ARCTIC HEALTH INSTITUTE Alaska Department of Health 19 4 9 The material in this pamphlet was published by the Alaska Department of Health to describe a vital research project proposed by the United States Public Health Service of the Federal Security Agency. Proposed site of Arctic Health Institute at the University of Alaska ARCTIC HEALTH INSTITUTE The difficulties and delays experienced by all Nations in their attempts to establish a stable population and a sound economy in Arctic areas can be traced almost en- tire' y to the faulty conditions of health and sanitation which are typical of these areas. Inability to overcome these inadequacies of health and sanitation are, in turn, caused by a lack of specific knowledge concerning man’s adjustment to the conditions which exist in Arctic areas. Little scientific information is available regarding the operation of physical Iawrs and ordinary biological processes under conditions peculiar to Arctic regions. Such information can be gained only through pains- taking research and experimentation on a long term basis. To be of value, such research must be of a scientific cali- ber, conducted on the spot under existing conditions, by trained specialists from many fields, with the necessary facilities and equipment to do a thorough job. THE NEED FOR AN ARCTIC HEALTH INSTITUTE Research in Arctic health has been long delayed by lack of any suitable facilities which would enable qualified scientists to carry on a program of investigation of suffi- cient length and scientific thoroughness to produce con- clusive results. Scientists capable of carrying out such a program will not and cannot generally afford, either professionally or financially, to undertake the necessary research activities in Arctic areas at the present time, nor so long as ade- quate facilities and equipment are lacking. In all of the Arctic area which lies within the West- ern Hemisphere, there is no facility or institution capable of meeting the basic needs of such an intensive program. Of the four countries which possess vast holdings within the Arctic, none, save Russia, has established research centers in such areas. Coincidentally, only Russia has suc- ceeded in establishing a city of a quarter of a million pop- ulation within the permafrost area. The obvious need for the development of a well- equipped Arctic health research institute has long been recognized, and has frequently been expressed by leading authorities in Government, medicince, biology and other fields. Research specialists in various fields have been asked to prepare lists of topics pertaining to Arctic health which they feel merit thorough investigation. The following statements, taken from letters submitted by scientists now engaged in research in their respective fields, indicate the opinion of these experts concerning the need for the establishment of an Arctic research center and the variety of research problems in need of investigation. “Frost defines epidemiology as ‘the science which w 11 give, firstly, a picture of the occurrence, distribution and the types of the (infectious) diseases of mankind, in dis- tinct epochs of time and at various points of the earth s surface, and secondly, will render an account of the rela- tions of these diseases to the external conditions surround- ing the individual and determining his manner of life’. Epidemiology is largely a closed book in Arctic regions. It is known that the epidemiological pattern of certain dis- eases varies remarkably from that of the same disease in temperate climates. The factors responsible for this varia- tion must be discovered before effective methods for pre- vention or control may be instituted. “Scientific investigation of health problems in the Arctic should include the following types of epidemiologi- cal work: Epidemiological Studies 1. Laboratory investigation. The two great sources of communicable dieseases of man are man himself and lower animals. More precise knowledge is needed of the agents responsible for disease in Alaska. This would require laboratory facilities for the study of parasitic, virus, and rickettsial infections as well as diseases of bacterial origin. 2. Investigations of epidemics in the field. Careful in- quiry should be made of epidemics in Arctic areas in 4 order to determine the fundamental epidemiological characteristics of disease under Arctic conditions. The factors to be considered should include the influence of age, sex, color, season, occupation, community sani- tation, nutrition, the common and usual sources of in- fection, the degree of communicability of the disease, the infectiousness of the case, the role of the carrier, the severity of infections, mortality rates and methods of the control. 3. Analysis ct epidemiological data. The analysis of data collected at the time of routine epidemiological investigation should play an important role in epidem- iological studies. 4. Imported diseases. As far as is known, most of the common communicable diseases of the temperate zone may manifest themselves in the Arctic. The greater the migration to Alaska, the more probable this will be. Diseases which are transmitted from man to man more readily under crowded conditions, from close association with domestic animals, or from eating in- adequately cooked meat, may be expected to be of major importance.” “There is a great need for epidemiological studies in tuberculosis in the Arctic. Such studies would require various technical services which could be made available through the establishment of an institution for research, in view of the relatively high prevalence and the high mortality rate from tuberculosis in Arctic areas, it is es- sential that studies be undertaken to determine possible reservoirs of infection, including a careful search for ani- mal and other possible reservoirs of infection, other than human. Tuberculosis Studies “Because of the isolated nature of many of the Arctic communities, an excellent opportunity exists for the study of the evolution of the disease amongst groups (native) previously free of tuberculosis and native groups into whom tuberculosis-free outsiders are introduced. Such studies would have enhanced value where the population 5 groups are so tightly knit and where there is so little movement of the people in that group, that there is little danger of their being lost from observation. “Studies of the bacteriology of tuberculosis should be performed, particularly those leading to the determination of the types, strains, variations and mutations, which might be found in Alaska. Some statements have been made that the tubercle bacillus in Alaska is different from the organism which is seen in the States. This should be definitely be determined. If it is true, then the role of this organism in causing clinical disease should also be assessed. Possibly there are several strains with varying characteristics which can be found amongst Alaskans. This work would be better done in Alaska because of difficulty in shipping live organisms. “Bacteriological studies should also be made to de- termine the susceptibility and resistance of the strains found in Alaska to the various antiseptic and therapeutic agents employed. “The work of the Institute should be coordinated with the work in clinical facilities in the Territory to secure information concerning various therapeutic agents, includ- ing those now in existence, those now on trial, and those which may be useful in the future. It is also possible that present therapeutic methods must be varied for this group of people for whom tuberculosis is a more acute disease. “Certainly, studies should proceed on the role of the various elements in the diets common to the various groups in Alaska in maintaining adequate nutritional status as well as in contributing toward resistance. Such studies can best be undertaken in Alaska, utilizing foods derived at the source, on experimental animals housed in Alaska. “A study should be conducted to determine the factors which result in non-pulmonary forms of tuberculosis; for example, tuberculosis of the bones and joints and tubercu- losis of the skin. These forms are more common propor- tionately in Alaska than they are in the rest of the United States. 6 “The Arctic Institute could undertake, in cooperation with the Department of Health, an evaluation of the var- ious immunizing agents now being advanced for the crea- tion of resistance in people exposed to tuberculosis.” Venereal Disease Studies “If it is possible to establish a research institution in Alaska there are a number of ways it could be valuable in venereal disease control. The following are venereal Dis- ease prob'ems which should be investigated. 1. Serology cf syphilis. Determine the true incidence and prevalence of syphilis in the different racial stocks. There is evidence that Indians give a higher rate of positive blood tests for syphilis than can be accounted for by syphilis. Such a study would fit into studies being conducted and contemplated in Central America and north into Mexico and the United States. These studies may be instrumental in determining the cause of biologic false positive tests and may provide a way of eliminating them. 2. Resistance of the gonococcus to penicillin and the inci- dence of non-gonorrheal urethritis in the male. When treating large numbers of patients with urethritis the problem frequently arises as to which cases are caused by the gonococcus and which by other organisms. When this differentiation can not be made, claims are made by physicians of the occurrence of penicillin re- sistant gonococci. This injures the control program. It is important to be on the alert to discover penicillin resistant strains if they do occur. Gonorrheal ure- thritis is easily controlled with penicillin while other types of urethritis frequently are not affected by this drug. 3. Other venereal diseases. To what extent do lympho- granuloma venereum, chancroid, and granuloma in- guinale occur in Alaska. To determine this it is nec- essary to have high quality laboratory service. 4. Clinical research. Syphilis affects various racial stocks differently, e.g., predominance of cardiovascu- lar involvement in the American Negro, neurosyphilis 7 in the white European stock. It is desirable to study the effect of the disease on the Alaskan Indian and Eskimo. In order to successfully carry out studies of this type it is necessary to have a laboratory of re- search caliber. “As studies indicated above are undertaken other problems needing investigation will develop. It is import- ant to any venereal disease control program to have access to a laboratory capable of research work to study new problems as they arise.” Parasitological and Entomological Studies “Amoebiasis is an intestinal disease of worldwide dis- tribution; its prevalence increases in areas with poor sani- tation. Low temperatures are known to extend the via- bility of the infective cysts, by means of which the disease is spread. A recent survey in a community of 900 per- sons above the Arctic Circle is said to have revealed 60% positive for Endamoeba histolytica, a prevalence 3 to 10 times as high as that encountered in temperate and sub- tropical areas. This amazing claim should be investigated. If confirmed, the details of transmission should be ex- plored. “Diarrhoea and dysentery are said to be prevalent in certain areas of Alaska especially along the Bering Coast. The respective roles of E. histolytica and bacteriological etiologues should be determined. To explore this communi- cable problem would require bacteriological and parasito- logical laboratory facilities, and competent field epidemi- ologists. “Giardiasis. The distribution of giardiasis is world- wide; its transmission is dependent upon unsantitary con- ditions. It is probably pathogenic for children. It has been demonstrated that the presence of this disease inter- feres with the absorption of fat and that it may, there- fore, prevent the utilization of fat-soluble vitamins A and D, a circumstances of some significance in the Arctic region. The prevalence of giardiasis in Alaska should be determined, especially among children, and its effect on nutritional deficiences appraised. This would require the 8 same exploratcry facilities mentioned above in connection with amoebiasis, to be used by biochemical and nutritional experts. “Helminth Infections. Little is known of the preval- ence or even the occurrence of worm infections in Alaska out it seems probable that these might be of considerable magnitude. It is known that natives are infected with certain species of Diphyllobothrium, but its prevalence and distribution as well as the manner of infection are un- known. It is probable that trichnosis also exists in Alaska. Population suveys in different parts of the Territory should be undertaken to determine the incidence and dis- tribution of worm diseases and epidemiological studies made to determine the manner of infection. “Insects. The high incidence and vicious biting habits of mosquitoes and flies is considered a serious problem in the Territory of Alaska. Although insect-borne diseases are not known to be extensive, the annual severe incidence of pest mosquitoes and blood sucking flies interferes markedly with human efficiency and is a virtual public health problem. “Mosquitoes are a serious problem over extensive areas. From Nome, eastward across Alaska and south- ward down the Alaskan panhandle, mosquitoes are exces- sively abundant, generally beyond any number known ex- cept in the very worst areas in the United States. They were a major problem during construction of the Alcan highway. The tundra, where the mosquitoes breed, is studded with small seepage pools, snow-water pools and hummocks of moss, bunch grass and willows. Constant seepage and melting snows during the mosquito season constantly renews the countless little pools, requiring fre- quent application of insecticides. The frozen ground com- plicates drainage problems. “The insect control problem is further complicated by blackflies, deerflies and gnats which breed in running streams and moisture saturated ground. At least 19 spec- ies of blackflies, eight of ‘punkies’ and a number of deer- fiies are known to be present. 9 “It is proposed to make a thorough investigation of insect problems related to public health and outdoor work- ing conditions. Where investigation shows the intensity of the problem to be of such magnitude as to adversely affect the health, well-being and livelihood of the inhabi- tants steps should be taken to inaugurate control measures. It is anticipated that insect control will be necessary in the vicinity of approximately 15 major population concen- trations.” Studies Relating To Animal Reservoirs of Disease “The two most important points of a veterinary pub- lic health research program in the Arctic would be: to de- termine the prevalence of animal diseases communicable to man, and to establish control procedures which would include adequate quarantine regulations. “The incidence of animal diseases in Alaska is not ac- curately known. It is known that there is a sizeable pop- ulation of dogs, cattle, reindeer, fur animals, and migra- tory birds. Animal diseases that have been recognized in Alaska are tuberculosis, rabies, brucellosis, and salmon- ellosis. Preliminary investigations will be aimed at de- termining the incidence and prevalence of these diseases. “The Scandinavian and Russian Veterinary Research Institutes have carried on considerable investigation of animal diseases in the Arctic and near Arctic regions. The Scandinavian conditions have not deviated very much from chose found in temperate climates because of the influence of the Gulf stream on that peninsula. Russian investi- gations have uncovered many problems that do not exist in temperate zones. These investigations have reported the presence of animal encephalitis and pasteurella in- fections. The most important pasteurella disease of ani- mals found in Siberia that affects man is tularemia. This disease has been found in many types of rodents, birds, sheep and swine; also, occasionally in dogs. Plague, an- other pasteurella disease, is confined only to rodents, has been reported in the U.S.S.R. area adjacent to Northern Manchuria and in Mongolia. 10 “Preliminary studies in Alaska should include the sur- vey of animal tuberculosis in cattle, reindeer, and dogs. It is important to keep in mind that the interchange of tuberculosis is not in one direction from animal to man but may occur from man to animal and in turn to man again. To do such work it will be necessary for tuberculin testing, autopsy of reactors, and bacteriological and pathol- ogical examination of infected tissues. To determine the incidence of rabies and differentiate it from other en- cephalitides of dogs, diagnostic facilities will have to be provided. It is important to remember that many types of salmonellosis disease exist in a subclinical or carrier form in animals. Even though the incidence of these dis- eases may not be sizeable at present in Alaska, all efforts should be made to eradicate them before there is an in- creased animal population which will extend the reservoir that the increasing human population will contact. “The storage of food in the Arctic has been a diffi- cult problem and for that reason diseases caused by toxins or bacterial contamination should not be overlooked. The toxins of streptococcus, staphylococcus, and Clostridium origin are the most important. “The most extensive animal disease work is being carried on in the U.S.S.R. veterinary schools and research institutions in northern Russia and Siberia. Inasmuch as there is no free exchange of scientific information between these two institutions in the western world, it is necessary that adequate facilities be established for such work. Dr, Vilhjalmur Stefansson has pointed out in an early book of his, “By 1930 leadership in polar exploration has passed from west Europeans and North Americans to the Union of Soviet Socialist Republics”. To develop the knowledge that will put us on a scientific par with the research work of Russia, an institution should be established at the University of Alaska for permanent study. The Veterin- ary Public Health Program will be a very important part of such an operation.” Nutrition Studies “There is a marked paucity of scientific information, 11 either observed or experimental on human biology in the Arctic regions. Previous studies on the relation between food and low temperatures have concerned themselves with exposure under highly artificial conditions, at rela- tively great physiological stresses and for short periods of time. The information on the nutritional problems of existence at low temperatures for months or years is meager. Under proper conditions these problems could and should be investigated. “The food and nutritional factors in survival and ac- climatization in Arctic regions may be investigated through studies on native population groups as well as on newly arrived populations. Problems which might be in- vestigated include: 1. Food factors related to survival in exposure, and in acclimatization to prolonged cold, 2. The nutritional factors in disease whose incidence varies markedly with climate and in those unique in cold environment, (e.g., frost bite). 3. The difference, if any, between newcomers to Arctic regions and natives with respect to physical and nu- tritional status, performance, adjustment mechanisms, and resistance to cold. ‘ Studies should also be undertaken to determine: 1. The effects of prolonged cold on growth, longevity, and maintenance metabolism with relation to food intake. 2. The effects of prolonged cold on body requirements or calories, proteins, minerals, and vitamins. 3. The effect of the proportion of fat, protein, carbo- hydrate in the diet on resistance to cold. 4. The role of the specific dynamic action of food in heat conservation of the body. 5. The basal energy needs and variations with climates. 6. Energy expenditures during polar stresses, 7. The effects of solar radiation on the skin and eyes, (e.g., snowblindness), and their influence on vitamin requirements and metabolism. “In addition, the problems concerning food supply, food preservation, preparation and general food technology 12 are of vital importance, as is the preparation of optimal food rations for survival use in catastrophies where water supply may be a crucial problem. It would be important to study the psychological or emotional stability of men as affected by frequency and type of feeding and to study the entire problem of feeding in the field. All these are ex- tremely rewarding and necessary fields of investigation if Arctic colonization is to be a reality/’ Dental Studies “Preliminary results of rather limited investigations on the incidence of dental caries in Alaska indicate the in- cidence of this disease is very low in primitive groups which have had but limited contact with modern civiliza- tion. On the other hand, the incidence of this disease is very high among children of groups whose contact with modern civilization has become extensive during recent years. It would appear that detailed epidemiological studies designed to determine the factors responsible for the wide differences in caries incidence in the natives of the various areas might prove highly profitable in track- ing down some important factors relating to the cause of dental caries. “At the present time, there are indications that period- ontal disease among the natives of Alaska is almost non- existent but that contact with civilization is effecting a change in the situation. It would appear that a study of periodontal diseases among the different populations of Alaska might prove highly profitable and might materially assist in uncovering some of the basic causes of these diseases. “Because of the extremely low temperatures under which dental equipment, supplies, and materials must be stored, manipulated and exposed, studies should be foster- ed to determine the desirable modifications that will give maximum effectiveness in the Arctic area.” Studies in Physiology “Fundamental studies of human physiology and man’s acclimatization to prolonged low temperatures, wide varia- 13 tions in daily and seasonal amounts of sunlight and ex- posure to other climatic factors peculiar to an Arctic en- vironment are of primary importance to the applied sciences in the public health field. “Opportunities for research in functions of the human organism in the Arctic have been so limited in the past that only isolated phenomenon have been attacked and often under limiting and artificial conditions which are not representative of the inter-relation of climatic factors as they actually occur in the Arctic regions. Long range pro- grams in these fields have not been feasible through lack of permanent facilities, both as regards space and equip- ment. The establishment of an institute for research in health and in the Arctic area should provide a real be- ginning for the investigation of more than expedient problems and should lay the foundations for a body of facts on which applied sciences may draw in the future for ready solution of current problems. Thus, the program of the Institute, over and above the epidemiological and health engineering programs, should have definite pro- vision for research, either directly or by sponsoring visit- ing investigators, in studies which are not directed to a specific solution but which elaborate the biological prin- ciples under the influence of this drastic environment. “It is suggested that research may be carried on by the Arctic Institute of Health in the general areas outlined below. The specific examples illustrating these areas are not intended as research projects of exclusive character, indeed they will need, in all probability, an inter-disciplin- ary approach, especially if rapid strides are to be made. The advance of any field should not be dependent on the work of single investigators as such, but rather on pooled mental and technical efforts which, relatively indepen- dently, explore the parameters of each problem. “Functional studies: 1. The maintenance of body temperature by organic re- sponse of circulation and metabolism has been the subject of active research in the military applications. Much fundamental information regarding the adapt- 14 ability of these mechanisms in natives and whites re- mains to be obtained. These data will be useful in general health regulation and of great significance to persons attempting settlement for civil reasons in the Arctic. The problems of comfort in clothing and adaptability to protection as well as functional free- dom is an applied problem which must rely for its basic information on the physiologic relationships es- tablished by such a study of the several organ sys- tems which effect temperature regulation of the body. The effects of metabolic factors are of obvious im- portance as corollaries. Selection of individuals for colonization and specific duties will be greatly en- hanced by such knowledge. 2. A study of insensible water loss from the body as a skin function under Arctic conditions is closely corre- lated with 1 as regards the organ systems involved, but it is an attribute which must be faced in dealing with the same general problem of clothing since evap- oration and the consequent establishment of various degrees of humidity of the space adjacent to the skin are undeniable. The areas of normal variation and racial differences, especially as i elated to diet, are of primary interest. 3. The relation of respiratory response to extensive cold and the correlated behavior of the mucosal surfaces of the respiratory tract—especially in relation to re- sistance and to infection by virus or bacterial agents is of great bearing on the possible prophylaxis in re- lation to the several communicable diseases now ser- iously threatening the Alaskan population. First ap- proaches to this problem may be made on a very fun- damental level in studying respiratory behavior at different temperatures and the concomitant surface temperatures in the upper respiratory passages. Studies of the circulatory response under these conditions could readily be included. “It'is possible that coordinated projects may deal with identical material in these experimental approaches and 15 thus permit direct correlations which may be of consider- able value. It is important, however, that sufficient lati- tude in selection of studies and specific approaches be left to the individual investigators, while careful selection be exercised in the implementing of the staff of the labora- tory especially in respect to caliber of scientific ability.” “Lack of fundamental knowledge of the many factors affecting environmental sanitation in the Arctic and Sub- arctic areas of Alaska is a serious deficiency which will delay most advantageous use of these areas. Worthy of careful consideration in normal times, in a period of world stress our lack of fundamental knowledge about the area could well become a matter of grave national concern. Environmental Sanitation Studies “Of the more obvious problems involved in environ- mental sanitation (in the Arctic) those briefly outlined below are the most important, and the ones which should be attacked on a scientific basis as soon as possible. All of these would be most worthwhile projects for any in- stitute which might be formed for the study of Arctic health. 1, Water Supply. Our entire concept of water supply must be revised when Arctic areas are involved. Per- manently frozen ground exists from a few inches or feet below the surface to great depth. Therefore, water is not obtainable from surface or underground sources except during a few months of the year when surface thawing provides limited quantities, the qual- ity of which is usually bad. During the winter months ice is the most frequent source of water. Scarcity and cost of fuel preclude anything but the most simple of water supplies under these conditions. There is need for investigating thoroughly this entire sub- ject, in order that the basic facts may be known and the most feasible means of meeting the problem may be revealed. Some work has been done in this field by the military forces; chiefly, of course, from the point of view of field operations. This work might possi- bly be of considerable value in determining the course 16 of future research. There can be no doubt that very little progress will be made in the way of developing the potential resources of the Alaskan Arctic until some means is found of providing the people involved with somewhere near an adequate supply of safe water. 2. Excreta Disposal. As in the case of the water supply, fundamentally different problems must be faced in the disposal of body wastes in the Arctic. Water-carried sewerage systems, except under very special and iso- lated cases, have not been used, both because of the lack of water and because of the need for heating the sewers to prevent freezing. Only the most primitive methods of excreta disposal have been employed in most sections of the Arctic. Many outbreaks of dis- ease in Arctic villages have resulted from the use of water obtained from surface pools which have been polluted with fecal material. A solution to this prob- lem, which may be applied generally, has not been found, yet its importance to life in the Arctic can hardly be overestimated. 3. Refuse Disposal. In at least one area of northern Alaska indiscriminate dumping of garbage and general refuse has led to infestations with rats and the poten- tial health hazards associated with those rodents. Flies capable of spreading infection breed prolifically dur- ing the summer months in the refuse from native villages and camps. Disposal of refuse by the so- called “sanitary fill” method is out of the question because of the permafrost conditions and the gener- ally flat terrain. A simple, practicable method of dis- posing of general refuse—(one which can be applied in the loosely organized native villages as well as in the more highly developed communities)—is greatly needed. 4. Insects. Although isolated studies in some parts of Alaska have been made, our knowledge of insect populations is extremely limited there. For most of the Arctic regions we probably do not have anywhere 17 near a complete list of existing species of mosquitoes and other blood-sucking insects. Without this funda- mental information we should be greatly handicapped if an insect-borne infection, perhaps a mosquito-borne encephalitis, should appear. Regardless of whether any direct connection between insects and health exists or may appear, there can be no doubt whatever that the pest varieties hamper all activity during the warmer months. This has been so severe, in fact, that var- ious mining and other companies have employed en- tomologists to try to solve the problem in certain local areas. During the war the army carried out a few minor control projects, but relatively little study was given to the problem in a balanced way. Qualified entomologists should delve into this field exhaustively, both to recommend practical methods of pest-insect control where feasible and, perhaps more important, to build up our fund of knowledge of in- sect species present. 5. Shelter, This word, when applied to Arctic life, has a deeper meaning than anywhere in the temperate zones. Most native shelters today are far less effi- cient from the point of view of conservation of heat than those used before contact with the white man. Copying of the white man’s dwelling, built entirely above the ground surface with no modifications to compensate for additional heat lost thereby, has pro- duced structures which are not at all well adapted to the climate. Until the recent studies by the army of unit type structures with provision for adequate regu- lation of internal temperatures and for maximum con- servation of heat, no real thought had been put on this problem, one of the most serious in Arctic life, both for the Eskimo and the white man. “The connection between inadequate shelter, resulting in the crowding of many persons into a single small shack, with the health of a population is perhaps nowhere sa clearly shown as among the Eskimos. 18 “Concerted and intensified study of this matter should take place. It seems likely the type of dwelling which may eventually prove to be most suited to this climate will embody fundamental differences which may only appear after the problem has been delved into scientifically.” Training Program “It is felt that a basic part of the proposed program for the research institution should be the training of all the basic types of Public Health personnel utilized in Arc- tic health. It is proposed to provide short intensive periods of field framing for public health workers in order to ac- quaint them with new preventative and public health methods applicable to Arctic regions. Such courses are considered to be essential in order to rapidly put into ef- fect new public health methods which are developed in the wake of new scientific discoveries. The lack of basic train- ing of many of the public health workers in State and local health departments is a fundamental weakness of the pub- lic health structure today. It is impractical to give many of these workers formal public health training. The best solution to the problem is to make available to them short courses in that field of public health in which they are to earn their living. “Even public health workers who have been fortunate enough to obtain formal training require a period of prac- tical field training in order that they may translate the theory which they have learned into actual field practice. It is proposed that field training courses conducted at che institution would require from three weeks for sanitar- ians to six weeks for health officers and public health nurses. Consideration should be given to other types of training. An important example would be the training of hospital and health department laboratory personnel. “It is felt that the training program should be de- veloped as a cooperative project with the Alaska Depart- ment of Health; technical personnel from the Department of Health would be utilized in the teaching program. The training program in all aspects would be coordinated with the operating program of the Department of Health.” 19 WHAT HAS BEEN ACCOMPLISHED In recognition of the long standing need for the de- velopment of research facilities in an Arctice area, the Territory of Alaska has taken steps toward the establish- ment of such a facility by introducing into the 81st Con- gress, through its Delegate, the following Resolution re- questing authorization of an appropriation to establish an Arctic Health Institute: Authorizing an appropriation for construction of build- ings and facilities in or near the University of Alaska for research in Arctic health. HOUSE JOINT RESOLUTION 7* Whereas the Territory of Alaska now constitutes one of the principal areas of our Nation in need of econ- omic development and is of increasing importance to our national defense and security; and Whereas the full potentialities of this area cannot be realized until substantial numbers of additional per- sons can be induced to establish permanent resi- dence there; and Whereas migration to that area on an adequate scale is not likely to occur until health conditions, as well as social and economic conditions, can be made satis- factory; and Whereas comprehensive studies made by responsible bodies, such as the American Medical Association and the American Public Health Association, have revealed alarming health and sanitation deficiencies in Alaska which seriously undermine the health of the present population and constitute a serious haz- ard to others who may establish residence there; and Whereas a serious obstacle in the way of correcting these health and sanitation deficiencies is the lack of specific knowledge regarding the operation of physical laws, biological processes, and human ad- justments under circumstances peculiar to Arctic regions; and Whereas the Public Health Service is prepared to con- duct and assist in the conduct of research in Arctic health problems, and the medical departments of the armed forces and other governmental and non- governmental agencies are prepared to cooperate in ♦lntroduced on January 3, 1949 20 such research, if adequate facilities are made avail- able; and Whereas the area in which the University of Alaska is situated, because of its unique Arctic location and because of the university’s established scientific de- partments, provides a logical location for permanent research facilities for the conduct of Arctic health studies; Now, therefore, be it RESOLVED BY THE SENATE AND HOUSE OF REPRESENTATIVES OF THE UNITED STATES OF AMERICA IN CONGRESS ASSEMBLED, That there is hereby authorized to be appropriated a sum not to exceed $7,775,000, for the acquisition of land and the erection and equipment thereon of suitable and adequate buildings and facilities for an Arctic Health Institute, including necessary living quarters for personnel, for the use of the Public Health Service in carrying on reseach and other activities pursuant to the Public Health Service Act (42 U.S.C., ch. 6A), with particular emphasis on health problems pertaining to the Arctic regions, and in cooperating with the medical departments of the armed forces and with other public and private agencies in carrying on such activities. The Federal Works Administrator is authorized to acquire, by purchase, condemnation, donation, or otherwise, a suitable and adequate site in Alaska, for such build- ings and facilities, which site shall be selected on the advice of the Surgeon General of the Public Health Service, and may be located within the grounds of the University of Alaska, notwithstand- ing any limitation in the grant of such grounds to the University, and to erect thereon, furnish, and equip such buildings and facilities. The amount authorized to be appropriated in this joint resolu- tion shall include the cost of preparation of draw- ings and specifications, supervision of construction, and other administrative expenses incident to the work: PROVIDED, That the Federal Works Agency shall prepare the plans and specifications on recom- mendation of the Surgeon General, make all neces- sary contracts, and supervise the construction. DONATION OF SITE In further recognition of the need for and desirability of bringing about the establishment of an Arctic Health Institute in Alaska, the Board of Regents of the Univer- 21 sity of Alaska have donated land adjacent to the Univer- sity campus as a possible site for the institution. Copy of Resolution Adopted by Board of Regents of the University of Alaska, October 5, 1948 “Whereas the development of Alaska is vital to the health, industry, security, and continued well being of the people of the United States, and “Whereas those who engage in the development of Alaska need, to insure success, the best information and advice obtainable through research on problems of health, suitable food, proper sanitation, good water, correct clothing, safe sewage disposal, com- fortable housing, and all other factors important to the forging back of the Arctic frontier, and “Whereas the development of Alaska is an Arctic de- velopment in an area of low temperature unparallel- ed in the history of the United States, and “Whereas the University of Alaska at 64° 51' 21" North latitude is a center of research and education, and “Whereas the University of Alaska desires to cooper- ate to the fullest extent with the Federal Govern- ment in order that the Institute of Arctic Health shall be advantageously located for the proposed re- search, “Now, therefore, be it resolved that the following described area be, and hereby is, offered to the Fed- eral Government for the purposes heretofore set forth. A tract of land lying in the north half of Section 6, T 1 S, R 1 W, Fairbanks Meridian, which is a por- tion of the property of the University of Alaska, and more particularly described as follows: Beginning at the Southeast corner of property leas- ed to the United States Coast and Geodetic Survey which lies in the Northwest quarter of Section 6, T 1 S, R 1 W, Fairbanks Meridian, thence South one hundred fifty-two and seven tenths (152.7) feet on an extension of the eastern boundary of said United States Coast and Geodetic Survey property, thence North eighty-nine degrees fifty-five minutes (89° 55') east one thousand seven hundred twenty-five (1,725) feet parallel to and on the North side of existing road, thence North six hundred twenty-two and one half (622.5) feet, thence West one thousand 22 seven hundred twenty-five (1,725) feet to a point on the eastern boundary of aforesaid United States Coast and Geodetic Survey property, thence South along- said eastern boundary four hundred seventy- two and three tenths (472.3) feet to the point of beginning. “The foregoing resolution having been introduced by Regent LEO F, RHODE who moved its adoption received the affirmative vote of all of the seven members of the Board present at the meeting. Of the eight members who constitute the Board of Regents one was absent from the meeting. Certified to be a true and correct copy.” /s/ MRS. LUTHER C. HESS Mrs. Luther C. Hess Attest Secretary /s/ ANDREW NERLAND Mr. Andrew Nerland President (UNIVERSITY OF ALASKA) (CORPORATE SEAL - 1935) RESEARCH BEGUN Under a special Congressional appropriation entitled “Disease and Sanitation Investigations, Territory of Alaska”, passed in June 1948, preliminary steps have been taken toward setting up a research program in certain phases of Arctic health under the auspices of the U. S. Public Health Service. The activities included in this pro- gram are necessarily limited by the available facilities and the willingness of research workers to come to Alaska and to tackle investigations under existing conditions. Un- til such time as adequate working facilities and equipment can be provided, this program will fall far short of its ultimate goal, namely, to gather complete and detailed information concerning the effects exerted by Arctic phenomena on human health and existence to be applied in solving existing problems. Recommendations 1. It is recommended that in order to promote sound re- search in Arctic Health problems, definite action be taken to make the establishment of an Arctic Health Institute a reality. 23 2. It is recommended that the proposed Arctic Health Institute be located within the permafrost area at a spot easily accessible to available modes of transpor- tation in close proximity to potential centers of de- velopment. The site offered by the University of Alaska meets these requirements admirably and with the additional advantage that both the Institute and the University would benefit mutually through the association. The already established and growing facilities of the Uni- versity and its academic atmosphere would undoubted- ly serve to interest and attract specialists in many fields. 3. It is also recommended, in view of the relative isola- tion of the site, that the proposed Institute be develop- ed as an independent self-sustaining establishment. Tentative plans include facilities for generating power, for storage of equipment and supplies, and for housing at least a portion of the contemplated personnel, as well as the essential laboratory, office and library facilities. 4. It is recommended that planning for the Institute be made on a sufficiently broad scale to permit the de- velopment of a well-rounded program of research through the provision of such special facilities and equipment as may be required for specialized projects in various fields of medicine and biology. 5, It is recommended that the research program of the proposed Arctic Health Institute be planned and de- veloped with sufficient scope to include problems in all aspects of medicine and biology relating to human existence in an Arctic environment. It is specifically recommended that such problems as housing, food and clothing be given consideration in the basic programs of sanitation and disease control investigation. 6. In order to permit some degree of correlation and ex- change of information in Arctic research activities, it is also recommended that, as a matter of policy, the facilities of the proposed Arctic Health Institute be made available to all qualified research workers inter- ested in studying problems relating to Arctic health.