health Service 27 40 TOTAL 115 131 294 £, Public Education Seventy-five column inches of English and 37 column inches of foreign language news appeared in local newspapers during September* F, New Supervisor of Honolulu Program Effective September 20, Assistant Sanitarian (R) Bertram Gross was designated as supervisor of the Honolulu mosquito control program* He is responsible for general supervision of the work, including direction, assignment and training of personnel, selec- tion of equipment and allocation of automotive vehicles. Prior to coming to Honolulu, Mr0 Gross was supervisor of the Aedes con- trol program at Key West, Florida and larer general supervisor of the Aedes control work in the State of Florida, With respect to the supervisory setup, Mr, F, K, Lee continues to be Field Supervisor, R, Mikuni, assistant and the supervisors of the district offices are S0 Iraada, Kapahulu, T, Mukaida, Central and No Takamura, Lanakila, G, Mosquito Control Sanitation Company Activated On September 23, 1944* military personnel assigned to mosquito control and sanitation duty in Honolulu and Wahiawa with the Board of Health became members of the 114th Medical Service Com- pany (Sanitary)o This action provides a table of organization for the personnel as well as permitting formal company organiza- tion. Lt, Go Jo Brett is commanding officer and 2nd Lts, W, C, Downey and W, B<> Conneamey are the junior officers, III, Wahiawa Program VMMBHBUnMHCW OM— ■MahTTMWI Personnel—4 The Wahiawa citywide Aedes breeding index was 0,5$ in mid-September and 0,7$ at the end of the month, following the same trend as Honolulu, Following is a summary of the inspection activities for the month of September; No0 of premises inspected 2,325 No0 of premises breeding Aedes 15 Aedes breeding index on September 30 0,7$ No* of inspections per man-day 44•6 IV, Kauai Program Personnel—40 During the period August 16 through September 15 a total of 13,400 premises were inspected on the Island of Kauai, Of these , 180 were 295 found to be breeding Aedes mosquitoes, Following is a list of the Aedes breeding indexes as of September 15* 1944: Aedes Breed,. Aedes Breeds Town Index Town Index Eleele Huleia Camp 3 1.0 Hanalei Kalaheo — Hanamaulu — Kapaa •6 Hanapepe ok Kapaia 2.K Kealia 3e3 Makaweli — Kekaha •2 Nawiliwili 1.0 Kilauea le k Port Allen — Koloa 1«2 Puhi — Koloa Mill Wahiawa — Lihue 2,8 Camp 2 — Waimea 1.4 Because of the cooperation of Kauai residents the elean-up phase of the control program has been considerably reduced,, Larvieiding for Culex control has been done regularly in some areas and intermittent- ly as necessary in other places, At Kapaa and Waimea rather extensive Culex breeding areas exist due to swampy areas in and around these citieso V« Hawaii Program ■manfn iwjra aK£BaBsar*aEB9B*SBaB - J Personnel—57 Effective September 23p 1944, Army personnel who had been conducting mosquito control on the Island of Hawaii were withdrawn for service elsewhere,, Control activities had been operating in selected cities on this Island since March 16, 1944 and the excellent work done is reflected in the fact that the Islandwide Aedes breeding index was reduced from £,2$ to 206% during the period of control. One of Hawaii*s breeding hazards not encountered extensively else- where in the Hawaiian Islands was the presence of hundreds of cisterns upon which the residents in some communities depend for their water supply, A widespread fish-stocking program was inaugurated and carried through to a successful conclusion,, In the period covered, 115*>823 inspections of premises were made and Aedes breeding was found in 4,4&4 instances. During the same period 605,159 containers of all kinds were inspected and eliminated as potential mosquito breeding places. There have been no recent locally- acquired dengue cases on the Island of Hawaii, though "off-shipping11 cases have been reported. Intermittent survey inspections are planned for this Island in order to cheek the extent of mosquito breeding. 296 A widespread educational program is being prepared to urge the residents of Hawaii to cooperate in maintaining their premises free from Aedes breeding,, During the period August 16 through September 23 (previously unreported) 21,202 premise inspections were made, of which 635 were found breeding Aedesc Following is a tabulation of Aedes breeding indexes on Hawaii at the time of the last inspection for each citys Town Aedes Breed. Index Town * Aedes Breed. Index HaksQ.au 1.6 Mt0 View 6.0 Hilo 1.8 Ninole 1.7 Honohlna 1.1 Olaa 6.3 Honokaa 2.3 Paauilo 3.0 Honorau 1.9 Pahoa 10.0 Kailua 1.7 Papaaloa 2„2 Karauela 8.3 Papaikou 3.2 Kealakekua 7ol Pepeekeo 2.3 Kukai.au 9.0 VI. Rural Oahu Program Personnel—73 (part time) During the month of September, 7,118 premise inspections were made in rural Oahu communities on which ten were found breeding Aedes0 No Aedes larvae were found in Aiea, Haleiwa, Pearl City or Waialua during September. Following is a summary of Aedes breed- ing indexes as of the end of the month: Aedes Breed„ Aedes Breed, Town Index Town Index Ewa Laie 1.9 Kahuku — Waipahu .3 VII. Entomological Data of General Interest from the Reports of Assistant Sanitarian (Rj David D. Bonnet A, Breeding Habits—Distribution It has been noted that Aedes albopictus „ although breeding in artificial containers, also breeds in large numbers in natural containerso In order to compare the breeding habits of Aedes albopictus and Aedes aegypti. 500 larval specimens of each species were selected at random and compared with r espect to type of container in which they were found. There is presented herewith lists showing the percentage of the total samples which were found in each type of container* given in descending rank for Aedes albopictus0 Also for comparison* a similar list isgiven for Culex quinquefasciatus based on 346 samples0 Aedes Aedes Culex Containers albopictus aegypti quinquefas ciatus Flower vases 16,2% 15.2* k,3% Lily plants 15.8 2*4 0*8 Vine bowls 10*2 5.8 4*3 Tin cans 8*0 10*4 15 *0 Ant Cups 6*2 7o2 0*0 Tree holes 6*0 2*0 0.0 Bottles 5.6 11*4 0,3 Pans 4o4 5.6 2*6 Ape plants 4*0 3.6 0*0 Barrels 3.8 2*2 6*9 Buckets 3.8 11*8 10.4 Jars 3,2 0,2 1*4 Tires 2*6 2*0 0.6 Rock holes 2® 2 1*0 0*3 Pipes 1*2 1*0 1*4 Ground Pools 0*8 0*0 14,8 Bamboo 0o6 0*0 0*0 Plumbing F±x0 0*6 0*0 0.0 Troughs 0*6 7*0 3.B Tubs 0.4 5*0 5.3 Fish ponds 0*4 0.4 6.1 Storm drains 0*4 0*0 7«2 Tarpaulins 0*2 0*0 0*0 Tanks 0*2 1.8 0.0 Catch basins 0.2 4*0 3.8 Water Coolers 0*2 0*0 0*0 Boats 0*2 0*0 1.7 Bird Baths 0*2 0*0 0*0 Cesspools 0*0 0*0 1.7 Water meters 0*0 0*0 1*7 Water fountains 0*0 0*0 ,6 Concrete struct 0*0 0*0 1,7 Ditches 0*0 0*0 5.1 Miscellaneous 0*0 0*0 ,3 According to the above* 26.6$ of the Aedes albopictus samples were taken from natural containers* i. e., tree holes, rock holes* lily plants* ape plants and bamboo* whereas for Aedes 298 aegypti only 9$ of the samples came from this type of container, Aedes albopictus shows a greater percentage in the following container typess flower vases, lily plants, vine bowls, tree holes, jars, barrels and rock holes, Aedes aegypti shows a greater percentage in the following container types: tin cans, ant cups, bottles, pans, buckets, troughs, tubs, tanks and catch basinso For other containers there was a difference of 1$ or less between the two species, Lily plants were more important as mos- quito breeders than ape plants in the case of Aedes albopictus, whereas Aedes aegypti breeds almost as often in one as in the other MwnCMUMM* —dJMWWI m with a slight preference for the ape plant, Albopictus is rarely found in catch basins, while 20 of the 500 samples of aegypti were found in such containers, B. Flight Range of Aedes albopictus In the studies on the flight range of Aedes albopictus, hand * catching has been used because traps have been found not to capture the local Aedes mosquitoes in quantity. During the months of August and September a total of 3*531 marked mosquitoes were released,t The dusting method of Clarke (1934) has been utilized with the various dyes mixed with flour. Each week mosquitoes marked with a different color are released. The total number of mosquitoes captured has been 4*084, Of these, 153 were marked, giving a recovery of marked mosquitoes of 4,3$, Some of these mosquitoes were recaptured at the point of release in order to ascertain dispersal. The other capture stations are located at various distances from the point of release, ranging from 25 yards upwards. The maximum distance that a marked mosquito is known to have traveled is 450 yards (upwind), The maximum time of recovery of marked mosquitoes has been 27 days after date of release. This work will continue until sufficient data has been gathered to give a good picture of the effective flight range of Aedes albopictus, It is planned to shift the point of release in order to eliminate as much as possible local factors which might influence mosquito flights, C. Preliminary Experiment with DDT A preliminary experiment has been tried utilizing DDT as a dust for larval control. Test plots of one-tenth acre size have been laid out in a wooded area and receptacles containing larvae have been planted to observe the effectiveness of DDT dusting* Later it is expected that other tests will be run using DDT in solution and in emulsion. Both initial kill and residual kill are being checked*. 299 D, Culturing Mosquitoes In order to provide large numbers of larvae for the DDT ex>- periments and for the flight range experiments, a system of culturing has been set up which is producing at the present time approximately 1,000 adult mosquitoes a week. Eggs are obtained from breeding cages of male and female Aedes albopictus which are maintained on sucrose, raisins and a growing plant* The females are provided with a blood meal at regular intervals. Egg-laying dishes are provided in the cages. The larvae are raised in flat dishes filled with water and with some organic debris. They are fed on polished rice and powdered dog biscuit. The total time of development is approximately 8 to 9 days with maximum food supplies at room temperatures of SO0 to 84° F, Pupae are removed daily, counted and placed in the flight range cages and occasionally in the breeding cage to maintain the breeding stock. Larvae are removed from the larvae pans as needed for experimental purposes and to reduce crowding. Some difficulty and loss of larvae has been experienced due to the. formation of a thick surface film of unknown origin and steps are being taken to prevent this formation. Particularly large and robust speci- mens are produced with water containing rice and a milky sus- pension of yeast. Respectfully submitted, /s/ Wesley E0 Gilbertson Wesley E0 Gilbertson P, A, Engineer (R) i/c Dengue Mosquito Control 300 FEDERAL SECURITY AGENCY U, S. PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report August, 1944 I, Monthly Summary A, Dengue Fever Gases Cases acquired within Territory—5 (civilian) Cases "off shipping"—19 B, Control Program—Territorywide (As covered in this report) Number of Premises inspected 112,131 Number of premises breeding Aedes 990 Total personnel engaged in program 344 II* Epidemiology of Locally Acquired Cases The five cases of dengue fever which occurred during the month of August were widely scattered throughout the City of Hono- lulu, It was not possible to connect any of them with previous cases, although three of them occurred in areas where dengue fever had been present some time ago—at Makaoe Lane in Waikiki, at Kahanu Street in Kalihikai and at the Kaluwahine Homesteads, in. Control Activities in Honolulu A, Special Activities Connected with Dengue Cases On August 12 an area equivalent to about ten square blocks located in the vicinity of John Eha Road in the Waikiki district was sprayed with a power sprayer. This resulted from finding a dengue case with residence in that area and another case which was employed in the area. One block occupied by an industrial plant in the Kakaako district was sprayed. In carrying out the above spraying activities, together with other individual premises sprayed, the following were covered: 301 Residences—123 Rooming houses—4 Apartments—17 Garages—45 Bomb Shelters—11 B. Inspection and Indexes The citywide Aedes breeding index in Honolulu continued to de- crease during the first half of the month (0.7$ to 0,6$). Dur- ing the last half of August an increase to 0,8$ occurred. Follow- ing is a summary of the month’s activities: No. of premises inspected &3,302 No. of premises breeding Aedes 574 Aedes breeding index on August 31 0.8$ No. of inspections per man-day 44 At the end of August six zones had indexes above 3$ and one had an index above 5$o C. Special Crews 1. Trouble Shooting Crew In addition to the spraying activities, the trouble shooting crew filled 2<,827 tree holes with cement, of which 35 or 1,2$ were breeding at the time; 447 rock holes were filled, of which 14 or 3ol$ were breeding; 270 pipes were filled, of which none were breeding; and 210 bamboo stumps were filled, of which 4 or 109$ were breeding. 2. Manhole and Catch Basin Larvicide Work The motorcycle spray outfit was out of service most of August, However, together with the district control offices, the following work was dones Storm drains checked , 229 Storm drains larvicided 105 Storm drains breeding ' Aedes 7 3. Special larviciding activities included the treating of 9 ditches, 6 cesspools, 4 streams, 2 bomb shelters, 2 ground pools and one pillbox. 4<* Roof Gutter Work The roof gutters of 17 premises were inspected during the current period. 302 5• Clean-up Activities The clean-up crew collected and disposed of 70 truck loads of accumulated debris from 115 premises scattered through- out the city® 6, Fish Stocking The following places were stocked with mosquito minnows: 7 ponds, 2 tanks, 1 well and 1 bomb shelter, 7® Inspection of USED baseyards and waterfront area Fourteen USED baseyards were inspected during August, Three Aedes breeding places and two Culex breeding places were found Forty-five piers and other installations along the Honolulu waterfront were also inspected, on which Aedes mosquitoes were found breeding in two places® D, Personnel Field Total Array- 85 . 85 Chamber of Commerce 6 9 Uo S, Public Health Service 31 43 TOTAL 122 137 E, Public Education Thirty-seven column inches of English and 12 column inches of foreign language news appeared in local newspapers during August. IV, New Mosquito Control Regulation Adopted by Territory ' On July 25, 1944, the Governor of Hawaii signed the new mosquito control regulation which had been presented to the Board of Health and approved® The new regulation, which is Section 73 of the Rules and Regulations of the Board of Health, clarifies and strengthens the legal aspects of mosquito control® The owner or tenant is responsible for maintaining the premises free of mosquito breeding under the regulation, which provides seven alternate methods of control depend- ing upon the type of breeding place® Provision is made for inspec- tions by the Board of Health for the purpose of enforcing the regu- lation. 303 V, Release of the 715th Mosquito Control Detachment The 715th Mosquito Control Detachment, which initially carried mosquito control on the Island of Maui and later assigned to certain areas in rural Oahu, was released back to the Army on August 10, 1944 for transfer to forward areas0 VI. Wahiawa Program Personnel—4 The citywide Aedes breeding index at Wahiawa was 1,3$ in mid-August and 0.5$ at the end of the month0 Analysis of the types of containers found breeding at Wahiawa indicates that ant cups and tires are the biggest problems,. Following is a summary of the inspection activi- ties for the month of August: Noo of premises inspected 2,88£ No. of premises breeding Aedes 24 Aedes breeding index on August 31 0.5$ 7IIC Kauai Program Personnel—41 During the period July 16 through August 15 a total of 13,340 premises were inspected on the Island of Kauai, One hundred eighty-nine premises were found to be breeding Aedes mosquitoes. As of August 15, 21 cities and camps were under control on the island. One city—Hanalei—had an index above 3$« Following is a list of the Aedes breeding indexes as of August 15, 1944: Town Aedes Breed„ Index Town Aedes Breed. Index Eleele ****** Koloa 2.7 Hanalei 5.9 Koloa Mill — Hanamaula —— Lihue 2.4 Hanapepe -— Makawexx —— Huleia Camp 3 1.1 Nawiliwili .8 Kalaheo .6 Port Allen .8 Kapaa .8 Puhi ... Kapaia -— Wahiawa .5 Kealia 1.8 Camp 2 —. Kekaha • 2 Walmea .3 Kilauea Id 304 VIII, Hawaii Program Personnel—57 During tne period July 16 through August 15 a total of 19,915 premise inspections were made on the Island of Hawaii. During this period Aedes mosquito breeding was found on 445 premises. Inspections were made in 23 cities and camps during the first half of August. Five places had indexes above 3% and one had an index above 5% Following is a list of Aedes breeding indexes as of August 15,1944 Aedes Breed. Aedes Breed. Town Index Town Index Hakalau 4a Mt o View 4.4 Hawi 1.7 Naalehu 1.0 Hilo 1.6 Ninole 3.3 Honohina 2.2 Olaa 5.0 Honokaa 2,7 Ookala 1.8 Honorau 2,7 Paauhau — Honuapo — Pahala 1.2 Kailua 2.4 Pahoa 9.0 Kamuela — Papaaloa 1.5 Kealakekua 2.5 Papeikou 2.1 Kohala 2.1 Pepeekeo 2.5 Laupahoehoe — From an islandwide standpoint, ant cups caused the most trouble. The most numerous breeder was the classification including barrels, tubs, tanks, jars and buckets. It is interesting to note that water-holding plants have not been a major source of mosquito breeding recently. During the reported period the clean-up crew stocked 35 tanks with mosquito fish at Kealakekua and hauled 8 truckloads of containeis from Hilo, IX.Rural Oahu Program Personnel—105 (part time) At the end of the first half of August the 719th Medical Sanitary Company received orders to take special training temporarily re- quiring about one-half of their time. For this reason it was not possible to cover rural Oahu communities as thoroughly as previously. The 715th Mosquito Control Detachment made repeat in- spections in a number of communities which were covered for the 305 first time during the month of July. Since this detachment is being released, these communities will not receive further control. In general, rural Oahu communities which have been under regular control have very low Aedes breeding indexes. None were above during the month of August. In two communities, Haleiwa and Kahuku, no Aedes breeding was found. Following are the Aedes breeding indexes fof rural Oahu communities for the period ending as indicated: Aedes Breed. Town Index Period Aiea o3 8/15/44 Bwa <,2 3/31/44 Haleiwa — 8/31/44 Kahuku — 8/31/44 Kaneohe 1,0 8/15/44 Kuliouou 2»3 8/15 /44 Kunia 1.6 8/15 /44 Maile 10,8 8/15/44 Military Inst0 c2 8/15/44 Nanakuli 21,5 8/15/44 Niu 5a 8/15/44 Moanalua 4.0 8/15/44 Pearl City a 8/31/44 Waialua •4 8/31/44 Waianae 4o4 8/15/44 Wailup© 5.7 8/15/44 Waipahu o3 8/31/44 Respectfully submitted, /s/ Wesley E. Gilbertson Wesley E„ Gilbertson P0 A. Engineer (R) i/c Dengue Mosquito Control 306 FEDERAL SECURITY AGENCY U. S0 PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Monthly Narrative Report July, 1944 I. Monthly Summary A, Dengue Fever Cases Cases acquired within Territory—5 (civilian) Cases noff shipping”—4 B. Control Program—Territoryvd.de (As covered in this report) Number of premises inspected 111,544 Number of premises breeding Aedes 1,162 Total personnel engaged in program 307 II, Epidemiology of Locally Acquired Gases The five cases of dengue fever which occurred during the month of July were all located in Honolulu but were scattered throughout the central and Kaimuki portions of the city. It was not possible to determine the likely source of infection of any of the cases. The only significant epidemiological finding was that two of the victims were employed at the Pearl Harbor Navy Yard, though in different parts of the yard, III, Control Activities in Honolulu A, Special Activities Connected with Dengue Cases During the month of July the following premises were sprayed in the follow-up of dengue cases? Residences—150 Garages—65 Barracks (Hickam Field)—13 Apartments—10 Stores—6 Rooming houses and office buildings—1 each Restaurants—2 The power spraying equipment was used at Hickam Field, at an Hawaiian Camp on Ilalo Street, and at a large restaurant. 307 B, Inspection and Indexes The citywide Aedes breeding index in Honolulu dropped from 1,1$ at the end of June to lo0% at the middle of July and 0*7% at the end of Julye This is the lowest index experienced in Honolulu since the beginning of the program, Following is a summary of the month’s activities; NOo of premises inspected £2,733 No* of premises breeding Aedes 727 Aedes breeding index on July 31 0*7% No* of inspections per man-day 46 At the end of July two zones had indexes above 3$ and one had an index above 5$o Co Special Crews lo Trouble Shooting Crew In addition to the spraying activities, the trouble shooting crew filled 2,004 tree holes with cement, of which 240 or 12% were breeding at the timee Also, 77 rock holes were filled of which 12 or 15$ were breeding at the time, 20 Manhole and Catch Basin Larvicide Work During the month the motorcycle spray outfit, together with supplemental aid from the district control offices, checked , 514 storm drains and manholes and larvicided 184, Nineteen were found breeding mosquitoes0 3, Special larviciding activities included the treating of four cesspools, three ditches, two small streams, a swimming pool, an air raid shelter and a flooded basement of a build- ing, 4o Roof Gutter Work The roof gutters of 162 premises were inspected on which the following corrections were made; 3& gutters cleaned, 5 repaired, 4 removed and 3 perforated, 5. Clean-up Activities During July the clean-up crew collected and disposed of 79 truck loads of accumulated debris from 140 premises scattered throughout the city. 308 6, Fish Stocking The following places were stocked with mosquito minnows: 9 fish ponds, 3 streams, 1 ditch and 1 swamp, 7, Inspection of USED baseyards Twenty-three USED baseyards were inspected during July, of which 4 were found breeding Aedes mosquitoes, D, Personnel / Field Total Army 94 94 Chamber of Commerce 5 8 Uo S0 Public Health Service 32 41 TOTAL 131 143 E. Public Education One hundred four column inches of English and 70 column inches of foreign language news appeared in the local newspapers during July, F, Chamber of Commerce Budget Approved The Public Health Committee of the Chamber of Commerce has approved a budget of plus $500 balance, for dengue mosquito control for the six month!s period, July through December, 1944° IV, Wahiawa Program Personnel—4 In addition to the regular crew of four men at Wahiawa, a clean-up crew was assigned to the city for a temporary period. Large accumula- tions of tin cans, bottles and debris were cleared from twelve differ- ent locations. Following is a summary of the inspection activities for the month of July: No, of premises inspected 2,966 No, of premises breeding Aedes 30 Aedes breeding index on July 31 0,9^ 309 V, Kauai Program Personnel—41 In general the Aedes breeding indexes on Kauai continued their downward trend during the last half of June and the first half of July, A total of 10*953 premise inspections were made from June 16 through July 15* of which 170 premises were found breeding Aedes, In a few cities—Hanalei* Kilauea and Nawiliwili—the Aedes breeding indexes were up. Following is a list of the Aedes breeding indexes as of July 15, 1944: Tom Aedes Breed0 Index Tom Aedes Breed, Index KLeele 1.1% Koloa XM Hanalei 10o2 Koloa Mill 1.1 Hanamaulu 1.5 Lihue 1.5 Hanapepe 0.0 Makaweli 1.7 Huleia Camp 3 3o2 Nawiliwili 4.8 Kalaheo 5.0 Port Allen 0.0 Kapaa *8 Puhi .4 Kealia o3 Wahiawa 1.6 Kekaha .6 Camp 2 0.0 Kilauea 6.2 Waimea .3 Kapaia 2. 4 For the period from the beginning of the work on March 27 through July 15* 1%4* special work accomplished on Kauai including the periodic larviciding of 7 air raid shelters located in Kekaha and Hanapepe* the disposal cf 7 truck loads of old tires and the larviciding of 135 additional tires* the disposal of 81 truck loads of miscellaneous receptacles and the filling of 3 ditches, VI, Hawaii Program tumjnux*esar..mm *.■*. .ap Personnel~57 During the period July 1 through July 15* 8*716 premise inspections were made on the Island of Hawaii of which 194 or 2,2$ were found breeding Aedes, The islandwide index thus is lower than for the previous period. Other work included the stocking of 137 water tanks in Kealakekua with mosquito fish. Following is a list of the indexes as of July 15* 1944s Aedes Breed„ Aedes Breed, Tom Index Town Index Hakalau 1.5 Honokaa • 7 Hilo 1.9 Hon cam 1.9 Honohina 1.2 Homiapo 1.0 310 Town Aedes Breed« Index Town Aedes Breed, Index Kailua 6.2 Ninole 13.7 Kamuela 3.3 Paauhau 0,0 Kealakekua 4o4 Pahala .7 Kohala o9 Pahoa 3.5 Laupahoehoe 2.9 Papaaloa 2,6 Mt0 View 5.5 Papaikou 2.0 Naalehu 1,2 Pepeekeo 2.2 VII, Maui Program The 715th Mosquito Control Detachment, upon receiving orders, left Maui and arrived on Oahu during the latter part of June, Several areas in rural Oahu are assigned to this unit for control. As a means of maintaining surveillance on the mosquito breeding con- ditions on the Island of Maui, it is expected that all the more im- portant cities and communities will be checked at intervals of about six weeks, using a small crew from the Honolulu program, VIII, Rural. Oahu Program Personnel—62 The Aedes breeding index (combined) forthe cities of rural Oahu which had been under regular control increased from ,5$ at the end of June to at July 15 to 102% at the end of July, However, none of the cities had an index over 3oC$0 Following is a summary the Aedes breeding indexes as of July 31s Town Aedes Breed0 Index Town Aedes Breed,, Index Aiea loO Military Inst0 o 2 Ewa Moanalua 4.6 Haleiwa OoO Niu 6.7 Kahuku 02 Pearl City .2 Kailua •7 Waial.ua 1.2 Kaneohe 2.9 Wailnpe Kemoo 3«o Waimanalo •3 Kuliouon So .3 Waipahu 1,3 IXo New Mosquito Control Laboratory mhnw* — — u «■ f a^gat-acaMi>.t«saiT—1», i--> jtawttwwipw On July 1 the laboratory for the mosquito control program was moved from Bishop Museum to the Kalihi Hospital laboratory. At the beginning of the control program the Director of Bishop Museum generously provided laboratory space which was utilized until the end of June, By arrangement with the Director of District No, 10 the laboratory formerly utilized by the U0 Se Public Health Service in connection with the leprosy hospital was made available. Adequate space is now provided for rearing and experimenting with mosquitoes and larvicides, Some of the equipment and supplies stored in the hospital are being utilized, X, Accumulated Totals for Past Fiscal Year From the beginning of the expanded program, September 15, 1943, to the end of the fiscal year, June 30, 1944, the following work was accomplished; Total number of premise inspections .,••••• 995,223 Total number of premises breeding Aedes 21,348 Total number of tree holes filled e ,,,,,, • 10,381 Total number of rock holes filled , . 0 • . . , , • 6,269 Total number of truck loads hauled by clean-up crew 3,597 Total number of ponds stocked with mosquito fish 137 XI, Training of New Sanitary Company wawourwuwi r i mtm. itb »iiti lami...':»i ■. .ijwmatuu A new colored sanitary company consisting of 114 men and 3 officers reported for training in Aedes mosquito control on July 12« After two days of classroom instruction followed by two days of field training in Honolulu, the group was assigned for further field training in rural Oahu, All phases of the control program were covered, including Inspection, supervision, clean-up and statistical. The company was released on July 29, 1944o Respectfully submitted, /s/ Wesley E0 Gilbertson P0 A0 Engineer (R) i/c Dengue Mosquito Control 312 FEDERAL SECURITY AGENCY Uo So PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Twentieth Semi-Monthly Narrative Report Period Ending June 30, 1944 Note; Because of the greatly reduced incidence of dengue fever and the more routine nature of the control program, progress reports will hereafter be issued on a monthly basis. I. Epidemiology k0 Number and Extent of Cases One case of dengue fever, residing in the Waikiki district, was reported during the semi-monthly period ending June 30o This brings the total to date to 1,496 caseso Besides the single confirmed case of dengue, $ suspected cases were reported during the period, all of which were diagnosed later as other diseases„ The total number of confirmed cases for the month of June is threeo During July, 1943, the month in which the epidemic started, 8 cases were reported0 During June, 1944, a period of three weeks elapsed without a single case being reportedo He Special Work A0 Wholesale Spraying Due to excessive mosquito breeding found in a twelve square block area in the Kapalama district between Vineyard and King Streets, the area was sprayed with a power sprayer on June 160 A total of 194 premises were covered0 Also to reduce the Aedes mosquito population, a smaller area comprised of 34 premises on Ohua Avenue in the Waikiki district was sprayed0 Bo Trouble Shooting Crew The trouble shooting crew sprayed 19 apartments, 11 garages, 8 dwellings and a business establishment in the follow up 313 of suspected and confirmed dengue cases during the period. Spraying operations proceed as soon as a suspected case is reported, rather than waiting until a positive diagnosis is made0 lo Manhole and Catch Basin Larvicide Work Storm drains checked 111 *» « sprayed 99 " * breeding 54 2, Tree and Rock Hole Filling Work Tree holes filled—898 Tree holes breeding at the time of filling—37 Percent breeding—4o2$ Rock holes filled—251 Rock holes breeding at the time of filling—31 Percent breeding—1603% 3o Fish Stocking and Miscellaneous Six pools were stocked with fish, 35 upright pipes were filled and numerous Culex breeding areas were larvicided during the period, C o Clean-up Crew During the period the clean-up crew was reduced from approximately 30 men to 4 men, including the foreman0 The number of clean-up referrals has gradually decreased during the past several weeks0 It has been decided to utilize the dengue control clean-up crew only where no other means of removal of accumulations can be effectively utilized. Abatement orders will be served for removal of accumulations either through municipal sanitation services or otherwise. It is believed that this initial step in placing responsi- bility on the premise occupant or owner is justified. During the past period a total of 88 truck loads of con- tainers were disposed of from 119 different locations. The accumulations handled were as follows? 40 loads from Lanakila, 35 from Central and 13 from Kapahulu. / Permission has been granted by the City and County Board of Supervisors for the use of authorized dumps without payment of the usual dumping fee. 314 III* Inspection and Indexes - Honolulu Summary Noo of premises inspected 43,380 NOo of premises breeding Aedes 466 Aedes breeding index 1„1% Noc of premises breeding Culex 139 Culex breeding index 0.3$ Noo of inspections per man-day (7-hour day) 45o2 The present citywide index of lol% represents an increase of 0*1/6 in the previous semi-monthly period. Following is a summary by districts of the zone indexes which were reduced, increased and unchanged: District Zone Indexes 2e Zone Indexes Down Zone Indexes Unchanged Central 10 U U Kapahulu 9 9 ' 6 Lanakila j±. 6 -A- TOTAL 34- 29 U Six zones or 7% of the total had indexes above 3% and 3 zones or of the total had indexes above IV. Personnel A0 Honolulu Field Total Army 90 90 Chamber of Commerce A 6 Uo So Public Health Service _2L. A7 • 129 143 The number of army personnel was reduced during the period from to 90o Bo Rural Oahu, Kauai, Maui, Hawaii Armys Rural Oahu (including Wahiawa) — 58 Kauai°“41 Hawaii~*57 315 Vo Public Education Ao News Releases Eleven column inches of English and 6 column inches of foreign language news releases appeared in the local news- papers during the current semi-monthly period« VI• Chamber of Commerce Budget for Dengue Mosquito Control A budget was submitted to the Public Health Committee of the Chamber of Commerce of Honolulu covering proposed expenditures for the dengue mosquito control program for the period July 1 through December 31. 1944-° A total of $3,724 in new funds, plus approximately 1500 balance from the previous six-month period, was requested, giving a complete total of |4,224o The budget for the previous six months was $5,338o50o VII• Public Health Service Expenditures for the Past Quarter Year Month Salaries Supplies & Equipment Miscellaneous April $7416.28 11120.25 145.15 May 8245 o 4?- 667.25 19o30 June 8314.49 378.52 38.25 TOTAL $23,976.19 $2,l66o02 $102o70 GRAND TOTAL—126,2440 91 The grand total for the period January 1 through March 31 1944- was |27,051o53 VIIIo Iftaui Program ■ imam 5£ NOo of premises breeding Culex 25 Culex breeding index 108# No0 of inspections per man-day (7-hour day) 37.1 The citywide Aedes index increased 0,2% during the last half of JuneQ X. Kauai Program A total of 6,858 premises was inspected during the period June 1 through June 15o The breakdown by cities is as follows: fife Prem0 Aedes Prem. Culex Prem0 Breed0 Breed„ Breed0 Breed0 Siiz InsPo Aedes Index Culax Index Eleele 178 2 Id 1 • 5 Hanalei 71 3 4.2 Hanamaulu 373 8 2d 3 08 Hanapepe A&3 7 lo5 3 06 Huleia Camp 3 191 6 3d 1 o5 Kalaheo 307 12 3«9 8 2.6 Kapaa m 9 io8 A 08 Kapaia 165 12 7o2 1 06 Kealia 202 3 lo* Kekaha AAA 6 lo3 A o9 Kilauea 159 5 3ol 5 3ol Koloa 645 16 2,4 11 lo7 Koloa Mill 185 3 io6 1 o5 Lihue 769 20 2.6 4 o5 Makaweli 196 3 lo5 1 o5 Nawiliwili 231 U 6„o 2 08 Port Allan 256 4 lo5 Puhi 465 8 1.7 1 «2 Wahiava 377 6 lo5 2 o5 Camp #2 118 6 lol 1 o5 Walmea 580 8 Mk. _5_ <>9 TOTAL 6858 161 2o3 57 O08 317 The islandwide Aedes index for Kauai continued to decrease, this period being 0o3% lower than the previous period0 Twelve communities had lower breeding indexes, 7 had higher indexes and one had the same index as the previous period„ XIC Rural Oahu Program Only 28 premises located in Rural Oahu communities were found to have Aedes mosquito breeding in 5,4-7$ inspections during the period June 16 through June 30o The combined index (0o5%) was 0ol% lower than for the previous periodo The breakdown by cities is as follows? |SJ io o Premo Aedea Prem0 Culex Premo Breed 0 Breedo Breedo Breedo Cite iDSPo Aedea Index Culex Index Aiea 344 2 o5 2 o5 Ewa 860 2 02 3 o3 Haleiwa 276 1 o3 2 o? Kailua 843 4 o4 9 loO Kaneohe 934 13 lo3 12 1.2 Pearl City 528 1 o2 9 lo7 Waialua 539 2 o3 Waimanalo 258 2 o7 Waipahu 893 1 .1 12 _1q3_ . TOTAL 5m 28 0o5 49 0.8 XIIo Hawaii Program Of 9«766 premia© inspections8 Aedes breeding was found on 2£7 premises during the period June 16 through June 300 The islandwid© index increased slightly“~203% to 205%0 In Hilo, the index decreased from 20J$> to 203%0 The breakdown by- cities is as follows? Noo Prenio Aedes Prenio Culex Prem0 Breedo Breedo Breedo Breedo CJJgr lME° Aedes Index Culex Index Hakalau 226 7 3o0 2 08 Hawi 284 14 4o9 2 o7 Hilo 5042 121 203 48 o9 Honohina 84. 9 10o7 0 c0 Honokaa 400 2 o5 2 o5 Honorau 251 3 lol 0 oO Homi&po 50 0 oO 0 oO Kailua 41 8 19o5 0 oO Kealakekua 231 11 4o7 3 1„2 Kohala 316 0 oO 0 oO Laupahoehoe 87 1 Id 1 lol 318 pity Noo Premo Inspo Premo Breedo Aedea Aedes Breedo Index Prem. Breed0 Culex Culex Breedo Index Mto View 290 * 5 lo7 5 lo7 Naalehu 185 2 lo0 0 o0 Olaa A95 U 2.8 A 08 Ookala 213 U 1.8 0 o0 Paauhau 180 0 oO 0 o0 Pahala 387 3 07 3 o7 Pahoa 200 7 3o5 8 Ao0 Papaaloa 170 8 Uol 3 1.8 Papaikou 288 8 207 1 o3 Pepeekeo 264 7 2.6 1 o3 Wailea 81 13 5Z7 16.0 1 1.2 TOTAL 975S" 2o5 w 08 Other work included: the stocking of 135 water tanks in Kealakekua with mosquito fishj and disposing of 8 l/2 truckloads of containers collected in Hilo0 XIII. Summary: Territory of Hawaii Noe, of premises inspected 73,824. Noo of premises breeding Aedes 1,040 Total personnel engaged in program 342 Respectfully submitted, /s/ Wesley E„ Gilbertson Wesley E0 Gilbertson Po A. Engineer (R) i/c Dengue Mosquito Control Notes P„ A0 Sanitary Engineer (R) Bernard B0 Berger who very successfully conducted the territorywide dengue mosquito control program during my absence has been assigned by the Board of Health as Sanitary Engineer for the Island of Hawaii 319 FEDERAL SECURITY AGENCY U, So PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Nineteenth Semi-Monthly Narrative Report Period Ending June 15, 1944 I. Epidemiology A. Number and Extent of Cases Two cases of dengue fever were reported during the semi- monthly period ending June. 15* This brings the total to date to 1,4-95 caseso These two cases, a decrease of one case from the previous semi-monthly period, represent the lowest semi-monthly incidence of the disease since the beginning of the control program. The two cases were reported on the first day of the month. We have therefore not had a case of dengue reported for a period of two weeks0 This is the longest period with no case of dengue fever reported since the beginning of the epidemic in July, 1943. II, Special Work A. Wholesale Spraying One residential area including 107 individual premises, a Coast Guard station and a school were power sprayed during the current period„ 8, Trouble Shooting Crew The trouble shooting crew sprayed 11 dwellings during this period. lo Manhole and Catch Basin Larvicide Work Storm drains checked 168 n w sprayed 22 n • breeding 28 20 Tree and Rock Hole Filling Work Tree holes filled°°l,812 Tree holes breeding at the time of filling—21 Per cent breeding—lo2% 321 Rock holes filled--3£8 Rock holes breeding at the time of filling—21 Per cent breeding®-604$ 3o Fish Stocking Three fish ponds, 27 storm drains.and a culvert were stocked with fish during the current period0 In the case of the storm drains, grit and street debris de- posited in the catch basins partly plugged the drains, preventing flow at low water depth0 Several instances of Aedes and Culex breeding were observed in the water in the drains» Oiling was not too effective due to slight intermittent rainfall and resulting loss of larvicide* Resort was made to the use of mosquito destroying fish as a simple and effective means of control until action could be taken by the public au- thorities o A similar condition existed at the culvert,, Uo Miscellaneous control activities included the filling of 193 vertical fence pipes, and oiling of two cess- pools and one stream., 5o The low reported dengue incidence will permit the use of the power spraying equipment in areas where Aedes breeding is found to be high, although the disease may be absento A spot map showing the locations of active breeders found is being maintained0 When centers of breeding are determined, a massive spraying job will be performed to coincide with an intensive inspection of the area0 Co Roof Gutter Crew The roof gutter crew inspected 60 premises, of which $0 were found to have unsatisfactory gutters«, Thirty-nine roof gutters were cleaned, 5 perforated, 4 removed and 2 repairedo Do Clean-up Crew With an average working force of 32 men utilizing 3 one and one-half ton trucks and 1 one-half ton truck, the clean-up crew collected and disposed of 100 truckloads of miscellan- eous bottles and tin cans. Due to the public health necessity for rigid control of garbage and rubbish disposal sites, the Board of Supervi- sors of the City and County of Honolulu hss authorized the use of only two dumps in the city„ The two sites are city- owned and supervised» A fee of 50 cents per cubic yard of 322 waste is charged0 Special action on the part of the Board of Supervisors is required in order that the Honolulu Dengue Mosquito Control program may be permitted the use of these authorized dumps without payment of the charge0 The necessary steps for the approval of our use of the author- ized dumps have been taken0 Until approval is obtained, the operations of our clean-up crews will be seriously curtailedo E, A study of the statistical reports indicates that the re- cent Bottle Removal Drive sponsored by the Honolulu Junior Chamber of Commerce resulted in the elimination of approximately 11,OCX) bottles in Honolulu which were classi- fied as potential mosquito breeders0 III, Inspection and Indexes - Honolulu Summary No, of premises inspected 41,12? No0 of premises breeding Aedes 418 Aedes breeding index lc($ Noo of premises breeding Culex 128 Culex breeding index 0*3$ Noo of inspections per man-day (7-hour day) 45o2 The present citywide index of lo0% represents no change from the index of the previous semi-monthly period0 Several factors for the interruption in the definite downward trend of Aedes breeding may be mentioned0 As Aedes breeding reaches the relatively low levels indicated by the recent in- dexes, it beporoes increasingly difficult to produce further re- ductions c A second factor may be the rainfall occurring during the latter part of the period0 A third factor is the recent intensified inspection of vacant premises0 Spot checks by supervisory personnel had indicated that vacant premises in residential areas were not being covered thoroughly by the in- spectors o It was also found that many vacant premises were being used as disposal sites by neighboring residents0 In several cases such unwholesome practices were referred to the police authoritieso Following is a summary by districts of the zone indexes which were reduced, increased and unchangedg District Zone Indexes Ss Zone Indexes Down Zone Indexes Unchanged Central 10 U A Kapahulu 7 15 2 Lanakila ■2!" _12_ JL. TOTAL 42 9 323 Eight zones or 1C$ of the total had indexes above % and 3 zones or IS of the total had indexes above %<> IV o Personnel A® Honolulu Field Total Army U8* U8* Chamber of Commerce 2 U Uo So Public Health Service _2i_ -J±L. TOTAL 185 199 Bo Rural 0ahu5 Kauai9 Hawaii Arrays Rural Oahu (including Wahiawa) — 58 Kauai—41 Maui—43 Hawaii--57 Vo Public Education mt>m«m ■ ■ i — ii»i—nw im L-rgii.u A0 News Releases Sixteen column inches of English and 8 column inches of foreign language news appeared in the local newspapers during the semi-monthly period0 B o Radio The previous schedule of spot announcements (1-a-day) was continued® Co Public Talks Two public talks were given by officers on the staff of the Honolulu Dengue Control during this period0 These talks included one given before the Custodians Association of Oahu and a talk entitled “Progress on Dengue Control in Honolulu1* given before the Engineering Association of Hawaii, *Includes 91 men on detached service and 57 men from a Medical Sanitary Companyo Near the end of the period9 the latter were recalled to their organization for a different assignment0 Assurance has been given that replacements will be assigned to the Honolulu Dengue Control program® 324 VI. Excerpts of Talk Given to Engineering Association of Hawaii "The prospects at the present time of eliminating dengue fever from the civilian population in the Territory are fair0 The incidence of the disease has shown a definite response to the control techniques applied„ The highest weekly incidence of dengue amongst the civilian population in Honolulu was 159 caseso This occurred shortly after the expanded control program was initiated0 At the present time the weekly inci- dence is between one and two cases0 As a matter of fact, we have had no case of dengue reported to us for approximately two weekso ■This favorable picture must necessarily be qualified«, We have reason to believe that dengue among the civilian popular tion still occurs but remains unreported as no physician may be calledo We have a large susceptible population and we know, of course, that Aedes mosquitoes are prevalent We still have with us, therefore, the three elements necessary for dengue transmittal in epidemic form0 "With our present control methods we can expect to terminate dengue among the civilian population in the Territory only by the elimination of the virus causing the disease0 That is why we attach such considerable importance to reporting and epide- miological work, isolation of victims and the destruction of Aedes mosquitoes at locations designated by the epidemiological • surveyo "We do not believe it feasible to destroy all Aedes mosquitoes in the Territory„ We find that our inspection-correction-edu- cation program is extremely effective against Aedes aegypti but not quite as effective against Aedes albopietus0 It appears that Aedes aegypti exhibits a definite preference for breeding in those containers usually found in the immediate vicinity of habitationso Aedes albopictus. however, would apparently just as soon breed in tree holes, rock holes and other natural con- tainers as in tin cans and bottles„ Such natural containers are frequently difficult to uncover, especially in the heavily wooded areas at the heads of the valleys extending into the city of Honoluluo The time, effort and manpower required to find and eliminate the breeding places in such locations make this activity unfeasible and unwarranted at the present time0 At the start of this control program it was estimated that Aedes albo- pictus and Aedes aegypti were present in a ratio of U to 1G The present ratio is at least 15 to 10 These ratios clearly indicate the greater effectiveness of our inspection program in the elimination of Aedes aegypti0 "The question will undoubtedly be asked whether or not the con- trol program should be terminated when we are certain that dengue fever has been definitely eliminated from the civilian population 325 It is our opinion that the control program should not be ter- minated at least as long as the war effort in the Territory is essential. We know definitely that we will have two of the three elements necessary for the spread of the disease0 These two elements are the transmitting mosquitoes, Aedes albonictus (assuming we destroy all Aedes aegypti mosquitoes) and a large susceptible population0 We are also aware that the danger of re-introducing dengue fever to the Territory is ever-presento The military authorities are taking effective measures to pro- tect military personnel and the civilian population from "off shipping" caseso There is always a chance, however, that a case will escape observation and that protective measures adopt- ed will not be applied0 If this should occur, a new dengue epidemic might actually be in the offing," Vile Maui Program During the period May 16 through May 31, 8,037 premises were inspectedo The breakdown by cities is as followss Noo Prem, Aedes Prern, Culex Prem, Breedo Breed, Breed, Breed, Citjr Inspo Aedes Index Culex Index Haiku 479 41 8,5 20 4.1 Kahului 454 6 1.3 5 1.1 Lahaina 2022 67 3o3 31 1,5 Makawao 506 3 06 9 1.8 Paia 1069 18 lo7 11 1,0 Puunene 999 14 lo4 20 2,0 Spreckelsville 450 4 o9 5 1,1 Waikapu 132 2 1.5 4 3,0 Wailuku 1926 45 2,3 JL5L 1,0 TOTAL 8037 200 2,5 124 1.4 The Aedes breeding index for the latter semi-monthly period of May was 20%0 This represents a decrease of 0o4$ from the pre- vious periodo The Aedes breeding index was lower in all communi- ties on Maui with the exception of Haiku, Kahului and Waikapu, One community of the nine covered during this period had an Aedes breeding index above % and two had Aedes breeding indexes above 3%. This office was informed that during the early part of June the activities of the Mosquito Control Detachment on the Island of Maui were temporarily restricted to military areas0 The contin- uity of the program has therefore been broken. 326 VIII* Wahiawa Program Summary No0 of premises inspected 2,115 No, of premises breeding Aedes 7 Aedes breeding index 0®3% Noo of premises breeding Culex 28 Culex breeding index 1*3% Noo of inspections per man-day (7-hour day) 51*6 '■ The citywide Aedes breeding index, for the first semi- monthly period in June represents no change from the index fop the previous semi-monthly period0 Aedes breeding was found on only 7 premises of 2 115 premises inspected. The control in Wahiawa has reached the.point where significant decreases in the Aedes breeding may no longer be expected, IX. Rural Oahu Program Aedes breeding was found on 32 premises of 5,530 inspected during the first semi-monthly period of June, The Aedes breed- ing index in rural Oahu was therefore 0o6$6, the same as that for the previous period. The breakdown by cities is as follows: Citz Nfio Prem0 InsPo Prem. Breedo Aedes Aedes Breed 0 Index Prem0 Breedo Culex Culex Breedo Index Aiea 562 8 loA 1 ol Eva 8U 0 o0 2 o2 Hale lira 279 1 o3 0 oO Kahuku a? 0 oO 1 o2 Kailua 811 5 06 3 o3 Kaneohe 100A 15 loA 8 o7 Pearl City 4.61 1 o2 0 oO Waialua 527 0 oO 1 ol Waimanalo 258 1 o3 2 07 Waipahu _2Z0_ 1 -4- TOTAL 5530 32 0o6 23 OoA Of the 10 communities included in the program, 7 had lower Aedes breeding indexes during the current period than in the latter part of May, and 3 had higher indexes0 A total of 51 containers was found in which active Aedes breed- ing was taking place0 Twenty-six of these containers were lo- cated inside residences0 327 lo Kauai Program A total of 6,615 premises was inspected during the period May 16 through May 31, 19AA? the last period for which statistical re- ports have been submitted0 The breakdown by cities is as follows: NOo Prem0 Aedes Prem0 Culex Premo Breed *> Breed 0 Breedo Breedo Cltx Tnspo Aedee Index Culex Index Eleele 89 0 o0 0 o0 Hanalei 134 6 4o4 4 2o9 Hanamaulu 359 12 3o3 2 o5 Hanapepe 234- 3 lo2 2 o 8 Huleia Camp 3 65 3 4o6 2 3o0 Kalaheo 133 4. 3»0 0 oO Kapaa 858 29 3o3 12 lo3 Kapaia 154 14 9o0 5 3,2 Kealia 415 3 o? 3 o7 Kekaha 863 22 2o5 3 o3 Kilauea 352 12 3o4 6 lo7 Koloa 331 10 3o0 5 lo5 Koloa Mill 9-4 5 5o3 0 oO Lihue 821 20 2o4 3 o3 Makaweli 373 7 2„4 3 o3 Nawiliwili 66 3 4o5 2 3o0 Port Allen 120 0 oO 0 oO Puhi 233 3 102 1 o4 Wahiawa 189 4 2„1 0 oO Camp §2 58 2 3o4 0 oO Waimea TOTAL 674. SSis 10 172 ■-M- 4 o v a 58 -U_ 0o8 The Aedes breeding index for the Island of Kauai during the lat- ter half of May was 206$„ a decrease of QoU% from the Aedes breeding index for the previous period0 Twelve communities had lower breading indexes and seven communi- ties had higher breeding indexes during the period May 16 through May 31 than in the previous period0 In two communities the Aedes breeding indexes did not change* The control program on the Island of Kauai appears to be operat- ing smoothly0 While there are no spectacular drops in the Aedes breeding index, the decrease in breeding has been consistent, XIo Hawaii Program During the first half of June 10,120 premises were inspectedo Aedes breeding was found on 236 premises0 The Aedes breeding index, 20%9 represents a decrease of 101# from the index for the previous period* The summary by cities is as follows: NOo Prem0 Aedes Prem0 Culex Prem* Breedo Breedo Breedc Breedo Cit£ InsPo Aedes Index Culex Index Hakalau 222 1 o 4 0 oO Hawi 277 2 o7 2 o7 Hilo 5290 129 2o4 49 o9 Honokaa 401 2 o4 3 o7 Honomu 249 6 2o4 4 106 Honuapo 49 0 oO 0 oO Kamuela 77 0 oO 2 2o5 Kohala 315 1 o3 2 06 Laupahoehoe 87 1 lol 0 oO Mt0 View 292 13 4o4 7 2o3 Naalehu 188 5 2C6 2 loO Olaa 979 42 4o2 12 1.2 Ookala 209 5 2o3 2 o9 Paauhau 200 3 lo5 0 oO Pahala 373 8 201 7 1.8 Pahoa 189 12 6.3 8 4.2 Papaaloa 188 1 o5 1 o5 Papaikou 290 2 07 0 oO Pepeekeo 245 3 1.2 1 _o4 TOTAL 10,120 236 2.3 1ST loO Of the 21 communities inspected during the latter half of May, 19 were re-inspected during the first part of JuneQ The Aedes breeding index was lower in fourteen communities and higher in five communities during the first half of June than in the previous semi-monthly period. The Aedes breeding index for Hilo was lowered from 3®0% in the latter part of May to 20/S in the first part of June0 A study of the types of containers breeding Aedes indicates that barrels and other large containers in Hilo, Olaa and Mto View constitute approximately one-third of all the active breeders found on the island. The length of the inspection cycle for the crews operating on the Island of Hawaii appears to be satisfactory. With the ex- ception of a few minor communities, the island was covered with in a fourteen day period. Two clean-up crews operating in Hilo collected and disposed of twenty-six 1-1/2 ton truck loads of miscellaneous tin cans and bottles during the first semi-monthly period in June. 329 Sixty-one water storage tanks in Pahoa, 59 in Kailua and 52 in Kealakekua were stocked with mosquito fish during the first half of June0 The fish stocking program remains an important control measure in many areas on the Island of Hawaii0 During the latter half of May, 46 samples were collected from active Aedes breeders in six communities on the Island of Hawaii, On the emergence of the adult mosquito, 41 samples were identi- fied as Aedes albopictus and 5 as Aedes aegypti. The three cities where Aedes aegypti were found were Hilo, Mt„ View and Olaa, XIII, Summary: Territory of Hawaii No, of premises inspected 73,544 No, of premises breeding Aedes 1,065 Total personnel engaged in program 393 During the current semi-monthly period officers of the dengue mosquito control program made visits to Hawaii and Maui, Respectfully submitted, /s/Bernard B<> Berger Bernard B0 Berger Po A0 Sanitary Engineer (R) i/tc Dengue Mosquito Control 330 FEDERAL SECURITY AGENCY Uo So PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Eighteenth Semi-Monthly Narrative Report Period Ending May 31, 1944 lo Epidemiology Ao Number and Extent of Cases Three cases of dengue fever were reported during the semi- monthly period ending May 31» This brings the total to date to 1,493 cases0 These three cases, a decrease of 9 cases from the previous semi-monthly period, represent the lowest semi-monthly incidence of dengue since the begin- ning of the control program. None of the three cases occurred in an area previously defined as a focus of infection0 The two incipient foci in Kapalama and Kalihi-uka described in the preceeding report were apparently eliminated without further trans- mission of the diseaseo In addition to the three cases occurring during this period, seven suspected cases were reported but not con- firmed O lie Special Work Ao Wholesale Spraying One residential area, a hotel and vicinity, and a church and vicinity were power-sprayed during the current perioda The residential area sprayed included 130 separate premises in the Makiki section which had been visited by an inspector on this program who was a suspected case. Bo Trouble Shooting Crew The trouble shooting crew sprayed a total of 187 residences 1 and 11 business establishments« lo Manhole and Catch Basin Larvicide Work jt Storm drains checked 333 " n sprayed 81 * * breeding 75 331 2. Tree and Rock Hole Filling Work Tree holes filled—2,001 Tree holes breeding at the time of filling—24 Per cent breeding—1«2% Rock holes filled—400 Rock holes breeding at the time of filling—2 . per cent breeding—0o 5$ 3* Fish Stocking Sixteen privately owned ponds and nine cisterns were stocked with fish during the current period. 4® Miscellaneous control activities included the filling of 312 vertical fence pipes and oiling of numerous ground pools and cesspools0 C. Roof Gutter Crew The roof gutter crew inspected 54 premises of which 42 were found to have unsatisfactory gutters. Thirty-four roof gutters were cleaned, 4 perforated, 3 repaired and 1 removed. Do Clean-up Crew With an average working force of 33 men utilizing 5 trucks, the clean-up crew collected and disposed of 240 one and one-half ton loads of miscellaneous bottles and tin cans. III. Inspection and Indexes - Honolulu Summary No. of premises inspected 46,316 No. of premises breeding Aedes 502 Aedes breeding index 1.056 No. of premises breeding Culex 122 Culex breeding index 0.2% No. of inspections per man-day (7-hour day) 45 The present citywide index of 1.0J6 represents a decrease of 0.356 from the semi-monthly period ending May 15® 332 Following is a summary by districts of the zone indexes which were reduced, increased and unchanged: Zone Indexes Zone Indexes Zone Indexes District SE Down Unchanged Central 7 18 3 Kapahulu 9 12 3 Lanakila JL 6 TOTAL 21 u IT Seven zones or 9% of the total had indexes above 3% and 2 zones or 2q6% of the total had indexes above 5%a IV. Personnel Ao Honolulu Ao Honolulu Field Total Army us us Chamber of Commerce 2 U Uo So Public Health Service 35 47 TOTAL 185 199 Bo Rural Oahu, Kauai, Maui, Hawaii Army; Rural Oahu (including Wahiawa) — 58 Kauai—41 Maui—43 Hawaii—57 Vo Public Education Ao News Releases One hundred sixty column inches of English and 80 cdlumn „ inches of foreign language news appeared in the local news- papers during the semi-monthly period. Bo Radio The previous schedule of spot announcements (1-a-day) was „ continuedo VI0 Gratuities for Military Personnel on Detached Service Assigned to Honolulu Dengue Mosquito Control The Honolulu Chamber of Commerce in cooperation with the Terri- . torial Board of Health and the U„ S0 Public Health Service and with the approval of the military authorities has granted monthly 333 gratuities to all men on detached service with the Honolulu dengue mosquito control program. The first gratuities were disbursed for the month of May, Among the justifications for this program are the followings (1) Proper adjustments in army ranks corresponding to assigned duties and responsibili- ties cannot be made for army personnel on detached service with the Honolulu control program, (2) Assigned personnel have demonstrated interest in the work and there has been a definite increase in proficiency, (3) Service personnel as- signed to this program are required to have a neat appearance, necessitating higher laundry bills than normal0 (4) The gra- tuities will be appreciated by the men as a recognition of the important service performed. VII. Maui Program During the period May 1 through May 15, 7,944 premises were inspected. The breakdown by cities is as followsi SiS2 No0 Prem0 Insp0 Prem0 Breedo Aedes Aedea Breedo Index Prem0 Culex Culex Breed. Index Haiku 323 13 Uo0 8 2*U Kahului 425 1 02 2 oU Lahalna 980 65 606 29 2«9 Makawao 135 13 9.6 3 2.2 Paia 1737 32 1.8 13 07 Puunene 1000 26 1.6 16 1.6 Spreckelsville 395 6 lo5 5 102 Waikapu U0 1 o7 2 loA Wailuku 2809 80 2.8 37 lo3 TOTAL 79U 237 2o9 115 lo^ The Aedes breeding index for the Island of Maui during the first semi-monthly period in May was This represents a decrease of 2,3$ from the previous periodo The Aedes breeding index was lowered in all communities on Maui with the exception of Puunene. Two communities of the 9 covered during this period had Aedes breeding indexes above Three had breeding indexes above A total of 37 truck-loads of miscellaneous tin cans and bottles were collected and removed for permanent disposal. In addition, 37 truck-loads of worthless tires were collected from a garage in Wailuku and removed to a dump for disposal. Some difficulty is being experienced in the efficient operation of the clean-up crews due to the few available dumping grounds. The military authorities on this island are experiencing similar- difficulties and are taking steps to obtain new dumping grounds. 334 These will be made available to the clean-up crews on the local mosquito control program0 The inspection crews are completing the inspectional cycles within the desired elapsed time0 One crew is at present operat- ing on a 10-day cycle 9 the other on a 14-day cycle« Minor ad- justments will be made in order that the inspection cycle of each of the two crews may be equal. An officer on the Honolulu staff visited Maui during this period and investigated the proficiency of the men engaged in inspec- tionQ Emphasis was placed on the need for an intensified in- spection, especially in regard to the uncovering of concealed breeders• VIII* Kauai Program A total of 4*642 premises were inspected during the period May 1 through May 15* 1944° The breakdown by cities is as follows; No. Prera, Aedes Premc Culex Prem0 Breed0 Breed0 Breed0 Breed0 citr InsPo Aedes Index Culex Index Eleele 89 1 lol 1 lol Hanalei 65 3 4o6 Hanamaulu 182 6 3o2 A 201 Hanapepe 209 2 o9 1 oA Huleia Camp 3 58 A 608 1 lo7 Kalaheo 126 2 lo5 2 lo5 Kapaa 4.06 18 4-0 A A o9 Kapaia 73 4- 5oA 2 207 Kealia 192 5 2„6 2 loO Kekaha A35 13 209 2 oA Kilauea 175 11 6„2 Koloa 316 18 5o6 9 2^8 Koloa Mill 92 3 3o2 1 loO Lihue 681 18 2„6 A o5 Makaweli 186 12 6 0 4- 1 o5 Nawiliwili 136 A 2o9 2 lo4- Port Allen 127 2 lo5 Puhi 476 6 lo2 1 02 Wahiawa 184 A 201 Camp #2 60 Waimea 37 A 6 1»6 JL 1.0 4642 142 3o0 a 0.8 The Aedes breeding index for the Island of Kauai during this period was 3oOj6o This represents a decrease of 102% from the Aedes breeding index for the previous period. 335 Twelve communities had lower breeding indexes and 9 communi- ties had higher breeding indexes during the period May 1 through May 15 than in the previous period. The number of days of elapsed time to complete an inspectional cycle was 14 during the current period. IX, Wahiawa Program Summary Noo of premises inspected 2,298 No. of premises breeding Aedes 9 Aedes breeding index 0.3/6 Noo of premises breeding Culex 13 Culex breeding index 0.5/6 No. of inspections per man-day (7-hour day) 45.9 The citywide Aedes breeding index, 0.3/6, for the latter semi- monthly period in May represents a decrease of 0.156 from the index for the semi-monthly period ending May 15. Only nine containers on nine premises were found to be breeding Aedes at the 2, 298 premises inspected. The successful operation of the inspection program in Wahiawa is due in large measure to the efforts of the Wahiawa Community Association in enlisting the cooperation of the local population, X. Rural Oahu Program Seven thousand four hundred sixty-three premises were inspected during the period May 16 through 31, 1944-0 The statistical summary by cities is as follows: No, Premo Aedes Prem0 Culex Prem0 Breed0 Breed» Breed. Breed„ CitZ Inspo Aedes Index Culex Index Aiea 1013 5 o h 3 .2 Ewa 855 5 o5 6 ,7 Haleiwa 303 Kahuku A13 1 o2 Kailua 832 7 o 8 2 o2 Kaneohe 1023 18 lo? 6 o5 Pearl City 193 2 U 08 Waialua 665 1 .1 Waimanalo 520 2 1 o2 Waipahu 1246 JL, *2 .6 TOTAL 7463 U5 0.6 31 0o^ The overall Aedes breeding index in rural Oahu was 0.6* during the latter semi-monthly period in May. This represents a de- crease of 0.2* from the Aedes breeding index for the first part of May. 336 Of the ten communities included in the program, seven had lower Aedes breeding indexes in the latter part of May than in the first part of May, two had higher indexes and one remained sta- tionary0 A total of 63 active Aedes breeders was found on 45 of the 7,4-63 premises inspected. XI. Hawaii Program Nine thousand nine hundred twenty-six premises were inspected during the latter half of May0 Of these, 338 premises were found to be breeding Aedes, giving an index of 3»4%o The sum- mary by cities is as follows* NOo Prem, Aedes Premo Culex Prem, Breed0 Breed0 Breed0 Breed0 Citjr Inspo Aedes Index Culex Index Hakalau 222 11 4o9 A i»8 Hawi 280 2 o3 2 o3 Hilo 5086 156 3o0 52 loO Honokaa 382 3 o7 6 lo5 Honomu 253 8 3d 6 2o3 Honuapo 48 1 2o0 Kailua 79 A 5o0 2 2o5 Kamuela 69 1 1<>4 3 Ao3 Kealakekua 462 34 7o3 8 lo7 Kohala 313 8 2o5 1 o3 Laupahoehoe 87 A 4.6 1 lol Mto View 287 23 8o0 13 4o5 Naalohu 186 3 1.6 2 loO Olaa 486 37 706 7 1„4 Ookala 213 3 1<>4 Paauhau 205 2 o9 Pahala 355 5 lo4 5 loA Pahoa 185 17 9ol 5 207 Papaaloa 189 6 3d 1 o5 Papaikou 294 8 207 U 4o7 Pepeekeo _245_ -A. i«6 9926 338 3o4 134. lo3 The present iblandwide breeding index is 0o9% greater than the index for the previous period0 The Aedes breeding index for the city of Hilo increased from 109% for the first half of May to 3oA% for the latter part of the month0 The rise in the islandwide Aedes breeding index is due in large measure to the greater number of premises in Hilo found breeding,, A contribut ing factor was the inclusion of vacant premises in Hilo in the inspectional program,, An officer on the staff of the Honolulu Dengue Mosquito Control had visited Hawaii during the period and observed that vacant premises were not being inspected. The need for the complete elimination of breeders on such prem- ises was emphasized, especially in view of the undesirable 337 usage of these locations as private dumps0 Increased rainfall and more effective inspection were also important factors con- tributing to the increase in Aedes breedingo Of the 21 communities covered during the first part of May, 20 were reinspected during the latter half of the month. Of these 20 communities the Aedes breeding index was higher in 11 commu- nities during the latter half of the month than in the first part of May0 Two clean-up crews operating in Hilo collected and permanently disposed of 19 truck-loads of tin cans and bottles during the latter semi-monthly period in May0 One hundred ninety-two water storage tanks in Mt. View and 178 in Pahoa were stocked with mosquito fish during the last half of May. The fish stocking program is an important control mea- sure in certain areas on the Island of Hawaii. In several com- munities almost every residence has a rain water storage barrel, usually without adequate cover and not infrequently containing mosquito larvae. XII. Summary: Territory of Hawaii No. of premises inspected 78,589 No. of premises breeding Aedes 1^273 Total personnel engaged in program 398 During the current semi-monthly period officers of the dengue mosquito control program made visits to Hawaii and Maui to check on the progress of the local programs and to advise on more effecient operation. Respectfully submitted, /s/ Bernard Bo Berger Bernard B. Berger Po A, Sanitary Engineer (R) i/tc Dengue Mosquito Control FEDERAL SECURITY AGENCY U0 So PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Seventeenth Semi-Monthly Narrative Report Period Ending May 15, 19kk lo Epidemiology Ac Number and Extent of Cases Twelve cases of dengue fever were reported during the semi°monthly period ending May 15o This brings the total to date to 1,490 cases0 These 12 cases represent an in- crease of 7 cases from the previous semi-monthly period,, Three of the cases occurred in the Kalihi-uka area defined earlier as a focus of infection0 The three cases occurred in two adjacent houses0 The entire section was resprayed to eliminate the adult mosquitoes0 The last case in the Kalihi-uka area had occurred in the first week of Aprilo It appeared probable that interme- diate unreported cases had been present0 In an effort to determine the existence of unreported cases, the Public Health nurse assigned to the Territorial Board of Health was requested to make a premise-to-premise investigation,, No cases, however, were uncovered in this canvassingo A new focus of infection was apparent in the Kapalama section where three cases occurred in Kaauwai Place. Massive spraying was resorted to in this section to destroy the adult mosquitoes. Several cases occurred in Nuuanu0 The locations of these cases were not far from the lolani School section where massive spraying had been applied several months ago. This general area will be closely observed in order that proper remedial action might be taken immediately upon the determination of a focus of infection. The remaining cases were scattered throughout the city. lie Special Work A0 Wholesale Spraying 339 Two residential areas were sprayed during the current periodo These areas were in the Kalihi-uka and Kapalama sectionso A total of 103 premises was covered0 Bo Trouble Shooting Crew The trouble shooting crew sprayed 122 residences, 3 tene- ments, 9 business establishments, 2 pillboxes and a cathe- dral. 10 Manhole and Catch Basin Larvicide Work Storm drains checked 19$ M M sprayed $2 n n breeding 24. 2. Tree and Rock Hole Filling Work Tree holes filled—1,33$ Tree holes breeding at the time of filling—10 Per cent breeding—0*756 Rock holes filled—2,49$ Rock holes breeding at the time of filling—$ Per cent breeding—0o256 3o Fish Stocking Eight privately owned ponds were stocked with fish during the current periodo 4o Miscellaneous control activities iricluded a stream and numerous ground pools at an evacuation camp oiled0 Co Roof Gutter Crew During the current period the roof gutter crew inspected 2$$ premises of which 160 were found to have unsatisfactory gutterso One hundred thirty-one roof gutters were cleaned, 7 perforated, 7 repaired, 4 removed and orders issued to 11 householders to make permanent corrections0 Do Clean-Up Crew With an average working force of 30 men utilizing $ trucks, the clean-up crew collected and disposed of 144 one and one-half ton loads of miscellaneous bottles and tin cans0 IIIo Bottle Collection Drive A Bottle Collection Drive sponsored by the Honolulu Junior Cham- ber of Commerce and endorsed by the Soft Drink Bottlers* Asso- 340 elation, several breweries and liquor manufacturers and two dairies commenced on May 15o For a period of one week all grade school children on the Island of Oahu will collect bot- tles and bring them to a central disposal center where remun- eration will be made by firms owning these containers« In previous drives the collection was limited to soft drink bottleso At the instigation of the dengue mosquito control program, the present drive was expanded to include glass con- tainers of every variety„ The unclaimed bottles will be moved to the municipal dump by dengue mosquito control clean-up crews* Further assistance by means of publicity is being provided* The bottle collection drive will undoubtedly result in the permanent elimination of large numbers of actual and poten- tial Aedes breeders* It is estimated that a million contain- ers will be moved* The enthusiastic participation of the school children was apparent on the first day of the drive* An appraisal of the effectiveness of the drive will be given in the next semi-monthly narrative report* IV* Inspection and Indexes - Honolulu Summary No* of premises inspected 44,006 No* of premises breeding Aedes 590 Aedes breeding index 1*3% No* of premises breeding Culex 190 Culex breeding index 00lS Noc of inspections per man-day (7-hour day) 42*7 The downward trend of the Aedes breeding index continued during the current period* The present citywide index of 1*356 repre- sents a decrease of 0*5$ from the semi-monthly period ending April 30* Following is a summary by districts of the zone indexes which were reduced, increased and unchanged; Zone Indexes Zone Indexes Zone Indexes District Ug Down Unchanged Central 6 22 0 Kapahulu 11 12 1 Lanakila 10 _i2_ 2 TOTAL 27 47 3 Ten zones or 13% of the total had indexes above 3% and 8 zones or 10% of the total had indexes above 5%o Vo Aedes Breeding in Containers By Type In the table below is given the Aedes breeding index by type of container for the semi-monthly periods from February 1 to the period ending May 15J Tyne of Container Index for Semi-Monthly Periods Ending; 2-16 2^2 3-16 2=20. 4-16 ■Mmb* A=20 1=16 Fish Ponds o3 1.7 1.9 1.3 lol 06 o3 Catch Basins lol 08 1.7 1.4 o9 oO o 4. Cesspools ' loU oO 06 loO oO 08 oO Ditches, Ground Pools Animal Drinking c2 o3 o3 lo2 1.5 o7 o3 Troughs or Pans Barrels, Tubs. Tanks, .1 oO ol ol oO ol oO Jars, Buckets o3 loO 1,8 1.9 1.4. 08 «5 Tin Cans, Pans o3 1.2 2o0 1.7 1.8 1,2 o7 Tires o5 lol 201 2.6 2o0 1.4 o5 Bottles ol ol o3 o 4 o7 06 c4 Ape Plants o2 .4- ol ol ol ol ol Lily Plants oB Ie2 lol 08 08 loO o7 Ant Cups Flower Vases, I®? 201 4.2 2.6 lo9 1.4. 1,6 Vine Bowls 1.5 1.4 1.4- lo5 1.6 1*4 1.2 Others 1.8 4o 6 7,7 9?4 6.2 297 1,6 TOTAL 0o-4 0.7 1.2 1.2 lol 0o7 Oo5 It should be noticed that there is a general reflection of the heavy rainfall of early March with increases in the index of al~ most all types of containers* This is particularly noticeable in the case of breeding in old automobile tires and in the *Others” groupo The principal items in this latter group were tree holes, rock holes and other water containers which dry out and usually do not breed, except after heavy rains0 The rapid response to the rainfall is undoubtedly due to the presence of viable eggs which hatched immediately on contact with rain water0 It is also to be noted that inside breeders such as flower vases and vine- bowls did not show a significant response» The slight increase was probably due to cemetery flower vases which are in the open. The absence of a greater response to rainfall in the breeding taking place in ape and lily plants is probably due to the familiar- ity of our inspectors with the locations of these breeders and regular and frequent larvicidal treatment* A contributing fac- tor may be that there is usually a considerable time interval be- tween the rainfall filling the water containing structures and the laying of eggs by the mosquito, since the continued growth of the plant will not permit the carrying over of eggs from a previous wet period* 342 VI. Personnel A. Honolulu Field Total Army 140 UO Chamber of Commerce 2 4 U, So Public Health Service 36 48 TOTAL 178 192 All military personnel formerly assigned to special work crews, with the exception of foremen of clean-up crews, have been recalled to their .organizations and replaced with men from a medical sanitary company. B. Rural Oahu, Kauai, Maui, Hawaii Army: Rural Oahu (including Wahiawa)—=>58 Kauai—41 Maui--43 Hawaii-57 VII. Public Education A0 News Releases Fourteen English and 9 foreign language news releases appeared in the local newspapers during the semi-monthly period. Bo Public Talks Two staff members represented the Honolulu Dengue Mosquito Control program on the panel at a round table conference on tropical diseases held under the auspices of the Territorial Medical Association0 Approximately 200 members and guests attended this meetingo Co Radio The previous schedule of spot announcements (1-a-day) was continued 0 VIII. Chamber of Commerce Funds In December, 1943, the Public Health Committee of the Chamber of Commerce had approved a budget of |5,338o50 for dengue mosquito control work in Honolulu during the period January 1 to June 30, 1944o Disbursements since January 1 have been as follows: 343 Allocation Expenditures Salaries $3912.50 #1717.33 Transportation 360o00 263.09 Miscellaneous 1066000 1097ol5 TOTAL #5338.50 #3077.57 Balance $2260093 As it had been recognized that the allocation for an individual item might be exceeded, although the total sum would be adequate, considerable flexibility in the use of the funds has been allowedo IX* Resume of Discussion on Dengue Fever Control in Honolulu at Round Table on Tropical Diseases Held Under the Auspices of the Territorial Medical Association Discussion of the dengue mosquito control program of the Terri- torial Board of Health commenced with the question relative to its effectivenesso A description of control measures was given and an appraisal made, based on lowered Aedes breeding and dengue fever incidence0 It was brought out that this is pos- sibly one of the few times in the history of dengue epidemics that the disease was checked at the outset in a large, densely populated area0 It was further remarked that suppression of mosquito breeding was only part of the program0 There appeared to be a general agreement as to the importance and successful functioning of the mosquito control program0 The possibility of dengue becoming endemic in Honolulu was discussedo It was brought out that the dengue mosquito con- trol program was designed not only to prevent the epidemic spread of the disease but to eliminate it entirely and that theoretically this could be achieved0 In this connection the assumption of a short flight range for Aedes mosquitoes was attackedo It was maintained from the floor that under ab- normal wind conditions Aedes mosquitoes could travel signi- ficantly long distances,, No factual evidence was cited to support this statement for the local species0 Other mosquito-borne diseases were discussed0 No definite con- clusions were reached relative to the transmission of filariasis in the Territory of Hawaii„ The absence of Anophelines and malaria transmission in the Territory was attributed by Dr0 Pemberton, Hawaiian Sugar Planters” Association Entomologist, to the inability of the Anophelines in the past to survive the relatively long boat voyage0 It was pointed out, however, that in recent years air travel has brought with it the danger of introduction of Anophelines« Rigid control measures to prevent this introduction have been taken0 Drc Pemberton stated that in the past five years examinations of incoming planes have produced the Anopheles mosquito on six occasions0 In one instance the mosquito was alive, although the plan© had been routinely sprayed. X0 Maui Program During the period April 16 through 30, 5,550 premises were inspectedo The breakdown by cities is as follows: Cits No<> Prem0 Ins£« Prem0 Breedo Aedes Aedes Breedo Index Frem0 Breedo Culex Culex Breedo Index Haiku 345 U 1207 21 6o0 Kahului 519 6 lol 6 Id Lahalna 975 78 8,0 28 2,8 Makawao 235 25 10,6 17 7o2 Paia 993 32 3o2 29 2o9 Puunene 995 25 2o5 21 201 Spreckelsville U3 12 207 8 1,8 Wailuku 67 6,i 27 205 TOTAL 5550 289 5o2 157 2.8 The Aedes breeding index for the Island of Maui during the last semi-monthly period in April was 502%0 This represents a de- crease of 5o3% from the previous period0 The Aedes breeding index was lowered in all communities on Maui. Four communities of the eight covered had Aedes breeding in- dexes above %0 Five had breeding indexes above 3^« The dengue mosquito control program on Maui is proceeding more effectively as the inspection crews gain in experience and traveling time between communities shortened by more efficient routes of travel. XIo Kauai Program In the period April 16 through April 30, 19AA, 4-,470 premises were inspected0 The breakdown by cities is as follows • 0 Noe Prem0 Aedes Prem0 Culex Prenio Breedo Breedo Breed0 Breedo Citz Inspo Aedes Index Culex Index Eleele 88 0 o0 1 lol Hanalei 71 6 2 2,8 Hanamaulu 170 11 6o5 2 1.2 Hanapepe 197 0 o0 2 loO Rulela Camp 3 67 5 loK 0 o0 Kalaheo 283 13 2 o7 Kapaa 393 17 U°3 2 o5 345 Noo Prem0 Aedes Prem0 Culex Prem0 Breed0 Breedo Breedo Breedo Cit£ Inspo Aedes Index Culex Index Kapaia 73 8 10.9 0 o0 Kealia 197 5 2o5 0 o0 Kekaha 409 18 AoA 2 oA Kilauea 161 11 6,8 A ZoA Koloa 526 28 5,3 10 1.9 Koloa Mill 177 8 Ao$ 3 1,6 Lihue 467 25 5o3 A 08 Makawell 167 10 5o9 3 lo7 Nawiliwili 68 6 808 1 UA Port Allen 120 0 ,0 0 o0 Fuhi 208 7 3o3 1 oA Wahiawa 190 2 lol 2 lol Camp #2 60 1 lo7 0 oO Waimea TOTAL _m_ U70 let- ij,„. 4.2 tI" _i*2_ . 1.0 The Aedes breeding index for the Island of Kauai during this period was Uo2%a This represents a substantial decrease from the index for the previous period when the Aedes breeding index was 9<>256o Every community included in the program with the ex- ception of Kekaha showed a lower Aedes breeding index in the semi-monthly period ending April 300 The program on Kauai continues to progress in a satisfactory mannero The duration of the inspection cycle is approximately ten daySo XII. Wahiawa Program Summary NOo of premises inspected 2g2T7 Noo of premises breeding Aedes 10 Aedes breeding index 0aA% NOo of premises breeding Culex 8 Culex breeding index 0.3/6 NOo of inspections per man-day (7-hour day) 43o8 The citywide Aedes breeding index, 0,4$, for the first semi- monthly period in May represents a decrease of 0,3/6 from the index for the semi-monthly period ending April 30, Only twelve containers on six premises were found to be breeding Aedes at the 2,277 premises inspected. The progress of the local pro- gram is obviously satisfactory. 346 XIII. Rural Oahu Program Six thousand one hundred and ninety-nine premises were inspected during the period May 1 to 15 inclusive„ The statistical sum- mary by cities is as follows! CitX Noo Prem0 Inspo Premc Breedo Aedes Aedes Breedo Index Prem0 Breedo Culex Culex Breedo Index Aiea 439 6 lo3 4 o9 Ewa 846 9 loO 5 o5 Haleiwa 293 1 o3 1 o3 Kahuku 638 2 o3 2 »3 Kailua 1131 16 lo4 2 ol Kaneohe 722 7 o9 5 06 Pearl City 422 2 o4 3 06 Waialua 569 3 o5 2 o3 Waimanalo 282 1 o3 1 o3 Waipahu _82Z_ 6 JL 08 TOTAL 6199 53 0o8 32 0o5 The overall Aedes breeding index in rural Oahu was 0o8% during the current semi-monthly period0 The Aedes breeding index for the last half of April was 2o0%<, The Aedes breeding index for all communities in rural Oahu with the exception of Kahuku de- creased during the current period0 The index for Kahuku rose from 0oC% to 0o3%o The program in rural Oahu continues to progress in a satisfactory manner0 XIV. Hawaii Program Statistical reports have been received from the Island of Hawaii for the semi-monthly periods April 16 to 30 and May 1 to 15? inclusiveo The earlier report was not included in the last semimonthly narrative reportc The breakdown by cities for the semi-monthly period ending April 30 is as follows; NOo Premo Aedes PremQ Culex Prem0 Breedo Breedo Breed 0 Breedo Cits Inspo Aedes Index Culex Index Hakalau 225 20 808 4 lo7 Hawi 267 0 o0 0 oO Hilo 4744 217 4o 5 94 lo9 Honokaa 386 4 loO 5 102 Honomu 167 10 5o9 4 203 Kailua a 16 39 oO 3 7o3 Kamuela 79 0 .0 4 5o0 Kealakekua 243 120 49o3 19 7o8 347 Noo Prera0 Aedes Prenio Culex Premc Breedo Breedo Breedo Breedo Clt£ XnsPo Aedes Index Culex Index Kohala 30^ 5 1.6 2 06 Laupahoehoe 127 15 11.8 5 3o9 Mt0 View 179 35 19o5 11 6.1 Olaa 442 80 18C0 29 6.5 Ookala 173 18 10o4 7 4o0 Paauhau 187 10 5o3 6 3o2 Pahoa 182 52 28.5 19 10o4 Papaaloa 303 23 7<>5 8 2e6 Papaikou 253 32 12.6 10 3o9 Pepeekeo 227 -22- -10.1. 202 TOTAL 8529 680 7o9 235 207 The summary for the first period in May is as follows: Hakalau 211 8 3o3 5 2.3 Hawi 254 2 o7 1 o3 Hilo 5079 97 1.9 49 o9 Hinokaa 366 2 o5 2 «»5 Honorau 229 0 cO 2 08 Honuapo 45 1 202 0 oO Kailua 38 3 7o8 1 2.6 Kawaihae 15 1 606 0 oO Kealakekua 225 19 8.4 6 2.6 Kohala 297 3 loO 1 o3 Laupahoehoe 59 6 10a 2 3o3 Mto View 272 29 10.6 7 2„5 Naalehu 185 3 1.6 0 oO Olaa 432 23 5o3 7 1.6 Ookala 281 11 3o9 5 1.7 Paauhau 190 3V* 1.5 0 oO Pahala 388 2 ' o5 6 1.5 Pahoa 179 12 6.7 2 1.1 Papaaloa 148 3 2o0 4 2o9 Papaikou 288 7 2o4 1 o3 Pepeekeo 235 5- 2d 2 08 TOTAL 9416 240 2o5 103 loO It appears that the program is proceeding at a very satisfactory rate0 The islandwide Aedes breeding index was for the last half of April, the same as for the previous period*, The index for the first part of May was 205j6o The Aedes breeding index for the city of Hilo decreased from 4*5% in the latter half of April to for the first half of Mayc Of the 18 communities covered during the latter part of April, 17 were reinspected during the first half of May. Of these 17 communities, the Aedes breeding index was lower in 16 communi- ties during the first half of May than in the last half of April, 348 Two clean-up crews operating in Hilo collected and permanently disposed of eight truck loads of tin cans and bottles during the first half of May* One hundred sixty-three water storage tanks in Olaa and 49 in Mto View were stocked with mosquito fish during the first half of May. During the latter part of April 193 samples were collected from active Aedes breeders in 15 communities on the Islando One hundred eighty-seven of the samples on the emergence of the adult mosquitoes were identified as albopictuso When a sufficient number of samples has been examined, an analysis will be made to determine the presence of specific geographical preferences exhibited by the mosquitoes0 A representative of the Honolulu Dengue Mosquito Control pro- gram visited the Island of Hawaii and delivered educational talks at 17 grade, intermediate and high schools in & communi- ties o The film, "Life Cycle of the Aedes Aegyptiwas shown. Approximately 6,600 children received the benefit of this educational program. It had originally been intended to enlist the participation of the school children in an inspection program this spring0 Due to the short time before the summer recess, however, this school program has been postponed until the fall. XV. Summary: Territory of Hawaii No. of premises inspected 80,447 Noo of premises breeding Aedes 2,048 Total personnel engaged in program 391 Respectfully submitted, /s/Bernard B. Berger Bernard B0 Berger P0A. Sanitary Engineer (R) i/tc Dengue Mosquito Control 349 FEDERAL SECURITY AGENCY U. S. PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Sixteenth Semi-Monthly Narrative Report Period Ending April 30, 1944 lo Epidemiology A. Number and Extent of Cases Five cases of dengue fever were reported during the semi- monthly period ending April 30. This brings the total to date to 1,4-78 cases. These five cases represent a de- crease of 12 cases from the previous semi-monthly period, and is the lowest semi-monthly incidence of the disease since the inauguration of the dengue mosquito control program. No focus of infection was apparent during this period. Two of the five cases, however, occurred in areas where foci had been present in the paste These areas are River Street and Waikiki. The remaining three cases were lo- cated in Nuuanu, Manoa and Aieac Bo Correlation of Rainfall, Aedes Breeding Index and Dengue Incidence Included with this report are graphs showing the weekly incidence of dengue cases, by date of onset, the average rainfall in inches and the Aedes breeding index in’Hono” lulu for the seven months period between October, 1943 and April, 1944-c These graphs do not cover the period between July, 1943 and September, 1943 in which the dengue inci- dence first assumed epidemic proportions0 Graphs for this earlier period are included in the Narrative Report for the latter half of December, 19430 The graph showing dengue incidence does not include *off shipping* cases, A definite correlation between rainfall and the Aedes breed- ing index is apparent, as would be expected0 The general downward trend in the Aedes breeding index was interrupted by the rainfall occurring in late November and December0 The peak rainfall reported for March 8 was followed by a peak in the Aedes breeding index0 The index rose a value of 1.0$ to 3o$$, the highest value recorded the commencement of the enlarged control program in Hone- 351 luluo Tree holes, rock holes and other natural potential breeding places were found to be breeding in large numbers following rainfall® The permanent elimination of such con- tainors by filling with cement was a primary cause for the satisfactory drop in the Aedes breeding index following the period of high rainfall® It is interesting to note from the graph that a time lag of two to three weeks occurred between the rise in rainfall and the resulting increase in the breed- ing index. A marked decrease in weekly dengue incidence is apparent since October and November, 194-3o In the week ending October 19, 159 persons became ill with the disease as compared with four during the week ending April 19, 1944o There is no clear cor- relation between the number of dengue cases occurring in any period and the Aedes breeding index during that period. Effec- tive epidemiological work, isolation of the patient, elimination of breeders and insecticidal spraying probably account in large measure for this lack of correlation. II. Special Work A o Wholesale Spraying One military reservation and two coast guard stations were sprayed during the current period. Bo Trouble Shooting Crew The trouble shooting crew sprayed 52 residences, 2B tene- ments, 24- business establishments, 5 offices, 1 school and 1 USO recreational center in the follow-up of dengue cases0 lo Manhole and Catch Basin Larvicide Work Storm drains checked 52 " * sprayed 29 * H breeding 23 20 Tree and Rock Hole Filling Work Tree holes filled—987 Tree holes breeding at the time of filling—31 Percent breeding—3 01% Rock holes filled—2,232 Rock holes breeding at the time of filling—0 Percent breeding—0 3o Fish Stocking Fourteen privately owned ponds and one storm ditch were stocked with fish during the period® 352 Uo Miscellaneous control activities included one drainage ditch oiled and forty uncapped vertical pipes filled. Co Roof Gutter Crew During the period the roof gutter crew cleaned 91 gutters, realigned 9. perforated 8, removed 5 and issued orders to 40 householders to effect permanent correction of their gutters. Do Clean-Up Crew With an average working force of 35 men utilizing 5 trucks, the clean-up crew collected and disposed of 146 one and one-half ton loads of miscellaneous bottles and tin cans. III. Inspection and Indexes Summary NOo of premises inspected 37,873 No. of premises breeding Aedes 713 Aedes breeding index 1.8^ No. of premises breeding Culex 236 Culex breeding index 0£>% No. of inspections per man-day (7-hour day) 41o6 The downward trend of the Aedes breeding index increased more sharply during the current period0 The present citywide index of 1.8$ represents a decrease of 1.3$ from the first semi-monthly period in April. Following is a summary by districts of the zone indexes which were reduced, increased and unchanged; Zone Indexes Zone Indexes Zone Indexes District Sc Down Unchanged Central 13 15 0 Kapahulu 5 19 0 Lanakila SL 18 2 TOTALS ' 23 52 2 Fourteen zones or of the total bad indexes above 3%f and eight zones or 10/6 of the total had indexes above 5%0 IV. Personnel A. Honolulu ulu Field Total Array 132 132 Chamber of Commerce 6 7 Uo So Public Health Service 33_ 42. TOTAL 171 181 353 Bo Rural Oahu, Kauai, Maui and Hawaii Army: Rural Oahu (including Wahiawa)—56 Kauai—Al Maui—43 Hawaii—57 Vo Public Education A, News Releases Six English and 7 foreign language news releases appeared in local newspapers during the semi-monthly period, B o Public Talks A paper, "Certain Biological Aspects of Mosquito Control in the Territory of Hawaii," was delivered before the Hawaiian Academy of Science by Assistant Sanitarian (R) David Do Bonnet, entomologist0 Approximately 50 members were present, Co Radio The previous schedule of radio spot announcements (1-a-day) was continued. VI, Studies on Distribution of Aedes Aegypti and Aedes Albopictus, Abstract of Talk Delivered Before the Hawaiian Academy of Science, The distribution of Aedes aegypti and Aedes albopictus in the Territory of Hawaii is being studied continuously through regu- lar collections of samples in all controlled areasc At the present time in the City of Honolulu, Aedes albopictus appears to be six times more abundant than Aedes aegypti, Since this proportion was approximately three to one at the beginning of the control program, it would appear that there is a differential effect of our program on these two species0 This would be ex- pected in view of the preference of Aedes aegypti for artificial containers, and the greater frequency with which Aedes albopictus breeds in tree holes, spider lilies and other natural containers, Studies of the distribution of Aedes aegypti and Aedes albopictus in the separate mosquito control inspection zones have shown that the relative proportion varies from 93% aegypti in some zones to 0o4% aegypti in others0 There were apparently no aegypti in some areaso 354 A preliminary survey of rural Oahu and some of the other islands has shown that aegypti is present in the following towns out of 43 towns from which samples were obtained: Oahu Waianae, Waipahu, Ewa, Pearl City, Aiea, Honolulu Kauai Waimea, Kekaha Maui Lahaina Hawaii Hilo, Olaa, Pahoa, Honokaa, Kailua, Kealakekua The itudy of the distribution of these species, Aedes aegypti and Aedes albopictus is being continued. It is possible that one or the other specie may prove to be the better vector for dengue and the information obtained from the study of the dis- tribution of these closely allied species is therefore desirable. VII. Maui Program During the period April 1 to April 15, 3,971 premises were in- spectedo The breakdown by cities is as follows: No, Prem0 Aedes Premc Culex Prem. Breedo Breedo Breedo Breedo citr Inspo Aedes Index Culex Index Haiku 336 86 25o5 37 IloO Kahului 419 12 208 19 4° 5 Lahaina 127 29 22„8 15 n„8 Makawao 390 72 ISo* 89 22,8 Paia 537 50 9o3 26 4o8 Puunene 911 64 7o0 32 3o5 SpreOkiesvilla 316 16 5o0 8 205 Wailuku 809 78 9o6 29 3o5 Waikapu 126 10 709 9 7ol The program on Maui is not yet operating in a thoroughly effec- tive mannero The duration of the inspection cycles is not sufficiently short to allow an effective control of the produc- tion of Aedes mosquitoes. The underlying difficulty appears to be a loss of inspection time due to the locations of the cities with respect to each other and resulting time lost in traveling. A more efficient route of travel for inspection crSws is being considered and it is expected that in the near future the major difficulties obstructing the progress of the local program will be eliminated. VIII. Kauai Program A total of 3,779 premises were inspected during the period April 1 to April 15, inclusive. This semi-monthly period is the first 355 complete period for which a report has been submitted0 The program is progressing in a satisfactory manner0 The overall Aedes breeding index for the first semi-monthly period in April is 902%a The breakdown by cities is as follows: Citl Noo Prenu Inspo Prem0 Breedo Aedea Aedes Breedo Index Prem0 Breedo Culex Culex Breedo Index Eleele 100 1 loO 1 loO Hanamaulu 163 30 18.4 4 2o4 Hanapep© 175 11 602 7 4o0 Kalaheo 117 13 11.8 3 2o5 Kapaa 363 43 11.8 11 3o0 Kapaia 61 8 13ol 5 8C1 Kekaha 354 10 2.8 1 02 Koloa 213 21 9.8 7 3.2 Llhue 393 42 10o6 6 lo5 Makaweli 167 12 7ol 3 lo7 Nawiliwili 56 14 25 o0 3 5o3 Port Allen 121 4 3o3 1 08 Puhi 229 9 3o9 2 08 Waimea 345 24 6.9 3 c8 IX. Wahiawa Program Summary Noo of premises inspected 1^657 Noo of premises breeding Aedes 13 Aedes breeding index 07t> Noo of premises breeding Culex 5 Gulex breeding index NOo of inspections per man-day (7-hour day) 30o7 The Wahiawa citywide Aedes 0o7%. for the last half of April indicates a noteworthy reduction in breedinge The highest Aedes breeding index for this communityf 9c2%9 was recorded for the first semi-monthly period in March0 The index for the first half of April was 3o2%• The general container index9 is likewise significantly low0 The excellent cooperation consist- ently maintained in Wahiawa undoubtedly is reflected by the low Aedes breeding indexc Some credit belongs to the Wahiawa Com- munity Association for its active part in the local program. Xo Rural Oahu Six thousand eighty-nine premises were inspected during the period April 16 through April 300 The statistical summary by cities is as follows? 356 No. Prem. Aedes Prem. Culex Prem. Breedo Breedo Breed. Breed. Cit£ Insp0 Aedes Index Culex Index Aiea 251 7 207 2 o7 Ewa 83-4 10 1.1 10 lol Hale lira 309 8 2.5 4 1»2 Kahuku 447 3 06 Kailua 1379 46 3o3 2 ol Kaneohe 726 19 2„6 10 lo3 Pearl City 473 7 lo4 5 lo0 Waialua 582 10 lo7 10 lo7 Waimanalo 243 3 lo2 1 o4 Waipahu 8-45 12 lo4 7 08 The overall Aedes breeding index in rural Oahu was 2o0ffo during the current semi-monthly periodo The Aedes breeding index for the first half of April was 607^0 The program in this appears to be progressing in a satisfactory raanner0 All of the com- munities covered by this program showed a lower Aedes breeding index in the latter half of April than in the previous period. In some cases the decrease was most substantial. The Aedes breeding index for Waimanalo decreased from 2202% to that for Kaneohe decreased from to 20 and that for Kailua from 10o0$6 to 3o3/6, XI, Hawaii Program A total of 7,909 inspections were made on the Island of Hawaii during the first semi-monthly period in April, The breakdown by cities is as follows! No* Premo Aedes PremQ Culex Prem. Breedo Breedo Breedo Breed0 Cltl Inspo Aedes Index Culex Index Hakalau 55 10 18.1 2 3.6 Hawi 507 15 2o9 13 205 Hilo 448 0 279 6.2 98 202 Honokaa 368 24 6.5 6 1.6 Honomu 227 21 9o2 12 5o2 Honuapo 43 1 2o3 1 2o3 Kailua 48 29 60. 4 12 25o0 Kamuela 85 8 9o4 Kealakekua 252 54 2104 24 9o5 Kohala 329 12 3.6 8 2o4 Mt0 View 317 47 14.8 46 14o5 Naalehu 213 19 8.9 8 3o? Olaa 124 13 10o4 10 8,0 Pahala 358 15 4.i 15 4d Pahoa 177 65 36.7 20 llo2 Papaikou 247 15 6o0 15 60 0 Pepeekeo 79 10 12.6 7 8.8 357 FEDERAL SECURITY AGENCY U0 S0 PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Fifteenth Semi-Monthly Narrative Report Period Ehding April 15, 1944 I, Epidemiology A. Number and Extent of Cases Seventeen cases of dengue fever were reported during the semi- monthly period ending April 15 o This brings the total to date to 1473 caseso These 17 cases represent an increase of 7 cases over the previous semir-monthly period,, The focus of infection in the Kalihi-uka district which developed during the first half of March was apparently not completely stamped out, 6 cases being loqafced in that area during the current period® Other areas which had previously been listed as foci and which had cases during the last period are as follows: Buckle Lane—1| Kakaako—1; Judd Street—1®Seven other cases were scattered throughout the city® II® Special Work A* Wholesale Spraying The entire area in the district previously sprayed was resprayed and an adjacent area of about two square blocks was covered in addition® B« Trouble Shooting Crew The trouble shooting crew sprayed 185 residences, 5 business establishments and 2 hotels in the follow-up of dengue cases0 1® Manhole and Catch Basin Larvicide Work Storm drains checked 44 " " sprayed 28 11 " breeding 23 359 2, Tree and Rock Hole Filling Work Tree holes filled—-1277 Tree holes breeding at the time of filling—42 Per cent breeding— 3*2^ Rock holes filled—450 Rock holes breeding at the time of filling—84 Per cent breeding—18,6£ 3* Fish Stocking Fifty-one pools and streams were stocked with fish during the period, 4e Miscellaneous control activities included 13 ground pools oiled and 2 drainage ditches oiled, C. Roof Gutter Crew During the period the roof gutter crew cleaned 134 gutters, realigned 19, perforated 8 and removed 4 gutters, D, dean-Up Crew With an average of 34 men and 5 trucks, the clean-up crew picked up and disposed of 100 1-1/2 ton loads and 68 half ton loads of miscellaneous bottles and tin cans, III, Cooperation with City County Activities Recently a report was rendered to Mr, J, F, Kunesh, Chief Engineer, City County Public Works Department, concerning the condition of streams and ditches in Honolulu wherein Aedes and Culex mosquito breeding was noted. In response to this report Mr, Kunesh directed the Public Works Department to utilize three crews of Oahu prisoners (two more than previously) in stream and ditch cleaning activities, A list of 22 areas was established, with first priority given to sections of the water courses where the worst conditions were noted. IV, Inspection and Indexes Summary No, of premises inspected 36,890 No, of premises breeding Aedes 1,134 Aedes breeding index 3»1% No, of premises breeding Culex 277 Culex breeding index 0,7^ No, of inspections per man-day (7-hour day) 40 360 For the first time since the latter half of January the Aedes breeding index was lower during the current period than during the previous period. The present citywide index of represents a decrease of 0*k% from the last half of March. Ex- amination of the daily citywide indexes for the period April 1 through April 15 Indicates the daily downward trend of Aedes breeding. Following is a summary by districts of the zone indexes which were reduced, increased and unchangeds District Zone Indexes Hi Zone Indexes Down Zone Indexes Central 10 0 Kapahulu 9 14 1 Lanakila 8 11 2 TOTALS s? 47 3 Nineteen zones or of the total had indexes above and 33 zones or of the total had indexes above 3%a V. Personnel A. Honolulu Field Total Arngr U6* 146 Chamber of Commerce 9 10 U0S, Public Health Service iH" 40 Be Rural Oahu, Kauai, Maui and Hawaii Annys Rural Oahu (including Wahiawa)— 56 Kauai—>41 Maai—43 Hawaii—5? ♦Includes new group of soldiers assigned for training. 361 VIo Public Education A0 News Releases Six English and three foreign language news releases appeared in local newspapers during the period. In addition, papers from the outside islands carried stories of newly inaugurated control programs there. Bo Public Talks A lecture was given and a film shovnn to 750 students at Waialua High School. Co Radio The previous schedule of radio spot announcements (1-a^-day) was continuedo VII. Wahlawa Program No„ of premises Inspected 1,057 Noo of premises breeding Aedes 34 Aedes breeding index 3*2% No0 of premises breeding Culex 15 Culex breeding index 104$ No0 of inspections per man-day (7-hour day) 22*4 The Wahlawa citywide Aedes index for the current period is 09% lower than the previous period and is less than half of that of one month ago0 A committee representing the Wahlawa Community Association, working as a contact group, has been able to persuade local residents to clean up serious accumulations of tin cans, bottles and other debris, thereby obviating the necessity of assigning a clean-up crew in that city0 The spirit of local cooperation has been excellent0 VIII. Maui Program The second semi-monthly (March 16 through 31) report has been received from the Island of Maui0 Thus far the cities of Lahalna and Paia have shown the heaviest concentrations of Aedes breeding® Regarding the types of containers, it has been found that tires, vine bowls, flower vases and ant cups have the highest container indexes at the present time® A total of 3,424 premises were inspected during the current period® 362 The breakdown by cities covered during the period is as follows: No. Prem, Aedes Prem. Culex Prem. Breed. Breed. Breed. Breed. City InsD. Aedes. Index. Culex Index Lahalna 830 230 27.7 86 10.4 Paia 10$2 1U 13.6 104 9.3 Spreckelsville 323 27 3.3 32 9.9 Wailuku 1219 107 3.7 133 10.9 IX. Rural Oahu Program During the period April 1 through April 15, 6,179 premises were inspected. The breakdown by cities is as follows: No. Prem. Aedes Prem. Culex Prem. Breed. Breed. Breed. Breed. Clt£ Inso. Aedes Index Culex Index Aiea 667 31 4.6 12 1.7 Ewa 778 19 2.4 13 1.6 Haleiwa 306 20 6.5 23 7.5 Kahuku 371 8 2.1 6 1.6 Kailua 736 74 10.0 8 1.0 Kaneohe 955 138 14.4 12 1.2 Pearl City 756 37 4.8 16 2.1 Waialua 57-4 28 4.8 15 2.6 Waimanalo 134, 41 22.2 5 2.7 Waipahu 352 19 2.2 18 2.1 Analysis of the cycle of inspection indicates that the cities in windward Oahu are now on an Inspection cycle of slightly under ten days while leeward Oahu has a cycle of approximately thirteen days Adjustments in the latter will be made as inspection crews become more familiar with their assigned cities. X. Hawaii Program During the period March 16 through March 31 a total of 10,224 inspections was made on the Island of Hawaii. Of these 6,419 wore in Hilo, 363 The breakdown by cities is as follows; No, Preinc Aedes Prem, Culex Prem, Breedo Breed, Breed, Breed, City Insp, Aedea Index Oulex Index Hakalau 183 12 6,5 7 3.8 Hilo 6419 344 5*3 136 201 Honokaa 394 44 m 29 7*3 Honorau, 231 19 802 9 3*8 Honuapo 106 3 2„8 5 4.7 Kailua 46 , 11 23*9 8 17.3 Kamuela 79 2 2o5 10 12.6 Kealakekua 209 71 33®9 46 22®0 Kohala 328 41 12, 5 12 3.6 Mto View 315 67 21.2 54 17*1 Naalehu 20? a 10ol 9 4.3 Olaa 713 103 14*4 58 8,1 Pahala 429 18 4*1 17 3*9 Pahoa 176 53 30,1 36 20,4 Papaikou 276 a 7o6 9 3*2 Pepeekeo $3 8 9.6 6 7.2 Wailea 30 2 6®6 1 3*3 XIe Kauai Program The two crews doing inspection work on the Island of Kauai ccom- pleted their established lists of assigned cities within a period of 14 days elapsed time on the first cycle of inspection,, In- creased familiarity with the cities under inspection will un- doubtedly reduce the inspection cycle subsequently ta approxim- ately 10 days * During the initial period March 2? through March 31 a total of 1,322 premises were inspected,, The breakdown by cities is as follows s Noo Pram. Aedes Prem0 Gulex Presu Breedo Breedo Breedo Breed0 City Insp0 Aedes Index Cuiex Index Eleele 60 1 I06 Hanapepe 1?1 22 12.8 4 2*3 Kekaha 404 32 7o9 14 3®4 Makaweli 131 , 17 12«9 5 3.8 Port Allen 118 4 3o3 Wahiawa 143 9 6<, 3 3 201 Waimea 295 44 Ua 9 13 4e4 364 XII* Summary s Territory of Hawaii No* of premises inspected 59*096 Noo of premises breeding Aedes 3*0^0 Respectfully submitted, /s/ Wesley E0 Gilbertson Wesley Ec Gilbertson P0 A0 Ehgineer (R) i/c Dengue Mosquito Control 365 FEDERAL SECURITY AGENCY U* S* PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Fourteenth Semi-Monthly Narrative Report Period Ending March 31$ 1944 I. Epidemiology A* Number and Extent of Cases During the semi-monthly period ending March 31* 10 cases of dengue fever were reported, bringing the total to date to 1456 caseso Twelve cases were reported during the first half of Marche thus making 22 cases for March* Of the 10 cases reported during the last half of tne month,, 3 occurred in the Kalihi-uka district on Kamanaiki Street, 2 in the Kaluwahin© Homestead area and the remainder were scattered,, Cases "off shipping11 from the Southwest Pacific continue to be reported throughout the Hawaiian Islands 0 B. Records of the first 1300 dengue cases have now been set up on punch cards and preliminary analysis completed* , Of these cases, approximately 60$ were among females and 40$ among males* It appears that about two-fifths of the cases were probably con- tracted at the place of occupation and about three-fifths at the place of residence* Cases which occurred in the same zone and on the same street as one or more previous cases, i* e», "multiple cases'1 ran about 70$* Fifty per cent of the dengue cases were reported before 3-1/2 days after onset, 57$ before three days, 73/6 before four days and 90$ before six days* Most of the lag in reporting is dd© to delay in calling a physician* Many physicians are at present phoning their reports to the Bureau of Communicable Diseases* The infectious stage of dengue begins about one day prior to onset and extends three or four days after onset* Patients are always placed under bed nets and the premises sprayed within one day after reporting, but on the basis of the lag in reporting indicated above, nearly three-fourths of the cases are past the infectious stage before the isolation technique is made effective$ hence, a great importance is attached to adult mosquito destruc- tion by spraying* 367 Other data such as statistics on symptomology, age distribu- tion, correlation with mosquito Indexes and correlation with population densities are being worked out for later presenta- tion in detail along with the above data. II. Special Work A. Trouble Shooting Crew During the period the trouble shooting crew in the follow up of dengue cases sprayed 89 residences, 3 tenements, 7 in- stitutions and 6 business establishments. 1* Manhole and Catch Basin Larvicide Work Storm drains checked 204 ” w sprayed 31 m 11 breeding 9 2, Tree and Rock Hole Filling Work Tree holes filled—1840 Tree holes breeding at the time of filling—145 Per cent breeding—7® 8£ Rock holes filled—119 Rock holes breeding at the time of filling—12 Per cent breeding—10.0£ 39 Miscellaneous control activities included 3 drainage ditches larvicided, one ship sprayed and 222 vertical pipes in the ground filled. B. Roof Gutter Crew During the period the roof gutter crew worked on the gutters of 130 premises. Ninety-one gutters were cleaned out, 22 repaired, 15 perforated and 2 removed. G. Clean-Up Crew The clean-up crew collected and disposed of 274 half-ton and 22 one and one-half ton truck loads of water-holding containers during the period. D. Fish Stocking During the month of March, 9 fish ponds and a swimming pool were stocked with mosquito destroying minnows in the Kapahulu dis- trict. 368 IH. Inspection and Indexes Summary No. of premises inspected 37,094 No. of premises breeding Aedes 1,332 Aedes breeding index 3o5^ No. of premises breeding Oulex 301 Culex breeding index 0.8^ No. of inspections per man-day (7-hour day) 3&*9 The Aedes breeding index in Honolulu continued to rise during the last half of March but the increase in breeding appeared to be slowing down. A great many natural mosquito breeding places, such as rock and tree holes—previously dry—have become filled with water and are now breeding. The rise in the Aedes index is also undoubtedly partly due to an increase in proficiency of the inspectors. It has been observed that the types of breeders found recently are such that they could easily escape the attention of a less experienced inspector. A majority of the presently assigned inspectors have three months or more experience, thereby providing a greater period for learning the work. Following is a summary by districts of the zone indexes which were reduced, increased and unchanged? .Zone Indexes Zone Indexes Zone Indexes District 2e Down Unchanged Central 15 13 0 Kapahuln 18 6 0 Lanakila .. XL . 7 1 TOTALS 50 26 1 Twenty-four zones ©r one-fourth of the total, had indexes above and 38 zones or one-half of the total, had indexes above 3&> Special inspections were made in 7 cemeteries in which 470 con- tainers were checked* Of these, 39 or were breeding* IV« Personnel A. Honolulu Field Total Array- 146* 146 Chamber of Commerce 7 a UoS„ Public Health Service 37 -JWL TOTALS 190 199 Total new group of soldiers assigned for training. 369 B. Rural Oahu, Kauai, Maui and Hawaii Rural Oahu* 5B Kauai 41 Maui 43 Hawaii 57 (A portion of the total company strength on Hawaii and in rural Oahu are assigned to company maintenance duty,) V. Public Education A, Public Talks The following public talks were given during the period: Attendance Rotary Club, Wailuku, Maui 40 Rotary Club, Hilo, Hawaii 50 B, News Releases Thirteen English news releases appeared in the local newspapers and 10 in foreign language newspapers, C, Radio Fourteen radio spot announcements were broadcast on a 1-a-day basis during the past period, VI. Public Health Service Expenditures for -phe Past Quarter Year Month Salaries Supplies Equipment Miscellaneous January February Mareh 17794.09 7866.47 8096.70 #630.96 748.33 176.51 #623.57 808.12 48.30 #172.34 _ 85.64 TOTALS #23,757.26 #1,556.30 #1,479.99 #257.98 GRAND T0TALS~$27,051.53 The grand total for the period September 1 to December 31, 1943 was 133*308.79* * *Includes 5-man inspection crew at Wahiawa assigned from Honolulu, 370 VII. Wahiavra Program Summary No0 of premises inspected 934 Noo of premises breeding Aedes 39 Aedes breeding index 4„1^ No„ of premises breeding Guleoc 11 Culex breeding index No. of inspections per man-day (7-hour day) 26©7 The Wahiawa citywide Aedes index for the previous period was 9.2$. It appears, therefore, that the increase in Aedes breeding in Wahiawa has been suppressed and the situation is under control. Excellent cooperation has been received from the residents of Wahiawa in cleaning up the area. VIE. Maui Program Reports have been received from the control program on the Island of Maui, covering the period March 7 to 15« During this period a total of 2024 premises were inspected. The breakdown by cities is as follows: No® Prem* Aedes Prom® Oulex Prem® Breed® Breed® Breed® Breed® Cities Insp® Aedes Index Oulex Index Kahului 364 17 4®6 20 5,4 Puunene 966 18 8„1 62 6o4 Spreckelsville 156 16 10®1 1? 10®7 Waikapu 126 5 3o9 24 19o0 Wailuku 410 26 6.4 36 8®8 IX, Rural Oahu Program The Aedes control program in rural Oahu began operating on a stabilized personnel basis on March 23. During the period March 23 to 31 a total of 2625 premises were inspected. The breakdown by cities is as follows g No. Prem. Aedes Prem. Culex Prem. Breed. Breed. Breed. Breed. Cities In3pQ Aedes Index Culex Index Aiea W8 32 7.3 10 2.4 Ewa 15k 37 4.9 33 4.3 Kaneohe 508 a 8,0 16 3.1 Pearl City 180 13 7.2 5 2,8 Waipahu 775 15 1.9 9 lei 371 X. Hawaii Program The control operations on the Island of Hawaii began operations on March 13# Statistical reports have not been received as yet. XI. Kauai Program The Aedes control program on the Island of Kauai began operations on March 2?. The cities to be placed under control were divided into two groups and assigned to inspection crews as follows; inspection crews as follows; Crew 1 Crew 2 Waimea Kekaha Port Allen Kalaheo Eleele Makaweli Hanapepe Wahiawa (McBryde Mill) Koloa Village Proper Koloa Mill Village Lihue Hanamaulu Puhi Nawiliwili Kapaa Kapaia Hanalei Kealia Kilauea Respectfully submitted, /s/ Wesley E, Gilbertson Wesley E. Gilbertson P. A. Engineer (R) i/c Dengue Mosquito Control 372 FEDERAL SECURITY AGENCY U. S, PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Thirteenth Semi-Monthly Narrative Report Period Ending March 15, 1944 I. Epidemiology A, Number and Extent of Cases Twelve cases of dengue fever were reported during the semi- monthly period ending March 15* This brings the total to date to 1446 cases o The lowest number of cases previously reported for a half month period was 17, since the peak of the epidemic„ One focus developed—in the Kalihi-uka district—on Merkle and Kamaaaiki Streets, Other cases were scattered throughout the city, one being in the Buckle Lane area, one near Kakaako, three scattered in Kalihi and one on Round Top, II, Special Work A, Wholesale Spraying The focus of infection which occurred in the Kalihi-uka area was given wholesale spraying treatment. An area of approx- imately two blocks comprised of 75 premises were sprayed, both interior and exterior, B0 Trouble Shooting Crew During the period the trouble shooting crew in the follow-up of dengue cases sprayed 74 residences, 34 bomb shelters and 5 large institutions, 1, Manhole and Catch Basin Larvicide Work Storm drains checked 132 " 11 sprayed 78 n 11 breeding 3 Water, gas, electric and telephone manholes checked 31 n n n tf i» h sprayed 3 fl ,! 11 ,f " tt breeding none 373 2. Tree and Rock Hole Filling Work Tree holes filled—216 Tree holes breeding at the time of filling—74 Per cent breeding—34*2^ Rock holes filled—1335 Rock holes breeding at the time of filling—S3 Per cent breeding—6,2^ 3, Miscellaneous control activities included; 16 swampy areas, 5 cesspools and 3 drainage ditches larvicided with oil5 2 water tanks and a stream stocked with Gambusia minnows, C, Roof Gutter Crew The roof gutters of 77 houses were permanently corrected, D, Clean-Up Crew The clean-up crew collected and disposed of 232 truck loads of cans, bottles and other water-holding containers. The previously used Moilili dumprwas closed for this purpose and the longer haul to the Apili dump reduced the amount of material disposed of during the current period. Ill, Inspection and Indexes Summary No, of premises inspected 29*057 No, of premises breeding Aedes 913 Aedes breeding index 3.1$ No, of premises breeding Gulex 339 Culex breeding index 1.1% No, of inspections per man-day (7-hour day) 35«& The Honolulu citywide Aedes breeding index increased during the first half of the month from to Heavy rainfall conditions are continuing and it is difficult to predict the trend in Aedes breed- ing, Enough rainfall is being experienced in the form of inter- mittent showers to reduce the number of inspections made per man-day from 45 for the previous period, to 35 for the current period. Following is a summary by districts of the zone indexes which were reduced, increased and unchanged? District Zone Indexes He Zone Indexes Down Zone Indexes Unchanged Central 23 5 0 Kapahulu IS 5 1 Lanakila 12 8 5 TOTALS 53 IS 6 374 Sixteen zones, or one-fifth of the total, had indexes above 5% and 31 zones, or two-fifths of the total, had indexes above 3%• A special survey of approximately 1200 premises was made by the foremen, giving a cross-section picture of the entire city. The purpose of this special survey was to determine whether an accu- rate index was being provided by the inspection reports of the regular inspectors. Analysis of the reports by the foremen in comparison with those by the regular inspectors during the identical period showed that the regular inspectors are missing many breeders, and the actual Aedes breeding index is somewhat higher than that in- dicated. IV, Personnel A, Honolulu lIu Field Total Array 78 78 Chamber of Commerce 11 12 Uo S0 Public Health Service 38 .47 TOTALS 12? 137 B, Rural Oahu, Maui and Hawaii Rural Oahu* 112 Maui 43 Hawaii 63 V* Public Education A, A special &*>00 budget request was approved by the Public Health Committee of the Honolulu Chamber of Commerce for public educa- tion activities The increased rainfall and mosquito breeding has made it desirable to inaugurate an increased publicity cam- paign for public cooperation with inspection activities. The funds will be spent for pamphlets, radio spot announcements and direct mail contacts. Bo News Releases During the period iSmews releases appeared in the local Ehglish newspapers and 10 in foreign language newspapers. Kauai detachment still on Oahui also includes Wahiawa crew assigned from Honolulu. 375 Co Radio The regular Board of Health "How to Keep Well" was devoted to dengue control on March 12» VIo Wahiawa Program Summary Noo of premises inspected 722 Noo of premises breeding Aedes 67 Aedes breeding index 9„2$ No© of premises breeding Culex 3 Culex breeding index 0«4$ Noo of inspections per man-day (7-hour day) 24„9 The increase in the Wahiawa Aedes breeding index represents a 50 % rise over the previous period® Through the efforts of the inspectors and foremen, a great many dumps of cans, bottles and other receptacles are. being removed® However, it may be neces- sary to assign additional manpower to this work, if such can be made available® VIIo Training in Rural Oahu After completion of a brief training course in Honolulu, the two colored medical sanitary companies were assigned for a temporary period to Aedes control activities in rural Oahu. Eleven 6-man inspection crews with foremen and sub-fofemen were selected on the basis of written examinations and ratings made while in the field training course® The remainder of the companies (with the exception of those needed fnr company maintenance duty) were divided into clean-up crews® The cities of Kaneohe, Kailua, Kahuku and Waimanalo wore placed under the crews of one company and the cities of Aiea, Bwa, Waialua, Pearl City, Haleiwa and Waipahu were placed under the crews of the second company® Although the work was considered to be an extension of the training activity, complete records were maintained and indexes computed® As of the end of February these cities showed the following indexes as calculated from reports provided by these inspections? Aiea 2o8 Evm 2o8 Haleiwa 2<>0 Kahuku 205 Kailua 4o6 Kaneohe 20o6 Pearl City la 9 Waialua 205 Waimanalo lo4 Waipahu lo7 Waianae 2«2 376 Due to the somewhat untrained status of these inspectors, these indexes are considered lower than the actual breeding conditions® In addition to the inspection work, the clean-up crews were put to good use in cleaning up bad areas located in the above cities. VIII. Maui Program During the current period the mosquito control detachment of 42 men and one officer inaugurated Aedes control on the Island of Maui. The men are divided into two inspection crews and two clean-up crews. For purposes of inspection, the cities on Maui have been divided into two groups, each of which will be the responsibility of one inspection crew. Crew 1 Crew 2 Puunene Kahului Sprecklesville Waikapu Paia Wailuku Haiku Lahaina Makawao The clean-up crews will be transferred from city to city depending on clean-up needs® The army has provided the following transportation; Four 1 l/2 ton cargo trucks One jeep IX. Hawaii Program The mosquito control company of 61 men plus 2 officers were transferred to Hawaii during the period® The men assigned to mosquito control duty are divided into four inspection crews and two clean-up crews® It is anticipated two inspection crews will be needed constantly in Hilo> which is considered the second largest city in the Territory® The other cities on Hawaii which will be under control were divided into two groups as follows; Crew 1 Crew 2 Pahala Hawi Honuapo Kohala Naalehu Honokaet 01 aa. Koalakekua Mt0 View Kailua Pahoa Kamuela 377 Other smaller cities and plantation camps will receive inspec tion service occasionally as time permits. The clean-up crews will work initially in Hilo, and later in other cities where the need is greatest. The army furnished the following transportation: Five l/2-ton weapon carrier trucks Three 1 l/2-ton cargo trucks Two jeeps Respectfully submitted, /s/ Wesley E, Gilbertson Wesley E, Gilbertson P. A* Engineer (R) i/c Dengue Mosquito Control 378 FEDERAL SECURITY AGENCY U® S® PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Twelfth Semi-Monthly Narrative Report Period Ending February 29, 1944 I* Epidemiology A® Number and Extent of Cases During the semi-monthly period ending February 29, 18 oases of dengue fever were reported, bringing the total number to date to 1,434® The number of capes reported during the last half of February was approximately half that was reported for the first half of the month, but was higher than the number reported for the last half of January® The cases resided in scattered areas throughout the city and no important focal point of infection could be de- termined® Two or three cases occurred at places which had previously been danger spots but now appear to be dying out® Bo Epidemiology on Recent Kauai Case Because most dengue patients do not remember when they were bitten by mosquitoes prior to the onset of the dis- ease, and practically none of the patients can give the date they received the disease-transmitting mosquito bite, it is difficult to determine the incubation period of dengue except under certain conditions® In a recent semi-monthly report a case of dengue was re- ported from the Eleele Camp on the island of Kauai; also a suspected case of dengue which had occurred previously in the same household® Additional information has been secured regarding these oases which indicates that the , suspected case was dengue, contracted in Honolulu, and had an incubation period of over 14 days® The length of the incubation period makes the case worthy of note® Fol- lowing is the information received on these casesg 379 1, On November 2, Mr, Masayuki Nishi, 18, 250-C N, • Beretania Street, Honolulu, T, H, came down with dengue. He was ill until November 9, 2, On the morning of November 27, twenty-five days later, Hiromi Nakagawara, who had been residing at 250 N, Beretania Street, Honolulu, departed for Kauai, arriving at his home. House 49, Eleole Camp, the same day, 3, He took sick on the eve of December 11, was admitted to Eleele Hospital on December 13, with diagnosis of "flu" and discharged on December 16, He later re- ported having had a rash on his arms, A period of 14 l/2 days elapsed from the date of his departure from Honolulu until the onset of his sickness on December 11, 4, On December 21 Henry Nakagawara, 14, residing in House 49, Eleele Camp, took sick with a slight tem- perature, He was hospitalized on December 22, tem- perature 100,6°„ On December 23 the temperature was 103° and the patient had a rash. The case was diag- nosed as dengue, 5, All usual precautions were taken, including covering the patient with a mosquito net, spraying of interiors and exteriors of all buildings within a five hundred foot radius of the patient*s home and inspections to eliminate mosquito breeding. No further cases occurred. In view of the above facts, it appears that Hiromi Naka- gawara had dengue, not "flu," and was the connecting case which brought the dengue from Honolulu to Eleele Camp, The incubation period (14 l/2 days) is one of few which can*be definitely ascertained and is the longest of which we have a record. II, Special Crews A, Trouble Shooting Crew During the period the trouble shooting crew, in the follow- up of dengue cases, sprayed 230 residences, 18 institutions, 6 business establishments and 3 hotelso Following is a resume of manhole and catch basin larvicide work g 380 Storm drains checked 273 Storm drains sprayed 156 Storm drains breeding 1 Water, gas, electric and telephone manholes checked 136 Water, gas, electric and telephone manholes sprayed 11 Water, gas, electric and telephone manholes breeding none During the period a new service was started as part of the work of the trouble shooting crew, consisting of fill- ing rock and tree holes with neat cementc This is a permanent corrective work. Its immediate value is attested by the number of such holes which were actually found breeding just prior to the filling operation. Below is a summary of the work completed during the four days of operation of this service: Rock holes filled 599 " * breeding 44 Percent breeding 7.7$ Tree holes filled 15 n w breeding 6 Percent breeding 40$ B. Fish Planting Top-feeding mosquito minnows were planted in four fish ponds and one animal watering trough during the period. Die stream which passes through Waiala© Golf Course, where minnows had been planted previously, was checked and it was found that the fish had died due to the polluted con- dition of the water. The breeding areas will be oiled as necessary. C. Roof Gutter Crew The roof gutters on 59 buildings were checked and perma- nent corrections made. D. Clean-Up Crew Die clean-up crew collected and disposed of 316 loads of water-holding receptacles. The work of this crew has been distributed throughout all areas of the city. E. Larvioiding—Culex Control Dvo days were spent in spraying low-lands in Manoa Valley with larvicide oil to control Culex breeding places. 381 Ill, Inspection and Indexes Summary Number of premises inspected 35,629 Number of premises breeding Aedes 681 Aedes breeding index 1»9$ Number of premises found breeding Culex 104 Culex breeding index 0,2$ Number of inspections per man-day (7-hour day) 45,1 The Honolulu citywide Aedes breeding index increased from 1,0$ for the first half of February to 1,9$ for the last half, reflecting the greatly increased rainfall which is occurring. The current Aedes index is the highest en- countered since the beginning of the augmented control program in September, However, earlier records of the Chamber of Commerce mosquito control work indicate that a higher breeding index existed in August prior to the serious increase in dengue cases, beginning in September. Analysis of the trend of the indexes in the various types of breeders indicates that while flower vases and vine bowls—which are interior breeders—have continued to decrease, fish ponds, jars, pails, tin cans, tires and ant cups are responsible for most of the increase which has occurred. Six zones, three in the Lanakila district and three in the Central district had indexes above 5$, Fourteen zones, or 18$ had indexes above 3$, Following is a summary by districts of the zone indexes which were reduced, increased and unchanged* Zone Indexes Zone Indexes Zone Indexes District Vp Eovm Unchanged Central 17 9 1 Kapahulu 12 8 4 Lanakila 16 6 3 TOTALS ST nr* A special survey of all rivers and streams in the city was started. Accumulations of tin cans, bottles and other miscellaneous containers were noted on the banks and in the dry stretches of the stream beds. Many of these con- tainers were filled with water and breeding Aedes mos- quitoes. A crew of prisoner labor under City County super- vision has been cleaning a portion of Pauoa Stream and it is hoped that this activity will be extended to include other troublesome stretches of streams. 382 IV* Personnel A« Total Personnel As of February 29 the following personnel were on duty on the Honolulu and Wahiawa programs* Field Tbtal Army 99 99 Chamber of Commerce 12 13 Public Health Service 39 48 TOTALS rar !BT The two colored medical sanitary companies have almost completed their temporary assignment on Aedes control in war-connected communities in rural Oahu and are ready for transfer to the outside islands« Vc Public education A o News Releases During the period eleven news releases appeared in the local English newspapers and eight in foreign language newspaperso VIo Staff Training A complete program of orientation and education in mosquito- borne diseases and their control has been started for the staff assigned to the Honolulu program« A special lecture each week is being delivered at each of the three district officeso Appropriate charts and movie films are also being included« VII. Wahiawa Program SHBg Number of premises inspected 993 Number of premises breeding Aedos 64 Aedes breeding index 6*4$ Number of inspections per man-day (7-hour da^29«2 The situation at Wahiawa reflects the serious increase in rainfall as in Honolulu* During the period an additional inspector was assigned to the Wahiawa program for special duty in connection with roof gutter work* Respectfully submitted, /s/Wesley S. Gilbertson P»Ao Engineer (R) i/c Dengue Mosquito Control 383 FEDERAL SECURITY AGENCY U. So PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OF HEALTH TERRITORY OF HAWAII Eleventh Semi-Monthly Narrative Report Period Ending February 15, 1944 I. Epidemiology . A, Number and Extent of Cases During the semi-monthly period ending February 15, 37 cases of dengue fever were reported, bringing the total number to date to 14l60 The increase in cases noted towards the end of January continued during the first half of February, One focus developed, probably beginning with unreported cases, near lolani School on Judd Street in lower Nuuanu Valley. At least ten cases have developed there to date. Two cases were reported from the Kakaako district and the others were scattered throughout the citye The prospect of early eradication of dengue fever from Honolulu is not good at the present moment0 This is due, among other things, to the difficulty in obtaining prompt and complete reporting of cases and to the dif- ficulty in reducing the citywide Aedes breeding index much below one percent as yet0 Many newspaper articles have been published and radio announcements have been broadcast urging people to call a physician or the Board of Health immediately upon the appearance of symptoms, but often this is not done, thereby preventing follow-up control of the cases0 With respect to the Aedes breeding index, it is possible that current increase in dengue cases may be due in part to an increase in mosquito popu- lation which was reflected by a higher index after the rains early in December„ II. Wholesale Spraying The above-mentioned focus of infection in Nuuanu Valley received a thorough treatment by spraying inside and outside of all buildings and around the yards to eliminate all mosquitoes0 The area comprised of about two square blockse A one-block area around Willard Inn in Waikiki was also sprayed0 385 Hie Special Crews Ao Trouble Shooting Crew and Catch Basin Spraying Two hundred thirty residences were sprayed in the follow® up of dengue casespalso 12 business establishments, 5 institutions and 18 hotels and apartments0 Following is a resume of catch basin and manhole checking and spraying activitiess Storm drains checked 362 Storm drains oiled 189 Storm drains breeding 5 Water, gas, telephone and electric company manholes checked 213 Water, gas, telephone and electric company manholes oiled 48 Bo Roof Gutter Crew During the half month period 121 buildings with faulty roof gutters were checked, of which 101 received per- manent correctiono Co Clean-up Crew A total of 347 truck loads of miscellaneous containers were collected and hauled to disposal sites0 Do Larviciding—Culex Control In the Damon Tract a ditch carrying septic tank effluent from a military establishment overflowed and flooded nearby residential areas along a four-block stretch. These places, together with the ditch itself, were sprayed for Culex control„ Oil drip cans were tried but were not completely successful0 Gambusia minnows have been intro- duced in the attempt to aid the control activities. The low land in the Moilili stone quarry was sprayed with a power sprayer, after which minnows were introduced for Culex control. A swampy pasture land area of about two acres, located in the Manoa Valley was sprayed with the power sprayer and supplementary work was done with knapsack sprayers in covering small ground holes and hoof prints0 This area is located within a good residential districto 386 Dengue Mosquito Inspector treating a spider lily plant (Grimm sp.) with larvicide. The initial Aedes breeding index for lily plants was A.2% and is now 0.4% (Photo by Signal Corps, U. S. Army) rne ape plant (Alocasla sp.) is another tropical plant which collects water at the base of the leaf stem. Many of these plants have been cut off at ground level, others treated with larvicide. The present index is 0.2% (Photo by Governorfs "Work to Win” Program) IV. Inspection and Indexes A. Summary Number of premises inspected 41*231 Number of premises found breeding Aedes 439 Aedes breeding index 10($ Number of premises found breeding Culex 83 Culex breeding index 0o2% Number of inspections per man-day (7 hour day) 4606 The Honolulu citywide Aedes and Culex breeding indexes remained at the same level during the first half of February as they were during the last half of January0 The increase in rainfall recently experienced occurred during the last part of the current semi-monthly period and has not as yet affected the mosquito breeding indexes0 Four zones9 two in the Lanakila district and two in the Central district9 had indexes above 5 percent0 Six zones or 9 percent had indexes above 3 percent• Following is a summary by districts of zone indexes which were reduced9 increased and unchanged? District Zone Indexes 2e Zone Indexes Down Zone In- dexes Unchanged Central u 13 1 Kapahulu 11 8 5 Lanakila 12 9 Jl. TOTALS 37 30 10 B. Analyses of Aedes Breeding in Containers by Type There is tabulated below the Aedes breeding indexes by type of container for the period ending October 15 and for the period ending January 31s Container Index 0cto 15 * aliQ J?4- Fish Ponds 207 0o7 Catch Basins 202 O06 Cesspools 00 2»2 Ditches9 Ground Pools 3o2 2 o 8 Drinking Troughs or Pans <>5 Ool Barrels3 Tanks9 Tubs loO 0o9 UrnSj Buckets9 Pails 202 OoS Tin CanSj Pans io8 0o6 Tires 2o3 lo7 387 Index Container Oct. 15 Jan* 31 Bottles 06 0o2 Ape Plants lo3 0o2 Lily Plants Ao2 OoA Ant Cups 4o9 102 Flower Vases Ac 7 0o8 Vine Bowls 6o5 lo9 Others 2 © 1 1.6 A study of the type indexes over the entire period of the control program indicates that reductions have been made in mosquito breeding in practically every kind of breederQ At the present time, although the indexes are rather low, the group comprised of tin cans and pans and the group comprised of all kinds of bottles, are still the most numerous breeders throughout the city0 At the beginning of the enlarged program in September lily plants and ape plants were also included in this categoryc However both of these latter types of breeders have responded quite satisfactorily to control0 We have recommended removing ' them, cutting holes to drain them or have treated them with paris green or phenothiazine (see pictures included in this report). Initially less than 15 percent of all of the breeding places were in vine bowls and flower vases which are considered interior breeders and in ant cups which are also usually found indoors. However, due to the comparatively faster elimination of outdoor breeding places, indoor breeders now comprise about 20 percent of the total0 By way of explanation, the Aedes breeding found in cess° pools is not in those which are in use but rather abandoned cesspools which have collected run-off and storm water0 The Aedes breeding indicated as having been found in ditches and ground pools is generally that actually occurring in tin cans, bottles and other receptacles accumulated in ditches and other low areas. However, to date the inspect- ors have found three instances of Aedes albopictus breed- ing in “true" ground pools. All of these have been small pools located beneath buildings. This can probably be explained by the presence of gravid females which, though preferring water contained in receptacles, deposited their eggs in the only available water0 Beverage bottles, though having small necks, are found to be heavy breeders in Honolulu, Among the unusual types of breeders which have been found are coconut shells and coco- nut fronds (on the ground). Bomb shelters have been found 388 breeding both Culex and Aedes mosquitoes and also appear to furnish excellent mosquito harborage® With increased rainfall, rock and tree holes which were formerly dry have made their appearance as regular breeders® Perma- nent correction of these places is being accomplished by filling with neat cement® No breeding has been observed in leaves of banana trees, though occasionally a hollow banana stump has been found to contain larvae® V, Personnel A, Total Personnel As of February 15 the following personnel were on duty on the Honolulu and Wahiawa programs; Field Duty Total Array 99 99 Chamber of Commerce 15 16 Ue So Public Health Service _29„ J/L TOTALS 153 163 Temporarily assigned to duty for Aedes control in other Oahu communities are the two colored Medical Sanitary com~ panieso At present there are approximately 91 men, in° eluding the officers, assigned to inspection work, and approximately 4-0 assigned to cleanup activities. The companies are now on practically a self“Sufficient basis under the supervision of the officer personnel„ Statistical clerks have been trained to handle the necessary compilation and computation of reports and indexes, VI. Public Education A. News Releases During the period 11 news releases appeared in the local English newspapers and 7 in the foreign language newspapers® B. Talks Talks concerning dengue control were given at the Kamehameha Preparatory School, Fern School PTA and Rotary Club, 389 VII. Wahiawa Program Summary Number of premises inspected 1353 Number of premises found breeding Aedes 41 Aedes breeding index 3o0% Number of premises found breeding Culex 4 Culex breeding index 0o2% Number of inspections per man-day (7 hour day) 3&06 The Wahiawa citywide index shows a further decrease from the previous period• Arrangements were completed for the continued support of Aedes control at Wahiawa through funds collected by a special com- mittee of the Wahiawa Community Associationc All business firms are being assessed $5o00 per month for this purpose. Arrangements were also made whereby the group of high school boys under a local supervisor which has been doing inspection work will shift from this activity and instead place major em- phasis on clean-up and similar work so that better supervision can be given to the boys. Respectfully submittedt /s/Wesley E0 Gilbertson Wesley E0 Gilbertson P0 A. Engineer (R) i/c Dengue Mosquito Control 390 FEDERAL SECURITY AGENCY U0 So PUBLIC HEALTH SERVICE DENGUE CONTROL TERRITORIAL BOARD OF HEALTH HONOLULU, To Ho TENTH SEMI-MONTHLY NARRATIVE REPORT Period Ending January 31, 19A4 I. Epidemiology A, Number and Extent of Cases Up to January 31 a total of 1379* cases of dengue were reported, 11 of which were reported during the last semi- monthly periodo During the previous period 28 cases were reported, indicating a considerable drop during the last half of Januaryo However, during the closing days of the month there appeared to be a slight increase in the number of cases occurring0 Every portion of the city was represented in the locations of the cases of the last semi-monthly period. It has been observed that occasionally a small focus develops, wherein two or three secondary cases occur in the same household as the initial source or in an adjoining household0 Un- fortunately, some of these small foci have been unreported until one or two weeks after the occurrence of the second- ary cases. When this happens it is not unlikely that enough mosquitoes become infected and disseminated to pro- long the infection in that neighborhood. II. Special Crews A. Trouble Shooting Crew During the period 186 premises were sprayed with insect!” cide in the follow-up of dengue cases0 Of these, 25 were business establishments, 2 were large institutions, and 3 were rooming houses. Two hundred seventy-five storm drains were checked, of which 72 were breeding0 One hundred twenty-one storm drains were oiledo * The total number of cases reported up to Jan0 15, 1944- should have been 1368 instead of 1388 as printed in the last reporto 391 B, Roof Gutter Crew Eighty-eight premises with faulty roof gutters were perma- nently corrected, and the occupants of 79 additional prem- ises were requested to remedy faulty guttersc The downtown area and the areas in the vicinity of the formerly restricted Buckle Lane-River Street district have been completely checked by the roof gutter crew. At the present time they are working in the Kakaako area. Co Clean-Up Crew The clean-up crew picked up and hauled away 359 loads of bottles, cans and other debris during the period. Utili- zation of a new dumping area which is nearer to the areas being cleaned, resulted in a substantial increase in the amount of material moved. Do Fish Stocking Top feeding mosquito minnows were introduced into two swamp areas and two fish ponds which were found to be breeding mosquitoes. III. Inspection and Indexes Summary No0 of premises inspected 45,994- No* of premises found breeding Aedes 499 Aedes breeding index lo0$ NOo of premises found breeding Culex 130 Culex breeding index 0o2% NOo of inspections per man-day (7 hour day) 49.0 Despite the heavy training load imposed upon the field forces (see SecQ VIII) the Aedes breeding index was fur- ther reduced and was 0o2% less than at the close of the previous periode Low rainfall conditions have greatly aided mosquito control activities0 For the first time since the program started no zone had had an index above 5oC$, nine zones or \2% had indexes above 3oOj60 Following is a summary by district of zone indexes which were reduced, increased and unchanged: 392 District Zone Indexes Zone Indexes Zone Indexes He Down Unchanged Central u 12 2 Kapahulu 8 11 5 Lanakila 7 _14. .a. Totals 29 37 11 IV. Personnel A. Total Personnel As of January 31 the following personnel were on dutys Field Duty Total Army- 95 95 Chamber of Commerce 16 17 Uc So Public Health Service _22_ J£_ Totals 150 160 During the period 5 employees were added to the Public Health Service payroll and one was separated. V. Public Education A0 News Releases During the period 14 news releases appeared in the local English papers and 7 in the foreign language newspapers. VI. Wahiawa Program Summary No. of premises inspected 1772 No. of premises found breeding Aedes 61 Aedes breeding index 3oA% No. of premises breeding Culex 4 Culex breeding index 0o2% No. of inspections per man<=day 53o7 The Wahiawa citywide index 0°A%) shows a decrease of 105% tinder the previous period0 Three additional inspectors were assigned to Wahiawa for approximately 10 days in order to stop the increase in mosquito breeding which had pre« viously occurredo 393 VII. Surveys of Islands of Kauai and Maui Two 7~man soldier inspector survey crews trained on the Honolulu program were brought to Kauai and Maui respectively during the period to make surveys of Aedes breeding in communities which are congregating areas for military personnel* Preliminary indi- cations are that Kauai indexes will be just as high as those found on Oahu, but the Maui indexes will probably be rather low® VIII. Expansion of Aedes Control; Training of Necessary Personnel Because of the position of this Territory as a military rest and replacement center and the dangers of immediate and con= tinuous reintroduction of dengue fever, expansion of Aedes control to all Islands in the group is urgento During the period two colored Medical Sanitary Companies (228 men) were assigned for general orientation in mosquito control activities and for training in Aedes control• Each company was given one week of preliminary class work, followed by a week of concentrated instruction in differentiation of species, control methods and regular field activity® The trainees were rated daily on their field work, and at the end of the period, on their class workD Potential inspectors are being selected from those who showed satisfactory knowledge in both phases at the end of the period. The remaining per« sonnel will be divided into clean~up crews® After a tempering period doing actual control work in Oahu communities, the two companies will be divided among the islands of Oahu, Hawaii, Maui and Kauai® Necessary officer personnel for supervision has been requested0 All personnel will be assigned to the UQ SD Public Health Service and reassigned to the Territorial Board of Health under which the Aedes control program will operate® Experienced Aedes control foremen from the Honolulu program are being detailed with the newly formed inspection crews for supervision during the initial period of operations® Respectfully submitted, /s/tfesley Ec Gilbertson Wesley E® Gilbertson P0 Ac Engineer (R) i/c Dengue Mosquito Control 394 FEDERAL SECURITY AGENCY UG So PUBLIC HEALTH SERVICE DENGUE CONTROL TERRITORIAL BOARD OF HEALTH HONOLULU, T. Ho NINTH SEMI-MONTHLY NARRATIVE REPORT Period Ending January 15, 1944 I, Epidemiology A, Number and Extent of Cases Up to January 15 a total of 1388 cases of dengue were reported, 28 of which were reported during the last semi- monthly period. The latter figure represents a drop of 17 cases from the previous period0 The cases were scattered throughout the entire city of Honolulu, All previous foci of infection were quiet and no new foci developed. The relatively long incubation of the disease and the lag in reporting some of the cases considerably compli- cates epidemiological analysis0 Often it is necessary to attempt to construct the epidemiological picture by questioning the dengue patient concerning his activities over a period ranging from 10 days to 20 days prior to the day of questioning. Obviously, some incomplete and inaccurate information results due to the patient not being able to remember every detail of his movements after that lapse of time, ■ II, Spraying Activities A, Special Work In an effort to kill all adult infected mosquitoes and stamp out the last few cases9 if possible, spraying measures have been instituted at every place where dengue might have been contracted or where cases were visited while in the infectious stage0 During the current period the OCD portable power sprayer was utilized for spraying a four-block area in Kakaako district9 three downtown markets, and the USED camouflage factory in Kalihi, Since the heart of the downtown area had been frequented by a number of dengue patients while in the prodromal 395 infectious period, daily spraying by business firms was considered to be of some prophylactic valuec A total of 534 business firms were contacted the first week of Jan- uary, with a request to spray the interiors of their es- tablishments each day for a period of two weeks0 About one“third of the firms were found not to have adequate spraying facilities, but the remainder agreed to comply with the request. Bo Regular Work On the follow-up of dengue cases, 120 residences. 7 apart- ment buildings and rooming houses, 16 offices, and 15 other business establishments were sprayed with insecticide. Trips were made to Ewa, Wahiawa and Pearl City to follow up cases in these communities«, The entire plant at Child = ren#s Hospital was sprayed and one of the wards of Queen*s> Hospital also received the same treatment. Recently a new use of the sure-shot sprayers has been de- velopedo By removing the spraying nozzle and using the nozzle extension pipe only a powerful spray is produced which can be used to spray underneath houses, in out- buildings and other exterior areas. Methyl Chloride gas is used as a pressure agent. This use is considered very important because there is undoubtedly a period of ten days or more between the time when the patient received his infection and when the spraying crew arrives (due to the dengue incubation period and lag in reporting) and mosquitoes would be able to disseminate to surrounding areas, whether the home is screened or not. It has been difficult to spray satisfactorily these areas, except with power sprayers which are unhandy for short, scattered spray jobs. Therefore the new use of the sure-shot sprayers solves a pressing problem. C. Storm Drains and Catch Basins Summary Storm drains checked 182 * • oiled 12* tt * breeding 19 Water, gas, electric, and telephone manholes checked 155 » oiled 40 Arrangements were made to spray catch basins in the mili- tary restricted area along the Honolulu waterfront. 396 Ill. Inspections and Indexes Summary No® of premises inspected 38,639 Noo of premises found breeding Aedes 489 Aedes breeding index 1<,2% Noo of premises found breeding Culex 110 Culex breeding index 0.2$ Noo of inspections per man-day (7 hour day) 4609 Hie citywide Aedes breeding index for the period is the same as for the previous periodo It appears, therefore, that the increase in mosquito breeding which occurred during the month of December has been slowed up. Following is a summary by districts of the number of zones which had increases, decreases and the same indexes during the current period, compared with the previous period* Zone Indexes Zone Indexes Zone Indexes frown No Change Central district 9 16 3 Kapahulu 8 11 5 Lanakila " 10 11 4 Totals 27 38 12 A complete inspection of the Royal Hawaiian Hotel buildings and yard (Navy restricted area) was made during the periodo No breeding was found but recommendations were given for correc- tion of a number of potential breeding places0 Special inspections were made of seven bottle yards in Honolulu owned by beverage and junk companiese Considerable progress was noted since the last special inspection a bout one month ago. As a result of correction activities by these firms, no serious breeding conditions have been found in the bottle yardse During the past two months a number of Board of Health orders have been issued for abatement of mosquito breeding conditions where inspections have indicated that there was chronic viola- tion of the regulationso Compliance has resulted in every case. IV. Special Activities A. Roof Gutter Crew During the period the 2-man roof gutter crew accomplished the following* 397 Roof gutters cleaned 52 n w removed 13 Bo Fish Stocking Four ponds and swamp areas were stocked with mosquito fish during 1116 period» C. Clean-Up Crew The clean-up crew picked up and hauled away 160 loads of miscellaneous receptacles during the periodo Fifty- eight loads of debris previously unreported bring the total number of loads disposed of by the clean-up crew to date to l,161o V. Public Education A» News Releases During the period 22 news releases appeared in the local English newspapers» Bo Stuffers Ten thousand stuffers were released during the period through cooperation with a locallaundry« The electric company bills for the past month contained 30,000 stuffers on dengue mosquito control» Co Other Publications The Hawaii Farm and Home magazine carried an article on the Honolulu dengue epidemic and the responsibility of householders for mosquito controlo VI. Surveys of Rural Oahu Communities Completed Completing the list of Oahu communities outside of Honolulu which have been surveyed for Aedes breeding, the following summary is presented: Location Aedes Breeding Index Percent Containers Wet noi Breeding Aiea llol 24o6 Ewa 3o6 25o4 Kawailoa 4o0 38o9 Pearl Oity 5o2 23ol Waianae 3 o4 20 o2 398 VIIo Personnel A« Total Personnel As of January 15 the following personnel were on dutyt Field Duty Total Army 95 95 Chamber of Commerce 19 20 U0 S. Public Health Service 36 44 Total 150 159 During the period 7 employees were separated from the Public Health Service payrollo Seventeen new soldier inspectors reported during the period, 8 as replacements and 9 to cover zones previously covered by civilian inspectors« B. Chamber of Commerce Personnel As of December 31, 1943 the fund of approximately $23,000 established by the Public Health Committee of the Chamber of Commerce for dengue epidemic control was practically exhausted.. A new six-month budget of $5338 <>50 was pre- sented to the Public Health Committee and passed by that groupo Of this amount approximately $1900 was set up for payrolls for one month for the special mosquito control staff which was employed through Chamber of Commerce funds at the beginning of the epidemic in August, 19430 Arrange- ments are being made to take over on the Public Health Service payroll these employees on or before February 1, 1944o An additional $1950 was earmarked for salary ex- penditures for new recruitees which are being initially employed through Chamber of Commerce funds pending investi- gation by the Federal Civil Service and appointment on the Public Health Service payroll., Approximately $1400 was placed in the budget for maintenance of certain automo- tive vehicles in use on the dengue control work and for printing and other necessary items0 At the request of the Board of Health, due to an increase of typhus here, arrangements are being made to return as soon as possible to rodent control activities, some mem- bers of the Chamber of Commerce Rat and Mosquito Control Squad who had been assigned exclusively to the dengue pro- gram since August of last year* All of these trained individuals have been in supervisory positions and re- placement on the dengue control staff is therefore quite difficulte The first man was released on December 1, 1943, two more on January 15, 1944, and two men will be released at the end of January0 399 VIII. Public Health Service Expenditures Expenditures incurred by the U« S. Public Health Service for dengue control for the period of September 1 to December 31, 1943 are as followsj Month Salaries Supplies and Equip. September ♦2272o84 $3566.66 October 7165o31 547.86 November 9411o98 899.25 December 8585.77 542.65 Final payrolls 416o47 Totals $27852.37 $5556.42 Grand Total |32$08.79 IX. Wahiawa Program Summary Noe of premises inspected 1059 No. of premises found breeding Aedes 52 Aedes breeding index 4.9$ No. of premises breeding Culex 5 Culex breeding index No. of inspections per man-day 34.1 (7 hour day) The Wahiawa citywide index (40 shows an increase of ld% over the previous periodo This reflects, as did the Honolulu indexes during the previous month, an increase in rainfall. Additional inspectorial manpower will be assigned to the Wahiawa program for a short period in an effort to reduce mos- quito breeding in the higher zones. X. Progress Report on Entomological Studies A. Distribution Studies on the distribution of Aedes albopictus and Aedes aegypti on the island of Oahu and partlcularly in the ciiy of Honolulu are being continued. On the basis of present figures (subject to revision) it is observed that the Aedes aegypti is restricted to the leeward side of the island, while Aedes albopictus is widely distributed. Within the city of ’"Honolulu, Aede s aegypti is restricted to zones which are in the lower areas along the sea and particularly in the more densely populated zones. Ihe 400 data on distribution is being continued with special em- phasis on obtaining a significant number of samples from every zone. B. Longevi ty Cage studies on the duration of life of the adults of Aedes albopiotus have indicated that they will live for periods of at Teast two months, at room temperature (67-72°F) . the males were fed on moist raisins 'or honey water and the females were fed on human blood® Labora- tory tests of the duration of life of female Aedes albo- piotus which had been fed on a dengue patient during ihe infectious stage were inconclusive, due to the small numbers of mosquitoes used® However, one of the infected mosquitoes lived for four days longer than the non-infected controls and none of these mosquitoes lived longer than 16 days. C. Flight Range The flight range experiment is continuing® Difficulty has been experienced in recapturing after release of stained specimens® Tests are being conducted on various types of traps suitable for the Aedes mosquito® D. Filariasis Transmission A study of the transmission of Filariasis by the mosqui- toes of Hawaii is underway® A study of the local popu- lation of Samoans is being made in order to discover a good carrier of microfilaria® Mosquito colonies and .experimental cages are being prepared for this work. Respectfully submitted, /a/Wealey E» Gilbertson Po A« Sanitary Engineer (R) i/o Dengue Control 401 FEDERAL SECURITY AGENCY U. S. PUBLIC HEALTH SERVICE DENGUE CONTROL TERRITORIAL BOARD OF HEALTH HONOLULU, T. H. EIGHTH SMI-MONTHLY NARRATIVE REPORT Period Ending December 31, 1943 I. Epidemiology A* Number and Extent of Cases During the last semi-monthly period 45 cases of dengue were reported, bringing the total reported to December 51 to 1,340 cases. Five oases previously included in the total have been dropped because the final diagnosis was not dengue. The epidemiological picture has changed considerably during the past two months. The number of cases had dropped off markedly so that individual case histories can be better studied. They must be relied on to a greater extent than previously because it is difficult to make satisfactory statistical epidemiological studies from week to week. It is particularly significant that no large foci of in- fection continue to exist. The recent cases have been scattered over most of the city, with the central portion showing the highest concentration. There is included with this report a chart showing the progress of the epidemic to the end of the year. The rise and fall of the cases in the three areas (Waikiki, Kakaako, and Buckle Lane-River St.) which were foci of infection are also shown. These cases are allocated by residence. At the present time work is in progress to comple-te the epidemiological picture by allocating the scattered cases to place of probable contact. Symptomological statistics are also being worked up. Military authorities lifted all dengue restrictions for service personnel on December 30. 403 At the beginning of the period a study was made to locate areas which have been the site of sporadic cases reported during the past month, or, where possible, to locate sources of infection for cases living elsewhere. A total of 17 such areas were delineated, ranging in size from a single residence with the surrounding half dozen houses to a 4 square block area in the Kakaako district. II. Spraying Activities A. Special Work An Army decontamination truck was utilized for on© full week, spraying the exteriors of all premises included in the above described list of 17 special focal areas. At the same time a crew of six men equipped with hand sprayers sprayed the interiors of all homes and business establishments. lyre thrum base spray with water as a diluent and added emulsifier was used for the exterior spray. A total of approximately 1900 gallons were used. In the hand sprayers pyrethrum extract diluted with kero- sene was used for interior spraying. B. Regular Work The trouble shooting squad, in regular follow-up of dengue cases, sprayed 170 homes, 11 apartments andtenernent rooms, 7 warehouses, and 2 business places. C. Motorcycle Spraying Unit for Catch Basins A catch basin spraying unit was put into use during the last days of the period. It consists of a three-wheeled motorcycle equipped with a pressure tank, hose, and spray gun. The vehicle, which was formerly owned by the Shrinerst Hospital, had been in use by the Office of Civilian Defense and was turned over to the mosquito control program by the latter organization. The Public Health Committee of the Chamber of Commerce furnished funds for preparing the machine and properly equipping it for the work. There has been an increase in the rainfall during the past four weeks, accompanied by an increase in mosquito breeding in catch basins. These generally breed Culex mosquitoes but Aedes have been found a number of times. Of 90 catch basins checked, 57 contained water and re- quired oiling and 15 were breeding. Water, gas, telephone and electric company manholes are also being checked, oiled if necessary, and the proper officials notified if found containing water. 404 III. Inspections and Indexes Summary Noo premises inspected 43,173 Noo premises found breeding Aedes 519 Aedes breeding Index 1.2$ No. premises found1breeding Culex 76 Culex breeding Index .2$ No. Inspections per man-day 52o4 The citywide Aedes breeding index for the period (1.2$) is 0.1$ higher than the previous period and 0.3$ higher than the lowest index, which occurred during the last half of November. Five zones or 7$ had indexes above 5$; 9 zones or 12$ had in- dexes above 3$j and in 9 zones or 12$ no Aedes breeding was found. In 41 of the 77 zones there was an increase in mos- quito breeding. IV. Special Activities A. Roof Gutter Crew The activities of the 2-man roof gutter crew were con- centrated in the congested area of Honolulu, • and covered an area of approximately 25 square blocks during the period One hundred gutters were checked and 46 received permanent correctiono B. Fish Stocking Ten ornamental back yard fish ponds were stocked with top- feeding minnows during the period. Co Clean-Up Crew The clean-up crew picked up and hauled away 226 loads of miscellaneous containers from 46 locations during the periodo V. Public Education During the period there were 14 news releases in English news- papers and 10 in foreign language publications. Three hundred posters, printed through Chamber of Commerce Health Committee funds, are being distributed to public places throughout the city by Boy Scouts. 405 Attached to this report is a copy of the new householders bulletin with four foreign language translations (Filipino, Korean, Chinese and Japanese) on the reverse side, and a copy of the Traveller's Edition of the Hawaii Health Messenger. VI• Surveys of Rural Oahu Communities Utilizing military personnel from the Honolulu control program, Aedes breeding surveys of 8 war-connected communities in rural Oahu were completed during the period« Following is a summary of the results thus fars Location Aedes Breeding Index Percent Containers Wet but not Breeding Lanikai 4o0 42 Waialua 6oX 39 o4 Haleiwa 7ol 35»8 Kahuku 7 oS 42o4 Waipahu 9o2 32 Waimanalo 10 o 5 37 Kailua 18o3 29 c9 Kaneohe 21 o? 57 The Public Health Committee of the Chamber of Commerce fur- nished funds for noon-day meals for inspectors on survey duty in rural 0ahuo VII. Personnel A. Total Personnel As of December 31 the following personnel were on duty: Field duty Total Army 86 86 Chamber of Commereo 19 20 Uo So Public Health Service 43 52 Totals T55“ During the period three employees were separated from the Public Health Service payroll» Bo Absenteeism The problem of absenteeism among civilian personnel has been difficult to cope with. Initially, it was hoped that by appealing to the men most unnecessary absences would be eliminated. However, recently it has been shown that disciplinary action is necessary. 406 .Police have been called in to investigate certain chronic absentees under the military law. Further, this office has adopted the policy of giving disciplinary leave with- out pay in all cases of unauthorized absence• During the current period such action was taken on 23 of the 46 field employees. VIII. More Dengue on Kauai Another case of dengue was reported from the island of Kauai in the Eleele Camp, which adjoins the Port Allen Camp where the previous cases occurred. The onset of this case was December 21. There was also another suspected case in the same household with onset-on December 11. The latter person had been in Honolulu during the last week of November. More information has been requested in an effort to establish the probable point of contact, lb date there have been reported three confirmed cases and two suspected cases of dengue on Kauai. Vigorous exterior and interior spraying, accompanied by inspection-correction activity, were instituted again imme- diately after the additional cases in Eleele Camp were reported. IX. Wahiawa Program Summary No. Premises inspected 1524 No. Premises found breeding Aedes 58 Aedes breeding Index 3.8^ No. Premises found breeding Culex 5 Culex breeding Index 0.3$ No. inspections per man-day 54.4 The Wahiawa citywide index (3.8?Q for the current period is reduced to less than half of the index found during the survey. The inspectors report excellent cooperation from most of the householders. Through funds provided by the Wahiawa Community Association, householder bulletins similar to the one attached to this report have been provided for distribution to local citizens. Through the efforts of the military foreman in charge of the Wahiawa inspection forces, a number of dumps which were sources of mosquito breeding have been removed. Respectfully submitted, /s/Wesley E. Gilbertson Wesley fi. Gilbertson P. A. Sanitary Engineer (R) i/c Dengue Control 407 saved. Once Dengue gains a foothold, it is hard and costly to control. Your cooperation can be of great help now, during these critical War days. Remember that although you may feel perfectly well now, it takes the disease 3 to 1 5 days to incubate in your body before symptoms are no- ticeable. At the first sign of ill-health get in touch with your Doctor or the Board of Health at your destination. Special Travelers Edition THE Hawaii Health Messenger PUBLISHED BY THE TERRITORIAL BOARD OF HEALTH Honolulu, T. H. December, 1945 BE ON GUARD—KEEP Deng U£ FROM SPREADING FURTHER! YOU HAVE JUST LEFT A I)en.CJ,U£ FEVER AREA! hesitate to call the Board of Health or your Doc- tor IMMEDIATELY if you experience any of the following symptoms; Aching Joints Fever Tired Feeling Severe Headache Do NOT go to your Doctor, have him come to you. Go to bed in a screened room, under a mos- quito net if possible. is infectious dur- ing the first four days of the disease. If your case is diagnosed as Dengue, stay under a bed net until the infectious stage of the disease has passed. DON'T TAKE ANY CHANCES! If Dengue Fever can be confined to Honolulu, a great amount of vital time and money will be Courtesy of Life Magazine WARNING THE CITY OF HONOLULU is now suffering from an epidemic of DENGUE FEVER. You may have been bitten ALREADY by the MOSQUITO which spreads DENGUE and not be aware of vour infection. Preventing the spread of DENGUE FEVER from Oahu to the other Islands is of extreme impor- tance. Upon arrival at your destination do not 48 2050 The spread of DENGUE FEVER must he stopped! Everyone can and must help to eliminate the day mosquito. Don’t let your home or yard serve as a breeding place for mosquitoes. £ Remove all old tires, tin cans, bottles, etc. 2 Puncture and drain the water cups of lily plants. 3 Cut off ape plants at ground level. A Treat all NECESSARY water containers with kerosene once a week. 5 Hoot ivy vines and other water plants in earth or sand. Follow these simple rules: It is YOUR responsibility to prevent mosquito breeding on your OWN premises. PREPARED BY THE PUBLIC HEALTH COMMITTEE OF THE CHAMBER OF COMMERCE OF HONOLULU Alduw a panagiwaras ?i lamok ti Dengue a Giirigor. Keb- beng mo nga aramiden dagitoy sumaganad a nalaka nga pa- musposan tapno maatipa dagiti lamok nga agrway dita ina- Jadan yo: 1. Ibel-leng mo wenno paklebem amin a di nakassasapol a pagikkan danom. 2. Ipunget mo nga pukanen dagiti aglungsot a mula. 3. Pabaroem a kanayon ti danom tay macetas mo a lily. H “ — -fe S* a' 3ft ft T .(j4. x7' s$ SaS?® m* co U »« U ■>Y.% cr?K* * £ (* li t c Bfe? «fc|ISt < TCS t ° ® t •i j: m m ° y < 4^£s to#*i t Es U * <7) ®T: 0 M 9 - # & B tt « j® £ * ± 0 v # III ii # §s Mm % m it m If ° M ° ° l lJ /fl fii W- M W BT i$ ?K 7K M ° If is# ff ° * ft W fill % 48 2952 FEDERAL SECURITY AGENCY U® S® PUBLIC HEALTH SERVICE DENGUE CONTROL TERRITORIAL BOARD OF HEALTH HONOLULU, To H. SEVENTH SEMI-MONTHLY NARRATIVE REPORT Period Ending December 15, 1943 I. Spidemiology A. Number and Extent of Cases A total of 1,300 cases of dengue were reported up to December 15® During the last semi-monthly period the total was 98 cases. This averages 605 cases per day, in comparison with 8o8 cases per day, 16o4 cases per day, and 21«3 cases per day for the proceeding semi- , monthly periods in reverse chronological order to the highest semi-monthly period. During the first week of December there was a slight in- crease in the number of cases reported from the Buckle Lane-River Street area. This rise did not continue0 All other previous foci of infection continued to decrease® Vigorous daily spraying measures instituted some weeks ago in certain public schools from which a number of cases had been reported among school children has resulted in a considerable decrease in new cases reported from this age group. Dengue has now been contracted by a total of 3 of the dengue control personnel® One was a foreman and the other two were inspectors—one civilian and one soldier® II. Spraying Activities No large scale wholesale spraying work was undertaken during the current period® However, analyses of epidemiological data revealed that the 100—200 block district on Kukui Street in the Buckle Lane-River Street area was the probable source of a number of cases, and the interiors of all residences and business establishments, although they had been previously sprayed in connection with the regular follow-up of cases, were re-sprayed as an additional factor of safety® 409 The trouble shooting crew, which follows up the cases, sprayed during the periods 157 residences, 282 tenement rooms, 17 apartments, 8 warehouses, and 66 business establishments0 In addition, this crew checked 264 storm drains and oiled 127 storm drains, 35 of which were found breeding. The recent in- crease in rainfall has resulted in storm drains becoming greater hazards• III. Inspections and Indexes Summary No. premises inspected 42,274 No. premises found breeding Aedes 480 Aedes breeding Index 1.1^ No. premises found breeding Culex 62 Culex breeding Index 0d$ No. inspections per man-day 50.6 The citywide Aedes breeding index {1*1%) has raised 0.2$ since the last semi-monthly period, reflecting increased rainfall over the entire city. Thirty-seven zones had higher indexes this period than last period, and the remaining forty were the same or lower. The zones where increased mosquito breeding was found are scattered throughout the city. Eight zones or 10$ had indexes above 3$, and three zones or 4$ had indexes above 5$. The military dengue-restricted areas had the following indexes* Zones Area 8B, 9B Buckle Lane-River Sto 0<>5$, 0.0$ 2A> 4, 5A, 5B Kapalama-Kalihi-kai 4.5$, 1.0$, 0.2$, 0.7$ 14A, 14B Kakaako 2.2$, 0.0$ These indexes are slightly higher than corresponding indexes for the previous period. Each of the three district offices is starting a "mother foci" and "chronic breeder" map. The total number of premises with Aedes breeding in the city now has been reduced to the point that troublesome places may receive individual attention. When a small neighborhood shows repeated breeding in miscel- laneous containers, this fact may be taken to indicate that ■there is an undiscovered "mother" or generating focus in the area. A special thorough search may result in locating a hidden breeding place. 410 The "chronic breeder" maps will also aid in pointing out prem- ises which call for Board of Health police power to abatement of the mosquito breeding hazard. IV. Special Activities A. Clean-up Squad During the period the special clean-up squad with an average of 23 men and 4 trucks collected and disposed of 218 loads of containers consisting mostly of tin cans and bottles«. As a result of conferences and field trips throughout the city with the engineer of the Bishop Estate, this group has agreed to employ a crew of men to clean up premises and lots under their control and place the accumulated piles of.containers and debris in places which are accessible to the dengue control clean-up truckso After this work has been completed, the Bishop Estate is placing the responsibility for maintenance of satisfactory conditions upon the tenants0 Arrangements were made with the Hawaii Housing Authority for a complete clean-up of the slum area located along Vineyard Street» This area adjoins the Buckle Lane dis- trict, and the timely action probably helped to prevent a localized outbreak in another slum districto B. Roof and Gutter Squad Two inspectors were assigned on December 10 to inspection and elimination of roof and gutter breeding places in the Honolulu business districto Initial reports Indicate that the recent heavy rainfall filled many clogged gutters, and mosquito breeding had already commenced» In addition to the numerous gutters cleaned and drained, 15 gutters were permanently eliminated as mosquito breeding place So V. Personnel A. Total personnel As of December 15 the following personnel were on duty? Field duty Total Amy 66 66 Chamber of Commerce 23 24 Uo So Po Ho S. 46 55 Totals 175— ITT" 411 During the period three employees were separated from the Public Health Service payroll. B. Since September 1 a total of 105 applicants (foremen and inspectors) have been referred to .this office by Civil Service. Of these, 79 were suitable for appointment, 33 of which were later separated,leaving the present total of 46 Public Health Service employees on field duly. VI. Public Education A. News Releases During the period a total of 11 newspaper releases appeared in the local newspapers. Through the Governor’s "Work to WinM Committee, the Governor, Chairman of the War Manpower Commission, and leading businessmen have issued published statements urging public cooperation with measures for control of Aedes mosquito breeding. B. Visual Education A photographer from the ’’Work to Win" Committee took a number of photographs to be utilized with publicity cam- paigns. The same committee also prepared an excellent exhibit utilizing the themes "Dengue Steals Vital Man- hours From the War Effort." C. Travelers Bulletin At the request of the Board of Health, a special pamphlet has been prepared for distribution to all inter-island air and surface travelers concerning the importance of prevent- ing dengue from spreading to the outside islandso A sum- mary of the symptoms of dengue is included and emphasis placed on the necessity of calling a doctor upon the ap- pearance of any suspicious symptoms.. D. Stuffers Distributed Through the cooperation of the Hawaiian Electric Company, 30,000 stuffers were distributed with the monthly electric bills. These contained instructions to each householder for the elimination of dengue mosquito breeding places. VII • Wahiawa Program Final tabulations on the Wahiawa survey indicates an Aedes breeding index of This information was brought to the attention of the local government physician and the Wahiawa Community Association, pointing out that an explosive outbreak 412 could occur with the existence of such a high breeding index., The Community Association agreed to support a dengue mosquito control campaign and initially allocated a sum of |500°00 for a period of three months. This fund is to be used for the continued employment of an experienced mosquito control fore- man and a group of about a dozen high school boys to do mos- quito control work on a one-day-a-week basis» In addition, a series of posters and pamphlets are being prepared for distri- bution to the householders of Wahiawa. Beginning Tuesday, December 7, three soldier inspectors and a foreman began regular house-to-house inspectorial service at Wahiawa. VIII. Dengue on Kauai A case of dengue was reported on the island of Kauai, Port Allen Camp, with onset date on October 30. The patient had been in Honolulu within the maximum incubation period of dengue. Immediate remedial measures taken by the Board of Health in- cluded isolation of the case, spraying of all houses and yards within a radius of 500 feet, and inspection of Port Allen Camp and two adjoining communities, Eleele and Hanapepe. Exterior spraying was done with commercial insecticide, utilizing Army Chemical Warfare high pressure sprayers. Two complete cycles of inspection by soldier inspectors were made, each followed by re-checking of premises where breeding was found. A second case of suspected dengue appeared on November 26 at the office of the same doctor who diagnosed the first case, with what appeared to be the terminal rash of dengue. This patient lived about 600 feet from the first case.' The history indicated none of the usual symptoms of dengue, except slight general malaise. This case was not reported as dengue until the appearance of the third case. The third case with onset on December 6 was reported by the same physician as soon as seen by him—on December 7. This patient lives across the street from the first case. The area was again sprayed both inside and outside of houses, in some cases to a distance of 1,000 feet, on December 9. Re-inspection of the three communities was started. On December 14 the entire area was re-sprayed. Routine inspection has been established. Since December 10, every home in Port Allen Camp, Eleele, and Hanapepe has been visited by a Board of Health or O.C.D. nurse to locate other cases, if such occur. This will continue for two weeks. No new cases have been reported sine© December 7. Radio, newspapers, and the O.C.D. organization have dissemi- nated dengue mosquito control information to the general public on Kauai in order to stimulate elimination of breeding placet. Respectfully submitted, /s/ Wesley £. Gilbertson Wesley E. Gilbertson P. A* Sanitary Engineer (R) i/c Dengue Control 414 FEDERAL. SECURITY AGENCY U0 S0 PUBLIC HEALTH SERVICE DENGUE CONTROL TERRITORIAL BOARD OF HEALTH HONOLULU* To H0 Sixth Semi-Monthly Narrative Report Period Ending November 30, 1943 I. Epidemiology A, Number and Extent of Gases Up to November 30 a total of 1,202 cases of dengue were reportedo During the last semi-monthly period 132 cases were reported, in comparison with 231 cases during the period ending November 15, and 321 cases during the period ending October 31° A study of the locations of these cases indicates that the Kakaako and Buckle Lane-River Street areas appear to be gradually showing the results of control„ The Kalihi-kai or Kapalama area from which a few cases have been reported each week, appears to be gaining headway rather than dying out0 If this continues, wholesale spraying measures will be instituted in the area0 B„ Follow-Up of Cases With fewer new cases of dengue being reported each week* a more complete epidemiological study of each individual case is being made by the epidemiologist and public health nurses0 From these studies* much valuable information is being gained by which control operations are being guidedo For instance* insecticide spraying is now being done at many places where it is suspected that the case might have been contracted* and also where the dengue victims visited during the infectious period0 II. Spraying Activities On November 18 the portable gasoline driven sprayer was utilized for a complete spraying of the McKinley High School Buildings, bomb shelters, and nearby restaurants where students eat noon luncheso This action was taken because of the sudden appearance of a number of dengue cases among the students and teachers in the institution,,' Two business firms. Bunny Ranch (a sandwich factory) and Easy Appliance Company (electrical appliance firm) were also thoroughly sprayed after epidemiological studies in- dicated these places were possible sources of infection,, For 415 the same reason, the Kewalo Theater located in the Kakaako area was sprayed, utilizing sure-shot hand sprayers. The Mary Knoll Convent, comprised of 10 buildings, also received a complete spray job. XXX. Inspection and Indexes Summary Total inspection of premises. .... ,4-2,326 Number premises breeding Aedes 4-20 Aedes breeding index. . 0.9% Number premises breeding Culex $$ Culex breeding index 0,1% Number'of inspections per Man-day . . . .42.1 The current Aedes breeding index is 0,1% lower than the index for the previous period. Five zones or 7% had indexes above 3%» and one zone or 1,0% had an index above 5%. Twenty seven zones had higher indexes during the last period than previously, and thirty-seven were decreased. The highest zone (7,1%) was 11C, located in Nuuanu Valley, was also highest last period. Two zones have been free of Aedes breeding for one month and in a third zone ho breeding has been found for six weeks. On an average, two containers have been found per premise found breed- ing. The military dengue-restricted areas had the following indexes: Zones Area Indexes SB, 9B Buckle Lane-River St, 0.9?, 0.0? 2Jim- Uf 5Aj $B Kapalama-Kalihi-Kai 0,0$, 1.0$, 0.0$,0.0$ 14a, 14B Kakaako 1 • 0$, 0,0$ These areas are all significantly reduced from previous periods, reflecting the impact of concentrated control effort. IV. Special Activities A. Clean-up Squad During the period the special clean-up squad with an aver age of 24- men and 4 trucks, collected and disposed of 192 loads of containers, consisting mostly of tin cans and bottles. 6. Bottle Yards Special inspections were made of 6 large bottle yards owned and operated by junk dealers and liquor bottlers. At all of these yards there are tremendous accumulations of bottles of all types, many of which could collect water during rains and become mosquito breeding hazards,, At each yard, however, the management has a crew of 1 to 5 persons sorting bottles and placing them in crates in an inverted or horizontal position. At one yard provision had been made for covering the bottles with a tarpaulin at night. In each case‘the management was contacted and emphasis placed on the necessity of completing the bottle sorting and crating activities be- fore the advent of raipy weather. V* Personnel A, Total Personnel As of November 30 the following personnel were on duty Field duty Total Army* " 68 68 Chamber of Commerce 23 24 U0 S0 P0 H„ S0 50 61 . Total 141 153 During the period 10 employees were separated from the Public Health Service payroll. B. The recruitment of new civilian personnel has been extremely slow during the month of November. In fact, during the last one-half month only two applicants were referred by Civil Service A complicating Civil Service regulation recently instituted ne- cessitates that all persons of Japanese ancestry must be sub- jected to investigation, requiring at least two weeks, prior to authority to make the appointment. Since approximately three-fourths of all applicants are of Japanese ancestry, it is obvious that this regulation introduces an inconvenient prob- lem in the hiring of new personnel. VI* Public Education A. News Releases During the period a total of 15 newspaper releases appeared in the local news papers. B. Visual Education Movie Trailer—A two minute 35 mm0 movie trailer made through the cooperation of the Army Signal Corps, Navy Photographic 417 Laboratory, Array Special Services Division, and the Chamber of Commerce was completed and copies distributed to the various theaters , Initially, the trailer is being run in the "first run" houses and in theaters located in the most "heavy dengue-stricken areas. Arrangements have been made to cover all theaters in Honolulu, other theaters located in rural Oahu, and later on the out- side islands. In addition, several theaters have shown slides on dengue prepared from material from this office. The Army Signal Corps provided a photographer for taking a series of 26 pic- tures depicting a typical day in the life of the soldier inspector on duty. A large series of pictures were taken by the school photog- rapher while the spraying of McKinley High School was in progress. These are to be utilized in the school paper and annual publication. C. PTA Educational Program A short talk and demonstration were given at a meeting of the Parent-Teacher Association Executive Committee, Arrange- ments were made to circularize the officials of each PTA local unit on Oahu and also the outside islands with a pam- phlet regarding the dengue epidemic control problem. The Oahu units were offered a speaker for an early meeting. VII* Dengue at Wahiawa Three cases of dengue were reported from Wahiawa, all of which, upon epidemiological investigation, were traceable to dengue in- fected areas in Honolulu. A fourth case of dengue, which had occurred previously, was also located. An immediate follow-up was made on the three recent cases, including spraying of the residences and surrounding buildings, and complete inspections for the elimination of mosquito breeding places. In addition, all places, both public and private, (including a theater) which had been visited by the dengue victims during their infective periods were thoroughly sprayed for the destruction of adult mosquitoes. Next, a detail of six trained inspectors under the supervision of Mr. F, K. Lee and Sgt, Koch began a complete inspection of the town of Wahiawa for the elimination and treatment of all Aedes breeding places. Complete records are being maintained so that indexes can be computed to determine areas of heaviest breeding. Some mosquito control activities have been carried out during the past three months by interested citizens and the Office of Civilian Defense. Block Wardens visited all places under their jurisdiction and distributed educational pamphlets„ For the past several weeks,, an individual with previous mosquito control experience has been employed on a one day a week basis to supervise a group of about one dozen high school boys in mosquito control inspection activities. Undoubtedly, these canypaigns have resulted in a significant reduc- tion in Aedes breeding in Wahiawa,but preliminary calculations from our inspections indicate that Wahiawa still has a citywide Aedes index of approximately 10$, According to experience in Honolulu, this index is high enough to support considerable transmission of dengue. Wahiawa is a town of approximately 10000 population, located about 15 miles from Honolulu, It is a congregating and recreational area for a considerable number of military personnel. VIII, Spraying of Airplanes A complete investigation was made of the technique and efficiency of spraying of inter-island airplanes, due to several complaints of mosquitoes being found in planes while in flight. As a result, it was found necessary to provide written instructions for the air- lines employees, and to actually demonstrate spray techniques to the hostesses. Airlines company officials are very cooperative and are making eveiy attempt to carry out the instructions pro- vided. IX, Entomological In view of the importance of the understanding of the habits, life history, distribution, etc, of any mosquito that is respon- sible for the spread of disease, plans are being made to study the local vectors of dengue, Aedes albopictus and Aedes aegypti. The investigations will be primarily concerned with Aedes albo- pictus since the biology of this species, the commonest day mos- quito in Hawaii, is little understood. It has been assumed to correspond in a general way to the well-investigated Aedes aegypti but more accurate information is desired. Flight range experiments are being carried out by staining adult mosquitoes at a breeding spot and subsequently recapturing at varying distances from the breeding center. Preliminary labora- tory tests have been made to determine a satisfactory method of staining. A study of the distribution and breeding habits of the two Aedes species in the city of Honolulu is being carried out by having each inspector bring in samples of larvae, labeled as to location and type of container. The species is then determined and a complete record is kept. Data will be accumulated contin- uously and analyzed at a later date. 419 Examinations of the natural breeding places in the native forest are also planned in order to determine possible reservoirs for reinfectation of inhabited areas. Another experiment which is important from the epidemiological aspect is the determination of the longevity of adult female mosquitoes which are dengue infect- ed and non-infected. Tests are now being made to develop a sat- isfactory method of determining the average length of life of the male and female, Aedes aegypti and Aedes albopictus 0 The various stages of the life histories of the three mosquitoes, Aedes albopictus. Aedes aegypti and Gulex quinquefasciatus are being preserved and all will be made into permanent mounts to pro- vide study and record material of the developmental history of these species in Hawaii, Respectfully submitted, /s/ Wesley E„ Gilbertson Wesley E. Gilbertson P, A, Sanitary Engineer (R) i/c Dengue Control 420 FEDERAL SECURITY AGENCY U. S* PUBLIC HEALTH SERVICE DENGUE CONTROL TERRITORIAL BOARD OF HEALTH HONOLULU, To H* FIFTH SEMI-MONTHLY NARRATIVE REPORT Period Ending November 15, 1943 I. Epidemiology A, Number and Extent of Cases During the period ending November 15, a total of 231 cases were reported, bringing the total cases reported to date to 1,070* By comparison, the number of oases reported during the semi-monthly period ending October 31 was 321, and during the period ending October 15 was 221* A study of the location of these cases indicates that the Kakaako and Buckle Lane-River Street areas, being extremely congested, still continued to be dangerous spots, since there is a large remaining non-immune population living in the areas, thereby being in close contact with the currently infectious oases* A few oases continue to be reported from the Kapalama area, but have not been sufficiently concen- trated to warrant the wholesale outdoor spraying measures which have been utilized when a true focus of infection develops* The number of scattered oases appearing through- out the remainder of the city decreased during the period, reflecting the general reduction in mosquito population* A number of cases were reported among school children, and even among pre-school children* At McKinley High School seven teachers were absent at the same time with dengue, in addition to numerous students who were affected* During the closing days of the period the number of new cases reported each day decreased somewhat* B. Epidemiological Personnel On the epidemiological phase of the work, under Dr. J. R. Enright, Director, Bureau of Coramunicable Diseases, Maj. Shaw and Capt. Stuppy, have now been assigned, both on 421 part-time, to replace Maj. Spitz who was recalled to his organization* In addition, six Army nurses have been detailed to the Division of Public Health Nursing under Miss Mary Williams to augment the nursing follow-up made on each case* II. Spraying Activities On November 2 two small congested areas received wholesale out- door and indoor spraying, due to the appearance of a number of oases within the areas: (1) A triangular area bounded by intersecting King Street and Kapiolani Boulevard containing a "camp,” and (2) a "camp” on Pohaku Street near School Street* The total area is equivalent to approximately three square blocks* (A Mcamp,,f in local terminology, is a compact group of small cottages, usually in run-down condition*) For this work the large Army Chemical Warfare decontamination trucks were not used, but instead, a portable gasoline engine driven sprayer was procured from the Office of Civilian Defense* This unit makes a very satisfactory choice of equipment when the area to be sprayed is not more than a few square blocks in total area* III. Inspection and Indexes Most zones in the city were receiving their fifth cycle of inspection during the period ending November 150 A total of 45,822 premise inspections were made in 1,201 man-days, or 3801% per man-dayo Aedes mosquito breeding was found on 478 premises, or This represents a decrease of al% in the citywide Aedes breeding index since November 1* During the period three zones or 4% had indexes above and eight zones or 10% had indexes above 3%o In 26 zones the indexes increased and in 43 zones the indexes were decreasedo The highest zone (6*8%) was 11C, located in Nuuanu Valley0 Other zones located in the Nuuanu and Manoa Valleys were among the highest* The military dengue-restricted areas had the following indexes: Zones Area Indexes 8B, 9B Buckle Lane-River Sto lol%, 0oZ% 2A, 4, 5A, 5B Ka pa lama -Ka 1 ih i °ka i 0ol%, l05%, 0ol%, 0c0% 14A, 14B Kakaako lo9%, 0o4% 422 Figure 1. Outdoor spraying with pyrethrum-base spray for adult mosquito destruction. Standard Army Chemical Warfare Sprayer being used; also utilized, with excellent results, were Bean Tommy Gun Sprayers with l/32n orifice. (Honolulu Advertiser Photo) Figure 2. Chemical Warfare Decontamination Truck and Crew. Tank holds 4.00 gallons; pump maintains 400 lb. pressure with two spray guns in use. (Star Bulletin Photo) Figure 3. Crew of soldier-inspectors departing for respective zones. Honolulu Chamber of Commerce and Public Health Service employees are also assigned to premise-to-premise inspection activities. (Official Army Signal Corps Photo) Figure U. Inspector treating pineapple lily with larviclde. These, together with spider lilies and ape plants are either removed or treated with a long-lasting larvicide to prevent mosquito breeding. (Official Army Signal Corps Photo) During the period 117,905 potential mosquito breeding containers were located and eliminated by turning over or by larvicidal treatmento The per cent of containers found breeding was 0oQ% or 0,\% lower than the last period. The citywide Culex breeding index was 0.1$, or exactly one-half of the previous index. From a study of the types of containers which continue to show Aedes breeding, it is evident that the interior breeders are now in proportion of one interior to two exterior, whereas initially the proportion was one interior to four exterior. Up to the present time, the principal emphasis has been placed on exterior breeding with interior inspections made upon request or when inquiry revealed the presence of vine bowls or flower vases. It is expected that routine interior inspections will be started at the beginning of the next inspection cycle. IV. Special Activities A. Clean-up Squad During the period the special clean-up squad, with an average of 23 men and 5 trucks, collected and disposed of 225 loads of mosquito breeding accumulations, con- sisting mostly of tin cans and bottles., From zone 24-D, located at the entrance of Manoa Valley, a whole truck load of pineapple lilies was collected during the period. That this is a valuable service is testified by the fact that many of the containers were breeding mosquitoes when they were removed. B. Planting of Mosquito Pish During the month of October, not previously reported, 14 fish ponds, ground pools, and ditches were stocked with top-feeding mosquito minnows for general mosquito control. During the semi-monthly period ending November 15 mosquito fish were planted in three additional artificial fish ponds o C. Accumulations of Old Tires During the period a total of approximately 5,000 tires located at the yard of Industrial Reclaimers Incorporated were treated with paris green. The question has been raised as to whether it is necessary for the dengue control forces to expend the necessary effort to treat accumulations of old tires with larvioide. Experience has shown that old tires are favorite breeding places for the day mosquitoes inasmuch as they readily collect water and very little 423 evaporation takes place; and also furnish a sheltered breeding place for mosquitoes* All of the tires which have been treated have been located in the portions of the city which have been foci of dengue infection, such as the Kakaako and Kapalama districts. The firms themselves lacked the manpower for proper handling of these accumulations, therefore, it was felt advisable to proceed immediately with the permanent elimination of these places as mosquito breeders. V. Personnel A. Total personnel As of November 15 the following personnel were on dutys Field Duty Total Army 68 68 Chamber of Commerce 23 24 U. S. P. H. S. 58 68 Total 149 160 During the period 7 employees were separated from the Public Health Service payroll. B. Present Administrative and Supervisory Organization Headquarters Office Wesley E. Gilbertson 0 » « Officer in Charge F* K. Lee » ® » » « « « » Field Supervisor (Director of Rat and Mosquito Control for Chamber of Commerce) John P. Zurlo .00.00 Administrative Assistant Wendell R« McCool « « • <> Statistical Records and Public Relations Dr. David D« Bonnet » o o Technical and Entomological District Supervisors Central District—Tomio Mukaida—Offioe Robert Mikuni—Field Lanakila District-rNoboru Takamura Kapahulu District—Seiji Imada Special Activities Tomio Mukaida—Staff Training Robert Mikuni—Trouble Shooting Squad Theodore H, Decker—Clean-Up Squad S/Sgto James C. Koch—in charge. Army personnel C, Staff Training In order to strengthen and improve both the academic and field training of new inspectors, and to develop potential foremen, staff training has been established as a special function of Mr. Mukaida. Prior to acceptance of a new applicant, he is sent out on a field trial, after which a short screening examination is given in order to determine the aptitude of the potential appointee.. Following this, individual and group classes are held to acquaint the new employees with the life cycle of the mosquito0 Next, several days of field training is provided in locating and eliminating mosquito breeding places, proper approach to householders, and other factors in control worko VI. Chamber of Commerce Expenditures for Dengue Control The Public Health Committee of the Chamber of Commerce of Honolulu, ■which is in custody of funds acquired -through the Public Health Tonnage Charge, under which a voluntary contribution is made on all shipments passing through the port of Honolulu, up to November 15, 1943 had allocated a total of $21,802o50 to the dengue control program, in addition to the amount of approximately |2,000 a month being expended by the fiat and Mosquito Control Committee, primarily for salaries of the regular Rat and Mosquito Control squad which has been exclusively on dengue control activities since early Augusto This represents a very important financial contribution to the dengue control activities0 The flexibility in the use of these funds, which are subject only to local control, greatly enhances their valueo The use of Chamber of Commerce funds for public relations activities such as the purchase of radio time which is not possible with Federal funds, has been of special benefite The approximate breakdown in Chamber of Commerce allocations according to their use is as follows s Salaries —=114,000 Insecticide and other control materials-»>|4,900o00 Special education and publicity—11,500 <> 00 VII. Public Education A. Visual Education I. Three-hundred fifty car advertising cards, size 11” x 21M, were placed free of charge in buses belonging to 425 the Honolulu Rapid Transit Company, for a period of 30 days, where they will be seen an estimated 4,500,000 times by passengers. 2* One hundred posters, size 14" x 22", are being placed in store windows and school bulletin boards throughout the city through the cooperation of the Boy Scouts. These posters will remain in the windows at least two weeks and will be replaced by new designs at intervals of about 30 to 45 days* 3. A display of adult mosquitoes and larvae, together with a large drawing of the life cycle of the mosquito, was placed in the Honolulu Public Library. Photographs of recent spraying and other control activities were arranged with proper captions to augment the life cycle exhibit and specimens. This display was on view for the week ending November 1, 1943, and is being exhibited for one week at -the Ka pa lama Branch Library and then one week at the Kaimuki Branch. It is intended to transfer it to schools and other public places where the maximum number of people may view it. B. Radio Beginning November 8, Station KGU will carry five spot announcements per week during the morning hours for four weeks; also six spot announcements per week during the evening hours for two weeks. Station KGMB, beginning November 12 will carry twelve spot announcements per week for a period of one month. All copy was prepared by this office. C. Periodicals The Hawaii magazine is carrying in two issues the complete text of the dengue control story which was presented over the radio by a local special commentator,, The September issue of the Hawaii Medical Journal will carry an editorial on the dengue fever epidemic, based on informa- tion submitted by this office. The October issue of the Board of Health Messenger contains an article on dengue. D, News Releases During the period a total of 25 newspaper releases appeared in the two English language newspaperso In addition, 426 releases are being prepared for the following foreign language newspapers: New China Daily Press, United Chinese News, Hawaii Times, and Hawaii Chinese Journal,, VIII. The Question of Filariasis One of the regular meetings of the Dengue Committee was devoted to a discussion of the potential filariasis problem in the Territory of Hawaii, In addition to the regular committee members, the following guests were presents Lt. Col. du Preist, Medical Inspector, Central Pacific Area Dr. Elwood C» Zimmerman, Entomologist, Bishop Museum Dr. Shoyei Yamauchi, local practicing physician Dr. Satoru Nishijima, an associate of Dr. Yamauchi Dr. George W. T. C. Chu, Parasitologist, Territorial Board of Health Dr. Bernard Witlin, Bacteriologist, Territorial Board of Health Dr. Yamauchi discussed fifty oases of ohyluria which he had in his own practice, and which he attributed to filarial infection, although none of the cases showed microfilariae in the peripheral blood in day or night blood film examinations0 All of these patients had resided for a period of time varying from a few years to as long as 30 years in the Orient. Sixteen out of 46 oases, upon which he had complete case histories, had a definite history of filariasis, i.e., clinical symptoms that were attri- butable to filarial infection. Dr. Chu, who has had considerable experience with filarial infections in China, discussed from the parasitological point of view the question of filarial transmission. The local species of mosquito, Culex quinquefasoiatus, as pointed out by Dr, Chu, is known to be a vector in many endemic areas for filariasis, but as yet, there is no experimental proof on record to indicate that these mosquitoes are good vectors locally for the several species of human filaria. Dr. Chu suggested that transmission experiments be conducted for the three local species of mosquitoes in the Territory with microfilariae from man in order to determine the degree of susceptability in the culicine hosts. Dr. Zimmerman who has seen considerable filariasis in the Fiji Islands where the disease is endemic, pointed out that the habits of the natives of sleeping in the open or in native huts with considerable portions of the body exposed, would provide adequate opportunity for transmission by the day time biter, Aedes variegatus. The infective filariform larvae from the mosquito proboscis would get into the moist skin of the victim by penetrating the pores or injured surface (by mosquito bites) of the skin. Moisture and exposure to repeated mosquito bites 427 seemed to be important factors in filarial transmission0 The question as to why transmission of filariasis apparently has not ooourred in Hawaii, and as to the introduction of cases through military personnel returning from endemic areas was discussed, but on the basis of information at hand, no final conclusions were reached* IX. Dengue Cases on the Outside Islands During the current period the health officers of the islands of Kauai and Hawaii each reported one case of dengue which had been contracted in Honolulu, Immediate remedial measures were instituted along the lines of elimination of mosquito breeding places, spraying, and public education activities. In order to prevent the spread of dengue to the other islands, increased attention has been given to the matter of quarantine. The Hawaiian Airlines Company, which operates the inter-island commercial airlines system, has been provided with five sure- shot sprayers, one for each plane, and a quantity of pyrethrum insecticide in order to improve the anti-mosquito measures on inter-island plane traffic. Previously, for a period, aerosol bombs were in use, and later, hand sprayers with commercial insecticide. Regarding human quarantine, the nurses, on their follow-up of dengue oases, are now inquiring as to whether there are visitors in the home from the outside islands, or whether members of the household contemplate a trip. This will provide information which can be used to discourage inter-island traffic and also to notify health officers on the other islands of passengers coming from dengue-infected areas. Due to the sudden onset of dengue and with the appearance of no prodromal symptoms, a case of dengue is virtually impossible to detect while in the incubation stage, thus rendering normal quarantine procedures of no value. Respectfully submitted. /s/Wesley E. Gilbertson Wesley E. Gilbertson P. A, Sanitary Engineer (R) i/c Dengue Control 428 FEDERAL SECURITY AGENCY U. S, PUBLIC HEALTH SERVICE DENGUE CONTROL TERRITORIAL BOARD OF HEALTH HONOLULU, To Ho FOURTH SEMI-MONTHLY NARRATIVE REPORT Period Ending October 31, 1943 I• Epidemiology A. Number and Extent of Cases During the period ending October 31, a total of 321 oases of dengue were reported, bringing the total of cases reported to date to 851, By comparison, the number of oases reported during the week ending October 21 was 156, and the number of oases for the week ending October 28 was 133. The figure of 156 cases represents the highest number of oases reported during any seven-day period since the appearance of dengue in Honolulu. The Kakaako district continues to be the heaviest source of oases, and the Buckle Lane-River Street area is the next highest. A few cases were reported from the Kapalama area but were scattered throughout a relatively large district. The Waikiki district continued to be practically free of now oases. % Since the opening of the school year there has been a definite increase in the number of dengue cases reported among school children. For instance, at Pohukaina School located in the Kakaako district, 44 students were reported absent with dengue on October 15. Through the Director of Health Education, Department of Public Instruction, arrange- ments were made for twice daily spraying of every school room in schools located in areas with high dengue incidence. B. Restricted Areas Effective October 23, military authorities established restrictions prohibiting service personnel from entering the Kakaako, Buckle Lane-River Street, and Kapalama areas. 429 C* Severity of Gases and Sequelae There is a wide range in the severity of the case from very mild ambulatory oases to extremely sick, bedridden cases, with delirium and mental disturbances, No difference has been observed in the severity of cases in males and in females, although the white blood count seems to run somewhat lower in females. The usual mental and physical depression following an attack of dengue has been observed, but no other sequelae are in evidence, with the exception of a young Chinese man who reported poor vision following his attack. D« In the list of Dengue Committee members included in the report for the period ending September 30, 1943, the name of Jo Ro Enright, M..D., Director, Bureau of Communicable Diseases, was inadvertently omittedo All epidemiological investigations are being made through that division, the accumulative records maintained, and analysis of the trend of the epidemic charted„ II, Spraying Activities A. New Area Sprayed A congested area adjacent to the River Street area previously sprayed, was sprayed—-both interior and exterior--on October 250 The area is equivalent to approximately three city blocks and consists principally of three-story tenement houseso It has been observed that when dengue gets into a densely populated district such as this, a high incidence of cases usually follows*. B. Sure-Shot Sprayers and Pyrethrum Extract Received Toward the end of the current period a shipment was received of 48 Sure-Shot Sprayers and 500 gallons of Pyrocide 20 (2 percent pyrethrum extract in light oil)0 These sprayers and spray material were immediately put to use by the trouble shooting squad (for interior work) -which previously had been operating with blizzard-type sprayers and commercial insecticide*. On the mainland the Sure-Shot sprayers had been used with Freon 12 (liquid Freon gas) as a pressure and propulsive agent*, However, this office was informed by the War Production Board that Freon 12 has become an exceedingly critical item and the total allocation to the Territory of Hawaii for the month of October was only four cylinders of gas» Therefore, liquid methyl chloride gas is being used as a substitute*, Methyl chloride is slightly 430 toxic to human beings and animals but is not deemed dangerous under the careful control being exercised in the spraying operationso The chief advantage of the Sure-Shot sprayer is that it produces a fog-like spray consisting of particles of minute size, due to the immediate evaporation of the gas, leaving the insecticide suspended in the air„ C. Results of Wholesale Spraying Measures Prom a preliminary study of the incidence of dengue within the limits of the areas which received special outdoor spraying measures, it appears that these activities are definitely effective as an immediate approach to the control of this mosquito-bome disease. There is naturally an inherent lag between the time of completion from spraying activities and the time when the number of oases reported begins to decrease„ This is due to the incubation period of the disease and possibly other factors0 A complete study of this phase of the control work is now being made and will be reported on later0 III. Inspection and Indexes By the end of the period, the fourth cycle of inspection had been completed in all zones. A total of 46,028 premise inspections were made in 1,265 man-days or 3506 per man-day., Aedes mosquito breeding was found on 533 premises, or l„l$o The citywide index for the respective semi-monthly periods was as follows s First period - 10% (spot-check estimate) Second period - 10?$ Third period - 1„4$ Fourth period - 1„1$ During the period five zones or 6$, had indexes above 5$j and 12 zones, or 14$ had indexes above 3$0 In thirty-five zones the indexes increased, some only very slightly, and in forty-two zones the indexes were decreased,, With reference to the zones in which military dengue-restricted areas are located, 8B and 9B (Buckle Lane-River Street) had indexes of lo5$ and 1„2$ respectively?. 5B (Kalihi-Kai) was 0.2$j 14A and 14B (Kakaako) were 1„6$ and 1„9$ respectively,, The breeding indexes were highest in the zones located in the Nuuanu and Manoa valleys where rainfall is heaviest, except that two congested zones in the central part of the city have not been sufficiently cleaned up as yet„ 431 During the period a total of 124,108 potential mosquito breeding eon tain ere were located and either eliminated or treated by the regular Inspectors. The container index (percent of containers actually found with Aedes breeding) was 0.9$, exactly one-half of the index for the previous period. Rainfall increased somewhat during the period, which will tend to bring out mosquitoes, especially in areas which had been eery dry. lf« Special Crews A. Clean-Up Squad Formed On October 25 a special clean-up squad of 25 soldiers equipped with five trucks was formed to collect and remove miscellaneous containers such as bottles, tin cans, etc. from,vacant lots and other locations where such debris has been collected or accumulated. The crews were equipped with the necessary hand tools and carrying bags to facilitate the clean-up activities. By arrangement with the City and County, Division of Refuse Collection and Disposal, trucks are being unloaded at the Pahounui Dump on Apili Road. Up to toe end of the period these crews had collected and removed 82 truck loads of containers. B. Accumulations of Old Tires A detail of four men was assigned during the period to treat accumulations of old tires with paris green. At the Shintani Shoe Company, which manufactures slippers from old tires, approximately 3,000 tires were individually treated with paris green. In addition, arrangements were made through the War Production Board for release of approximately 500 additional old tire casings which the shoe factory could not utilise. These were hauled to the City and County incinerator where they are being utilised to replace fuel oil in charging the incinerator. Following this, 1,000 tires were treated at the Scott Shoe Company, 260 at the Motonaga Junk Company, and 50 at Tire Recapping Service. T» Special Student Inspections Fifty schools participated in the special student campaign in which each student inspected his own home premises and eliminated all water-holding containers. Of these all but one forwarded the results of their work to this office, where tabulations were made. A total of 25,796 home inspections were made in the city. 432 in which 30,708 water-holding containers were located by the students and eliminated as mosquito breeders. Of these 4,936, or 16%, were found to actually contain mosquito wrigglers« No attempt was made to differentiate between Aedes and Culex larvae on the Special Student Inspection. VI. Public Education During the period 32 news releases were carried by the two local English newspaperso Four public talks were given during the period--1/fe.ialae School, Realtors Club, Nurses class, and the Engineering Association. Three radio talks were given--one by a special commentator, one as an interview on a regular inter- view program, and one as a portion of the regular Territorial Health Department pro gram <> Two types of posters were prepared in quantity, one for placing in buses, and the other for posting on bulletin boards and other public placeso The Public Health Committee of the Chamber of Commerce approved a budget of $1,245 to be used for educational purposes in the dengue control campaign. Under the authorization, provision was made for procuring movie trailers, radio time, posters, and stuffers, as well as the usual newspaper releases» VIIo Personnel As of October 31 there were 147 men on field duty, consisting of 68 Army men, 27 Chamber of Commerce employees, and 52 Public Health Service employees0 It was necessary to separate three employees from the Public Health Service payroll during the period because of unsatis- factory serviceo In order to avoid training of men who later prove unsatisfactory, new applicants are now being interviewed more carefully and closer scrutiny is given to their past recordso Till. Automotive and Other Equipment As yet the Army vehicles assigned to this activity have not been recalled. In fact, the number was increased by five vehicles on October 25 when the 25 additional men were assigned to this work. The number of vehicles being utilized on the activity is the minimum which can be used without impairing the efficiency of the employees now assigned to the control work. 433 The ready availability of the various types of field and office equipment necessary for the conduct of the dengue control program has been of great benefit in expediting the worko As yet no serious shortages have developed for any of the materials and equipment -which are needed, It is interesting to note that it was possible to completely equip the initial crew of 100 inspectors in about six days* time, Usually, on the mainland it required a much longer period to procure the necessary items for inspectors* kitso IXe Military Establishments At the request of Lt, Cmdr. Hering, Medical Officer at Camp Gatlin, -which is a Marine Corps Base, a survey was made of the area in connection with anti-mosquito measures. Due to the anticipated increase in the size of Camp Catlin, it was recommended that initially a complete clean-up be made of the entire area to eliminate all types of water-holding containers which serve as mosquito breeders. Then a mosquito control detail is to be established which will regularly inspect and control the entire area. Recommendations were also made concerning the elimination of nearby Culex breeding places. X. Historical From a review of official reports and newspaper accounts of the Territory, certain facts concerning the dengue outbreaks of 1903 and 1912 have been brought to light. The Territorial Board of Health had not established an uniform system of communicable disease reporting at the time of the 1903 outbreak. However, the government physicians on the outside islands indicated in their monthly reports that dengue was severe and widespread that year. The Honolulu Commercial Advertiser, issue of January- 29, 1903, stated that a local physician, Dr, Mays, had noted the first appearance of dengue in Honolulu about three weeks previously, and that cases were occurring at that time at the rate of about ten new cases a day. It was stated that the disease was similar to a fever reported 10 years previously, raging principally among the natives, known as "Boohoo Fever," In 1903 local physicians thought that dengue had been introduced by transports returning from Manila, "The germ being carried on the clothing of soldiers, or even in letters and papers," The article concludes by stating that local physicians were extremely busy combating the epidemic. According to the librarian in charge of the Archives, it was almost impossible to get medical or nursing help at that time. According to the Report of the Sanitary Commission (1912) which was created by an act of the Territorial Legislature of 1911, the first mosquito campaign in Honolulu was inaugurated in 1904, 434 Several issues of the Commercial Advertiser in 1904 carried stories regarding the control being exercised to rid the area of mosquitoeso Particularly mentioned was the necessity of eliminating miscellaneous small water containers such as tin cans and bottles from the premises of all residents, and oil spraying of ground pools and ditches0 It is significant that although physicians in Honolulu apparently did not recognize the dengue of 1903 as being mosquito-bome, an anti =mosquito campaign was inaugurated the very next year0 Apparently, the implication of mosquitoes in disease transmission was becoming more widely known just at that time0 Entomologist Do Lo Van Dyne in the August 19, 1904 issue of the Advertiser stated that "mosquitoes were first introduced into Hawaii in 1826 at Lahaina, Maui, by the ship Wellington from San Bias, Mexico0” These were Culex quiquefasciatuso Mr„ Van Dyne stated that no Hawaiian word existed for mosquito prior to 1826, and that in 1903 the word "makika" had been in use, being a corruption of the word mosquitoo Apparently the Culex spread somewhat slowly at first after introduction» In 1850 some areas about 50 miles from Lahaina were still mosquito free, probably because of an intervening mountain range0 According to official Board of Health records, there were 108 dengue oases reported during the year ending June 30, 1912, of which 85 were from Honolulu0 In view of the statements made by local residents who were here at that time, the oases must have run much higher, although the exact extent and severity of the epidemic is not known, due to incomplete reporting and the tendency of newspapers at that time to suppress news which might interfere with the increasing tourist traffic in Hawaii„ Board of Health reports indicate that there were three oases of dengue reported during the next year and 11 during the year after thato On© case of dengue was reported in 19240 Respectfully submitted. /s/Wesley E. Gilbertson Wesley E, Gilbertson P0A„ Sanitary Engineer (R) i/c Dengue Control 435 FEDSEAL SECURITY AGENCY U„ Sa PUBLIC HEALTH SERVICE MALARIA CONTROL IN WAR AREAS DENGUE CONTROL Honolulu, I., Ho SEMI-MONTHLY NARRATIVE REPORT Period Ending October 15o 1943 I* Epidemiology A0 Number and Extent of Dengue Cases To date a total of 530 cases of dengue have been reported in Honolulu, or 221 during the current semi-monthly periodo Two serious foci of infection have developed—the Kakaako district and the Buckle Lane-River Street area0 A total of 135 cases have originated in the Kakaako area, which received a comprehensive spraying during the week of Octo- ber 4o The Buckle Lane-River Street area has not had such a high number of cases as yet, but appears to be develop- ing rapidly0 The Nuuanu district mentioned in the previous report has not become a focus of infection» B, Clinical Symptoms and Medical Aspects The average period of incubation is estimated at nine days0 The symptoms at the onset are a headache, backache, a fever of 102° to 103°o In two or three days the temperature may rise to 104° and even 105°c, followed by severe headache, pain behind the eyeballs, and the "breakbone,f feelingo Leukopenia, averaging 4400 is characteristic, with some- counts as low as 11000 Complete temperature charts are avail- able only in a few instances, but it appears that the saddle- back temperature curve is not present in all cases« Rash is present in about half of the cases0 The average period of illness is seven days0 At first most of the cases occurred in males, but recently the number of females affected has been increased, particularly in the Kakaako area, indicating that the disease was contracted at the place of residence0 Very few children have been affected, although the number of children, too, is increasing„ Gases still continue t© be confined to Honolulu on the island of 0ahu„ A few cases have been reported from rural Oahu and from the outside islands, but these all had a history of having been in Honolulu within the incubation period0 437 C* Economic Aspects It may be stated that although the number of cases has increased during the past thirty days from 25-50 per week to 75-100 per week, the epidemic is relatively mild in comparison with the usual course of dengue epidemics*. The sudden occurrence of many cases in a confined area, however, gives warning of what can occur on a citywide basiso If Honolulu should be affected by an epidemic involving 50 to 75 per cent of the population, it would be a serious hazard to the war effort* In addition, there would be very serious economic losses due to loss of time* Several interesting examples of the economic repercussions of the current outbreak have come to our attention* The Honolulu Rapid Transit Company which operates the bus lines, received a reduction in revenue of $1000 a day during the period that the Waikiki district was restricted to military personnel* The Waikiki Theater had a drop of $300 a day in gross income* In the Kakaako district the American Sanitary Laundry had 70 people off duty at one time, thus forcing the firm to abandon receiving new work for several, weeks,, and delaying the company’s delivery of work already accepted for at least two weeks0 Undoubtedly a number of other firms in the eating* drinking and amusement business located in the Kakaako district suffered severe loss of income during the period of restriction* II« Widespread Spraying Activities iin'>iriniiiiiOiMnKE The general container 440 index for Aedes breeding was 10£$0 On an average two Aedes- breeding containers per premise were recorded during the current period,, Analysis of the container indexes reveals that the heaviest- breeding is occurring in tin cans*, panss tires*, bottles,, and ape and lily plants„ The citywide Clean-Up Week should reduce the amount of miscellaneous small container breeding,. However*, a certain amount will remain until more drastic action is takenu The Board of Health has gone on record to the effect that legal action should be taken after proper warning fails to get owners to remove chronic mosquito breeders0 According to experience in Central and South America., the effects of larval control with trained inspectors should become noticeable .on the Aedes mosquito population after the fifth or sixth cycle0 This period would tend to be lengthened with untrained inspectors*, but Would also tend to be shortened somewhat with dry weather prevailing*, and through cooperative activities of an interest- ed publico Locally5 these factors will tend to compensate for each other with the result that about five cycles of inspec- tion should be necessary to reduce the Aedes breeding indexes in the various zones sufficiently to have an effect on dis- ease transmissiono It may be stated that the philosophy of the control program con- sists of reducing mosquito breeding in all areas as rapidly as possible through application of all known techniques of control*, and at the same time watching for localized outbreaks due to infected mosquitoes already on the wing*, and applying wholesale spraying measures when this occurs„ IVo Rezoning Rezoning of the entire city to establish inspectorial areas which can be completed within ten days, was delayed until after the third cycle of inspection, due to the spraying activities inter- fering with previous plans0 Beginning with the fourth cycle of inspection and the next semi-monthly period, the total number of inspectorial zones has been reduced by 17p leaving a total of 77 zoneso Wherever possible already established zones were combined in order that previous statistical records will continue to be of valueo V„ Trouble Shooting Squad Due to the importance of the work being done by the trouble shooting squad, and the increase in the number of cases being reported, the crew was increased to five men and a foreman„ 441 VI „ Clean-Up Week By proclamation of the Mayor, the week of October 3—9 was established as Clean-Up Weeko The regular City Trash and Garbage Disposal trucks were directed to pick up bottles, cans, buckets, and other containers as well as trash and debris on their regular collections„ In addition, through the facilities of the City and County Engineer, heavy equipment was provided for removal of over 250 .junked auto bodieso By special arrangement the extra collection activity of the garbage trucks was extended for an extra week,, The effects of the clean-up activities were decidedly noticeable in the removal of thousands of potential mosquito breeding containerso VII. Special Activities A0 Inspection of the Salvation Army premises in the Manoa district An interesting example of an inspection of a large plant was provided by a comprehensive coverage of the Salva- tion Amy premises 0 A total of 13 buildings and the grounds were carefully checked and all mosquito breed- ing places eliminated,, Three vases and two wash tubs were found breeding Aedes inside the buildings0 On the outside, 245 trees were inspected in which 86 tree holes were found which were treated with paris green; two tree holes were breeding Aedes; the roof gutters on all buildings were checked; three hundred coconut shells found breeding Aedes; one fish pond was breeding Culex; three pipes were breeding Aedes; 1,600 ape plants were cut down, of which £00 were breeding Aedes; 200 spider lily plants were treated with paris green, of which 50 were breeding Aedes; one tire was breeding Culex; 6,000 cans were removed, of which approx- imately 2,000 were breeding Aedes; 1,000 bottles were re- moved, of which approximately 100 were breeding Aedes„ About 36 man-days were required to make the inspection B0 Special School Spraying Activities The Interior of the Sacred Hearts Acadeny was thoroughly sprayed after the occurrence of dengue cases in two children attending the school0 Also through the office of Mr„ Tate Robinson, Director of Health Education, Territorial Department of Public Instruction, arrange- ments were made for twice daily spraying of public schools located in the Kakaako and Kapalama areas„ 442 Co Spraying of Queen3s Hospital. Several cases of dengue among nurses at Queen3s Hospital resulted in complete spraying of the hospital with pyrethrum aerosol bombs„ VIIIo Special Student Inspection Survey uumuriHi i-Eincaaciiik w.Tir i ii»r noii.Tirti,nw;r.MWtoB On October 5 the Special Student Inspection was carried out with each student being provided a sheet upon which he could note the number of containers found on his own premises and also the number found breeding mosquitoes. The complete results have not been tabulated as yet, but preliminary in- dications are that at least 75$ of the sheets were filled out and returnedo IX. Public Education During the period 24 news paper releases were carried by the two local English newspapers,, In addition, several Items have been carried by foreign language papers, and occasionally the radio newscasts have broadcast information regarding the dengue situation,, Five talks were given during the period? Pearl City Lions Club, Entomological Society, and three to the Professional and clerical staff of the Territorial Board of Health,, X„ Staff Education Thorough training in the technical aspects of control, mos- quito lore, and general methods of procedure, are considered to be an important- part of the continuation of the Aedes mos- quito control work. This training is essential for the civ- ilian personnel employed on the program for the duration, and equally important for the military personnel, who may be detailed to similar activities elsewhere after the present emergency in Honolulu is over® Two large meetings have been conducted, with the entire inspectorial staff being present„ Films were shown on the life cycle of the Aedes mosquito and demonstrations provided on types of breeders which are peculiar to Hawaii. After these meetings, it was felt that thereafter meetings should be continued in each district, thereby embracing a smaller group in which more questions could be asked by individual inspectors0 True and false exam- inations were given in order to provoke thinking and discussion on various phases of control and mosquito habits„ It is significant to note that the soldier personnel received noticeably higher grades than the civilian personnel,, 443 XIo Personnel The total number of field personnel as of October 15 was 113 men, consisting of 49 Array men, 27 Chamber of Commerce em- ployees, and 37 Public Health Service employees*, Eight Array men were recalled at the end of the period, due ,to their companies moving 0 In order to increase and improve the quantity and quality of applicants referred by the Civil Service Commission, Mr0 Zurlo had a number of conferences with the Civil Service Commission office and the U0 Su Employment Service in which our needs were emphasizedQ To date a total of 48 applicants have been appointed on the Public Health Service payroll,of which 11 have been subsequently separated,. Approximately 12 additional applicants failed to report- after being interviewed or were not selected because of not being suitable for the work*, XIIo Automotive Equipment As yet this office has not been notified of any action taken regarding the request made through the office of the Military Governor for automotive vehicles0 At present there are 8 Array vehicles assigned to the work, 4 from the Office of Civilian Defense, and one from the Chamber of Commerce0 The Territorial Board of Health received by transfer from the Board of Agriculture, 4 vehicles which are being repaired prior to assignment to the dengue control work„ Upon appraisal of these vehicles it is believed that these vehicles should be placed on ''limited service" duty0 Word has been received that the two Public Health Service vehicles shipped from Atlanta have arrived in California,, Arrangements have been made with the Array Port and Service Command for transshipment to Honoluluo XIII. Statistical Records The gathering and compilation of statistical records is essen- tial to the operation of Aedes control program,, It is necess- ary to know where the heaviest breeding is occurring, what types of containers are the heaviest breeders, where potential breeders are concentrated, whether the techniques of control on the various types of breeders are adequate, and whether a reduction in the breeding indexes is being accomplished,, The inspectorial staff on the Honolulu dengue control program is approximately five times larger than the staff on any single control program on the mainland,, The inspector’s sheets were devised to fit local conditions„ A clerical staff has been established to compile the records available from the inspect- ors sheets and to compute the various indexes which are needed 444 for analyses of the work0 From the various statistics avail- able, an adequate basis will be provided for supervision of the work and also the necessary information will be provided to the Array concerning potential danger spots from the stand- point of possible restricted areas, XIV. Administration The administrative functions under Mr. Zurlo are becoming well established and have resulted in clearing up all deficiencies which existed. Local purchases have been paid for, employees placed on semi-monthly payroll status, and other administra- tive details satisfactorily covered. Respectfully, /s/ Wesley E„ Gilbertson P.Ao Sanitary Ehgineer (R) i/c Dengue Control 445 FEDERAL SECURITY AGENCY Uo S. PUBLIC HEALTH SERVICE DENGUE MOSQUITO CONTROL BOARD OP HEALTH TERRITORY OF HAWAII SEMI-MONTHLY NARRATIVE REPORT Period Ending September 30, 1943 I. General Organization and Operation A. Personnel 1. The total number of field employees on the dengue control program as of September 30 was 105* Of these, 85 were assigned as zone inspectors, 12 as foremen, 3 as district supervisors, and 4 on trouble shooting duty„ The number of army men doing zone inspection work was 45, Chamber of Commerce employees, 16, and Public Health Service, 24« B, Inspection Activities and Breeding Indexes lo The city is being covered on a ten-day cycle (average)» Some of the initially established zones can be covered in a period of five days $ others require more than ten dayso The first complete cycle has been finished and most of the zones are nearing completion of the second cycle of inspectiono Adjustments will be made in the size of the zones before the third cycle is begun so as to approach the ten-day cycle as nearly as possible„ Exteriors of all premises are being checked and interiors of residences are being inspected when requested by the householder, and where water plants are growing inside the house.. As the program continues, it is planned to place more emphasis on interior inspections because the outside breeding will gradually be reduced through control activities«, During the period September 16 to September 30, a total of 48,086 inspections of premises was made, with 1,081 man-days of labor, or an average of 44o5 per man- day o A total of 861 premises were found breeding Aedes or a general outside breeding index of lol%o Premises 447 breeding Culex totaled 199, or an index of 0*4$* There are two factors which tend to reduce the importance of the citywide Aedes breeding index on this particular project* (a) Many breeding places are being missed due to lack of experience of the inspectors* (b) Due to the wide range of rainfall over the Honolulu city area, mosquito breeding varies (considerably) from less than 10 inches per year to over 150 inches* A much better picture of the mosquito density is afforded by analyses of the various zone indexes* Of the 91 zones which have been inspected, 26 had daily breeding indexes above 5 percent and 23 had daily breeding indexes above 10 percent* The highest is 46*1 percent* About 16/2 of the established zones had period Aedes breeding indexes above 5%o At the present time it is not possible to determine whether 5% is the lowest breeding index which will support an epidemic, as in the case (approximate figure) with yellow fever* In fact, it appears that the occurrence of dengue cases during the month of September is more correlated with the density of human population than with the mosquito breeding indexes* This could be explained on the basis of the short flight range of the mosquitoes* The zones with the highest breeding indexes are mostly up in the valleys, which receive several times more rainfall than the lower flat portions of the city* However, in the valleys the premises are large and the residences are widely separated* This makes it much less probable that the mosquitoes which are present will make the longer flight required to transmit the disease from household to household* II* Epidemiology A, Number and Extent of Cases 1, Total number of dengue oases up to September 30 ■was 309* These were scattered over the entire city area® In addition to the original focus of infection in the Waikiki district, another major focus has developed in the Kakaako area, which is near the center of town*, In Nuuanu Valley a number of oases have appeared, although they are sufficiently scattered so that it cannot be 448 said that a true focus is developing., During the month of September a total of 171 dengue cases was reported to the Board of Health, or an average of about 43 per week* It seems very probable that if the mosquito population is significantly increased, an explosive out break over the entire city would result because of the number of oases passing through infectious stage each day* Epidemiologists estimate that about 20$ of the oases are unreported because of doctor's negligence or patient's failure to report or call a doctor0 2. Coordination with control activities a. The names and addresses of all new cases are pro- vided each day by the Bureau of Communicable Diseases in order to assure placing emphasis on control activities in infected neighborhoods«, Regular conferences are held with the Epidemio- logists in order to make use of any information which might lead to discovering new foci of infectiono A special trouble shooting crew follows up each dengue case, as described later in this reporto III* Mosquito Distribution and Habits A. Preliminary Field Survey 1, A preliminary survey of Aedes breeding in Honolulu was essential before starting the oitywide ten*»day inspection cycle., The objects of the survey were: (1) To become familiar with mosquito breeding in the various sections of the city as a basis for establishing inspection zonesj (2) To discover unique local breeding spotsj (3) To determine the ratio of aegypti to albopiotus; and (4) To obtain a preliminary estimate of tke breeding index., Three experienced inspectors were used under the constant personal supervision of Mr» Lee, the General Foreman. Dr0 Usinger worked with each inspector in succession throughout the survey0 Specimens were collected from each container found breeding and these specimens were reared through to facilitate identification» It was founds (1) that mosquito breeding was very low in the dry portions (20 inches of rain per year or less) of the city, including Waikiki (index 4$) 449 where concentrated control work was done; (2) that the Aedes mosquito breeding index was 83% in Nuuanu Valley, where the average rainfall is 160 inches per yearj (3) that ape plants, pineapple lilies and other garden or forest plants of this type collect quantities of water and are the principal sources of mosquitoes in the wet parts of the city and in the native forests; (4) that only 15% of the day mosquitoes (Aedes) were aegypti; the remaining mosquitoes being Aedes albopictus; (S) that the index for the entire survey was lS .3%. All aegypti breeders except one were found in town, whereas albopictus was found everywhere from the con- gested city area up into the wet valleys and mountains. Aegypti was found in ant cups* water plants, an ice cream refrigerator box, and a water valve box. Albopictus was found in ant cups, flower pots, tin cans, bottles, a paper box, jars, a large shell, an auto tire, a tank, and in ape plants and pineapply lily water cups. B. Survey of Literature 1. A survey of the literature on albopictus reveals it to be a vector of dengue,’yellow fever, equine encep- phalomyelitis, bird malaria, hemogregarines of geckoes, and filariasis of man and dogs„ Despite this omplied wide range of hosts, precipitin tests of engorged females in Indo-China (Toumanoff) showed human blood, even when the mosquitoes were collected in stableso Toumanoff (1939) carried on extensive crossing experiments with albopictuso He found that female albopictus crossed readily with male aegypti; the generation resembling albopictus in every oase» The reciprocal cross was less successful. Only one specimen was obtained and this resembled aegypti. Although crosses were obtained between the two species in Tonkin, aegypti from Calcutta would not cross with albopictus from fonkin and vice versa. This suggests the possibility of local strains, probably of albopictus since aegypti is not a native of that section of the world. Robertson and Hu (1935) made an intensive study of the habits of albopictus in Shanghai. Their report indicates that the ”tiger mosquito,” albopictus, resembles aegypti so closely that the two species could be considered as identical from the standpoint of control. Actually, there are certain minor differences which pro- foundly influence the distribution and relative abundance 450 of the two specieso Albopictus has a slightly longer life cycle (18 days) than aegypti (17 days) in the summer season in Shanghai, but, significantly, albopictus has a shorter life cycle (24 days) than aegypti (27 days) in the winter, indicating a greater tolerance for cold weathero Reports from India, Australia and the Philippines state that aegypti is the dominant form in cities and hence is the principal vector of dengueo The opposite situation is true in Honolulu, according to surveys since 1912 showing albopictus to be much more abundant than aegypti0 The explanation for this situation may lie in the topography of the Hawaiian Islands® Unlike the low flat coastal cities of the Orient, Honolulu is situated adjacent to and actually in between and on high mountains® Densely forested ridges extend well into town® Albopictus breeds in tremendous numbers throughout the forest at high elevations where the mean temperature is 10° lower than in the city® Thus it is evident that albopictus is favored by forest adjacent to Honolulu® The flight range of albopictus is apparently quite limited as determined by Senior White in India, so effective control of dengue appears to be possible in Honolulu® However, eradication of Aedes in the Hawaiian Islands may be considered as impossible® IVo Special Trouble Shooting Crew Ao A crew consisting of four men and a foreman receives each morning a list of the newly reported dengue cases and pro- ceeds immediately with spraying of the interiors of the resi- dences and other buildings on the premises of each case0 A detailed inspection is also made to eliminate all mosquito breeding places, inside and outside0 Adjacent premises ar.e covered in the same manner. There has been ample demonstra- tion of the value of this crew because each time that a small focus of two or three cases has occurred, the trouble shooters have been able to locate actual mosquito breeding on the prem- ise or in the neighborhoodo V® kiaisofl With Military A, Army This office has kept in constant touch with the office of Brigo Genc King, Surgeon, Central Pacific Department,, Pro- 451 vision has been made for forwarding to his office reports on mosquito breeding indexes regularly and also to furnish spe- cial information from time to time as requiredo A description of the entire organization and operating methods, together ■with samples of the equipment and printed materials in use, and a zone map of the city have been furnished to the Sur- office to fully acquaint his staff with the control program., Official visits have been made to two army posts— Ft. and Hickam Field—in connection with mosquito control activitieso Sufficient phenothiazine has been furnished to the Corps of Engineers to treat all fire barrels located in the various construction and material yards. B. Navy A number of conferences have been held with the Epidemiologist and control personnel from the office of Admiral Chambers, Dis*- trict Medical Officer, 14th Naval District., Phenothiazine has been furnished so that comparative tests can be made against the larvioide which the Navy is now usingo VI. Inter-Island Quarantine A. Spraying of Planes All planes, military and commercial, which operate between the Islands are receiving interior spraying with aerosol bombso These bombs were supplied by the Army through this office after a survey of spraying technique in both passenger and freight planes revealed that spraying equipment and sup- plies were not effective. B. Survey of John Rodgers Airport A detailed survey was made of John Rodgers Airport which is utilized for planes engaged in inter-island traffic, in order to assure absence of Aedes breeding at the location where planes take on passengers and cargo. C6 Notification of Passengers Passengers from the island of Oahu to the outside islands are presented an instruction sheet concerning the nature and symp- toms of dengue, and given warning to report suspicious symp- toms to a personal physician or the local Board of Health. VII. Educational Activities A. Movie Trailer 452 lo A two-minute sound movie trailer on 35 mm® film has been prepared for commercial exhibition® The trailer provides a brief glimpse of the life cycle of the mosquito and demonstrates how the householder can correct the more common types of Aedes breeding places® The photography was done by the Army Signal Corps, the sound narrative commentator was provided by the Army Special Service De™ partment, the processing was carried out by the Navy Photographic Department, and the sound recording was handled by a commercial company® Arrangements have been made with the management of two theater chains to exhibit the trailer in their theaters on the island of Oahu first, and later on the outside islands® About 80 theaters will show the trailer. B. Special Student Survey 1. Arrangements were made for the 50,000 students who attend Honolulu’s public and parochial schools to make mosquito inspections of their own premises and to correct all breeding places during the first week in October® This activitiy coincides with a city Clean-up Week® Special survey sheets will be distributed by the teachers through the students® On the sheet the student-inspector will indicate the number of water containers eliminated on his premise, the number in which mosquito breeding was actually found, and any special mosquito problems occurring on his premises® Results will be reported later® C® News Releases 1® During the period a total of twenty news releases appeared in the two local papers® These were released through the Division of Health Education of the Territorial Board of Health® The local papers are cooperating, and will carry any significant news story on the dengue control work® Do Talks lo At a special meeting of school principals, teachers, health educators, and student leaders, talks outlining the current dengue situation irere presented, requesting aid from the schools in carrying out the special student inspection mentioned above® Demonstrations were provided to show the types of breeders commonly found in Honolulu, and a film on mosquito life cycle was exhibited® VIII, Dengue Committee A® A committee consisting of Dr0 Charles L® Wilbar, Jr®, President, Board of Health, Dr® Richard Lee, Director, of Public Health, 453 Mr, Tay, Director, Bureau of Sanitation, Miss Williams, Director, Bureau of -Public Health Nursing, Mr, Fc Kc Lee, Chamber of Commerce Mosquito Control Supervisor, Maj0 Spitz, M0Co Uo So Annjr, Ltc Allen, Uc S0 Navy, Lt0 Nebelung, Ue So Navy, Lto Stanes, U0 Sc Navy, Drc Usinger and Mro Gilbertson meet weekly to report on the various phases of the dengue epidemic and to discuss arrangements for control activities© This committee serves as a clearing-house for all the agencies interested in dengue control, IXo Administrative Activities A, With the arrival of Mr, John P, Zurlo, Administrative Assist- ant, the entire administrative phase of the program was turned over to him. Initially it will be necessary to establish pro- cedures to be followed for handling personnel and fiscal mat- ters, taking into consideration the relatively slow service through regular mail channels. Tentative procedures have been set up such matters as are necessary via radio and airmail, A summary of these has been forwarded for consideration and approval. X. Personnel A. Army 1, The special detail of 50 soldiers from the Medical Depart- ment were assigned on a one month basis. Therefore un- less the original plans are revised, these men will be recalled on October 15, It is planned to release men in small groups earlier than October 15, if sufficient civilian help can bo recruited and trained as replacements. At the time that the 50 soldiers reported for duty, ar- rangements had not been completed for feeding the sol- diers for the noon day meal. For a period of about one week each man was allowed 50 cents a day through Chamber of Commerce health funds to pay for noon day lunch. B, Chamber of Commerce Employees lo The original group of Chamber of Commerce men employed for dengue fever control activities has now been reduced somewhat by resignations9 but they will be replaced as rapidly as possible by new appointees0 C, Public Health Employees 1, Civil Service recruitment has been rather slow and so, if referrals do not materially increase, it will not be 454 possible to maintain the present level of inspection if the soldiers are withdrawn on October 15o Efforts have been made to locate other recruitment channels in order to supplement official referrals by Civil Serv- ice0 In general, the quality of civilian help has been low, although a few good men have been employed0 The established wage scale fits in with salary schedules already being followed by the Board of Health and the Chamber of Commerceo However, unless it is possible to considerably improve the number and quality of civil- ian field employees in the very near future, it is be- lieved that an upward revision of the salary schedule should be consideredo As would be expected with this type of personnel, there is considerable absenteeism and turnovero Out of 38 appointments seven have already been separatedo In spite of the difficulties mentioned above, field inspectors are being hired on an average of one per day0 XIo Automotive Transportati on A, The program has been operating with two less vehicles than the minimum needs0 Due to inexperienced inspectorial per- sonnel, constant field supervision is essential,, This re- quires a vehicle for each foreman„ The eight army vehicles which were provided on temporary loan are now needed by the Army for the purpose for which they were originally intended,. The Board of Health has been able to procure four used ve- hicles which are being assigned to mosquito control activi- ties as soon as necessary repairs can be completed,, All possible sources of obtaining vehicles have been contactedj American Red Cross, Office of Civilian Defense, rental com- panies, U0 So Engineers, and the Army„ In order to assure maintenance of adequate automotive transportation the Presi- dent of the Board of Health has requested through the Gover- nor’s office that the Commanding General make six vehicles available as soon as possibleo Respectfully, Wesley Ee Gilbertson PoAo Sanitary Engineer (R) i/c Dengue Control 455 FEDERAL SECURITY AGENCY U. S. PUBLIC,HEaLTH SERVICE MALARIA control in war areas DENGUE CONTROL HONOLULU SEMI-MONTHLY NARRATIVE REPORT Period Ending September 15, 1943 I. Conditions Upon Arrival A, Number of cases—148« (These are civilian cases only. The number of military cases, which was not released to the public, did not reach serious proportions.) B, Distribution of cases 1. Cases were distributed over most of the city, the Waikiki area being the only one which could be considered as serious. This area had been placed under military restrictions by Army and Navy authorities on August 8, C. Corrective measures 1, Field mosquito control activities a. A crew of approximately 35 men was on duty en- gaged in inspection and spraying activities. This staff was employed through the Chamber of Commerce Health Committee tonnage tax funds, and comprised 9 experienced rat and mosquito con- trol men, a group of temporarily employed mos- quito inspectors, plus five soldiers detailed from the Medical Department, b. Equipment consisted of seven automotive vehicles each equipped with one larvicide sprayer ladder, and an insecticide sprayer and necessary supplies, c. The method of spraying consisted of making in- spections and such corrective work as could be accomplished with the equipment at hand, proceed- ing in widening areas from the locations of dengue cases. Movable containers were inverted, but no permanent larvicides such as paris green or phenothiazine, were in use. 457 Houses where dengue cases occurred were sprayed with insecticides. Close to one-half of the city area had been covered through these operations. 2, Educational activities a. News releases. Daily news releases were being made on the number and location of actual and suspected dengue cases. Local papers carried a few stories with an appeal to the public for cooperation in mosquito control work. b. Radio. A number of spot announcements were carried by the local radio stations, c. Pamphlets. A one page leaflet was distributed to householders by inspectors. 3. Mosquito control by military authorities a. The Medical Departments of the Array, Navy, and Corps of Engineers had assisted in close in- spection of military areas accompanied by the use of oil larvicides as necessary. II, Management of Gases A, All cases and suspected cases were investigated by a physician for confirmation of diagnosis. Public health nurses assisted by getting patients under bed nets. House- holders were instructed in mosquito protective measures, such as spraying. Case histories were made and possible contact points established. The death reported as attributable to dengue was . a n elderly female and in- volved other serious complications as contributing causes. III. Liaison Established Upon Arrival A. Military 1. Contact was made immediately with Brig, Gen, King, Surgeon, Central Pacific Department, U, S, Army, and Admiral Chambers 14th District Medical Officer, U,S. Navy, concerning sup- plementary aid to the mosquito control program through U. S, Public Health Service facilities. Both officials agreed to cooperate in every way possible. B. Civilian 1, A meeting was held with the Chamber of Commerce at which it was agreed that all personnel would be combined to form a single control unit. I7. Offices Established A, Office quarters are being furnished by the Territorial Board of Health in the main building for central technical and administrative functions. For operational purposes the city has been divided into three districts. District field super- visory offices are quartered in the Board of Health Centers at Kapahulu and Lanakila and the main office building. B. Office equipment and supplies 1, The Board of Health is furnishing necessary office furni- ture at two of the District offices. It has been necessary to purchase desks and other office equipment and supplies for the central office and the third district office. V. Personnel A. Personnel needs In view of the wide distribution of dengue cases over the city and the general breeding found, it is essential that a complete citywide control program be operated. A total staff of approximately one hundred men, including the Chamber of Doramerce employees, is necessary. B, Civil Service Recruitment 1. Immediate contact was made with the Honolulu Federal Civil Service Commission office and requests made for seventy CPC-3 (inspectors) and five CPC-5 (foremen)„ Up to Sep- tember 10 only nine men had been referred by the Civil Service Commission,, All of these were appointed. C. Military 1. In order t© obtain an adequate staff to place the control program on a citywide 10 day inspection cycle basis, arrangements were made to obtain fifty soldiers from the Array. These arrangements were confirmed by a letter from Dr, Charles L. Wilbar, Jr., President, Territorial Board of Health, through Governor Stainback, to the Office of Military Governor. The fifty soldiers are being utilized as inspectors on a temporary basis until -adequate civilian personnel becomes available and trained. These men reported September 15, and together with military personnel previously assigned to the work. Chamber of Commerce employees, and Civil Service Commission appointees, make a total staff ©f approximately one hundred men. 459 Field Equipment A, Automotive 1, A total of thirteen automotive vehicles are now in use on the program obtained on temporary loan from the following sources: a* Army—eight vehicles b. Office of Civilian Defense—five vehicles These vehicles are being fueled and maintained by the owning agency. B, Inspectorial Equipment 1, Materials and supplies ©f excellent quality were purchased, though with some difficulty, to assemble one hundred in- spector's kits, consisting of the following items: mirror, flashlight, paris green bulb, bottle of kerosene, bottle of phenothiazine, report folder, chalk, pencil, referral slips, educational pamphlets and carrying bag* In addition, each truck will be supplied with containers for carrying supplies of the three larvicides to the field men, the previously used knapsack, sprayers, and insecticide sprayers* 2, New inspector’s daily report and referral sheets were devised to fit local conditions and were reproduced in quantity* Assistance of a local newspaper artist was enlisted in the preparation ©f a new educational premise bulletin for distribution t© householders* Enough ©f these have been produced to furnish Health Officers on the outside islands with supplies with which to carry on anti-Aedes campaigns* 3* Each inspector is identified by an arm band, several inches wide, bearing the words "Dengue Control," 4* Mime©graphed leaflets ©f detailed instructions were made up and issued to the foremen and inspectors. VII* Spot-check Survey of the City A, A 4-day spot-check survey of the city was made by Dr, R, L« Usinger, utilizing f©ur experienced mosquito con- trol inspectors. 460 B. Results of Survey 1. Breeding and Indexes a. It appears that the general overall breeding index of the Aedes mosquitoes (aegypti and albopictus) in Honolulu is approximately ten per cent. At the time of the survey, the range was from about five per cent in the Waikiki district, which had received a concentrated campaign of inspection and spraying, to about ninety per cent in the heads of the valleys such as Nuuanu, which receive heavy rain- fall, The Aedes population thus far sampled con- sists of thirty-two per cent aegypti and sixty- eight per cent albopictus. Undoubtedly, the breed- ing index of ten per cent, which is not seriously above the threshhold of sanitary importance, is the reason there has not been an explosive out- break of dengue in the city, but rather a scatter- ing of from thirty to fifty cases per week. The season has been very dry, thereby curtailing mosquito breeding. Usual experience here indicates that rainfall will increase during the latter part of October and continue through February, It is hoped, therefore, to obtain effective control before the rainfall increases, 2, lypes of Breeders Found a. All of the usual types of breeders found on the mainland are found in Honolulu, such as barrels, tanks, tubs, buckets, pails, jars, urns, bottles, tin cans, tire and chicken pans. Cisterns are not too plentiful, and where found they are usually too foul for Aedes, The principal new problems encountered are spider lilies, pineapple lilies, ape (ah’ pee) plants, and tree holes. The plants are very numerous and have cups which hold as much as one-half pint of water. It is planned to utilize paris green on the ape plants and phenothiazine on the lilies where there is some danger of injuring the plants, VIII. Method of Operation A, Official Status 1, The entire program is under the Bureau of Sanitation, Mr, S, W, Tay, Director, 461 B, Zoning 1, Utilizing the twenty-nine existing voting precincts as a basis, the entire city has been divided into ninety-four inspection zones suitable in size for seven to ten day coverage by one man. C, Supervision 1, Foremen—12 foremen have been designated, each having supervision over from six to eleven men, 2, District supervisors—three district supervisors are provided, each with four foremen under his supervision. 3, Field supervision—Mr. F, K, Lee, formerly Director of Rat and Mosquito Control for the Chamber of Commerce Health Committee has been designated as field super- visor. D. Inspection-Correction Work 1, Inspectors will proceed in an orderly manner from premise-to-premise and block-to-block in covering their assigned zones. The usual method of marking street comers and "IPs” in front of residences is being utilized. Correction techniques utilized on the main- land are being employed. Problems encountered by inspectors which cannot be handled are being referred in writing to the foreman for attention. Military foremen have been placed over military inspectors, and civilian foremen are over civilian inspectors. Arrangements have been made with Dr, Enright, Director, Division of Communicable Dis- eases, and Major Spitz, M. C,, who has been assigned to the Board of Health for epidemiological studies, to obtain current information as to any existing foci of infection so that concentrated effort can be placed on control activities in these areas. IXa Records A, Inspector's records will be compiled and necessary analyses made, to be used as guides to control operations in the placing of men and choosing of control techniques. The following data will be obtained, by zones, districts, and for the city as a whole: 462 Total number of premises inspected Total number of premises breeding Aedes Aedes breeding index Total number of containers inspected Total number of containers breeding Aedes General container index Total number of each type of container inspected Total number of each type of container breeding Aedes Individual container index X, Public Education A„ News Releases I* The public has been kept continuously informed regarding the development and aims of the control program* Direct appeals have been made to householders to clean up their own premises to eliminate mosquito breeding* Due to the postal situation here, only a few sample clippings are attached* B„ Other Educational Activities As time permits, arrangements will be made to make full use of other channels, such as the schools, service clubs, and dodgers* XI, Waikiki Restriction Lifted A0 Effective September 13, military authorities lifted the restriction on most of the Waikiki District, following study of the entomological survey results and the current epidemiological picture„ Though no apparent differential in mosquito densities was found in different parts of the Districts, the restrictions were retained on a few small zoneso XII* Future Reports A* More complete entomological data will become available soon and will be forwarded,, Summary reports of actual operations will also be sent,, Respectfully, Ro Lo Uainger P0 A0 Sanitarian (R) Wesley E„ Gilbertson P0 A0 Sanitary Engineer (R) 463 TERRITORY OF HAWAII BOARD -OF -HEALTH DENGUE MOSQUITO CONTROL September 10, 1945 To; Dr0 Co Eo Pemberton, Chairman Sub-committee on Mosquito Control Post-War Planning Health Committee Chamber of Commerce of Honolulu Through? Dr© C0 Lc Wilbar, President Board of Health Mr0 Bo Jo McMorrow, Director . Bureau of Sanitation Board of Health From: Arve H8 Dahl, Officer in Charge Dengue Mosquito Control Subject: Plans for Permanent Mosquito Control in the Territory of Hawaii As requested at the last meeting of the sub-committee on mosquito control, I am forwarding for consideration by the entire committee a plan for permanent mosquito control in the Territory of Hawaiic This plan is essentially identical to the one outlined verbally at the last meetingo Modifications were made following discussions with Dr„ Wilbar, President, Board of Health, and Mr0 McMorrow, Director, Bureau of Sanitation,, It is Dr« Wilbar*s desire that your committee consider this entire plan and make recommendations for its revision or approval before he submits it to the Governor for approval and funds„ Forwarded: 9/13/45 Respectfully, Co Le Wilbar, Jr0, M« Do President, Board of Health Arve Ho Dahl P0 Ao Sanitary Engineer (R) i/o Dengue Mosquito Control Forwarded? 9-12-45 AHD/en F0 Ao Schramm Assto Director, Bur* Sanitation Incl« 2 465 A. In considering the post-war project for mosquito control for the Territory of Hawaii, the following points must be considered: 1„ There are three species of mosquitoes present in the Terri- tory of Hawaii, each of medical importanceo a0 The two-days mosquitoes, Aedes aegypti and Aedes albopictus are vectors of dengue fever and yellow fevero The control of these diseases has been demon- strated by the control of these mosquitoes» Both species are domestic mosquitoes which breed in arti- ficial and natural containers and require premise to premise inspections for their control besides treat- ment of all city storm-drains and catch-basins, etc* bo The night mosquito, Culex quinquefasciatus, is the same mosquito that has been proven responsible for transmitting filariasis<> Control of this mosquito involves the treating of streams, swamps, ground-pools, storm-drains, and many of the same containers treated for Aedes controlo 20 The real danger of introduced mosquito-borne diseases in the Hawaiian Islands lies in the City of Honolulu where all transient visitors arriving in the Territory land* Furthermore, future travel will largely be by airplane, bringing persons to Hawaii from areas where dengue is endemic, such as Fiji, within the incubation period*, It is, therefore, important that maximum efforts be expended in Honolulu to prevent introduction of diseases which might also spread to the other is lands• 3The second point of danger which should be safeguarded is Hilo, Hawaii, the second largest city in the territory. The greatest amount of travel between the Hawaiian Islands is between Honolulu, Oahu, and Hilo, Hawaiio A small pro- gram similar to the Honolulu program should be operated. 40 A Division of Mosquito Control should be established under the Bureau of Sanitation, Board of Health, Territory of Hawaii, immediately» Bo The Division of Mosquito Control of the Hoard of Health would perform the following functions % lo Perform the necessary mosquito control activities in Honolulu and Hilo to minimize the danger of an outbreak of mosquito-borne diseases0 A low Aedes mosquito breed- ing index in Honolulu should be maintained to prevent an- other dengue epidemic and to control the potentially dangerous and annoying Culex quinquefasciatus mosquito. 467 2. These units must be comprised of a nucleus of weldetrained men who* in the event of an emergency* would train additional workers and direct expanded mosquito control activities0 In addition* the Division’s control organization must be on a mobile unit basis % i0e0* available to go to any part of the Territory to handle mosquito control problems. 3» All control work must be designed to use the best and most effective larvicides and adulticides available in the most economical manner. This will require the maintenance of a continuous supply of larvicides and adulticides to meet any emergencyo At present* pyrethrum and DDT larvicides and adulticides are recoramendedo 4o Continuous research should be done .to determine more effec- tive methods of dispersing larvicides0 This section would include in its studies! dispersal of DDT by airplane versus ground dispersal methods the effect of DDT and other larvi- cides on beneficial inssetso 5. Continuous surveillance around airports and ports of entry for possible new species of mosquitoes should be maintained. This information can be obtained largely through cooperating quarantine officials $ however* some field entomological check- ing should be done. In the event that a new species of mos- quitoes is found* appropriate control or eradication procedures must be instituted at oncOo 6o Educational work should be continuously promoted through the Board of Health’s Division of Public Health Education Efforts to include satisfactory class study on mosquito control through out the public school system are necessaryo Co Basic Plan of Organization for the Division of "Mosquito Control." (Attached is the complete personnel outline recommended showing Territorial Civil Service ratingSo) lo Personnels ae Directors Professional Sanitary Engineer* P-5t Supervisor of all mosquito control activities} coordinating work with other agencies} educational activitieso Must be a professional Sanitary Engineer trained in public health with special emphasis on mosquito or tropical disease control. b0 Medical Entomologistg Graduate medical Entomologist, P-4s "Responsible" for research on methods of using all types of larvicides and adulticides0 Responsible for surveillance activities to detect possible new 468 introduced species of mosquitoes and other insects of public health importance besides maintaining liaison with established quarantine officialso To assist in evaluating at all times the work of the Division<> Co Clerk-Stenographer, CAF-4s Stenographer for Division; keep statistical records on field work; and complete • files o do Supervising Mosquito Control Inspector, IN-5; Respon- sible for supervising a crew of five mosquito control inspectorso Normal operations will consist of: premise to premise inspections for detection and correction of Aedes mosquito breeding places using DDT larvicides; and use of power-spray equipment for adulticiding work, fo Mosquito Control Inspector, IN°4: Special positions to operate motorcycle units« fT) "to larvicide regularly all storm-drains, etcQ, and regular breeding spots re- ported by the inspectors; and, (2) to take care of all supplies mixing larvicides, equipment, and handle spe- cial referralso go Mosquito Control Inspectors, IN-3? To make regular prem- ise to premise inspections for detection and correction of Aedes mosquito breeding places using DDT larvicides; to operate equipment for eradication of adult mosquitoeso h0 Clerk-typist, CAF-2; To keep operational and statistical records on field operations0 Notes All personnel will be trained in all phases of mosquito controlo They will serve as a nucleus for an expanded program in the event of an emergency0 20 Normal Plan of Operations! In the city of Honolulu, there are approximately 23,000 premises„ An average inspector should be able to inspect about 70 premises per day or the entire city inspected in 330 inspector man dayso With five working days per week, 20 inspectors will cover the city of Honolulu on a 303 week cycle or every 23 dayso With the development of DDT larvicides, there are indi- cations that use can be made of the residual effects of DDT. Regular control operations of the Dengue Control Program at present include plans to use DDT larvicide applied to all potential and actual breeding places with an automatic dis- penser0 This dispenser applies a liquid volume of a little less than 1 coc0 with each squirt0 469 Special emphasis will be placed on the use of adulti- cideso Present plans call for the continued use of pyreth- rum sprays fortified with DDT dispersed by power-spraying equipment® The DDT is added to the water emulsion pyrethrum spray by including an additional amount of emulsifier® This spray is calculated to give a complete adult kill in the areas used as well as complete larval kill by the addition of the DDTo Regular special services call for two motocyole units. One unit will be used full time to oil storm-drains, catch- basins, small ditches, and other permanent breeding spots located by the inspeotional staff® These potential breed- ers will be inspected and larvicided on a two-week schedule® When a place is corrected, it will be dropped from the list by the man doing this work® The other unit is provided for the stock-room man who shall handle all supplies, prepare larvicides, have equipment repaired, etc®, and when free, assist in abating referral slips, such as filling of tree holes, etc® These two units will do the work of at least 12 inspectors® 470 Supply clerk. Tree-holes, Referrals, etc. 4815635 Clerk-Typist CAF-2 2—Inspectors IN-4. Motorcycle Units storm- drains, etc. Med, Entomologist P-A Supervising Inspector ItET Notes Inspection cycles in Hilo and Honolulu will normally be between three and four weeks* 2 Supv. Inspect, IN-5 IRzl. To work in the non- eritical zones of Honolulu HONOLULU PROJECT Inspection Crew Division of Mosquito Control Bureau of Sanitation Director P-5 1 2 Supv. Inspect. IN-$ PrJL To work in the critical zones of Honolulu Inspection Crew Clerk-Steno. CAF-A Supv. Iaasector IN-5. 3—Inspectors - IN-3 HILO PROJECT 471 DIVISION OF MOSQUITO CONTROL Biennium Budget Summary Personnel: Oahu Hawaii Total First year basic salaries M w salary bonus Second year basic salaries ,f ,f salary bonus $ 79,270,00 15.740000 83,330o00 15.740000 $ 9,780o00 2,160„00 10,280,00 2,160,00 $ 89,050,00 17.900.00 93.610.00 17.900.00 Total Personnel $194,080,00 $24,380,00 $218,460,00 Other Expenses: First year Second year $ 15,631o00 15,631o00 I 1,792.00 1,792,00 $ 17,423,00 17,423,00 Total Other Expenses I 31,262oOO $ 3,584,00 $ 34,846,00 Equipment: First year Second year $ 13,050,00 $ 1,700«00 $ 14,750,00 Total Equipment $ 13,050o00 $ 1,700,00 $ 14,750,00 Biennium Project Costs $238,392 oOO $29,664,00 $268,056,00 BOARD OF HEALTH Summary of Proposed Positions Annual Cost Figures (1945 Salary Schedule) ‘’Mosquito Control” on DtTSO V r AQ 37, Hq USAFPOA, File 300o4, Gen Orders POAo 21, File 725.1, Mosquitoes, Serial No, 38, 1944, HHD, Off of Dept Surg, 22, File 725.1, Mosquitoes, Serial Noc 60, Surg Off, CPA, 1944. 23» Incl #2o 24. Incl, #3o 25. File No, 620, Housing of Officers & EM, Serial Ho<, 13, 1944, (2 letters w/1 Incl to 2nd)letter, Surg Off, CPA, 26. File 620, Housing for Officers & EM, 1944 (Holiday House), Serial Noa 9, Surg, CPA, 27. Gen Orders #18, Hq POA, 6 Feb 45. 478a CHAPTER 39 Occupational Health (History of Preventive Medicine) WD Circular N0, 59,1 dated 24 February 1943, established the Industrial Medical Program of the United States Amy., It was stated in this circular that ”the Army is obligated to furnish safe and hygi- enic working conditions and to maintain an adequate industrial medical service,” Responsibility for making necessary provisions for the supervision of industrial hygiene was delegated to The Surgeon General, An Army Industrial Hygiene Laboratory was founded collaterally at Johns Hopkins University for the purpose of conducting surveys and investi- gations concerning occupational health hazards in Army-owned industrial facilities. The circular further stated the duties and functions of the Office of The Surgeon General and the Army Industrial Laboratory and established the relationship of the service commands to the Indus- trial Medical Program, It further provided for a qualified medical officer to act as industrial medical officer and outlined his duties; a qualified Sanitary Corps officer was authorized as assistai t. The relationship of the Industrial Medical Program to the Air Forces was given, and the functions of the medical officer or civilian physician, assigned to medical service in Amy operated plants were described. The Industrial Medical Program in Hawaii was instituted in the Hawaiian Department under the Department Surgeon, on or about 30 March 1943, An Industrial Hygiene Engineer and an Industrial Medical Officer were appointed,2 These officers drew up an outline of a ten- tative program for Industrial Hygiene and submitted it to the Assist- ant Department Surgeon, on 19 April 1943,3 This tentative program was subsequently approved by the Chief of Staff, A proposed department dircular, subject, ’’industrial Medical Program in the Hawaiian Depart- was prepared by the Industrial Hygiene Engineer and was submit- ted to the Chief of Staff, Hawaiian Department Service Forces, for approval. The proposed circular was in effect, a condensation of WD Circular 59, dated 24 February 1943, Contents of the proposed circular were subsequently published in the form of a letter to Commanding General, 7th Air Force; Department Chemical Officer; Department Engin- eer; Department Ordnance Officer; Department Quartermaster; Training and Security Officer; and Department Surgeon, on 20 July 1943, In the meantime the Industrial Hygiene Engineer personally with commanding officers of Department agencies. Letters were written to the commanding officers of these agencies requesting information on operations involving possible health hazards. Replies made to these letters formed the basis for subsequent investigations by the Industrial Hygiene Engineer, 479 In the course of their work on the industrial hygiene pro- gram* the Industrial Hygiene Engineer and the Industrial Medical Officer contacted the Territorial Board of Health in Honolulu* T0H<>, where a program of Industrial Hygiene was already in effecto® They found that the Board of Health was equipped with the necessary field instruments* a laboratory and a staff consisting of a Sanitary Engineer* and two chemists* both of whom were of Japanese ancestry,, Prior to this time* the Department Surgeon formed a Sanitary Detachment* attached to the Department Surgeon’s Office* for the pur- pose of assisting the Board of Health in carrying out sanitary inspec- tions of restaurants* housing* dairies* etc© A training school* known as the Hawaiian Department Sanitation School* was held at the 147th General Hospital which was then located on the campus of Sto Louis College* Honolulu* To Ho Army medical officers and civilian health authorities*conducted classes at the schoolo Field trips were taken by the detachment under the auspices of members of the Board of Healtho Men in this school were to be alioted to various Bureaus of the Board of Health to reduce the manpower shortage© The Industrial Hygiene Bureau was interested in getting a man* preferably a chemist, who could assist in investigations of industrial hygiene problems for the Army0 The UD S0 Engineering Department had requested assistance from this Bureau in detecting and controlling health hazards in con- struction worko Since the two field assistants were of Japanese ancestry* they were not permitted on Army posts© Therefore* the Bureau needed an Army man who could carry out the field tests and have access to restricted areas© An enlisted man was assigned on 12 September 1942 to the Board of Health to work in the industrial hygiene section© All work in industrial hygiene for the Hawaiian Department was then done by the Territory Board of Health until July* 194307 During this period* September* 1942 - July 1943* there was no official liaison between the Board of Health and the Hawaiian Department,, What work was done for the Army* was done at the personal request of the Safety Engineer for United States Engineering Depart- ment o Arrangements were made with the Board of Health to have tests and samples analyzed on the various jobs© Generally* the Army tech- nician accompanied the Safety Director to the location of the job and made the tests„ If there was evidence of potential poisoning* corrections were made immediately by authority of the Safety Engineer,, At that time there was considerable tunneling being done on the island. This was hard rook mining and all the health hazards associated with hard rock mining* such as dust* carbon monoxide* and nitrogen oxides were to be found,, The work was done under considerable pressure© Many jobs were started without provisions for adequate ventilation© There was not enough equipment on hand to provide blowers and ducts for every tunnel and there were oases of asphyxiation© In some instances although tests showed a positive health hazard there was no way in which to eliminate the hazard due to the 480 lack of equipmento Every effort was made, however, by the Safety Engineer to provide safe working conditions„ But, as stated before, the great pressure for defensive construction made it necessary to do without protective equipment,, One of the most trying and difficult problems at the time was the lack of good drinking water at the various construction jobs0 Many tests were made in the laboratory to determine the B-Coli count„ In all such tests water could not be considered potable0 Water was often hauled in by trucks for many miles and was distributed to the men by means of wooden barrels0 Generally the common dipper was usedo Although no official report was made of these investigations, results of the surveys were written and are on file at the Territorial Board of Healtho Several written reports of these tunnel surveys, however, are to be found in the Industrial Medicine Report, Pile No„ 729 „3 Hq Hawaiian Department, Office of the Department Surgeon for 19430 These reports were made after the Industrial Hygiene program was for- mally established,. Formal reports, however, do not give a complete picture of the hard, dangerous work which was performed by the men in these tun- nels o One must see men working on a high scaffold at the face of a tunnel where the temperature is considerably elevated and the noise is almost unbearable, with carbon monoxide and silica dust in the at- mosphere to provide a final threat, in order to understand -the purpose and need for Industrial Hygiene„ In these early days of the war, it was not uncommon to hear the remark ’’This is wars we expect to lose meno" Under the circum- stances, it was easy to pass off responsibility for providing safe work- ing conditionso Real support for the Industrial Hygiene program in the early days, however, came from the construction bosses who were well aware of the hazards of their work and who actively supported practical measures for improving working conditions„ A fine spirit of cooperation devel- oped between the Industrial Hygiene Inspector, the Safety Engineer and the men as a result of the continual effort to improve working condi- tions o Although working conditions in the tunnels were never developed to the standard desired, the efforts did result in some improvement,, Better water was obtained % better mess facilities were constructed ventilation was looked after carefully„ There were lapses in good practice of course, due to the pressure for results„ Unfortunately, the main volume of tunnel construction was completed before any ex- tensive and integrated program of Industrial Hygiene could be insti- tuted., It seems evident in retrospect that Industrial Hygiene should be on the job continually,, A back-log of experience and organization to meet situations of this kind is necessary and constitutes a vital portion of medical service,, 481 A more successful undertaking, however, was made in the sur- veys of the camouflage plants® There were two plants in the Central Pacific Area manufacturing camouflage garlands, and the attention of Industrial Hygiene Inspector of the Board of Health was drawn to these plants by the Safety Engineer, U0S0E0D0, because of the large number of women involvedo Camouflage in those days was manufactured in con- siderable quantities, although primitive methods were employed® The prepared paint was dumped into bath tubs, into which the women dipped the untreated burlap with their bare hands® They then put the burlap through wringers to remove excess paint® Women were suffering from dermatitis and production was limited® Efforts were then made to solve the production problem and to eliminate health hazards® One of the plant’s supervisors took an active part in this problem, and on encouragement from Safety Branch, and Industrial Hygiene Inspector, developed a paint bath and a mechan-i - cal cutter which increased production tremendously and eliminated al- most entirely the handling of material by hand® It was a notable accomplishment® Pictures were taken to show the improvements and at a later date, a report was submitted to the Essential Technical Medical Data,8 Other investigations were made as listed in the Industrial Hygiene Program summary from January, 1939 to July, 1943Improve- ments certainly were made® They were made as a result of demonstra- tive tests showing that a health hazard actually existed® The accomp- lishments took time, but were nevertheless effective in spite of handi- caps from the lack of official status in the Army® In the spring of 1943, when the Industrial Hygiene Engineer and the Industrial Medical Officer were developing the Industrial Hygiene Program for the Hawaiian Department, they found the situation at the Territorial Board of Health readily adaptable to their plans® Arrangements were made informally with the Director of the Territorial Board of Health, to incorporate certain activities of the Industrial Hygiene Branch of the Board of Health into the Industrial Medical Program in the Hawaiian Department® A new was designated Industrial Hygiene Engineer for the Hawaiian Department®H Permission to use the laboratory and instruments of the Territorial Board of Health was granted informally to the Department Surgeon® A history of Industrial Hygiene activities involving Army agencies in the Hawaiian Department from January, 1939 to July, 1943, the beginning of the Industrial Medical Program, was prepared by the newly appointed Industrial Hygiene Engineer®12 After the beginning of the formal Industrial Medical Program in the Central Pacific Area, a formal and organized approach was made 482 to the problem* There was considerable staff supporto The ground work with the various agencies had been laid and it was only a question of which agency would be studied! it was decided to survey Chemical War- fare Service activities at Schofield Barracks first0 The Industrial Hygiene Engineer and the Industrial Medical Officer conferred with Chemical Warfare Service Officers at Schofield Barracks and plans were made to carry out a survey of the impregnation plants* At that time, a very strict blackout was maintained on all Army postso The impreg- nation plants were using tetrachlorethane as a solvent in the impreg- nation of clothing against war gases* A very brief survey of condi- tions seemed, to warrant a more thorough study of these plants* Actually, little was known, at that time, about tetrachlorethane and the probable effects on the workmen, and no one seemed to be familiar with the actual potential health hazards* It was necessary to study plant operations and to study the literature on tetrachlorethane* The more information obtained, the more serious the problem appeared,, There was some pro- vision for ventilation in the plants, but it was found that the concen- tration of tetrachlorethane was well above the probable safe limit* A considerable body of information was assembled from chemical tests and from reports in the literature,. As a result of this survey, chemical warfare service officers supported the plan to revamp and develop the ventilation system0 The aid of the Engineer's Office, then known as the U* S0 Engineering De- partment, was enlisted,, A personal visit was made to the Engineer's Office by the Industrial Hygiene Engineer for the purpose of meeting the parties responsible for construct!on* At the time it seemed neces- sary to contact the Construction Branch in order to find out how to handle matters involving construction for a third party„ It y/as in- deed a very fruitful visito The Industrial Hygiene Engineer finally met the engineer who was in charge of the building sub-division,. A general discussion of the Industrial Medical Program was held, and the engineer was informed of the tentative program in view* The engineer, apparently sensing that such a program would involve considerable con- struction work and would put an additional burden on the already over- worked Engineering Department, was not very enthusiastic* He wanted to know who was going to back up the program,. He was reminded that the Surgeon, C*PoA*, was actively supporting the program, and apparently he decided that the Industrial Medical.Program was to be reckoned with, for from that time on, the Engineer's Office gave the Industrial Medical Program its whole-hearted support* Probably the greatest single factor in the success of the In- dustrial Medical Program in Hawaii was this close cooperation between, the Surgeon's Office and the Engineer’s Office* Too great an emphasis on the proper liaison between the Surgeon's Office and such a vital agent as the Engineer's Office cannot be given* Most industrial hygiene problems involve features which are too involved for one man to handle* 483 For instance, a man with chenical training, who is able to make tests with laboratory instruments is not likely to be an expert on the proper type of motors for a ventilation system, and is less likely to know the situation concerning supply. And, if results are to be obtained, close liaison must be maintained between the agencies involved. as stated before, preliminary studies and tests were made at the Chemical Warfare Service plants. When it was decided that a basis for definite recommendations was established, a meeting was called by the Industrial Hygiene Engineer of all the interested parties including the Commanding Officer of the Chemical Processing Company, and a representative of the Engineer’s Office. At this meeting the problem was discussed and definite proposals were made for construction of additional ventilation facilities, for rearrange- ment of machinery, and work hours and other problems associated with revamping of a going plant. The Industrial Hygiene Engineer prepared several with pertinent information and with definite recommendations for im- proving working conditions. The reports included a sketch of the pro- posed ventilation system and was forwarded to the Engineer’s Office. The Engineer’s Office further studied the problem from the standpoint of construction, and then drew up detailed drawings for construction. The work was given high priority and the work order was issued. While these matters were taking place, another aspect of the job was undertaken. Routine medical examinations and laboratory tests were provided for all employees in these impregnation There was continual study of this problem and adjustments and improvements were made from time to time. A review of the efforts to reduce the health hazards in these impregnation plants is given in a paper pub- lished in the Essential Technical Medical Data in 1944«"*'5 The whole matter was a good example of a major problem in Industrial Hygiene, of well established liaison between the various services, of very constructive results and of the judicious use of medical supervision. A number of other surveys were undertaken during the year 1944. a complete summary of Industrial Hygiene activities for 1944, is given in the Industrial Hygiene file 729.3 for As stated in paragraph lb of this report, Industrial Hygiene activities from 1 January 1943 to 31 December, 1944, included complete surveys of nine- teen Army plants, eighteen special projects requiring field tests or laboratory analyses, and nine special assignments including two lec- tures and three written articles for Essential Technical Medical Data. Inspections of eleven completed industrial hygiene construction pro- jects were made with the Medical Inspector, CPBC. Arrangements were made for periodic x-rays, physical examinations and laboratory tests of personnel in more hazardous occupations. Paragraph 1c of this re- port states that industrial hygiene problems of the CPBC were varied and included ventilation, lighting, dust control, elimination of toxic gases and fumesprevention of dermatitis and the introduction of pro- tective clothing, A considerable amount of money was involved in the construction of ventilation systems, sanitary facilities, new protec- tive equipment, and other measures for promoting good working conditions., This general resume of Industrial Hygiene activities for the year, 1944, is given in more detail in the aforementioned report of activitieso A glance at this report will show the wide scope of activ- ities, the variety of problems encountered at different Army agencies, and demonstrates the range of beneficial effects that a well supported Industrial Hygiene Program may have. In this list of activities, may be found occupational hazards involving Quartermaster laundries, Chemi- cal Warfare Service impregnation plants. Army printing plants, Ordnance shops, underground installations, hot plants, bakeries, a laboratory and a theatre. In each case, it was necessary for the Industrial Hygiene Engineer to establish liaison through proper channels and to study the general layout or process in an effort to obtain a complete picture of the situation. This was generally spoken of as a preliminary survey and took only a matter of hours. Later*on, instruments were brought into the plant or office to check up and determine the extent of the hazards or deficiencies. When the tests were completed and the data compiled which indicated that improvements were necessary, a written report was submitted to the Surgeon, Central Pacific Base Command, with recommendations for improvements. This report was accompanied by a route slip by which the basic communication, if approved by the Sur~ geon, was transmitted to the appropriate staff section and subsequently to the major echelons concerned. In this way, the report was given official recognition. Generally, the required or recommended construc- tion involving $500,00 or more. In such cases, the report was trans- mitted to the Engineer’s Office for comment and necessary action. Invariably liaison between interested parties was so well established that no misunderstanding or adverse criticism arose, and usually the drawings and work orders for such projects were issued promptly. It was customary for the Industrial Hygiene Engineer to follow up each project until finally completed. In order to record the progress on these various projects, and to show definitely what was accomplished, pictorial records of each job were made for the Industrial Hygiene section by Signal Corps photographers, A picture of a projected piece of construction was made before new construction was begun, and later a picture was taken of the completed job. Generally, these pictures were attached to reoorts which were submitted to the Surgeon, In the case of the camouglage plant, the services of the Signal Corps were enlisted to make a colorful motion picture of opera- 485 tions in the manufacture of garlands<, Colored motion pictures were taken of the processes before and after improvements were made, and they produced a striking contrast0 These motion pictures were used for some time as a part of an illustrated lecture on Industrial Hygiene and were later sent to Washington, D0 C0, for review0 They were not returned to this theater*, For additional information concerning the surveys reported in the summary of activities for 1944, reference is made to the Industrial Hygiene file No0 72903 Surgeon’s Office, Hq, CPA, 1944o Incidentally, it should be noted that the length of the written reports submitted to the Surgeon progressively decreasedo Re- ports which were written in late 1943 and early 1944 often amounted to fifteen pages of single spaced type, but those reports submitted in 1945 generally averaged a page or two*, Keeping a diary on a weekly or monthly basis was another very important part of administrative work in Industrial Hygiene<> Since these records were kept, there was little dif- ficulty in compiling a yearly report or a resume of activities when they were requiredo In the Medical Inspector’s Office, weekly reports of activi- ties were consolidated, and reports on venereal disease, epidemiology, sanitary engineering, industrial hygiene, and so forth, were all kept in the files of the Medical Inspector’s Officeo It was found to be convenient, however, to maintain a file copy of Industrial Hygiene activities separately for referenceo The objective of the long-winded reports which were submitted in 1943 and 1944 was to develop complete information as a basis for recommendation in construction or alteration0 In those early days of the new fledged program, it was considered necessary to make the basis for recommendations air-tight and completely documented with evidence*, The idea was to impress the Surgeon, the Engineer and the echelon com- mander with the need for improvement0 This was probably worth while, except that no one read such long reports carefully, and it was found that the same objective could be obtained by a concise statement of the particular problem, the results of the test, and any other necessary pertinent remarks, together with the recommendationso Mien all this information could be reduced to one page, the report was read, and it was not necessary to furnish tables of results, graphs, and plant lay- outs as was done earlier <> However, the scientific basis for recom- mendations, io60, the detection and the determination of the extent of the hazards, was always carried out*, In this way, a reputation for accuracy and soundness was maintained, and there was little danger of the Industrial Hygiene Program being discredited on such a basis„ Prom time to time reports were submitted to the Essential Medical Technical data on various Industrial Hygiene projects0 These 486 reports entailed extra effort in rewriting reports, but the effort was rewarded. Recognition of Industrial Hygiene activities in the Central Pacific Area was given by The Surgeon General’s Off and needless to say, this encouragement was highly valued. Only a few of the various Industrial Hygiene projects were reported in Essential Technical Medical Data, and those selected were intended to show the scope of activity and the kind of results that were obtained. It was keenly satisfying to the staff in the Industrial Hy- giene Section to see these reports published. The only other published report of Industrial Hygiene activities to our knowledge was a very interesting paper on laboratory procedure and field tests concerning dimethyl phthalate from the South West Pacific Command. Reports of Industrial Hygiene activities were expected with interest from other theaters, but if these reports were published, they never came to the attention of the staff in this theater. It was con- sidered regretable that a more active exchange of ideas in this field during the war was not carried out. Another activity which was undertaken by the Industrial Hygiene staff for the purpose of educating various groups interested in Industrial Hygiene was lecturing. An illustrated lecture on Indus- trial Hygiene was prepared by the Industrial Hygiene Engineer and was given upon request. This lecture was given to the foremen and super- intendents of the South Sector Engineer Repair Depot; to the Safety Superintendents of the Engineer's Office; to Officer's Candidate School at Schofield Barracks; and to Safety Officers of the Office of Civil- ian Affairs. Dermatitis was a recurrent problem at the South Sector Engi- eer Repair Depot, and at the request of the Safety Engineer, a lecture was given by the Industrial Hygiene Engineer on the prevention of derma- titis. These lectures, which broughtthe matter of Industrial Hygiene di- rectly to the man at the working bench, were considered very valuable from the educational standpoint. This particular organization, the South Sector Engineer Repair Depot, was a large, well organized group of men who were engaged in maintenance and repair of heavy duty machinery of all types, automobile repair, machine shop work, and fabrication of equipment. An active safety campaign had been carried on in the base yard. A well organized bond drive had been undertaken. And in such a group ideas which were pertinent to the work at hand were intelrli- r gently received. It was emphasized in the lecture to these men that production was very important to the war effort and it was pointed out that lost time accidents, occupational diseases, and absenteeism were hampering production in the war effort. Emphasis was laid on that particular plant as being important in the war effort and pride in their work was stimulated. From the lecturer's standpoint it was easy to see the response of these men when they were considered as soldiers on the production line. 487 It may be stretching the point to say that this type of activity is Industrial. Hygiene, but actually, there was comparatively little effort expended on information-education and morale for factory workers in this theater0 Although, too wide a variety of activities may tend to limit Industrial Hygiene accomplishment, this particular activity was considered essential by the Industrial Hygiene staff in this theater, and should be incorporated, it is felt, in all Industrial Hygiene work. An Industrial Hygiene Engineer has a rare opportunity to contact men in the plant, and as an expert on working conditions, and as an officer in the Army, he speaks with considerable influence on civilian workers* But, of course, lecturing is no substitute for practical construction and the elimination of health hazards* But, in its place, it is felt that this activity serves a very useful purpose* The arrangements for medical examinations for workers in- evitably becomes a part of Industrial Hygiene Service. When it was discovered that men were working in a potentially dangerous occupa- tion, action was taken to have the men given medical supervision be- fore clinical symptons of disease appeared. In the case of service personnel working in the Chemical Warfare Service impregnation plants, the whole company was given physical examinations and laboratory tests routinely. This entailed special arrangements; in fact, a project was made of this work. Records were kept and men were relieved from duty whenever there was any indication of poisoning. In setting up such a medical program, it was found that it was sound policy for the Industrial Hygiene Engineer, through the Surgeon, to outline the tests and examinations to be given and to state what records were to be kept, and how often men were to be exam- ined, so that complete and detailed information was recorded. From time to time it was found that tests and procedures needed modifica- tions, and such modifications were requested in writing. If a hospital or laboratory, which happens to be doing the tests and physical examina- tions, is suddenly moved, as was the case in this theater, records and information can easily be transferred to a new unit. The Industrial Hygiene Engineer must take it upon himself to see that the proper directions are given and that sufficient records are kept to make the program satisfactory. It was easy to make arrangements to have x-rays, blood tests, and physical examina- tions done on plant workers by proper request through military channels. At this point, a few words are ventured concerning the place of the Industrial Hygiene Engineer in the organization of the Army. In the Central Pacific Area, the Industrial Hygiene Engineer was attached to the Surgeon’s Office, Headquarters, and he functioned as a part of the Medical Inspector’s Office. This arrangement, it is felt, was ideal for the accomplishment of the Industrial Hygiene Program. The Industrial Hygiene Program fits in very well with the duties of the Medical Inspector’s Office,, Attached to Headquarters, the Industrial Hygiene Engineer is given the necessary support to deal with other echelons® Being on the staff of the Surgeon, enables him to balance field work with necessary medical advice, and the clerical staff of the headquarters provides excellent assistance in drawing up records and reportso Of course, the active and interested support of the Surgeon and the Medical Inspector cannot be over estimated,, Such support is felt by the Industrial Hygiene Engineer in every day of his work® The Industrial Hygien0 section of the Medical Inspector’s office functioned under three different Surgeons during the war® In all respects, the Surgeons gave sympathetic and active support to the program,. When the Industrial Hygiene Engineer in the Central Pacific Area found it necessary to start a survey of a major echelon such as Ordnance Service or Quartermaster Service for the first time, the Medical Inspector of the Central Pacific A with the full support of the Surgeon, would accompany the Industrial Hygiene Engineer on a visit to the Commanding Officer of that particular echelon® A pre- arranged conference would be held then with the Commanding Officer® Facts on the Industrial Medical Hr0gram would be presented to the Commanding Officer and the purpose of the intended surveys would be outlinedo Pictorial matter concerning previous surveys would be shown and a request would be made for a written letter introducing the Industrial Hygiene Engineer and stating to plant officers the purpose of the proposed visit® This letter was always supplied upon request and fulfilled a very useful purpose® A letter from the Com- manding Officer of a major echelon to a plant officer carries invalu- able supporto Although, this method of doing business may smack of high pressure salesmanship, it was considered strictly within bounds of military courtesy and operation® Certainly, personal contact with the Commanding Officer of the service and the knowledge on his part of the survey were desirable, for when reports were later submitted to his office, the Commanding Officer was already fully informed® Utilization of proper channels was found to be important to the Indus- trial Hygiene Engineer and was made standard operating procedure® During the year 1944, Industrial Hygiene activities expanded considerably and additional personnel were added to the staff® Very shortly after the Industrial Hygiene Program was begun, a search was undertaken for a qualified service man whose duty it would be to assist the Industrial Hygiene Engineer® A private, U® S® Army, was selected from a replacement depot on the basis of personnel records® He was a graduate chemist but had no practical field experience in chemical engineering or in industrial hygiene® During his assignment, however, he rendered valuable service in the laboratory and in the field® 489 During 1944, another service man was added to the staff„ He was algn a young graduate chemist without practical industrial experience.. It was necessary to teach these men the use of the various instruments used in industrial hygiene, and to supervise their work in the labora- tory o They were encouraged to study and to develop their own ideas, and both men were promoted during their tour*of duty., It is suggested here that the most important asset of the Industrial Hygiene Engineer in addition to his technical training and personal assets is his practical industrial experience., The man who has worked in various industries will find this experience most helpfulo He will have the feel of the factory., And with this back- ground of practical industrial experience he will be able to meet and work with experienced plant superintendents who are notoriously hard- headed individualso The civilian plant superintendent who works for the Army generally considers military supervision and inspection as unnecessary interference, and either resents or attempts to side step any effort to change conditions within his plant„ But it was the ex- perience of the industrial Hygiene Engineer in the Central Pacific Area that a demonstration of constructive effort was the best insurance for further cooperation and further improvement., With the addition of two men to the staff of the Industrial Hygiene Section and with the increasing number of projects under study, the facilities at the Board of Health became overburdened., There was only one set of instruments available and these instruments were shared by five operators0 There was only one-half of a laboratory bench avail- able and this also was shared by five people., For some time the possibility of establishing an Army Indus- trial Laboratory in this theater had been under consideration,, An itemized account of necessary instruments and laboratory equipment was made,. Part of the hospital laboratory of the 218th General Hospi- tal was made available to the Industrial Hygiene section,, A list of instruments and books required for Industrial Hygiene work was trans- mitted through the supply office of the Surgeon1s Office to The Surgeon General*s Office for approval and purchase„ In reply, The Surgeon Gen- eral* s Office sent information concerning Industrial Hygiene instru- ments which were available in field chests „ In general, the contents of these chests were similar to the instruments requested and the writ- ten request was then changed to conform with the suggestions of The Surgeon General*s Office„ In due time the two field chesis arrived in the Central Pacific Area and were found to contain all necessary field instruments and some additional equipment useful in laboratory experimentso It was evident that careful consideration had been given to the assembly of these chests„ The Industrial Hygiene Section was then able to establish its own laboratory and the arrangement with the Board of Health was terminated in September, 19440 490 On 20 May 1944-, War Department Circular No. was pub- lished, subject: Industrial Medical Program of U. S. Army. This circular was similar in most parts to WD Circular No. 59, but contained additional directions concerning personnel, supplies and other matters. From the first of the year, 194-5, until the end of the war, Industrial Hygiene surveys and activities were continued. A record of these activities is contained in the Industrial Hygiene File No. 729.3 Surgeon’s Office, Hq, CPBC, for 1945. among the surveys during this period were a number of Ord- nance plant surveys which involved such interesting problems as ventil- ation of a test firing range, ventilation of dust proof carburetor rooms, improvements in illumination, ventilation of metal treating plants, and dust collection units for lumber shops. Considerable time and effort was expended on providing ventilation in connection with tri- chlorethylene degreasing tanks which were installed at Ordnance, Signal and Engineer Plants when trichlorethylene became available in this theater. Provisions were not made at the time for eliminating fumes. Construction of ventilating systems was undertaken promptly but had not yet been completed at the end of the war. With the rapid favorable progress of the war in this area, the disadvantages of blackout were particularly obvious to the Industrial Hygiene Engineer, and his recom- mendations for modification and removal of blackout from shops was submitted at the earliest feasible date. Of particular interest at this time was a board of inquiry which made an investigation of working conditions in Chemical Warfare Service impregnation plants. As stated earlier in this report considerable work was done by the Industrial Hygiene staff at the impregnation plants of the Chemical Warfare Service. These plants had been in operation, however, before the Industrial Hygiene Engineer and his staff were on the job. As a result of the Industrial Hygiene survey, considerable remodeling and new construction of ventilation facilities were undertaken. The improvements in plant ventilation were considered satisfactory and adequate, and the Industrial Medical Program of physical examinations and laboratory tests was considered an effective preventive measure. Nevertheless a formal complaint was made to the Inspector General’s Office by one or more of the service men employed in these plants, and the Commanding General, CPBC, ordered an investigation. Three Chemical Warfare Service officers in this theater were appointed to the Board of Officers. Testimony was taken from personnel who had been involved in plant operations, in the physical examinations and tests, and in administrative procedures. The investigation was ex- tensive and the information obtained comprised a thick Results of this investigation were primarily concerned with procedures involving personnel records of men employed in plants. The extent of this investigation involving members of a hospital staff, a general 491 laboratory, company officers and men of the Chemical Warfare Service, the Industrial Hygiene staff, and a chaplain, indicates the potenti- alities involved in hazardous working conditions0 Another aspect of the industrial Hygiene Program developed early in 1945, with the establishment of a safety program for civil- ian employees of Army agencies0 The Safety Officer for the Office of Civilian personnel, called at the Surgeon’s Office to establish liai- son with the industrial Hygiene staff and to present a copy of the proposed Administrative Order No„ 1, subject: Safety Program for Civilian Employees of Army Agencies„ This Administrative Order was published on 26 March 1945o The Safety Officer for the Office of Civilian Personnel, was interested in safety in Army plants and depots where civilian workers were employed0 In very nearly all the plants in the Central Pacific Area civilians as well as military personnel were employed, and consequently, the safety program of the Office of Civilian Affairs and the Industrial Medical Program some- what overlappedo But as it developed, the Safety Officer was con- cerned with those particular safety hazards such as trip hazards, unguarded openings, falling objects, projection hazards and a number of other unsafe practices which are found in every planto The Safety Officer was very active in attempting to promote the safety program0 If he found conditions in any particular plant, which he had surveyed, which he thought involved health hazards, he notified the Industrial Hygiene Officer0 Thus, the two programs were complementary,. When the Safety Officer undertook a survey on the Island of Hawaii, he proposed that the Industrial Hygiene Engineer accompany him0 Other members of the inspecting party included the Field Director, Training Branch, Office of Civilian Personnel and the Deputy Commissioner, U0 S0 Employees Compensation Commission,, The party spent five days on Hawaii inspecting construction jobs and plantso This joint investigation worked very well„ The Safety Offi- cer was concerned with the immediate hazards to safety and he was able to correct many of them on the spot„ The industrial Hygiene Engineer on the other hand was concerned with those problems of a more involved nature„ For instance, the Industrial Hygiene Engineer spent considerable time inspecting the insect control facilities and fumigation facilities„ Among other things which came to the attention of Industrial Hygiene Engineer was the matter of preemployment physical examinations for civilian workers„ It was found in many cases that Form 2413, Certificate of Physical Examination, which is required by the Civil Service, was frequently not completely filled out, and that these examinations were done by local civilian physicians„ The matter seemed to warrant further study,, Very shortly after the parties’ return to Oahu, Circular No0 15520 came to the attention of the Industrial Engineer„ Circular No„ 155 stated that Mat installations having an industrial medical program established in accordance with WD Circular Nq0 198, 1944, the Civil Service Commission has agreed 492 that the determination as to the physical qualifications of an applicant for civilian employment may be made by the appropriate medical officer subject to instructions explained in the following paragraph.” It further stated that "where industrial medical of- ficers are so designated, they will act for the Civil Service Com- mission in approving and disapproving the physical qualifications of persons, both veterans and non-veterans certified by the Civil Sdrvice regional office or by the local board, who are considered for appointment to civilian positionIt was directed that War Depart- ment AGO Form No. 8-179, would be used by all industrial medical officers to record the examination. This circular was timely in- deed. A conference had been held with the Manager of Civil Service Branch Office in the Territory, and it was learned that physical exam- inations had been required by Civil Service in the past but that at the present time the appointing officer had been delegated authority to judge the physical fitness of a candidatec The matter was also taken up with the Officer in Charge, Office of Civilian Personnel, CPBCo It was decided as a result of these conferences that a survey of all employing agencies of Central Pacific Base Command would be made by the Industrial Hygiene Officer. The result of this survey showed that uniform procedures were not used by all the agencies employing civilians. All prospective civilian employees were not given a physical examination. Some were examined by civilian phy- sicians? others by Army medical officers. About half of the civil- ian employees had been given a blood Wassermann test and a chest x-ray. Since many civilian workers would probably become permanent employees of the Army, it was considered an opportune time to estab- lish a thorough-going program for preemployment examination. A proposed annex to Administrative Order N0. subjects Preemployment -Examinations for Civilian Employees of United States Army, was drawn up by,the Industrial hygiene Officer and submitted to the Surgeon. A memorandum containing pertinent facts which were discovered during the survey was attached. The proposed annex to the Administrative Order No. 1 contained the following general considerations lo That all prospective employees would be given a preemployment physical examination by a Medical Officer in government service., 20 That all prospective employees would use Form No® 2413 or WD, AGO Form 8-179 for the exami- nati on o 3o That in addition to the tests listed on these forms, all civilian employees would be given a blood test, and a chest x-ray0 40 That present employees would also be given chest x-ray, and blood test in case these examinations had not been done., 493 5o That facilities of U0 S0 Army hospitals and the Territorial Board of Health be used by Medical Officers for laboratory tests0 This matter of preemployment examination for civilians was still under consideration at the time Japan surrendered„ The end of the war with Japan found many industrial hygiene projects still under construction and requests continued to be made for industrial hygiene services. The comparatively short time in which the Industrial hygiene Program functioned limited to some ex- tent the scope of activity„ It was necessary, as late as 30 March 1943, to begin laying the ground work for this program® Considering the importance of industry in modern warfare and the direct influence which industrial hygiene has on production through maintaining good working conditions, it is hoped that War Department authorities will continue to recognize the usefulness and effectiveness of this type of work, and will provide a working basis for continuation of this type of work in the Army® It is quite likely that benefits would be derived from a continuous development of the Industrial Medical Program. 494 HEADQUARTERS HAWAIIAN DEPARTMENT OFFICE OF THE DEPARTMENT SURGEON In reply refer to: (MED) 729.3 Fort Shafter, T, H. 28 July 1943. Subjects Industrial Hygiene Program in Hawaii from January 1939-July 1943. To: The Department Surgeon. 1. The history of industrial hygiene in Ha-waii began about 1 January 1939 -when preliminary surveys of local industries were made under the direction of Mr. F. A, Schramm, Senior Sanitary Engineer, Territorial Boahd of Health, to determine the need for this service., Results of the survey revealed that approximately 10,000 workers in Honolulu were engaged in occupations where there was a potential health hazard. Inclosure No. 1 lists the number of workers exposed to each specific chemical in use. a. Support for the proposed program was readily obtained from insurance companies and industries in the Territory. When the need for the industrial hygiene program in Hawaii had been demonstra- ted to the United States Public Health Service, expenditure of Pub- lic Health Service funds for the work was authorized. The Industrial Hygiene Section was then included in the organization of the Terri- torial Board of Health, Bureau of Sanitation. Laboratory facilities and special instruments for the detection and determination of in- dustrial poisons were provided as well as books and magazines per- taining to the work. Technically trained personnel were employed. b. The organization of the program being completed, de- tailed studies of industrial hygiene problems were begun in coopera- tion with local industry. The studies included the collection af representative samples of gases, fumes, and dusts contaminating work- ing atmospheres, analysis of various materials in use, and a chemical determination of the extent of the hazard involved. Information con- cerning ventilation, light, humidity, noise, and temperature changes were included where they affected the problem. When exact data on the nature and extent of the hazard were obtained, a report was written of the study in accordance with the form attached as Inclosure No, 2. 2, Effect of the outbreak of war on the Territorial Board of Health Program, Incl. 1 495 a0 Needless to say, the outbreak of war increased the demands on public health services„ Request for assistance in pro- tecting plant manpower became urgent due to speed-up in production., It was expected that workers would be victims of industrial poisons in greater numbers, that new employees would be ignorant or careless of potential hazards, that new processes and techniques would create problems concerning health, but the very outlook was a challenge to industrial hygiene methods in protecting workers on vital war projects« bo Unfortunately the outbreak of war in Hawaii limited the scope of activities in industrial hygiene at the Board of Health * for a time because the two industrial hygiene chemists, who were of Japanese ancestry, were not permitted to enter on war projectso The Board of Health then requested the Army to, provide personnel to aid in carrying on the work in industrial hygiene and other pub- lic health serviceso 3o Joint effort of Army and Territorial Board of Health in maintaining Industrial Hygiene Program, begun 12 September 1942. a„ The Army cooperated in meeting the request of the Territorial Board of Health for additional personnel by assigning enlisted men from the Department Surgeon's Office to work on de- tached service with the Board of Health., Among these personnel was Techo 4th Grade We C„ Mawhinney who was assigned to work in the laboratory and in the field on industrial hygiene problems0 bo The UoSoEoDo, with many problems in industrial hygiene and safety to cope with as a result of rapid expansion, called on the Board of Health for assistance because the laboratory, the necessary instruments and the trained personnel necessary, were available0 A basis of technical data for the control of potential industrial hazards was established for work in tunnels, paint shops, camouflage plants, printing plants, etcD Co The Army made use of this industrial hygiene service during an emergency at Fort Kamehameha Ice Plant« do The Navy, while developing its own program, frequently used the facilities at the Board of Health0 40 Summary of industrial hygiene surveys on war projects including the hazards found (Jan 1943 - July 1943)e a0 During the past six months, detailed studies have been made of the following war projects and the necessary recommendations have been offeredo The summary is intended only as an outline showing the variety and number of problems studied together with an indication of hazards foundo 496 b. Painting in cold storage warehouses (10 plants). (1) Methyl alcohol and ethyl alcohol, as solvents in paint, caused severe irritation of the respiratory tract and eyes of painters working in enclosed rooms where ventilation was inadequate. Concentration of the vapors exceeded the lower explosive limit. c. Camouflage plants #1 and #2. (1) Women were affected with dermatitis from the use of paint thinner in removing bituminous emulsion con- tained in paint. (2) Lead was present in the paint which came off as a fine dust in the weaving operation. During this operation women were exposed to approximately half of .the concentration of lead permitted in a working atmosphere. d. U.S.E.D. Tunnels T-10, T-403, T-71, T-88, T-2291, T-89. (1) Toxic gases generated by dynamite in tunnel con- centration included carbon monoxide, nitrogen oxides, and smaller amounts of other gases. (2) Dust from mucking, dynamiting and drilling was a problem. (3) Lack of proper ventilation was a serious handicap. (4) Other factors included contaminated drinking water and lack of sanitary facilities. e. Fort Kamehameha Ice Plant. (1) Ammonia fumes from break in pipe exceeded safe limits o (2) Chromium compound in brine caused dermatitis. f. U.S.E.D. Reproduction Plant. (1) Ammonia fumes from developing box, and nitrogen oxide gases from open arc lamps were found to be con- taminating the work-room. (2) Improper ventilation was in use in the multilith room. 497 g. Halawa Water Tunnel. (1) Same difficulties encountered here as in U.S.E.D. tunnels, namely, dust, CO, NO2 and ventilation. h. U.S.E.D. Pipe Coating Operations using "Biturene.” (1) Analysis of Biturene which was handled by the workmen in the molten state revealed presence of hydrocarbons, sulfur, hydrogen sulfide, and nitrogen compounds, i. U.S.E.D. Hot Plants. (1) In this study, which is not yet completed, hot asphalt, dust, and dermatitis are the hazards. j. Test on U.S.E.D. fuel tanks. Dredge Holland & QM Barge #53. (1) Tests for inflammable gases are made on all fuel tanks and bunkers before men enter or begin welding. k. Test for combustible gases in enclosed tunnel at Bellows Field. (1) A leaking Valve in an aviation gas line developed an explosive concentration in an enclosed pit. Work- man was overcome by fumes. WARREN C. MaWHINNEY, 2nd Lt., Sn. C., 498 REPORT OF ACTIVITIES INDUSTRIAL HYGIENE DIVISION OF MEDICAL INSPECTOR'S OFFICE, CPBC 1 January - 31 December 1944 lo Introduction and General Information: a0 The Industrial Medical Program of the United States Army, as outlined in War Department Circular No® 59, is carried on in the Central Pacific Base Command by the Industrial Hygiene Division of the Medical Inspectors Office., The Industrial Hygiene Division is composed of one officer and two enlisted technicians* Laboratory facilities have been provided at the 218th General Hospital, Tripler Area* At the present time, field instruments of the Industrial Medical Depart- ment, U« S« Navy, are being used pending arrival of a complete set of instruments and equipment from The Surgeon General’s Office® A labora- tory equipped with all the necessary instruments and facilities for industrial hygiene work will be in operation in the near future* bo Activities of the Industrial Hygiene Division ft*om 1 Jan- uary to 31 Decentoer 1944 have included complete surveys of nineteen plants, eighteen special projects requiring field tests or labora- tory analysis, and nine*special assignments including two lectures and three written articles for Essential Technical Medical Data* Inspec- tions of eleven completed Industrial Hygiene construction projects have been made with the Medical Inspector, GPBCo Arrangements have been made for periodic x-rays, physical examinations, and laboratory tests for personnel in more hazardous occupations® Co Industrial Hygiene problems in the GPBC have been var- ied, and have included ventilation, lighting, dust control, elimination of toxic gases and fumes, prevention of dermatitis, and the introduc- tion of protective clothing * A considerable amount of money has been involved in the construction of ventilation systems, new lighting facilities, new protective equipment, and other measures for promoting good working conditions® do An illustrated lecture for the purpose of educating plant personnel on the subjects of industrial hygiene has been developed and used during the past year* e® A written report of each industrial hygiene survey was submitted to the Surgeon, CPBC* Photographs were taken of all major improvements instituted by the Industrial Hygiene Section* f* Held tests and, in certain cases, laboratory analyses were made in every survey as a basis of recemendations for iimproving working conditionso Inclo 2 499 2<» Industrial Hygiene Surveys and Accomplishments: a. Little Theatre* APO 957: Installation of exhaust fan and ductso b0 QM Laundry Area #3* Installation of eight exhaust fans over pressing section* a louver (80* x 5*) in marking section, and new lighting facilities in the marking and sorting departments <. Co Exchange Office, Headquarters, CPBCs Abatement of dust problem., do CWS Inpregnation Plants, APO 957s Installation of three plywood inclosures approximately 8' x 9* x 7* for collecting and ex- hausting tetrachloroethane fumes; erection of three large exhaust stacks in connection with exhaust fans and extension of fifteen smaller stacks above roof5 construction of additional 3* x 3* underground duct in connection with plywood inclosures; installation of one new large exhaust fan and four new sheaves; installation of six supplied air respirators; and construction of three closed condenser units8 e« Uo So Army Printing Plant, Fort Armstrong: Installation of two exhaust fans and new fluorescent lighting.fixtures» fo 3605th Ordnance HAM Go.,* Fort Armstrong: New lighting facilities; construction of portable metal fume exhaust hood with blower for metallizing unit; installation of three fans in paint shop; measures for prevention of dermatitis <, go -551st Ordnance HAM Co0, APO 957| Removal of blackout; installation of instrument light on machines; elimination of exhaust fumes from dust-proof carburetor room„ ho Underground Telephone Exchange* Bellows Field: Instal- lation of room conditioner io 3606th Ordnance HAM Coo, APO 957s Installation of new exhaust line for motor testing unit; installation of new fluorescent lighting facilities; introduction of personal protective equipment for sand blasters and painters; measures for prevention of dermatitis; construction of fume hood for metallizing unit0 jc 356th Ordnance M0M0 Co, Fort Huger; Installation of exhaust fans'in paint shop; introduction of respirators for lead grinders* ko Aliamanu Crater Hot Plant: Abatement of smoke and dust nuisance; installation of "Wet House«n 500 1« 81st Ordnance M*Mo (Tank) Co*, APO 957: Removal of blackout; introduction of respirators for painters; installation of exhaust fan in dust-proof carburetor shop* m» 'typewriter Repair Shop, APO 957: Installation of new fluorescent lighting facilities; construction of fume hood for solvent spraying * n« 231st Ordnance M«M* Co0, APO 957: Measures for preven- tion of dermatitis; protective equipment for painters; plans submitted and approved for new battery acid mixing plant* o* 3554th Ordnance M.M* Co , APO 957: Stoddard1s Solvent substituted for lead gasoline as cleaner; lighting facilities requested* p, QM Bakery, APO 957: Installation of new lighting facil- ities, new mess facilities, drinking fountains and new screening; blackout removed; installation of exhaust fan in bread storage room* q* Ordnance Depot, APO 456: Personal protective equipment supplied for personnel working with solvents* r* Hawaiian Ordnance Depot, APO 958: Improved ventilation in Rarkerizing plant; installation of dust collection machinery and ducts in lumber shop; rifle range sound-proofed* So 14th Medical Laboratory: Hew lighting facilities in- stalled* 3* Special Projects Conducted by Industrial Hygiene Section: a* Washing and sterilizing heavy woolen socks, cushion sole: Laboratory tests were made to devise a suitable method of washing socks in the field to prevent undue shrinkage and provide sterilization of fungi* b* Ammonia fumes at Fort Kam ice plant: Chemical tests were made in plant to determine concentration of ammonia fumes® Co Tests for Carbon monoxide at T-26, Waipio: Tests for carbon raonixide were made in Tunnel T-26 at request of Safety Engineer, USED* d« Analysis of Bendix Cleaner: Laboratory analysis of "Bendix” cleaner was made to determine irritant substance* e* Irritant properties of kerosene and Stoddard’s Solvent: Patch tests were made in the laboratory to determine relative degree of skin irritation caused by kerosene and Stoddard’s solvent* 501 fo Combustible Gas Tests: Tests were made at Ordnance * Depot, Aliamanu Crater, prior to removal of gas tanks„ go Dredge Sacramento: Tests for combustible gas and lead dusto Introduction of personal protective equipmento ho Tetra-ethyl lead: Study of lead cohcentration in U» S. Army ranges using tetra-ethyl lead gasolineo io Uo So Army Dredge B 61730s Tests for combustible gaso jo Protective equipment for graves registration details: Tests requested by 27th Division to determine suitable protective equipment for graves registration details handling dead bodies on battle-fieldso A Navy type MoSoAo cartridge respirator was supplied for protection against organic vapors0 ko Welding and Metallizing Shop, Base 6: Inspection request- ed by Safety Engineer, USEDo L Surgeon’s Office: Plans drawn up for soundproofing Surgeon’s Office, CPBCo mo Fumigation and Termite Control: Inspection of methods used in CPBCo Personal protective equipment introducedo n0 Lighting facilities for 18th Medical General Laboratory: Plans for new lighting facilities for laboratory were checkedo Oo Memorandum on Stoddard's Solvent: Plans for reclaiming used Stoddard’s Solvent were drawn up by Industrial Hygiene Sectiono p» Circular, CPBC? A circular on Industrial Hygiene was prepared for distribution in CPBCo This has not been published to date- 4o Special Assignments and Reports: a0 "Chemical Procedures for Determining Tetrachloroethane": A report written at the request of Captain A0 H„ Laube for use by the 110th Chemical Processing Co0, APO 957o bo "Sanitary Control of Milk, Ice Cream, and Soft Drinks"; A lecture given by Lto W0 Co Mawhinney to officers of the Medical In- spector’s Office® Co "Exhaust System for Metallizing Units": A report sub- mitted for publication in ETMDo 502 d. "Study and Report of Literature on Fatigue": Report submitted at request of Deputy Surgeon* CPA* e. "Industrial Hygiene in CWS Impregnation Plants": This report is being prepared for publication in ETMD. f* "Industrial Hygiene": A lecture delivered to the Officers Candidate School by Lt. W« C. Mawhinney. go "Recommendation for Removal of Blackout": A report submitted to the Surgeon* CPBC. h* "Development of Camouflage Plants": This report was written for publication in ETMD, 5* Medical Programs i v a. Physical examinations and laboratory tests were insti- tuted at 147th General Hospital and 14th Medical Laboratory for CWS Impregnation Plant personnelo b<, X-rays were given to lead grinders of 356th Ordnance MoM* Co.* Fort Ruger* Co Lanolin was supplied to all Ordnance shops for prevention of dermatitiso 60 Inspections: Inspections of the following,plants were made by the Industrial Hygiene Officer and the Medical Inspector* CPBC: a. 551st Ordnance Depot, APO 957* b. 231st Ordnance HAM Co** APO 957* Co 3606th Ordnance HAM Coo* APO 957# do 3605th Ordnance HAM Co** Fort Armstrong. e« 356th Ordnance M.M. Co.* Fort Ruger» f. QM Laundry, Area #3> Kaneohe. g. QM Laundry, APO 957. h. CWS Impregnation Plants (2), APO 957 and Typewriter Repair Shop* APO 957. i. QM Bakery, APO 957. 503 jo Waikakalaua Tank Farm, Waikakalaua® ko QM Laundry, East Range, APO 957e lo Pearl Harbor Navy Yard® 504 * » Inclosure 3 is War Department Circular 198 dated 20 May 1944« "Industrial Medical Program of United States Arny" Inclo 3 Inclosure 4 is War Department Circular I55 dated 28 May 1945 which contains a section on the Army Industrial Medical Program. Incl« 4 506 LIST OF REFERENCES Chapter 39 1. TO Cir No. 39* Washington, 24 February 194-3* 2. Extract, Special Orders No« 89, Hq Hawaiian Dept, Ft. Shafter, 30 March 1943* Ind. MED File No. 729.3* 1943* 3* Ind. MED (General File) 729*3* Serial No. 7, Hq Hawaiian Dept, Off of Dept Surg 1943* 4* Ind. MED (General File) 729*3* Serial No. 23, Hq Hawaiian Dept, Off of Dept Surgeon 1943« 3. Ind. MED (General File) 729.3, Serial No. 9* Hq Hawaiian Dept, Off of Dept Surg 1943. 6. Industrial Med. (General File) 729*3* Serial No. 9* Hq Hawaiian Dept$ Off of Dept Surgeon, 1943* 7. Author’s personal experience and participation in Industrial Hygiene Program from 12 Sept 1942 - 1 Sept 1945 is used as the basis for the following historical account. 8. "Development of Methods of Camouflage Manufacture, POA," Aug 1944* ETMDc 9. Industrial Hygiene Program in Hawaii fr Jan 1939 - July 1943* Ind. Med, File No. 729*3* Hq Hawaiian Dept Surg, 1943* Ind 1. 10. Special Orders No. 177* Hq Hawaiian Dept, Ft. Shafter, T. H., 26 Jun 1943* 11. Special Orders No. 196, Hq Hawaiian Dept, Ft. Shafter, T. H., 13 July 1943. 12. Industrial Hygiene Program in Hawaii from January, 1939 - July 1943* Industrial Medicine (General File) 729*3* Hq Hawaiian Dept, Off of Dept Surgeon, 1943 Ind 1. 13. "Chemical Tests for Tetrachiorethane in Impregnation Plants," Schofield Barracks, Industrial Hygiene File (Reports) 729.3* Surgeon's Office Hq, CPA, 1944* "Survey of Chemical Warfare Service Impregnation Plant, Bldg. 1163," IBID. "Survey of Chemical Warfare Service Impregnation Plant, Bldg. 363*" Schofield Barracks, IBID. 506a 13. (cont'd.) "Increasing Height of Exhaust Stack Above Roof of Impregnation Plants," IBID. Fume Hoods for Chemical Laboratories, 110 Chemical Processing Company, APO 957, IBID 14. "Survey of Chemical Warfare Service Impregnation Plant, Bldg 1663," IBID. 15» "Industrial Hygiene in Chemical Warfare Service Impregnation Plants," ETMD, CPBC, March, 1945* 16. Report of Activities, Industrial Hygiene Division of Medical Inspec- tors Office, CPBC, 1 January - 31 December 1944, Industrial Hygiene, Pile No. 729.3, Surg’s Off Hq, CPBC 1944, Incl No. 2. 17. Acknowledgement fr TSG Off, par 2a-b re ETMD Report of 19 Apr 1945, CPBC. 18. WD Cir No. 198, Incl No. 3. 19. Proceedings of a Board of Officers Convened Pursuant to Par #1, Special Orders #20, Hqs, Chemical Warfare Service, CPBC, Copies of Report are available at Hqs, CWS, CPBC, 28 February 1945* 20. WD Cir No. 155, Incl No. 4. 506b CHAPTER 40 Civil Public Health The health of the civilian population of the Territory of Hawaii during World War II was good. The over-all civilian death rate reached an all-time low of 5.7 deaths per estimated thousand of population during the fiscal year of 1945. This is a lower death rate than has ever been recorded for any State, In part, the low death rate results from the relatively large pro- portion of the population in the lower age groups. There have been no civilian catastrophies, Tuberculosis and dengue fever have been the only communicable diseases of major importance. Tuberculosis ranks fourth among the leading causes of death in the Territory, Efforts toward the control of tuberculosis have been considerably intensified during the war. This has been possible to a great extent through the assistance of Array in providing additional hospitalization facilities for contagious diseases, A dengue fever outbreak beginning in July 1943 was brought under control during the first half of the year, 1944, through vigorous control measures, largely supported by the Array, There have been two outbreaks of measles, two mild out- breaks of influenza, and two .small outbreaks of poliomyelitis. Early in 1942, there occurred an outbreak of 75 typhoid fever cases traced to the cafeteria of a public school. This occurred prior to compulsory immunization of all civilians against small- pox and typhoid-paratyphoid fevers in 1942, The ten leading causes of death in the Territory for the fiscal year 1944-45 are shown below; Rank No. Cause of Death Total 1944 Deaths 1945 1 Diseases of the heart (90-95)* 579 532 2 Cancer and other malignant tumors 365 358 3 (45-55). Congenital malformations; and diseases * • 259 276 4 of early infancy (157-161).. Tuberculosis (13-22). 272 265 5 Nephritis (130-132). 235 214 6 Intracranial lesions of vascular 197 192 7 origin (83)* Violent or accidental deaths (exclusive 271 188 8 of homicide and suicide) (169-195)* Pneumonia (107-109)* 146 119 9 _ Diabetes mellitus (6l). 81 73 10 Suicide (163-164). 50 45 Ten Leading Causes of Death, Territory of Hawaii* * Civilian population estimates. Territory of Hawaii, as of 1 July 1944, 492,379; 1 July 1945, 502,122, 507 During the first year of the war the Office of Civilian Defense, the Territorial Board of Health, the U. S0 Public Health Service, and the Arny maintained the closest possible liaison in matters of civilian public health and medical care. Both the military and civilian community were dependent upon one another in the defense of the vital military and Naval bases in the Territory. Two emergency hospitals were established under the Office of Civilian Defense (Wahiawa and Sacred Hearts), and additional temporary hospital'wards were set up at Kuakini Hospital. Array assistance was given to the construction of badly needed new addi- tions to Queen's Hospital, St. Francis Hospital, and Kapiolani Hos- pital. When it became necessary that the Array take over the U. S. Public Health Service Quarantine Station at Sand Island, it was arranged that in case of a civilian epidemic the Army would provide the necessary hospital Certain categories of civilian medical and hospital personnel have been very limited, so much so that Array personnel, including medical officers, nurses, hospital corps-men, and medical and sanitary technicians have been provided to the civilian community from time to time. These personnel have been supplied by the Array without charge.3” o in 1942, the Array- appointed a medical officer to act as Civilian Hospital Control Officer to keep check as to where bed vacancies existed among the civilian hospitals, particularly in order that night emergency cases would receive prompt treatment,‘ The Array established a policy of accepting civilian emergency cases for hospital treatment in all instances where civilian facilities were not available. This policy has continued up through the present time. Repeated checks have been made from time to time by rep- resentatives of the Surgeon, Hawaiian Department, concerning the adequacy of office-type medical care for civilians. Physicians' offices have operated under stress, reception rooms have been crowded, and appointments for non-urgent cases have often necess- arily been made weeks in advance. The services of physicians for home visits have been difficult to obtain. The adequacy of the number of physicians in the Territory has not been measurable as a simple quotient of the number of physicians divided by the popu- lation. Physicians practicing singly, particularly the large num- ber of Oriental physicians have not been as busy as the larger clinics and medical groups centrally located in Honolulu, There have been approximately 220 physicians on the island of Oahu to service approximately 340,000 civilians, a ratio of 1:1600. It has been the opinion of the President of the Honolulu County Medical Society and the Director of the Procurement and Assignment Service for the Territory of Hawaii that civilian medical care has been adequate. During 19459 the Procurement and Assignment Service for the Territory certified the availability of 83 civilian phys- icians for service with the Navy. Only a few of these physicians 508 have actually gone into Navy service. Inasmuch as 19,700 of the 28,500 civilian Ariry employees have been hired from among the civ- ilian population on Oahu, this has resulted in considerable relief of civilian medical facilities. Employees of the U, S, Engineer- ing Department and the Hawaiian Air Depot have been provided with dispensary service, and in the case of the Hawaiian Air Depot with hospitalization. During the early period of the war many civilians were brought to Oahu for employment by the Army who were in poor physical or mental health. These civilians imposed a heavy burden upon Array and civilian medical facilities, particularly the latter. During the past two years the medical screening of civilian Array employees on the mainland before transfer to Oahu has greatly improved. In 1945, a representative of the Office of Civilian Personnel, Central Pacific Base Command, was sent to the Seattle Port of Embarkation in the interests of further improving the screening program. The Surgeon, Central Pacific Base Command, has cooperated in the prepar- ation of a medical guide for the selection of civilian Array em- ployees for the Territory based on past experience. Housing on the island of Oahu has been very inadequate. However, this inadequacy has existed with very little measurable effect upon the health of the civilian community. The mild equable climate demands a minimum of provision for housing. Endemic typhus fever has shown an increased incidence during the war, but a re- duction in the normal peacetime rat control program among civilian residences may be the responsible factor. The 1945 Territorial Legislature has appropriated funds for the institution of typhus fever control measures in Honolulu during the coming two years. Crowded civilian housing facilities were considered when the Surgeon, Hawaiian Department, took the initiative in 1942, in eliminating the list of active tuberculosis cases awaiting admission to pub- lic sanitoria by arranging for the admission of the necessary num- ber of these cases to Army hospital facilities. The Array has assisted as much as possible in the pro- vision of housing for civilians. In 1945, the Array was housing 7,729 civilian employees in the Territory, Water supplies have been satisfactory. The Army has taken the initiative in accomplishing chlorination for the major civilian water distribution systems. All water distributed to Honolulu has been chlorinated from November 1943, up through Sep- tember 1945 a The food situation in the Hawaiian Islands has not been as critical as on the mainland. There has been no food rationing 509 program* Native fruits and vegetables, coffee, sugar, seafoods, and meats have usually been available, (see Chapter 24 concerning Nutrition)* The prohibition of the serving of milk in Army messes except for hospitals has conserved the available milk supply for the civilian population* Of the food items only fresh meats have become scarce from time to time during the latter half of the war period* Local fishing grounds have not been fully exploited during the war because of the necessary restrictions upon fishing applied by the Navy* During the latter part of 1944 and early 1945* the restrictions limiting fishing have, been progressively lifted* The first of a series of orders regarding immunization of the civilian population of the Territory of Hawaii against small- pox and typhoid-paratyphoid fevers was issued from the Office of the Military Governor on 17 February 1941This order required the immunization of the rural civilian population in the northern section of the island of Oahu* Subsequent orders extended the area until all Oahu, including Honolulu, and the Islands of Hawaii, Maui, and Kauai were included* All persons over the age of 3 years were required to be immunized against typhoid-paratyphoid fevers, and vaccination against smallpox was required of all persons over the age of six months, unless such persons had been so immunized since 1 January 1941o Exemptions and deferals were provided for persons who were actually ill, infirm, aged, crippled, or who suffered from any condition which in the opinion of a physician might be aggravat- ed by either typhoid or small pox vaccinations* The Board of Health working in collaboration with The Office of The Surgeon, Hawaiian Department, undertook the administration of the program*11 Triple ’typhoid vaccine and vaccinia virus as well as certain supplies and equipment were furnished by the U* S* Army* Army medical officers and nurses assisted in the vaccination program at the various vaccination centers whenever assistance was needed* Private physi- cians had their place in the program and cooperated fully* The Honolulu County Medical Society adopted a fee schedule applicable during the program of one dollar per injection of typhoid vaccine and one dollar for vaccination, and similar action was taken by the other island county societies* Time was given for individuals to be vaccinated by their own physicians if they so desired, and pri- vate physicians on Oahu vaccinated approximately one-half of the civilian population of the island prior to the opening of the free vaccination centers in Honolulu* Of the total enumerated popula- tion of the Territory of 41&,886, the number immunized or excused as of 1 September 1942 was 383,620* The number who were immunized against typhoid-paratyphoid fevers was 361,342,against smallpox 366,06?, and against diptheria 18,017o12 The results in the reduc- tion of typhoid fever cases in the Territory were outstanding* During the years 1943 and 19A4 there were only a tenth as many cases as there had been in 1940 and 1941, in spite of war-time conditions* Upon relaxation of military law in March, 1943, Hawaii Defense Act 510 No, 60 was prepared and passed to take the place of the military order requiring vaccination against the typhoid fevers and small- pox, By Hawaii Defense Act Rule No, 93, booster injections were required for those who had their first series in 1941-42, Diphtheria immunization was not required for civilians in 1942, but all parents were urged to have their children between the ages of nine months and ten years protected against this disease if they had not previously been immunized, Hawaii Defense Act Rule No, 60, in 1943, made dlphther ia immunization for children mandatory. Immunization against tetanus was not included in the pro- gram, The advisability of including this immunization was given careful consideration, but was not considered necessary in the interest of public health. The wisdom of this decision was not tested by the course of events, as no eneny invasion with attending civilian casualties occurred. During the years 1944 and 1945, there were 18 and 15 civilian cases of tetanus in the Territory, with 6 and 10 deaths respectively, The large number of cases of tetanus among enemy civilian casualties resulting from the in- vasion of Saipan might serve as a warning in case preparation of civilians for war may again become necessary. The number of cases of communicable diseases among civ- ilians has shown a steady increase during the war years, but has remained below the all-time high of 26,073 during the fiscal year 1940-41* The incidence per capita has decreased. The number of deaths from communicable disease have decreased. Comparative figures are shown below; Number Approx, Rate Per Communicable Approx, Death Rate Year of Cases 1000 Per Annum Disease Deaths Per 1000 Per Annum 1940-41 25,570 55 469 1 1941-42 6,644 15 474 1 1942-43 14,151 30 469 0,97 1943-44 18,172 37 468 0.95 1944-45 20,162 40 442 0.88 A tabulation of Communicable Disease Cases, Territory of Hawaii, is as follows; 511 1941-42 1942-43 1943-44 1944-45 Disease Cases Deaths Cases Deaths Cases Deaths Cases Deaths Dengue 0 0 0 0 1502 3 36 0 Diphtheria 73 0 90 2 24 0 37 2 Dysentery 79 2 226 1 372 2 395 0 Bacillary Gonorrhea 1220 0 1255 0 1292 2 944 1 Influenza 293 13 4288 ' 15 7002 12 3765 6 Measles 712 1 137 0 888 0 10264 16 Measles,Ger- 226 0 282 0 113 0 191 0 man Meningitis 6 3 34 5 60 5 33 4 Parotitis 178 0 2966 0 3008 0 818 0 Pertussis 638 16 1531 12 880 5 90 0 Pneumonia, 300 57 188 47 110 38 86 27 lobar Poliomye~ 31 5 74 0 8 0 4 0 litis Scarlet fever • 20 0 51 1 55 0 50 0 Syphilis 871 52 1049 61 823 62 503 48 Tetanus 30 8 17 7 18 6 15 10 Tuberculosis 766 269 1072 274 n2i 282 1042 284 Typhoid fever • 121 7 9. 2 5 1 7 2 Typhus fever 88 1 74 0 186 2 152 2 Varicella 457 0 14U 1 1427 0 1151 1 Others 535 40 439 41 399 48 579 39 TOTAL 6644 474 15223 469 19293 468 20162 442 An epidemic of typhoid fever occurred in Honolulu in March, 1942, among the students of one of the intermediate schools0 There were 78 cases and 5 deaths * Practically all cases were hospitalized, almost all of them by the Army, Epidemiological and laboratory investigation pointed to the school cafeteria as the source of the epidemic„ One of the employees, a girl of 17, was detected as a carrier and the prob- able focus of infection0 Army epidemiologists actively assisted the school nurses in visiting absentee pupils from this school and bring- ing all of those pupils suspected of having typhoid fever into the hospital for observation and treatment. Nevertheless, three cases occurred in homes among individuals not attending the school, secondary to cases in pupils which had missed detection. Following the typhoid- paratyphoid fever immunization program which was completed during the fiscal year 1943-43* the incidence of typhoid fever in the Territory showed a marked fall; 512 Typhoid Fever in Territory of Hawaii lear Cases Deaths 1940-41 69. 7 1941-42 121 7 1942-43 9 2 1943-44 5 1 1944-45 7 2 After an epidemic during the fiscal year (July-June) 1941-42, measles remained low in incidence until April, 1944, when numerous cases were imported to the Territory with the arrival of children of island residents from the mainland*, This was followed by a consider- able epidemic of measles during the fiscal year 1944-45, to be expected in a comparatively young island population,, Influent has been epidemic during the 1940-41 period# In June, 1943, influenza again appeared in mild form, beginning in rural Oahu, and spreading to Honolulu and the other islands during July, August, and September# During this outbreak there were over 11,000 reported cases# In the spring of 1945, another mild outbreak of in- fluenza occurred, determined by an Amy laboratory to be Type B# There were 3765 cases reported by the end of the fiscal year (June, 1945)® Dengue fever was introduced into Honolulu in July, 1943, after being absent from the Territory for two decades# The history of this outbreak, amounting to over 1500 reported civilian cases, is more fully described under the chapter on arthropod-borne infections. Prompt control measures were instituted. The Array and U. S. Public Health Service cooperated wholeheartedly with the Board of Health. The epidemic was brought under control during the first half of 1944* Eleven cases of poliomyelitis had occurred during the fiscal year 1941-42. In July, 1942, poliomyelitis appeared again, reaching a peak in October and November# There were 32 cases in this outbreak ending in December, 1942# In February, 1943, poliomyelitis appeared again, and by the end of the fiscal year (June, 1943) 74 cases had been reported# Through the combined efforts of the Office of Civilian Defense, the Territorial Board of Health, and the Array, a poliomyelitis hospital was set up to isolate and treat cases# The Array provided a number of nurses and hospital corpsmen. Tuberculosis ranked fourth among the leading causes of death in the Territory during the fiscal year 1944-45. The number of new cases reported during each year of the war has increased# Many factors have influenced tuberculosis statistics which make their 513 interpretation difficult0 A considerable number of the reported cases have occurred in war workers who were subsequently returned to their mainland homes for care* During the past few years the tuberculosis case finding program has been greatly improved in the Territory, par- ticularly through the use of a 4n x 5" mobile photoroentgenographic unito During the 1944-45 fiscal year, 37,000 chest x-rays were taken by the Board of Health in tuberculosis surveys* The emphasis in these case finding surveys has been placed on certain groups; industrial, selective service, low economic, teachers, food handlers, tuberculosis contacts, war workers, and pregnant women* In general, approximately 2% of those surveyed have shown X-ray evidence of tuberculosis0 Only 31o6% of cases found have been in the minimal and easily treatable stage* The number of new tuberculosis cases and mortality rate for tuberculo- sis in the Territory for each year of the war is shown below; Civilian Tuberculosis Cases, Territory of Hawaii Year New Cases Mortality/l000 000 1939-40 715 63,2 1940-41 740 53 o3 1941-42 766 57o3 1942-43 1072 56.6 1943-44 1121 57.8 1944-45 1353 54*9 Immediately following the enemy attack, 7 December 1941* a number of tuberculosis patients at Leahi Hospital, Territorial Tubercu- losis Hospital on Oahu, were discharged to provide hospital space for possible additional battle casulaties* Later some of these patients were readmitted to Leahi Hospital, but it was not possible to readmit all of them* Many newly discovered and reactivated cases had occupied the limited facilities* Furthermore, there was a serious shortage of doctors, nurses, and orderlies at Leahi Hospital* In March 1942, the Army hospitalized three civilian patients with tuberculosis who had been disciplinary problems at Leahi, and who had been offered prisoru . sentences or hospitalization by the Office of the Military Governor In August 1942p the Array accepted an additional 25 civilian patients who were active cases, of danger to the community, but who could not be admitted to Leahi Hospital for lack of facilities* In October, 1942, and for several months thereafter the Array loaned Leahi Hospital a medical officer experienced in the treatment of in November, 1942, the Array accepted an additional 100 civilian tuberculo- sis patients, eliminating for the first time in the history of the island of Oahu the list of active tuberculosis cases awaiting hospital treatment* ° During the years 1943-45* the Array admitted 356 civilian tuberculous patients* These admissions were to have been a temporary expedient* The Office of Civilian Defense was to construct a 100 bed unit for tuberculosis cases adjacent to the OCD Hospital at Wahiawa* However, this Wahiawa unit was not completed until November, 1943, at which time the Arny was hospitalizing approximately 170 tubercu- losis caseso When 10C of these cases were moved to Wahiawa, the Director, OCD, requestsd that the Array furnish a medical officer to care for them0 The Ar.ny agreed to provide consultation service only,1' Since that time, the Army has continued to provide hospitalization for the remaining cases, the Array census being 51 in June, 1944, and 43 in June, 1945o Further a-imissions of civilian tuberculosis patients to Array hospitals have been curtailed,, Throughout the three years the Array received monthly financial reimbursements from civilian agencies for the subsistence and medicinal accounts of these patients to the amount of $10?5 per patient per day; however, repeated difficulties have been experienced in the collection of these bills from the many different agencies involved,, One of the original plans considered in 1942, had been to build additional temporary wards on Leahi Hospital grounds for the accommodation of the civilian patients. This plan had been disapproved by the Department Surgeon, because of the already con- gested conditions at Leahi, and proximity of military objectives0 Had some plan of expanding existing civilian tuberculosis hospitalization facilities been possible, even if it would have been necessary for the Array to provide certain personnel, the Array might not have been burden- ed with these tuberculosis patients for so long a period. The period of the war has shown a consistent growth in the venereal disease control program in the Territory, During this period the venereal disease rate for locally acquired venereal diseases among Array troops in the Territory has fallen below one per thousand per annum. The total number of venereal disease cases reported has increased each year, but more and more of them have had their source of infection in the mainland. The numbers of venereal disease cases reported in the Territory by years, and the proportion of these which have had the source of their infection on the mainland are shown below; Gonorrhea Cases in Territory of Hawaii Year Local Infections Off-shipping Gases 1942-43 1093 123 1943-44 1155 442 1944-45 856 903 515 Syphilis Cases in Territory of Hawaii Year Local Infections Off-shipping Cases 1942-43 214 . 67 1943-44 65 126 1944-45 51 “303 Serelogical tests for syphilis taken during Selective Service examinations in 1942 showed approximately 2$ positives0 The control of venereal diseases in the Territory in spite of the large numbers of introduced infections has been a considerable achieve-* ment by the Board of Health,, Case finding through the tracing of con- tacts and sources of infection has been efficient„ An impetus was given to this program in April, 1942, with the passage by the Military Gov- ernor of General Order No, 107o This order required the reporting of all cases of venereal disease to the Board of Health within 24 hours after diagnosis by medical officers of the Army and Navy, as well as civilian physicians, provided for the naming of and investigation of contacts, and made the Board of Health responsible for placing infectious civilians under proper surveillance, the expeditious investigation of contacts, and the return of delinquent cases for proper treatment„ For a period in the Army provided hospitalization in a part of a local civilian hospital for the treatment of infected women found in the case-finding program who could not or would not provide their own private physicians0 With the relaxation of military law in March 19439 General Order No„ 110 (1943) was passed to replace General Order No„ 107 (1942) which automat- ically became rescinded,, General Order No0 110 has remained in effect during the emergency0 Openly acknowledged houses of prostitution flourished in the Territory until 1943* when prostitution was suppressed on Maui and Kauai, and September, 1944* when prostitution enterprises amounting to ten million dollars a year were closed down in Honolulu,, Contact statistics for military infections showed that 66-75$ ®f them were contracted from professional prostitutes, however, the military venereal disease rate for locally acquired infections was quite low. Since the closing of the houses of prostitution the militaiy venereal disease rate for locally acquired infections has become lower. Comparative statistics for all VD cases before and after the closing of the brothels on Oahu have shown a 38% reduction in gonorrhea and a UU% reduction in syphilis 0 While professional prostitution was flourishing in the Territory, as many as 40,000 prophylactic treatments were given at Arny prophylactic stations each month, A certain proportion of these treatments were given to civilians. 516 The Territorial Legislature, in 1943, passed a law requiring a serological test for syphilis for all pregnant women. In 1945, the Legislature passed a law requiring a serological test for syphilis as a prerequisite for a marriage license in the Territory, Blood serologic tests have been required of civilian food handlers. During the fiscal year the Territorial Board of Health released free of charge 54,500,OCX) units of penicillin for the treat- ment of gonnorrhea and syphilis cases. Results were reported as very successful. LIST OF REFERENCES Chapter 40 10 Civilian health statistics fr Annual Reports, Board of Health, To Ho, 1941-45" 2o Quarantine folders• 3o File 020, Sec0 of War, 1943* HHD, Off of Dept Surge 4. File 020, Seco of War, 1943, HHD, Off of Dept Surge 5o File 020, Sec. of War, 1943, HHD, Off of Dept Surge 6o File 020, SecQ of War, 1943* HHD, Off of Dept Surge 7o Gen Order No. 101, Off of the Mil Gov, 30 Apr 42. 8o Booklet, n Housing of Civilian Workers, Island of Oahu, T0 H»,u USAFPOA, Restrictedo 9. The Hawaii Health Messenger, pblshd monthly by the Board of Health, To Ho, Vol„ 1, Noe 10, April 1942e 10o Instruction for Vaccination, File 720.3 Vaccination, Immunization and Inoculation, HHD, Off of Dept Surg, 1942. 11 o File 720o3,9 Vaccination, Immunization, Inoculation, 1942, Serial #123, HHD, Off of Dept Surge 12o File 720.3? Vaccination and Immunization, Inoculation, 1942, Serial #117, HHD, Off of Dept Surge 13o Statistics obtained fr Board of Health, T. H. 14* File 710, Tuberculosis (1941), Serial #9, HHD, Off of Dept Surge 15" File 710, Tuberculosis (1941), Serial #10, HHD, Off of Dept Surge 16. File 701, Medical Attendance (1942), Serial #65 (News Release)« 17o File 701, Medical Attendance, Misc. 1943, Serial #84, letter w/lst Inde 518 CHAPTER 41 Foreign Quarantine and The Disinsectization of Aircraft (History of Preventive Medicine) The interest of the Hawaiian Department in foreign quar- antine was stimulated in May 194L, following receipt of a letter from the Chief Quarantine Officer, U, S„ Public Health Service, Honolulu, concerning compliance of 21 Army bombers arriving on Oahu with the provisions of Foreign Quarantine Division Circular No* 71 o Investigation showed that these Army planes had not com- plied with the quarantine directive, and action was taken in letters to the Honolulu Quarantine Office and The Adjutant General to prevent the recurrence of such omissions 0 2 Arrangement was made that the U, S0 Public Health Service would be notified in advance of such plane arrivals, The D0 S, Public Health Service was to provide as many as thirty hand sprayers and insecticide, and the Army was to detail the necessary personnel to accomplish necessary spraying of planesThe Commanding General, Hawaiian Air Force, was directed to give the necessary orders to effect compliance with this In November 1941, the Array consulted the Navy for information as to the method by which air- craft landing at the Pearl Harbor Navy Yard, or other Naval Sta- tions in the Territory were disinsecticized, after flights originating outside of the Hawaiian Islands„ The Navy in reply referred to 14th Naval District, District Order No, 5&-41, dated 30 September 1941On 30 October 1941, the Commanding General, Hawaiian Department received a letter from the Secretary, Hawaiian Sugar Planters * Association® emphasizing the dangers to the sugar industry and to the entire Territory of the introduction of crop destroying and disease carrying insects by aircraft. Array air traffic was increasing greatly, and military secrecy preluded the certainty that civilian quarantine authorities could be notified. Upon the recommendation of the Surgeon, Hawaiian Department, ' a radio was sent to The Adjutant General, Washington, D, Co, dated 8 November 1941, requesting authority to establish an Army disin- sectization service under Medical Department control at Hickam Field and other fields where planes from infected points stopped.8 The Hawaiian Sugar Planters' Association had offered the services - of entomologists in their employ stationed at Canton and Midway Islands for the inspection and disinsectization of Array planes enroute to Hawaii, This service was accepted and the necessary letters were sent,9-12 Upon receipt of radio authority from the War Department for the establishment of an Array disinsectization service, the Commanding Officer, Hickam Field, was instructed by letter dated 25 November 1941, to procure the necessary equipment 519 13 and institute this service on a 24 hour basis, A copy of the letter of instruction to the Commanding Officer, Hickam Field, was mailed to The Adjutant General, Washington, D„ C,, with a request that authority be obtained to substitute an Army inspec- tion service for the inspections of the Chief Quarantine Officer, Uo So Public Health Service, and the U, S, Department of Agri- culture Approval for this action was indicated in four in- dorsements and an added inclosure to the request; however, since the Territory had passed under martial law, further action was left by the War Department with the Military Governor of the Terri- tory, Authority for the substitution of a single Army inspection and disinsectization service at Hickam Field for the services of the Chief Quarantine Officer, U, S, Public Health Service, and the Plant Quarantine Inspector, U, S, Department of Agriculture, in Honolulu was given in General Orders No, 77, Office of the Mili- tary, Territory of Hawaii, dated 24 February 1942 In compliance with Foreign Quarantine Division Circular No0 71, Uo So Public Health Service, as revised 20 December 1941, radio request was made to the U, S, Public Health Service, through the War Department, on 6 February 1942, for authority to designate the senior medical officer of each airfield in the Hawaiian Depart- ment as quarantine officer for the inspection and treatment of military aircraft „ ® Approval for this was not received until 3 July 19420 In the meanwhile, on 16 February 1942, the Command- ing General, Hawaiian Air Force, directed that all airplane command- ers departing for stations in the South Seas or Far Eastern Theater would make entries on AC Form No, la whether or not yellow fever bearing mosquitoes were present in that locality and the date of each spraying of aircraft and the station where accomplished, these entries to be reported to the proper authority at the first stop in the Netherland East Indies In April 1942, the Commanding General., Hawaiian Department that the senior medical officers present at six outlying air bases in the Pacific, enroute to the Australian area be designated as acting quarantine officers for the purpose of disinsectizing and inspecting all arriving and departing aircraft in accordance with Array Air Forces Regulations No, 61-3, dated 11 February 1942, In May 1942, the Surgeon, Hawaiian Department, instituted a program of search of all planes arriving from places other than the Hawaiian Islands for insects dead or alive, in order that an estimate could be made of the results of the disinsectization progress report giving the results of these plane inspections was forwarded to The Surgeon General, U, S„ Army, by letter. Headquarters Hawiaan Department, (MED) 720,4, subject: Quarantine of Aircraft, dated 24 June 1942, In June 1942, instructions concerning inspection of plants were received from the Plant Quarantine Inspector, U, S, Department of Agriculture, and were transmitted to the Surgeon, Seventh Air Force and Surgeon, 7th Bomber circular No, 42, 520 Headquarters, Hawaiian Department, Quarantine Officers, was pub- lished 9 July 1942c Instructions for air base quarantine offi- cers were published in letters, Headquarters Hawaiian Department, subject; Procedure for Quarantine Officers, 12 July 1942, to each quarantine officer concerned. Necessary liaison was maintained between the Hawaiian Department and Air Transport Command to insure compliance of ? no o aircraft with quarantine directives of the Hawaiian area. 9 9 In October 1942, a representative of the Surgeon, Hawaiian Department, worked with an officer of the District Medical Office, 14th Naval District, to assist the Navy in organizing a program of disinsectization and inspection of Navy planes similar to that of the Army program0^9 5 In January 1943, the Commanding General, Hawaiian Depart- ment, received a report from the Commanding Officer, Christmas Island, the existing directives in respect to the disinsectization of aircraft were not being complied with by many aircraft arriving at that stationo Steps were taken to achieve corrective action and improve practices of all aircraft at all stations0 In December 1941, the Territorial Department of Agriculture reported that some live pets, including a raccoon, had been brought ashore and were then in the possession of newly arrived Army units. Such action was in violation of Territorial regulations requiring that such animals be placed in 4 months quarantine. Steps were taken to recover the animals, and commanding officers were notified of the Territorial In April 1942 commanders were again reminded of the necessity of compliance with Territorial laws in this difficult matter,28 and the Commanding General, Port of Embarkation, Fort Mason, California, was advised that the bringing of animals by individuals or organizations to Hawaii was prohibited,2* Circular No. 81, Head- quarters Hawaiian Department, Quarantine of Animals and Birds, was published 30 June 1943, for further emphasis of this subject.2***-*' On 10 March 1943, with the reestablishment of certain civilian rights of government, all previously published orders of the Military Governor were revoked, including General Order No. 77. Effective 10 March 1943, new General Orders were published, among them General Order No, 12 to replace General Order No. 77.™ This order has remained in effect up through the present, September 194$» On 5 JUh© 1943, the Commanding General, Hawaiian Department received a concern with reported failures to enforce strict compliance with aAF Regulation 61-3, dated 30 November 1942, and requesting that report be given the War Department on the matter. Reply by radio was to the effect that existing regulations were being com- plied with. A full report of quarantine activities within the Hawaiian Department was forwarded to The Adjutant General* Washington* D* C** by airmail* 13 June 1943It was evident that the War Department felt that existing regulations regarding the quarantine of aircraft were not being fully complied with, A letter was sent to the Commanding General* Seventh Air Force* directing that quarantine officers be alerted to full compliance with quarantine regulations* and that quarantine of aircraft not be carried out in a casual or routine manner*33 In July 1943* a medical officer representing the Surgeon* Hawaiian Department* made a trip to Fanning* Christmas and Canton Islands to observe disinsectization proceduresDeficiencies noted were reported through command channels* During the same month another report of deficiencies in aircraft disinsectization was made by the Surgeon* Christmas Island* 34*1 Command attention was given to this matter*34*2 Between July 1942* and January 1943* the Surgeon* Hawaiian Department required weekly memoranda from the quarantine officer* Hickam Field* to the effect that transient air- craft were being faithfully sprayed on arrival and departure* that planes were being inspected for insects* and that planes were supplied with spray guns and insecticide on departure* Upon the recommendation of the Hawaiian Department Surgeon* the Military Governor of Hawaii* on 1 November 1943* called a meet- ing of all military and civilian agencies concerned with foreign quarantine* This meeting was called in order that there might be no uncertainty regarding the quarantine methods in practice* and to determine if all agencies were satisfied that their respective quar- antine functions were being adequately discharged by them* or by Army or Navy .substitution* Representatives of the U* S* Public Health Service* the U* S* Department of Agriculture* the Territorial Board of Agriculture and Forestry* and the District Medical Office* 14th Naval District attended*-^ Following the November meeting on quarantine the draft of a proposed comprehensive quarantine directive was prepared-^0 and submitted to the Commanding Generals* Army Port and Service Command* Seventh Air Force* and Pacific Wing Air Transport Command* and to the Surgeon* Seventh Air Force (Air Quarantine Officer) for comment* The provisions of this proposed directive were agreeable to the Commanding General* of the Seventh Air Force* the Commanding General* Pacific Wing* ATC* and to the Air Quarantine Officer* but were criticized by the Commanding General* Array Port and Service Command* on the basis that-they included too great detail* 3' The proposed quarantine directive was defended by the Surgeon (Hawaiian Depart- ment )38 But his opinion was overruled* and on 2? December 1943«, it was directed that the draft of the proposed directive be revised to eliminate too detailed instructions* An abbreviated directive* HUSAFIGPA* File AG (Surg) 720*4 subject: Quarantine requirements and responsibilities*was approved and published 13 January 1944o^ 522 To implement the general provisions of Letter, HUSAFICPA, File AG (Surg) 720,4, subject: Quarantine Requirements and Respon- sibilities, 13 January 1944, the subordinate echelon responsible for administration of Ariry Ports in the Hawaiian Area, the Array Port and Service Command, published Annex No, 1 to Administrative Order No, 1, Headquarters Army Port and Service Command, subject; Quarantine Measures, USAT Vessels Entering Honolulu and Outlying Ports of AP&SC, dated 12 February 1944, and Changes No, 1, there- to, dated 15 February The above directive implemented the provisions of Foreign Quarantine Circular No, 85, U0 S0 Public Health Service, dated 4 October 1943* The services of Go, A, 305th QM Bn, Sterilizing Units was authorized for necessary delousing procedures. At the request of the Territorial Board of Agriculture and Forestry and the Chief Quarantine Officer, U. S, Public Health Service, Honolulu, Change No, 2, dated 14 March 1944, to the AP&SC quarantine directive was published concerning importation of animals, birds, and insects,^- By the provisions of the USAFICPA Letter, Quarantine Require- ments and Responsibilities, dated 13 January 1944, responsibility for the control of entry of animals and birds, as required by Federal and Territorial laws, was fixed upon the Commanding General, Array Port and Service Command, and the Air Quarantine Officer, or their representatives. Change No. 2 to the Hq, AP&SC directive. Quarantine Measures, USAT Vessels Entering Honolulu and Outlying Ports of the AP&SC, dated 14 March 1944, further extended the responsibility to the Commanding Officers of all grades, as well as the individual custodian or owner concerned, and provided that masters of vessels would complete and submit to the Territorial Veterinarian a Ship- Notice concerning any animals carried. Nevertheless, numerous instances of the entry of animals and birds into the Territory, without the knowledge of the Commanding General, Army Port and Service Command, and the Air Quarantine Officer continued to Troops used many methods to hide pets and mascots to avoid complying with quarantine requirements. Circular No, 81, Headquarters Hawaiian Department, Quarantine of Animals and Birds, 1943, had been rescinded with the publication of the Hq, USAFICPA Letter, Quarantine Requirements and Responsibilities, No direct- ive remained in force making a commanding officer responsible for quarantine or destruction of animals or birds illegally entered. To meet this need Section II, Circular No, 58, Hq, USAFICPA, Quarantine of Animals and Birds, dated 15 April 1944 was published. Coincidentally, the Civil Governor published a proclamation placing an embargo against the introduction into the Territory of any animals and birds from all islands in the Pacific Ocean, with the exception of Australia and New Zealand, and from the Continents of Asia and Africa, and islands in the Indian Further support was given by Changes No, 2, AR 55-485, dated 7 January 1944, which prohibited the carrying of pets or mascots on U, S, Array transports or vessels wholly allocated to the War Department, or the 523 carrying of pets or mascots at government expense on other vessels* Later, in 1945* some relaxation of the regulations was necessary for the accommodation of war dogs and seeing-eye dogs for blind veterans* Exceptions to the embargo against importation of dogs from the Pacific Islands, and the 120 day quarantine for dogs im- ported from the U. S* Mainland were made by the Civil Governor upon the request of the Commanding General, Central Pacific Base Command, specifically for certain war dogs in training, for dogs being returned from war service in the Pacific on discharge to their owners in the Territory, and for seeing-eye dogs of specif- ied veterans,, In all instances specified precautionary measures have been required to the complete satisfaction of the Territorial Board of Agriculture and Forestry* Thes3 precautions have in- cluded surveillance by the Army and Territorial Veterinarians, constant attendance of the dogs, confinement of imported dogs in isolation from local dogs, movement of dogs in insect-proof cages, and quarantine at the Territorial Quarantine Station where possible* By letter, dated 25 August 1944, the Director, U* S„ Public Health Service, District No* 10 (Hawaii) proposed to the Commanding General, USAFPOA, a plan for the integration of quaran- tine functions performed by the U. S* A ray. Navy, and Public Health Service in the Hawaiian area*44 This letter and the attached plan were forwarded to the Commanding General, Central Pacific Base Command, for remark and recommendation* The USPHS plan brought quarantine procedures in the Hawaiian Department for Navy, Army and civilians under one responsible head and unified control* It was believed that the plan would provide greater efficiency and more adequate safeguards of health in the community* The Command- ing General, Central Pacific Base Command, recommended approval of the plan in principle* To date the plan has not been placed in effect by higher headquarters* Quarantine requirements and responsibilities for all elements of the Central Pacific Base Command have been revised and republished as HCPBG, Administrative Order No* 1, (Index CPYSG 200*50), Quarantine Requirements and Responsibilities, dated 19 March 1945 This directive was written in conformity with AR 40-225, 21 November 1944, and a copy was submitted to The Surgeon General, through channels, as required by paragraph 3(a)(4) of AR 40-225o (No Air Force units are contained within the CPBC*) At the suggestion of the Chief Quarantine Inspector, U* S. Public Health Service, steps have been taken to spray the interiors of all Array mail and baggage rooms with DDT as a protect- ive measure against the chance introduction into the Territory of insect stowaways in mail and baggage* To implement this procedure HCPBC, Administrative Order No* 1 (Index CPYSG 200*32), Disinsecti- zation of Post Offices and Baggage Rooms, dated 14 August 1945, was published* 524 Investigation has shown that salvage tires beipg returned to the Uo S0 Mainland from the Pacific area have been prolific breeders of mosquitoes, particularly Aedes aegypti and Aedes albo- pictuSo In many instances these tires are collected in open sal- vage yards where they become partially filled with water from the rain0 Tires are tightly bailed for shipment, but water remains in them0 It is also known that Aedes mosquito eggs may be laid in the interiors of dry casings to subsequently hatch months later, possibly on the mainland, when water is added,, As a preventive measure it has been directed that all .salvage tires be treated with DDT insecticide prior to shipment from the Central Pacific Base Commando^8 To implement Section IV, Circular No. 43, War Department, 1945, a local directive, HCPBC, Administrative Order No„ 1, (Index CPYSG 204o90), Permit for Importation of Infectious Agents and Vectors, dated 17 June 1945.2+9 With the establishment of the Central Pacific Base Command, the Surgeon. CPBC, has had only limited jurisdiction over aircraft quarantine,50 nevertheless close liaison has been maintained with the Air Corps and Air Transport Command on matters of quarantine affecting the CPBC. In June 1945, the Chemical Warfare Officer (Bacteriological Warfare Officer), CPBC, reported that two new in- sects hitherto foreign to the Hawaiian area had been identified to be present in large numbers during the preceding month, and that 45 live insects had been found on ATC planes arriving on 0ahuo One had been found on a NATS plane. This information was trans- mitted to the Commanding General, Pacific Ocean Areas, by letter on 7 June 1945 * More specific information was furnished the Commanding General, POA, on 19 June 1945, including specific inform- ation concerning the identification of 6 insects newly established in Hawaii during the preceding months and insects collected upon inspection of Array planesA continued surveillance of insects collected from aircraft arriving in Hawaii had been maintained since April 1942«” In March and April 1945, the Surgeon, CPBC, had recognized inadequacies in the accomplishment of aircraft quarantine procedures and had participated in a survey of all aircraft quarantine techniques on Oahu with representatives of the Ue S„ Public Health Service, Quarantine Station, Honolulu, the Territorial Board of Agriculture and Forestry; and the Bureau of Entomology and Plant Quarantine, U. S0 Department of A copy of the report of this survey, had been sent to the Commanding General, USAFPOA, by the Medical Director, 10th District, U0 S0 Public Health Service, who had participated in the survey, so that the recommendations might be referred to the Commanding General, Array Air Force Middle Pacific and Commanding General, Pacific Wing, ATC, and Commander, Naval Air Transport Service, calling attention* to inadequacies of the present system of disinsectization of aircraft. No further 525 action has been taken through September 1945. The history of quarantine as it has affected the Array in the Hawaiian area has shown very significant developments. Basically, quarantine has a different significance for a number of different governmental agencies in the Territory. The U„ SQ Pub- lic Health Service has been primarily concerned with the quaran- tinable diseases, cholera, plague, smallpox, epidemic typhus, yellow fever, leprosy, anthrax, and psittacosis, with the inspection of ships for these diseases and rodents, with the importing of psittacine, birds, and with the disinsectization of aircraft for the control of mosquitoes. The U0 S0 Department of Agriculture has been concerned with control of the dissemination of insects, plants, and animals, and plant and animal diseases„ The Territorial Board of Agriculture and Forestry has acted in connection with the U, S0 Department of Agriculture and has been concerned with the enforce- ment of Territorial quarantine laws, among them the quarantine of animals liable to rabies. The security which has been necessary in connection with military traffic and the large volume of this traffic has made it necessary for the Array to assume many of the duties of these various agencies for the period of the war. The Array in the Hawaiian area has established quarantine procedures to meet the requirements of each of these agencies to the greatest possible extent. To the Army itself quarantine has had a much broader significance, including all procedures affecting the health of the command in connection with any of the communicable diseases or disease vectors of man or military animals. Many of these problems have been extremely difficult of solution (the quarantine of plants and animals), others have not been solved (perfection in disinsectization of aircraft). Nevertheless, the Army has made great progress during the war and has achieved an integration of the responsibilities of the various different quarantine agencies with its own quarantine needs. The integra- tion of the quarantine activities of the Army with those of the Navy and civilian~agencies has been suggested as a function of the U. S. Public Health Service. Instruction has not been received from higher headquarters in this matter, however, such an organiza- tion would be handicapped by the limited scope of activity authori- zed by law for the U. S. Public Health Service in quarantine matters. The Array has had the latitude of power during the war to take such action in connection with quarantine as has been necessary for the successful prosecution of the war and the safeguarding of both military and civilian health. 526 LIST OF REFERENCES Chapter LI 1, File 720.4 Quarantine, Serial No. 7, HHD, Off of Dept Surg 1941-42. 2, File 720.4 Quarantine, Serial No, 8, HHD, Off of Dept Surg 1941-42, 3, File 720.4 Quarantine, Serial No, 9, HHD, Off of Dept Surg 1941-42. 4, File 720,4 Quarantine, Serial No. 12, HHD, Off of Dept Surg 1941-42, 5, File 720,4 Quarantine, Serial No. 16, HHD, Off of Dept Surg 1941-42, 6, File 720,4 Disinsectization of Airplanes, Class. Serial No, 2, HHD, Off of Dept Surg 1941-42, 7, File 720,4 Quarantine, (R/S Surg, 4 Nov), Serial No. 17* HHD, Off of Dept Surg 1941-42. 8, File 720,4 Disinsectization of Airplanes, Class (Radio), Serial * No, 3* HHD, Off of Dept Surg 1941-42. 9, File 720.4 Disinsectization of Airplanes, Class (Ltr to Phil), Serial No., 5* HHD, Off of Dept Surg 1941-42. 10, File 720,4 Disinsectization of Airplanes, Class (Ltr to Midway) Serial No, 5* HHD, Off of Dept Surg 1941-42. 11, File 720,4 Disinsectization of Airplanes, Class (Ltr to Canton) Serial No. 5* HHD, Off of Dept Surg 1941-42, 12, File 720,4 Disinsectization of Airplanes, Class (Ltr to HSPA) Serial No, 5* HHD, Off of Dept Surg 1941-42. 13, File 720,4 Disinsectization of Airplanes. Class (Ltr to Hickam), Serial No, 8, HHD, Off of Dept Surg 1941-42, 14, File 720,4 Disinsectization of Airplanes, Class (Ltr to AG with 4 Inds and 3d Incl, a ltr to Gen Arnold fr Parran), Serial No, 7* HHD, Off of Dept Surg 1941-42. (For ltr to Gen Arnold fr Parran see file 720,4 Quarantine, Serial No, 19, HHD, Off of Dept Surg 1941-42.) 15, File 720,4 Disinsectization of Airplanes, Class, Serial No, 9, HHD, Off of Dept Surg 1942 (News article). 16, File 720,4 Disinsectization of Airplanes, Class (Radio 2102-6th), Serial No, 9, HHD, Off of Dept Surg 1942, 17. File 720.4 Disinsectization of Airplanes, Class (Radio 102 HD, (62 WAR) 60 V©), Serial No. 13, HHD, Off of Dept Surg 1942. 18. File 720,4 Disinsectization of Airplanes, Class (Special en- tries Fom la). Serial No. 10, HHD, Off of Dept Surg 1942. 19. File 720,4 Disinsectization of Airplanes, Class (R/S Surg - G-l and G-4, dated 16 Apr 42, w/sample Itr w/sarnple copy of Inclo- sure 2 thereto), Serial No, 11, HHD, Off of Dept Surg 1942. 20. File 720.4 Disinsectization of Airplanes, Class (Prog Rpt $L), Serial No, 14, HHD, Off of Dept Surg 1942, 21. File 720,4 Disinsectization of Airplanes, Class (Prog Rpt #2), Serial No, 18, HHD, Office of Dept Surg 1942, 22. File 720,4 Quarantine, (Ltr to Surg 7th AAF and Base Comd), Serial No. 35* HHD, Off of Dept Surg 1941-42. 23. File 720,4 Quarantine, Serial No, 39* HHD, Off of Dept Surg 19A1-42, 23.0 File 720.4 Disinsectization of Airplanes, Glass (Procedure), Serial No, 13, HHD, Off of Dept Surg 1942, 23.1 File 720.4 Disinsectization of Airplanes, Class (ATC Ltr), Serial No, 22, HHD, Off of Dept Surg 1942, 0 23.2 File 720.4 Disinsectization of Airplanes, Class (ATC Ltr) Serial No, 23, HHD, Off of Dept Surg 1942. 23.3 File 720.4 Disinsectization of Airplanes, Class (ATC Ltr) Serial No, 24 and 25, HHD, Off of Dept Surg 1942. 24. File 720.4 Disinsectization of Airplanes, Class (Ltr to Comdr Haw, Sea Force), Serial No, 17, HHD, Off of Dept Surg 1942, 25. File 720.4 Disinsectization of Airplanes, Class (Ltr to CG, HHD) Serial No. 17, HHD, Off of Dept Surg 1942, 26. File 720,4 Disinsectization of Airplanes, Class (Ltr with 5 Inis.), Serial No. 21, HHD, Off of Dept Surg 1942, 27. File 720.4 Quarantine, Serial No, 26, HHD, Off of Dept Surg 1941-42. 28. File 720.4 Quarantine, Serial No. 28, HHD, Off of Dept Surg 1941-42, 29. File 720.4 Quarantine (Radio to Diet), Serial No, 31* HHD, Off of Dept Surg 1941-42, 29.1 File 720.4 Quarantine, Serial No. 11, HHD, Off of Dept Surg 1943. 30. File 720.4 Disinsectization of Airplanes, Class (Extract - GO 12), Serial No. 25, HHD, Off of Dept Surg 1943. 31. File 720.4 Disinsectization of Airplanes, Class (Radio WD to CG), Serial No. 25, HHD, Off of Dept Surg 1943. 32. File 720,4 Disinsectization of Airplanes, Class (Last Itr in folder). Serial No, 25, HHD, Off of Dept Surg 1943. 33. File 720.4 Disinsectization of Airplanes, Class (Ltr to CG, 7th AAF), Serial No,. 25, HHD, Off of Dept Surg 1943. 34. File 720.4 Quarantine (Rpt of Col. Robertson w/2 Inds), Serial No. 18, HHD, Off of Dept Surg 1943. 34.1 File 720,4 Quarantine, Complaint fr AP0 915), Serial No.18, HHD, Off of Dept Surg 1943. 34.2 File 720.4 Quarantine, (Ltr by Gen Ryan), Serial No. 18, HHD, Off of Dept Surg 1943. 35. File 720,4 Quarantine, Class, Serial No, 9, HHD, Off of Dept Surg 1943. 36. File 720.4 Quarantine, (Ppsd directive). Serial No. 26, HHD, Off of Dept Surg 1943. 37. File 720,4 Quarantine, (Ltr to CG, AP&SC with 1st Ind), Serial No, 28, HHD, Off of Dept Surg 1943. 38. File 720.4 Quarantine, (R/S Surg to G-4 with 4 Memos), Serial No. 28, HHD, Off of Dept Surg 1943. 39. File 720,4 Quarantine, Serial No, 1, HHD, Off of Dept Surg 1944. ‘ . 40. File 720,4 Quarantine (Directive w/2 Incls & 1 Change), Serial No, 6, HHD, Off of Dept, Surg 1944. 41. Maj, Stuppy’s Unit File, Item 29 (Change No, 2 w/l Incl added), HHD, Off of Dept Surg 1944. 42. File 720.4 Quarantine, (R/S Surg to G-4), Serial No. 15, HMD, Off of Dept Surg 1944- 43* Pile 720.4 Quarantine, (News article), Serial No. 15, HMD, Off of Dept Surg 1944. 44» File 720.4 Quarantine, (POA Itr Yf/CPBC Ind, & Onstott’s Itr as Incl with Exhibit A only). Serial No. 18, HHD, Off of Dept Surg 1944. 45* File 720.4 Quarantine, Serial No. 3, HHD, Off of Dept Surg 1945» 46. File 725 Insects, Serial No. 21, (Ltr fr Brown), HHD Off of Dept Surg 1945. 47. File 725 Insects (AO No. 1), Serial No. 21, HHD, Off of Dept Surg 1945. 48. Maj. Stuppy's Unit File, Item 91. 49. Maj. Stuppycs Unit File, Item 81. 50. File 720.4 Quarantine (POA Cir. 61), Serial No. 6, 1945* 51. File 730 ABW, Misc, (Bact. Warfare Rpt, 7 June), Serial No. 28, 1945« 52. File 730 ABW, Misc (POA Message Form w/l Ind & 2 Incls), Serial No. 31, 1945. 53° File 720.4 Quarantine, (Complete list). Serial No. 16, 1945, and Class. Insect Control files. 54. File 720.4 Quarantine, Class, Serial No. 2, 1945«