WAR DEPARTMENT PAMPHLET NO. 
3 1-2 
CIVIL AFFAIRS HANDBOOK 
PUBLIC HEALTH 
IN THE 
JAPANESE EMPIRE 
WAR DEPARTMENT 
NOVEMBER 1944 
RESTRICTED. DISSEMINATION OF RESTRICTED MATTER.-The Infor- 
mation contained in restricted documents and the essential characteristics 
of restricted material may be given to any person known to be in the 
service of the United Slates and to persons of undoubted loyally and 
discretion who ate cooperating in Government work, but will not be 
communicated to the public or to the press except by authorized military 
public relations agencies. (See also par. 23b, AR 380-5,15 Mar 1944.) 
UNITED STATES GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1944 WAR DEPARTMENT, 
Washington 25, D. C., 28 November 1944. 
War Department Pamphlet No. 31-2, Civil Affairs Guide, Public 
Health in the Japanese Empire, has been prepared by Civil Public 
Health Division, Preventive Medicine Service, Office of Surgeon Gen- 
eral, and is published for the information and guidance of all con- 
cerned. 
[A. G. 300.5 ( 26 Oct 44).] 
order of the Secretary of War 
G. C. MARSHALL, 
Official 
Chief of Staff. 
J. A. ULIO, 
Major General, 
The Adjutant General. 
Distribution : RESTRICTED 
CONTENTS 
Page 
SUMMARY 1 
OBJECTIVES OF CIVIL AFFAIRS PUBLIC HEALTH 2 
PHASES OF CIVIL AFFAIRS PUBLIC HEALTH ACTIVITIES. ... 3 
Planning Phase 3 
Emergency Phase 3 
Organizational Phase 3 
ORGANIZATION OF CIVIL AFFAIRS HEALTH ACTIVITIES 4 
Organization at Theater Level. 6 
Organization at Task Force or Country Level 7 
Organization at Regional Level 7 
CIVILIAN MEDICAL SERVICE . J 11 
Emergency Treatment of Civilian Casualties 11 
Organization of Casualty Care Service 13 
Organized Medical Care 14 
LABORATORIES ------ 16 
COMMUNICABLE DISEASE CONTROI ... 17 
Amoebic Dysentery 18 
Bacillary Dysentery 18 
Cholera 19 
Dengue 20 
Diphtheria 21 
Encephalitis (Japanese B) __ 22 
Filariasis _ 22 
Influenza 23 
Leprosy 24 
Malaria. 24 
Plague 26 
Schistosomiasis 27 
Smallpox 28 
Trachoma 28 
Tuberculosis 29 
Typhoid-paratyphoid Fever 29 
Typhus Fever 30 
Venereal Disease 32 
I Page 
NUTRITION 35 
Assessment of Nutritions 35 
Prevention of Dietary Deficiency 36 
Protection Against Dietary Deficiency 37 
Relief of Dietary Deficiency r_ 37 
MATERNAL AND CHILD HEALTH 38 
Infant Care 38 
Immunization 39 
Shelters - * 40 
Additional Services for Children and Mothers 40 
SANITARY ENGINEERING 41 
Water Supply and Purification 41 
Excreta and Sewage Disposal 42 
Refuse Disposal - 43 
Mosquito Control 43 
Rodent Control 44 
FOOD SANITATION- 45 
MEDICAL SUPPLY 47 
DENTAL SERVICE 50 
VETERINARY SERVICE •- 51 
Anthrax 51 
Brucellosis 52 
Blackleg 53 
Glanders 53 
Hemorrhagic Septicemia 54 
Tuberculosis 55 
Tularemia 55 
Equine Encephalomyelitis 55 
Foot-and-Mouth Disease or Aphthous Fever 56 
Hog Cholera 57 
Rabies 57 
Rinderpest 58 
Trypanosomiasis 59 
Piroplasmoses 1 , 59 
Anaplasmosis 60 
Parasitic Conditions Encountered in Meat Inspection. 61 
NARCOTIC CONTROL 62 
VITAL RECORDS . 64 
HEALTH PROBLEMS OF DISPLACED PERSONS. 66 
FOREIGN QUARANTINE 68 
Quarantinable Diseases 68 
Definition of Quarantine 69 
Foreign Quarantine in War and Peace 69 
II FOREIGN QUARANTINE—Continued. Page 
Variation in Quarantine Problems 69 
Variation in Insect Control Problems 70 
Responsibility for Quarantine 70 
Basis for Quarantine 71 
Flexibility of Quarantine Control 1 72 
APPENDIXES. 
A. Organization of Civil Health Services in Japan Proper 73 
Institutes Under the Public Health and Welfare Department . 75 
Organizations Related to Public Health 75 
B. Organization of Health Services in Other Parts of the Japanese 
Empire 77 
Formosa 77 
Korea ' 78 
The Kuriles 80 
C. Nutrition Tables 81 
Table 1. Symptoms of Nutritional Deficiencies 81 
Table 2. Physical Signs of Nutritional Deficiencies 82 
D. Medical Supply (Forms used in Italian Theater) 83 
Executive Memorandum 83 
Issue Voucher 90 
Transfer Voucher 91 
Receiving Report 92 
Store Ledger 93 
Monthly Stock Report 94 
Monthly Report of Sales 95 
E. Bibliography 96 Note 
Civil Affairs Guides and Civil Affairs Information Guides are de- 
signed to aid Civil Affairs Officers dealing with problems in theaters of 
operation, each Guide being focused upon a specific problem in a par- 
ticular area. These Guides are not basic collections of factual infor- 
mation, as are the Civil Affairs Handbooks, nor are the recommenda- 
tions (or action programs implied in the Guides) intended to take the 
place of plans prepared in the field. They are rather designed to point 
the factual information toward the making and executing of plans by 
those Civil Affairs Officers assigned to this work in the theaters of 
operation. In no sense is a Guide to he taken as an order. Such orders 
will be issued in the normal manner. 
This Guide was prepared under the supervision of the Committee on 
Civil Affairs Guides and is approved by the Committee. 
This document contains information affecting the national defense 
of the United States within the meaning of the Espionage Act, 50 U. S. 
C., 31 and 32 as amended. Its transmission or the revelation of its 
contents in any manner to an unauthorized person is prohibited by 
law. 
IV RESTRICTED 
SUMMARY 
This Guide presents the objectives and organization for the public 
health division of civil affairs in the Japanese Empire. The organi- 
zation is of a pattern suitable for integration with the organization 
of the existing Japanese Health Department and should facilitate 
meeting problems likely to be important to public health in Japan. 
In the discussion of various public health functions and problems some 
limitations or alterations have been suggested to conform to standard 
military government policies and procedures. It has not been at- 
tempted to develop a textbook of scientific material, but rather to 
provide a guide for action to the civil affairs officers responsible for the 
medical and public health problems. It is believed that this guide 
will not only be helpful to Medical Department officers of civil affairs 
but will also orient general civil affairs officers in programs of public 
health and will suggest to them the initial steps to be taken in a public 
health or medical emergency. 
1 OBJECTIVES OF GVIL AFFAIRS PUBLIC HEALTH 
The field of responsibility broadly known as public health will 
ordinarily be a major component of civil affairs activities in an 
occupied country. Its importance rests on the following considera- 
tions ; 
Military operations can be seriously impeded by widespread disease 
in the civil popjulation, either through extension of disease to the 
military forces or through disruption of community activities sup- 
porting military operations. Responsibility for preventing such an 
occurrence, while resting primarily upon the commanding general and 
the chief surgeon of the occupying forces, will usually be delegated to 
the civil affairs section. 
Since public health is an integral part of government, the govern- 
ing authority in an occupied country must endeavor to protect the 
civil population against epidemics of preventable disease and provide 
minimum facilities for medical care. Standards of performance will 
not exceed those existing prior to military occupation. Public health 
measures required as a military necessity and in conformity with 
policies of higher authority wdll be carried out almost entirely through 
the use of local resources. 
The character of modern warfare, with its rapid movement, utiliza- 
tion of cities for defensive strong points, and aerial bombardment, 
greatly enhances the danger to the civil population, which frequently 
sustains grievous injury. Common humanitarianism and the needs 
as justified by military necessity for securing the good will and 
cooperation of the civil population will impel the military forces of 
the United States under such circumstances to assist in providing 
emergency medical care for civilians who come within their 
jurisdiction. 
2 PHASES OF CIVIL PUBLIC HEALTH ACTIVITIES 
Health activities directed to the civil population of an occupied 
territory may be divided into the planning, emergency, and organiza- 
tional phases. 
Planning Phase 
As in other types of military operations, intelligent planning is 
essential. Based on the strategic and tactical plans for the military 
operations as a whole, an attempt should be made to appraise the 
principal problems in health and sanitation likely to be encountered, 
assemble adequately trained Medical Department personnel to deal 
with those problems, outline so far as practicable the job each 
individual is expected to do, weld the whole into a team, and make 
provision for transportation and medical supplies with which to 
implement the health and sanitation program. 
The emergency phase corresponds to the period of active combat 
and is limited territorially to the immediate area of combat opera- 
tions. The principal civil health activities of this phase are directed 
to providing medical and hospital care, and transportation for the 
wounded and acutely ill civilians, assuring a supply of a few basic 
medical items, such as surgical dressings, disinfectants, morphine, 
and sulfonamide drugs, providing safe water for civilians, and 
initiating measures urgently needed for control of any communicable 
diseases present which are likely to become epidemic among the troops. 
Emergency Phase 
Organizational Phase 
Transition from the emergency to the organizational phase should 
begin at the earliest possible moment. Proceeding on the basis of 
carefully prepared plans, the principal civil health activities of this 
phase are reactivation under military control of the previously exist- 
ing public health organization, reestablishment of hospital and labora- 
tory facilities, provision of such emergency facilities and services 
as circumstances and military necessity require, and institution of 
measures designed to assure safe water supplies and sewage and waste 
disposal. Inauguration of programs necessary to prevent disease and 
such disorder a<s might endanger or impede military operations 
should follow without delay. Existing public health laws and regu- 
lations should be reviewed and those regarded as sound enforced, and 
additional regulations needed should be drafted for proclamation by 
the proper government officials. 
3 ORGANIZATION OF CIVIL AFFAIRS HEALTH ACTIVITIES 
The organization of civil public health activities will necessarily 
conform to the organization of civil affairs activities as a whole, which 
in turn will be determined in part by the organization of the military 
forces at the theater, task force, and communication zone level. It is 
the purpose of this section to present the principal functions which the 
public health division of civil affairs will be called upon to perform, 
and to suggest an appropriate organizational pattern designed to meet 
the functional needs. 
Experience in several theaters during this war has shown that public 
health activities constitute a major function of civil affairs. In order 
to properly fulfill this function, public health should be accorded the 
status of a major subdivision of civil affairs, coordinated with legal, 
fiscal, economic, and other major subdivisions. 
Since the civil affairs section is an integral part of Army organiza- 
tion there must be a clear-cut chain of command. At every level the 
chief civil public health officer should be responsible to the chief civil 
affairs officer of the organization to which he is attached. 
Medicine and public health are highly technical subjects. It is 
essential that there be clear-cut lines of responsibility in matters per- 
taining to the technical aspects of civil public health. Since the chief 
surgeon of the theater or task force is the principal advisor in medical 
matters to the commanding officer of the theater or task force, he (the 
surgeon) is by implication the senior technical consultant in all mat- 
ters pertaining to over-all policy in health problems. The chief civil 
affairs public health officer should recognize the chief surgeon’s re- 
sponsibility and make provision for close liaison with him, to the 
end that civil affairs health activities may be properly coordinated 
with the health and medical activities of the military forces.1 Like- 
wise, close liaison should be maintained between civil affairs medical 
officers of lower echelons and the surgeons of combat forces operating 
in the same area. (See figs. 1, 2, and 3.) 
1 The terms “military” and “civil” will be used to distinguish between the combat 
and supply services of the Army on the one hand and the services for the civil 
population on the other. 
4 The principal problems of civil affairs health activities can be 
grouped in four main categories: communicable disease control, hos- 
pitalization and medical care, medical supply, and sanitary engineer- 
ing. While the relative importance of one or another of these groups 
of problems may vary according to the phase of combat operations and 
according to the country in question, nevertheless throughout all civil 
public health operations problems related to each of these categories 
will likely be encountered. The functional organization of civil pub- 
lic health should therefore be based on this pattern, with key men 
assigned to each subdivision. 
In addition, various special health problems will be encountered. 
Among these will probably be venereal disease control, tropical dis- 
ease and malaria control, foreign quarantine, displaced persons, food 
inspection and vital records, which may be conveniently grouped 
under Communicable Disease Control'Section; maintenance of medi- 
cal institutions such as leprosaria, tuberculosis sanitoria, and mental 
hospitals, maternal and child care, nutrition, dental care, nursing 
service and laboratories, which may be conveniently grouped under 
Hospitals and Medical Care Section; narcotic control, which may be 
included under Supply. 
Depending somewhat on the character of the country in which 
military operations are being conducted the control of diseases of ani- 
mals may constitute an important problem, particularly from the 
standpoint of food supply. Directional services for programs for the 
control of animal diseases are provided by civil affairs through officers 
of the Veterinary Corps. In the Japanese Empire veterinary services 
are administered through the Ministry of Agriculture and Forestry. 
In conformity with the general policy of adapting the civil affairs 
organization to the organizational structure of the country occupied, 
it may be more feasible to attach those veterinary officers directly 
concerned with the health of animals to the agricultural section of civil 
affairs. In this case, however, since the Veterinary Corps of the U. S. 
Army is an integral part of the Medical Department it will be desira- 
ble to have a strong liaison established between this section and the 
public health section. This may be accomplished by appointing the 
senior veterinary officer as consultant to the Director, Public Health 
Section. 
It is evident that the organizational pattern suggested above does 
not conform closely to that observed in many health departments in 
the United States. While health problems are essentially the same 
everywhere, the relative importance of special aspects of the over-all 
problem differs under civil affairs, due to the temporary nature of the 
civil affairs program, the limited resources in personnel and supplies 
with which civil affairs must operate, and the paramount importance 
5 of expending effort in directions which give promise of the greatest 
assistance to military operations. 
For example, vital records are a basic part of every health depart- 
ment’s program, yet in the civil health program they must be used 
principally to provide a danger signal to herald the approach of an 
epidemic which might be a threat to military operations. All other 
considerations must be subordinated to this primary purpose. In 
addition, reports on the adequacy of hospital facilities, medical sup- 
plies, and food supplies must be obtained from small administrative 
units of the occupied territory for planning purposes at higher 
echelons. 
Another important factor which influences the organization pattern 
of civil public health is that the entire program must be conducted 
largely through the use of local resources in personnel and facilities 
with a minimum of directing civil affairs personnel. For this reason 
too, the organizational pattern should be kept as simple as possible, 
supplementing the administrative services rendered by the main sub- 
divisions with competent consultants in certain special fields. 
Welfare in its broad sense and including rehabilitation features will 
probably not be a function of military government. Yet, emergency 
relief as to food, clothing, and shelter will in many areas be an im- 
portant consideration and plans must be made to meet these emer- 
gencies. The mission of the public health section to prevent disease 
will require that there be provided at least a basic diet, sufficient cloth- 
ing to prevent exposure, blankets for the ill, and shelter for homeless 
persons. The administration of this program of limited emergency 
relief may become a responsibility of the public health section of civil 
affairs. 
Organization at Theater Level 
At both Supreme Headquarters Allied Expeditionary Force 
(SHAEF) and Allied Force Headquarters North Africa (AFHQ) 
civil affairs is organized as G-5 and directed by an Assistant Chief of 
Staff. Public Health forms a major branch of G-5. 
Assuming that this same or similar pattern of organization of civil 
affairs will obtain, the Public Health Branch requires certain key 
personnel in order to carry out its major functions of formulation of 
civil public health plans, recommendation concerning the assignment 
of personnel, and maintenance of liaison with the office of the chief 
surgeon of the theater and with other branches of G-5. While it will 
be desirable to limit the staff of the Public Health Branch, G-5, to 
essential personnel, the minimum requirements for the planning phase 
will be a director, and at least one well-qualified Medical Department 
officer to cover each of the four main subdivisions, communicable dis- 
ease control, hospitals and medical care, supply, and sanitary engineer- 
6 ing. One of the subdivision chiefs should be designated as deputy 
director of the Public Health Branch. Much of the detailed work 
during the planning phase should be delegated to special groups as- 
sembled for that purpose. Once the operational phase has begun, it 
may be possible to reduce the staff of the Public Health Section to a. 
director, a deputy director and an officer familiar with supply pro- 
cedure. Field operations will normally be under the immediate super- 
vision of the civil affairs staff at task force or country level as in- 
dicated in the succeeding paragraph. 
Organization at Task Force or Country Level 
On the assumption that for a time at least theater headquarters will 
be at some distance from the various military objectives, it will be 
necessary to select and organize the basic operational staff for each 
country as the operational plans develop. The staff should be very 
similar in organization to the theater staff and conform to the general 
pattern as indicated above. Initially this staff should be attached 
to the civil affairs section of the staff of the commanding officer of the 
task force charged with the conquest of a given country. Specialist 
consultants in such fields as venereal disease control, malaria control, 
tropical disease control, maternal and child health, nutrition, veteri- 
nary medicine, dental health, and entomology should be attached to the 
basic staff in such numbers as the situation requires. 
Upon occupation of the country and the transition to a territorial 
organization, this staff becomes the top operating staff of the country. 
For example, if Japan were the objective, this staff would superim- 
pose itself upon the Ministry of Health in Tokyo, assigned in stategic 
positions of the health organization, to supervise and direct the func- 
tions of the ministry at the policy-making level. Specialist con- 
sultants would be assigned in appropriate positions to supervise 
activities within their specialty. In addition, consultants would make 
such special investigations and surveys in their field as indicated and 
serve as technical consultants within their field to the director and to 
subordinate echelons of civil affairs. The organizational chart (fig. 8) 
illustrates a functional break-down embodying these principles. (See 
also app. A.) 
Organization at Regional Level 
Economy in the use of personnel will require certain geographical 
subdivisions. Again using Japan as an example, it is obviously im- 
possible to consider assignment of public health personnel to each 
of the prefectures in Japan. Thus a grouping of prefectures or selec- 
tions of important areas becomes necessary. The geographical areas 
within each region should be determined after consideration of several 
7 factors. Among these factors are relative importance to the ac- 
complishment of the military mission, political boundaries and dis- 
tribution of other civil affairs personnel, distribution of population, 
political and commercial importance of the area, and availability of 
personnel, both civil affairs and native. Military developments may 
make alterations in the distribution of personnel desirable. A geo- 
graphical grouping based on political boundaries and population 
COMMANDING GENERAL 
THEATER OF OPERATION 
SURGEON 
CHIEF CIVIL 
THEATER OF OPERATION 
AFFAIRS OFFICER 
HEALTH BRANCH 
CHIEF, PUBLIC 
COMMANDING GENERAL 
TASK FORCE 
SURGEON 
SENIOR CIVIL 
TASK FORCE 
AFFAIRS OFFICER 
SENIOR PUBLIC 
HEALTH OFFICER 
COMMANDING GENERAL 
ARMIES,CORPS, DIVISIONS 
SURGEON 
CIVIL AFFAIRS OFFICER 
ARMY, CORPS.DIVISION 
PUBLIC HEALTH OFFICER 
KEY 
COMMAND CHANNELS 
TECHNICAL CHANNELS 
LIAISON CHANNELS 
Figure 1. 
8 concentrations is illustrated in figure 4. Some of the less important 
areas, such as Regions I and VIII, may require little or no civil affairs 
medical personnel and public health administration may be left entirely 
in the hands of the native officeholders. 
The basic staff for each region should again be functionally similar 
to that described and have attached specialists as necessary. Each 
of the four functional divisions should be headed by a capable officer, 
one of whom serves as the director. 
COMMANDING GENERAL 
THEATER OF OPERATION 
SURGEON 
THEATER OF OPERATION 
G 5 
CHIEF, PUBLIC 
HEALTH BRANCH 
COMMANDING GENERAL 
TASK FORCE, OR 
COMMANDING GENERAL 
ZONE COMMUNICATION 
SURGEON 
CHIEF CIVIL 
AFFAIRS OFFICER 
SENIOR PUBLIC 
HEALTH OFFICER 
SCAD 
A PROVINCE 
S.CA.O. 
B PROVINCE 
SCAD 
C PROVINCE 
PUBLIC HEALTH OFFICER 
PUBLIC HEALTH OFFICER 
PUBLIC HEALTH OFF1CEI 
COMMAND CHANNELS 
KEY 
LIAISON 
CHANNELS 
TECHNICAL CHANNELS 
S.CA.O. 
SENIOR 
AFFAIRS 
CIVIL 
OFFICER 
Figure 2. 
618146—44 2 
9 SENIOR PUBLIC HEALTH OFFICER 
COMMUNICABLE DISEASE CONTROL 
HOSPITALS AND MEDICAL SERVICE 
VENEREAL DISEASE CONTROL 
TROPICAL DISEASE AND 
MALARIA CONTROL 
FOREIGN QUARANTINE 
VITAL RECORDS 
DISPLACED PERSONS 
FOOD INSPECTION 
MEDICAL INSTITUTIONS 
MATERNAL AND CHILD HEALTH 
NUTRITION 
DENTAL CARE 
NURSING SERVICES 
LABORATORIES 
SUPPLY 
SANITARY ENGINEERING 
MEDICAL SUPPLIES 
NARCOTIC CONTROL 
WATER SUPPLIES AND 
SEWAGE DISPOSAL 
RODENT CONTROL 
ENTOMOLOGY 
•VETERINARY CONSULTANT 
• VETERINARY OFFICERS FOR CONTROL OF ANIMAL DISEASES WILL BE ATTACHED 
TO THE PUBLIC HEALTH SECTION OR TO THE AGRICULTURE SECTION. 
Figure 3. 
JAPAN 
GROUPING PAGED ON GEOGRAPHY, v 
POPULATION CONCENTRATIONS AND' 
POLITICAL BOUNDARIES 
HOKKAIDO 
i 
m 
HONSHU 
m; 
IT 
>n 
37TT 
3L 
SHIKOKU 
UTTT 
KYUSHU 
3X 
Figure J/. CIVILIAN MEDICAL SERVICE 
Provision and maintenance of adequate medical care for civil 
populations will be an early responsibility of civil affairs adminis- 
tration and comprehensive plans for such care should be developed. 
The extent and nature of the initial civilian medical care program 
required will be dependent upon the degree of bombing preceding 
occupation, the number of civilian casualties, amount of property 
destruction, previous state of health in the area, and the availability 
of local medical facilities, supplies and personnel. Certain of these 
factors cannot be pre-ascertained, and will be apparent only after 
actual occupation. Consequently, an adequate plan will be one in 
which all exigencies have been considered, both for initial phases of 
occupation and subsequent periods. Because of certain geograph- 
ical and administrative diversity in various parts of a country, a 
general plan for medical service may be adopted and later adapted 
to meet specific needs of each city, community, or political subdi- 
vision. 
Emergency Treatment of Civilian Casualties 
In seaboard and industrial cities, or wherever bombing has been 
extensive, numerous civilian casualties may be expected. Civilian 
casualties from enemy bombing may occur in certain instances sub- 
sequent to the occupation. The problem of treatment and care of 
casualties may be increased by widespread destruction of hospitals, 
sanitary and transportation facilities, and inadequacy of supplies 
and trained medical personnel. Consequently, an inclusive plan for 
emergency medical service, a prompt survey of available facilities 
and personnel to assist in the program, and subsequent judicious use 
of the existing facilities and personnel are essential. In most in- 
stances, such pre-existing organizations and facilities as governmen- 
tal health and welfare agencies, hospitals, dispensaries, and clinics 
may be used to advantage. The actual operation of the emergency 
medical program in a community will usually be entirely dependent 
on native personnel. Local physicians with broad experience and 
administrative capacity, such as surgeons, public health officers, or 
n experienced hospital administrators may prove helpful in the opera- 
tion of the program. Compensation of civilian medical personnel 
and hospitals when necessary should be in accordance with the fiscal 
policies determined by Civil Affairs officials. 
Responsibilities of public health officer. The responsibilities of 
the public health officer in charge of medical care in the civil affairs 
administration of an area are: 
1. To determine the type and extent of emergency medical services 
required. 
2. To determine by survey the facilities available for care of cas- 
ualties and to determine the number of official and voluntary organ- 
izations and personnel available to participate in a program of 
medical care. 
3. To assist hospitals to equip and organize emergency medical 
units; also to make possible expansion of bed capacity in hospitals. 
4. To select sites for casualty stations. 
5. To plan and establish transportation service for casualties and 
medical personnel. 
6. To stimulate recruitment of local personnel to aid in the medi- 
cal care program and to provide facilities for instruction of such 
personnel in first aid if adequate numbers are not already trained. 
7. To establish medical supply depots. 
Emergency rwedical field units. In areas of great destruction, 
basic medical equipment should be assembled in general hospitals, 
both private and governmental. Emergency medical field units, to 
include physicians, nurses, and aides, should be organized from the 
staff of the hospitals. An emergency medical field unit should con- 
sist of several squads. A physician should be appointed to super- 
vise the entire unit, and squad leaders in turn should be designated. 
The size of the emergency field unit should be in proportion to the 
bed capacity of the parent hospital. As far as possible, all mem- 
bers of field units should have had experience in first aid and in 
transportation of the injured. 
Transportation. In areas where destruction precludes use of 
vehicles or where vehicles are not available, the evacuation of 
wounded may be entirely by handborne litters. 
Medical and surgical equipment. The medical and surgical equip- 
ment for an emergency medical field unit squad consist of a working 
supply for each physician’s team and a reserve supply of sterile 
dressings and equipment in packs from which the working supplies 
of the teams may be replenished. The provision of working sup- 
plies for each physician in a separate container will permit the 
squad of a casualty station to split off teams of one physician and 
assistants who can be dispatched to set up subsidiary first-aid posts, 
12 Casualty stations and -first-aid posts. The location of a casualty- 
station should provide safety, shelter, and accessibility; clinics, 
health departments, health centers and substations, or schools may 
be suitable. These stations should be stocked with stretchers, cots, 
and blankets from available supplies and the injured may be directed 
or transported to them on stretchers by litter teams. The work of 
the casualty station should be limited to emergency first-aid proce- 
dures—the relief of pain, control of hemorrhage, prevention of 
shock, and care of burns. The seriously injured should be evac- 
uated as rapidly as possible to a hospital and those with minor 
injuries returned to their homes or assigned to temporary shelters. 
First-aid posts may occupy a temporary location and should provide 
emergency first aid for the more severely injured. At these posts, 
casualties may be classified so as to expedite the transfer of seri- 
ously injured to a hospital. 
Rescue amd litter squads. Rescue squads are groups organized for 
the extrication of persons trapped in collapsed or demolished build- 
ings. Such individuals should be equipped to render minimal first aid 
to casualties. Such casualties should be turned over to litter squads 
for transportation to first aid stations or casualty stations. 
Medical depots. Accessible medical depots should be established 
for storage of essential medical supplies needed in the care of casualties. 
Records. If possible, improvised identification tags should be 
affixed to the injured, and a record of casualties should be kept by each 
medical team. 
Hospitals. The available hospital beds, surgical facilities, matern- 
ity services, and children’s wards should be ascertained by inventory 
of hospitals, convalescent homes, and similar institutions. Provisions 
of additional equipment should be made in such institutions to augment 
the bed capacity for care of casualties. 
Organization of Casualty Care Service 
1. Rescue squads. Attached to first-aid Two to four persons Litters. 
post or casualty sta- per squad, three 
tions. squads per aid sta- 
tions. 
2. First-aid posts. Temporary, dependent Two to four persons First-aid kits, blan- 
upon need. trained in first aid, kets, and litters. 
or nurses. 
3. Casualty sta- Schools, medical cen- Emergency field units; Sterile dressings, 
tion. ters, health depart- numbers in proper- drugs, instruments, 
ments. tion to size of hos- blankets, and lit- 
pital. ters. 
4. Hospital. Existing hospitals. Staff. Usual hospital equip- 
ment so far as avail- 
able. 
Location 
Personnel 
Equipment 
13 Organized Medical Care 
Transition of a program for civilian medical care from an emergency 
type to a stabilized organizational type should be accomplished as early 
as possible. However, complete dissolution of emergency care pro- 
grams for casualties should not be undertaken until all danger of 
bombing has been eliminated. In a stabilized public health adminis- 
tration, the facilities of preexisting government and private health 
agencies, hospitals, sanatoria, clinics, and dispensaries should be re- 
established within limits of military government policy. Private prac- 
titioners, advantageously located and distributed, may be utilized to 
supply medical care to the bulk of the civil population. In such a 
program, civil affairs public health officers serve in a directorial and 
advisory capacity. Certain groups of the civil population will usually 
require special consideration; these include infants and children, preg- 
nant women, the aged, refugee groups, and inmates of sanatoria and 
mental institutions. Facilities for provision of adequate food, medical 
care, clothing, and shelter should be established. 
Supervision of hospitals will be a function of the civil affairs public 
health officer. Inadequate facilities for hospitalization will have 
existed in many localities under normal conditions; in war-torn areas, 
the inadequacies may be accentuated by destruction, increase)in disease, 
and occurrence of casualties. Intact structures suitable for conversion 
to hospitals may be selected when hospitals have been destroyed; 
churches, warehouses, Army barracks, store buildings, and schools may 
serve the purpose. Military forces will have precedence in use of civil 
hospital facilities for the hospitalization of military casualties. An 
emergency expansion plan should be developed and equipment and 
facilities should be provided to expand hospital bed capacity in such 
institutions as indicated. Reports of beds occupied and available 
empty beds in every hospital should be sent at regular, predetermined 
intervals by the local government administrator to the chief public 
health officer in the area. Readjustment of beds to provide for isolation 
wards, children’s wards, and maternity services may be necessary; in 
areas where such facilities do not exist they should be established. The 
maintenance of leprosaria, mental hospitals, tuberculosis sanatoria, 
and convalescent homes should be perpetuated. Management of hos- 
pitals should be by competent and trained native personnel, while gen- 
eral supervision over all hospitals, hospital staffs and the utilization 
of equipment, should be maintained by personnel of the public health 
section in the local civil affairs administration. 
Registration of medical persons, as physicians, nurses, midwives and 
dentists should be accomplished as early as possible. This will facili- 
tate planning medical care program by providing information as to 
numbers, qualifications, and distribution of personnel. Unequalized 
14 distribution of personnel may be rectified by planned relocation; medi- 
cal qualification should be based on preexisting standards for the coun- 
try. Supervision of the plans for relocation of medical personnel re- 
turning from the armed forces will probably be necessary. Registra- 
tion of personnel will be facilitated by access to local and national 
health organization records and the membership lists of professional 
societies. Particular attention should be given to registration of in- 
dividuals capable of planning for and attending special groups; these 
may include obstetricians, pediatricians, midwives and physicians for 
sanatoria and leprosaria. Training programs in medical and nursing 
schools may be accelerated wdien inadequate medical personnel exist. 
All personnel and facilities of medical and nursing schools should be 
utilized to maximum advantage in perpetuation of education and train- 
ing programs. 
General medical care may be provided in physician’s offices, clinics, 
dispensaries, and maternal and child health centers; the seriously ill 
and surgical cases should be hospitalized. Prenatal care may be given 
in similar centers and normal deliveries done by physicians or midwives 
in private homes or shelters. Obstetric consultation service should be 
provided when indicated and delivery of abnormal cases should be in 
hospital if possible. Isolation for communicable disease may be ap- 
propriate in the home or in isolation wards or units of a hospital. For 
cases quarantined at home, the services of visiting nurses are valuable. 
There is a State Health Insurance system in Japan covering several 
million families. The Public Health and Fiscal Civil Affairs officers 
should become familiar with the administration of this system and 
assume responsibility for proper supervision. 
Adequate stocks of essential medicines, drugs and biologicals should 
be maintained in medical depots. Release of these supplies should be 
only on order of authorized medical personnel. Distribution to con- 
sumers may be through hospitals, maternal and child health centers, 
doctors, dispensaries, or commercial pharmacies; these sources of dis- 
tribution may be stocked from locally available stocks or from medical 
supply depots. Drug and biological plants and laboratories should be 
rehabilitated and the manufacture of essential items resumed as early 
as possible. 
15 LABORATORIES 
A prompt survey to determine equipment, supplies, and personnel 
required for reestablishment of preexisting laboratories, both clinical 
and public health, should be made. Priority should be given public 
health laboratories for reestablishment of facilities to do laboratory 
procedures that are essential in epidemic control; tests of this type 
would include bacteriological, parasitological, and serological exam- 
inations. 
During combat phases of occupation, special attention should be 
given to reestablishment of blood typing facilities and blood banks 
for emergency care of civilians. Preexisting hospital laboratories 
should be prepared to perform the following laboratory procedures: 
blood counts, bleeding and clotting times, blood smear examinations 
for malaria, urinalysis, examination of stools for blood, parasites and 
ova, bacteriological smears and cultures for common disease produc- 
ing organisms, tests for serological diagnosis of syphilis, appropriate 
agglutination tests, and equipment for post mortem examinations. 
Local facilities for manufacture of biologicals should be appraised 
and manufacture of all biologicals essential to epidemic control should 
be restored as promptly as is possible. 
16 COMMUNICABLE DISEASE CONTROL 
The emergency nature of military government activities will indi- 
cate some modifications in the policies and procedures usually found 
in communicable disease control programs of a stabilized public health 
program. 
The basic policy of military necessity will direct initial concern to 
the control of those diseases or conditions which endanger the health 
of the occupying troops. 
The basic policy of maintenance of health and welfare of the gov- 
erned will direct attention secondly to control of diseases which might 
assume epidemic proportions, cause suffering, unrest or dissatisfac- 
tion among civil populations. Endemic diseases at low levels of in- 
cidence will rarely justify immediate concern. 
Attempts to raise standards of public health above prewar levels in 
an occupied country will not be feasible because of the limitations of 
supply and personnel. 
Control measures which offer immediate results will be perferred 
to long-range programs, which may not be effective for several years. 
The structure of the existing health departments and health regula- 
tions should generally remain unchanged. Because of probable short- 
age of trained public health personnel changes in the existing health 
staffs should be kept to the minimum consistent with security and 
urgent political necessity. Existing and reasonably sound procedures 
are preferable to new procedures which, though technically superior, 
are unfamiliar. Cooperation of native health and medical personnel 
is so important that moderate compromises in technical procedures are 
justified. 
A suitable system by which communicable diseases will be promptly 
reported is indicated. Early knowledge of existence of diseases of 
epidemic character is essential to proper control. Diseases of par- 
ticular importance such as cholera, plague, typhoid and the dysen- 
teries, smallpox, and typhus should be reported immediately by the 
most expeditious means to the civil affairs public health officer. Any 
unusual numbers of cases of undiagnosed febrile diseases should be 
immediately brought to the attention of civil affairs public health 
officers. Immediate steps should be taken to establish the diagnosis 
and institute the necessary control measures to avert an epidemic. 
17 In the following discussion of individual diseases, emphasis will be 
placed upon practical actions to be taken in both the preepidemic 
period and after outbreaks have occurred. 
These discussions are not to be considered a substitute for good 
professional judgment related to the problem at hand. They servo 
rather as a guide for planning purposes, and indicate the standards of 
public health which are considered feasible under military govern- 
ment. To nonmedical civil affairs officers, it may indicate essential 
measures necessary before a complete analysis by a public health 
officer can be made. (See SGO Cir. LTR 33—Treatment and Control 
of Certain Tropical Diseases; TB MED 47 Control of Diseases of 
Respiratory system and other Diseases transmitted by discharge from 
Respiratory Tract.) 
Amoebic Dysentery 
Distribution and 'prevalence. This disease is extremely common 
throughout every part of the Japanese Empire. In Japan proper 
the disease is most prevalent during early summer months and is said 
to be more common in the interior of the country. 
Epidemiology. The etiological agent is Endameba histolytica, both 
trophozoites and cyst forms being transmitted from person to person 
by contaminated food, water, or by flies. The extensive practice of 
fertilization with night soil in all parts of the Far East provides in- 
numerable opportunities for transmission of the infectious agent. The 
incubation period varies from 2 days in severe infections to 2 months; 
commonly 3 to 4 weeks. Cases should be considered infectious until 
repeated microscopic stool examinations are negative for trophozoites 
and cysts. Infected persons may harbor the cysts for many years 
without clinical signs. 
Recommended program of control. It is considered impracticable 
to attempt reduction of incidence as a routine measure. Troops sta- 
tioned in the area should be warned of the danger of eating uncooked 
foods or drinking water which has not been boiled; in some instances 
it may be practical to destroy the cyst by hyperchlorination (see San- 
itary Engineering) . All native eating establishments should be 
placed “off limits” for troops and a stool examination should be per- 
formed on natives acting in the capacity of food handlers at Army 
messes. 
Bacillary Dysentery 
Distribution and 'prevalence. This disease is extremely common 
throughout the Japanese Empire. Japanese reports also refer to a 
“dysenterylike” disease of unknown etiology called “ekiri,” occurring 
commonly among infants and children. 
Epidemiology. The etiologic agent is Shigella dysenteriae and 
other species of the genus Shigella. Sources of the agent are the bowel 
18 discharges of patients and carriers, and transmission is directly 
through infected food and water or indirectly by flies. Objects con- 
taminated by discharges of a patient or carriers may be a source. The 
incubation period is 1 to 7 days; persons remain infectious until the 
organism disappears from bowel discharges. A small proportion 
remain carriers for long periods. A relative and nonpermanent im- 
munity develops. 
Recommended program of control. It is not considered practicable 
to attempt reduction of incidence as a routine measure. Reliance 
should be placed on a sanitation program to keep the dysenteries at 
a low limit of incidence. Troops stationed in the area should be 
warned of the danger of eating uncooked food or drinking water 
which has not been boiled or chlorinated. In mass feeding programs 
(communal kitchens, refugee camps), every effort should be made to 
preserve high standards of sanitation. A fly-control program should 
be instituted; particular attention should be given to protection of 
kitchens and messes from flies. 
The occurrence of epidemics is usually limited to instances where 
large groups of people have obtained food or water from a common 
source. In such instances, attempts should be made to determine the 
source and sanitary safeguards should be inaugurated to prevent re- 
currence. The public should be warned of the dangers of the disease 
and of methods possible for individual protection. 
Cholera 
Distribution and prevalence. Epidemics of cholera were reported 
in Japan Proper in 1932, 1937, and 1938. The disease is endemic in 
Korea and the last epidemic reported was in 1933. Cholera was a 
serious disease problem in Formosa for many years; cases are known 
to have occurred in 1941. The enforcement of strict quarantine 
measures and the free use of cholera vaccination by the Japanese did 
much to reduce incidence of the disease in the prewar period. It is 
not known to what extent the anticholera vaccination program has 
been continued since the war. 
Epidemiology. The etiological agent is the Cholera vibrio (Vibrio 
comma) which is transmitted from bowel discharges and vomitus of 
infected persons to susceptible individuals through contaminated 
food and water and by flies. Ten percent of contacts may be healthy 
carriers. Articles freshly soiled by discharges of infected persons 
may be sources of infection. The incubation period is 1 to 5 days,, 
usually 3. Cases remain communicable ordinarly for 7 to 14 days, but 
much longer if the patient becomes a chronic carrier. 
Recommended program of control. A system of reporting cases 
which insures prompt notification and recognition should be adopted. 
19 Cases or suspected cases should be held in strict isolation during the 
communicable period; when possible, bacteriological examination of 
stools should provide the criteria for release. All measures to im- 
prove general sanitation in an area should be stressed. A cholera 
immunization program in areas where the disease has been reported 
is desirable; the goal of such a program should be to raise the level 
of immunity in population to a degree incompatible with occurrence 
of epidemics. The proportion of immunized persons necessary for 
this will be contingent on several factors, such as previous incidence 
of cholera in the population and standards of sanitation. 
Upon notification of existence of cholera, a prompt and thorough 
investigation for sources of infection should be instituted. Search 
should be made for unreported cases and carriers. Potability of pub- 
lic water supplies, milk, and any sources of food common to a majority 
of the cases should be studied. Strict isolation and quarantine should 
be imposed on all cases, carriers and contacts. Contacts should be 
promptly immunized. Restriction of population movement will be 
necessary. Thorough disinfection of the premises of the case should 
be performed before release. All public eating establishments or in 
some cases, the entire community should be placed “off limits” to 
troops. 
Stress should be placed on isolation technique of the case. Flies 
should be eliminated from contact with the patient or his dejecta. 
Stools, vomitus, and foods left by the patient should be burned or dis- 
infected by other satisfactory methods. The public should be notified 
that all drinking water must be boiled and all food thoroughly cooked. 
Dengue 
Distribution and prevalence. This disease occurs throughout the 
Japanese Empire except for northwestern China and Manchuria and 
is most prevalent in coastal areas. It may occur in any areas in which 
the Aedes mosquito is found. 
Epidemiology. The etiological agent is a specific virus and is trans- 
mitted to humans by the Aedes mosquito, usually the A. aegypti but 
at times by A. albopictus. Incubation period is 7 to 9 days after the 
bite of the mosquito, and patients may infect mosquitoes from a few 
hours before clinical onset to the third or fourth day of the disease. 
These mosquitoes become infectious for new hosts in 8 to 11 days and 
remain so for life. Diagnosis is based on clinical symptoms. The 
disease is rarely fatal, but frequently appears in epidemic proportions 
and may cause extensive morbidity in troops. In most instances, an 
attack of dengue confers permanent immunity; exceptions to this are 
recorded. 
20 Recommended,'program of control. The disease is unlikely to be a 
major problem among civilians since epidemics rarely occur among 
natives of an endemic area. For protection of troops, mosquito con- 
trol measures in the proximity of military encampments is indicated. 
Since the two common Aedes vectors are domestic mosquitoes, attention 
should be especially directed to elimination of collections of water in 
artificial pools as flower pots, rainbarrels, and dumps. Mosquito con- 
trol activities in a cantonment area is a responsibility of the tactical 
forces; civil affairs sections are responsible for these activities in 
extracantonment areas. 
Even in epidemics the disease is mild with negligible mortality. 
The course of the disease is self-limited. There are no satisfactory 
control measures except mosquito control. 
Diphtheria 
Distribution and prevalence. The incidence of diphtheria in Japan 
Proper remained essentially the same in the 4 years preceding the war, 
approximately 25,000 cases yearly. In the 7 years preceding the war, 
incidence of the disease increased in both Korea and Formosa. 
Epidemiology. The etiological agent of the disease is the Corni- 
bacterium diphtheria (Klebs-Loeffler bacillus). Transmission is di- 
rect by secretions from the nose and throat of cases and carriers or by 
infected milk or milk products. The incubation period is usually 2 to 
5 days. Cases remain infectious until the bacilli have disappeared 
from lesions or secretions of the nose and throat.1 Diagnosis is made 
from clinical symptoms and findings and demonstration of the organ- 
ism in secretions of the nose and throat. A virulence test should be 
made if practicable where positive throat cultures are reported 3 weeks 
or longer after onset of the disease. 
Recommended 'program of control. Cases should be promptly re- 
ported, isolation and quarantine instituted, and concurrent disinfec- 
tion done on all articles in contact with or soiled by discharges from 
the patient. Infants and young children in intimate contact with the 
patient should be given passive immunization by antitoxin. Older 
children and adults should be observed daily for early symptoms and 
attempt should be made to raise levels of immuruty in the child popula- 
tion of the community by active immunization, at the age of 9 months. 
In event of epidemics the same measures previously mentioned 
should be actively pursued. 
1 Ordinarily this period is 2 to 4 weeks, but may be several months. 
21 Encephalitis (Japanese B) 
Distribution and 'prevalence. Cases of this disease occur through- 
out Japan Proper but have been most numerous in the prefectures of 
Okayama, Kagawa, Hiroshima, Ehine, Hyogo and particularly in the 
region of the Inland Sea. This disease has been reported in Formosa, 
particularly the northern part with a seasonal prevalence from June to 
August. 
Epidemiology. The etiological agent is a specific virus and is trans- 
mitted from man to man by the bite of a mosquito. The virus has been 
demonstrated in the following mosquitoes: Culex tritaeniorhyncus, 
Culex pipiens and Aedes togoi. There is some evidence that a tick 
(Ixodes persidcatus) may be a vector. Diagnosis is made from 
clinical symptoms and findings, spinal fluid examination and demon- 
stration of the virus in the blood and spinal fluid. Neutralization and 
complement fixation test demonstrate the development of a specific 
antibody in the blood of convalescents. 
Recommended program of control. Suspected cases should be 
promptly reported and isolation and quarantine instituted. Patients 
should be protected from mosquitoes. Search for prior unreported 
cases among intimate contacts should be made, but to date this measure 
has been of no practical value in control. 
Measures for the control of both Culicine and Aedes mosquitoes 
should be instituted with intensification of the previously mentioned 
program, particularly in areas about troop encampments. 
Filariasis 
Distribution and prevalence. Filariasis occurs throughout the Jap- 
anese Empire and is most common in Japan proper in the Provinces 
of Nagasaki, Shizuoka, Kochi, Saga, Kumamato, Kagoshima, and 
Okinawa 
The disease is endemic in Formosa and Korea, being most frequent 
in the southern portions of both countries. 
Epidemiology. The etiological agent is a small worm belonging to 
the nematode group. Several species of nematode or filariids are 
known to infect man; TVuchereria bancrofti is the only one reported 
in Japan. Culex fatigans is the only reported vector although the 
possibility of other mosquitoes acting as vectors should not be dis- 
regarded. After the mosquito takes a blood meal from an infected 
person with circulating filaria embryos, the embryos develop into in- 
fective larvae in the mosquito in 14 to 21 days. The larvae are in- 
jected by the mosquito into the blood but cannot be demonstrated until 
at least 9 months after exposure; elephantiasis is not likely to develop 
for several years. Diagnosis is by clinical symptoms and findings and 
demonstration of the embryos in the blood. 
22 Recommended jxt'ogram of control. In endemic foci, epidemiolo- 
gical and entomological surveys should be made for incidence, reser- 
voirs, and vectors of the disease. Control measures should be based 
on survey findings and suitable antimosquito measures should be under- 
taken in the proximity of troop encampments. Gulex fatigans breeds 
in collections of dirty water as found in septic tanks and rainwater in 
tin cans. Screening of sleeping places is valuable since the mosquito 
characteristically feeds at night. 
Influenza 
Distribution and 'prevalence. Influenza occurs in the Japanese Em- 
pire about as it does in other parts of the world, tending to develop 
in waves of varying severity. No studies have been reported showing 
the distribution according to specific strains or virus. No epidemic 
comparable in severity to the 1918 pandemic has occurred in recent 
years. 
Epidemiology. The etiological agent is a filtrable virus. So far 
two distinct types of virus have been obtained, A and B. Each of 
these types covers a number of strains with a rather wide range of 
immunological character, but the difference between A and B strains 
appears to be complete in the immunological sense, and the clinical 
and epidemiological characters of influenza A and influenza B also 
seem to be different. It is probable that no other main types of in- 
fluenza virus exist. 
Transmission is believed to be by direct contact through droplet in- 
fection. The factors determining the occurrence of epidemic waves 
of influenza are not understood. A fair degree of strain immunity 
and perhaps some degree of species immunity is believed to occur as 
result of infection. Evidence on the usual duration of naturally ac- 
quired immunity is conflicting. A vaccine containing antigenic com- 
ponents of both A and B strains prepared from chick embryo yolk 
sac material appears to confer definite protection against disease due 
to these strains. The vaccine can as yet be produced in only limited 
quantities and will probably not be available for widespread use among 
inhabitants of occupied countries. 
Recommendations for control. Epidemic waves with low case 
fatality rate call for no special control measures. 
Outbreaks of greater severity may justify measures to reduce oppor- 
tunity for spread by prohibiting the gathering of unnecessary crowds. 
A point of great importance is that many epidemic diseases which 
offer a more serious threat to the community masquerade under the 
diagnosis of influenza. In the presence of a reported rise in influenza 
cases, steps should be taken to obtain verification of the diagnosis in a 
selected sample of cases in order to rule out diseases such as typhus 
23 fever, typhoid fever, plague, malaria, or others for which control 
measures are available. The diagnosis of influenza ordinarily will 
have to be made on the basis of clinical findings and by exclusion of 
other diseases. Where facilities are available, attempts should be 
made to confirm the diagnosis of the influenza by virus isolation and 
serological tests. 
Leprosy 
Distribution and 'prevalence. This disease is endemic in Japan 
Proper and there are numerous leprosariums on the islands. There 
are reported to be approximately 25,000 lepers in Korea and inade- 
quate facilities for hospitalization. In Formosa, it has been estimated 
that there are 2,000 lepers with institutional facilities for one-half that 
number. 
Epidemiology. The etiological agent is Mycobacterium leprae. 
The sources of infection are the discharges from leprous lesions. Inti- 
mate and long contact with infected individuals and some other as yet 
undetermined factors are necessary for transmission. Patients with 
open lesions must be assumed to be infectious. Patients with demon- 
strable acid-fast organisms in smears from skin or mucous membranes 
are potentially infectious though no ulcerative lesion exists. The 
incubation period is from 1 to several years. Diagnosis is by clinical 
signs and demonstration of the Mycobacterium leprae. 
Recommended method of control.—Cases should be promptly re- 
ported and isolated in leprosaria, if practicable. As a temporary ex- 
pedient, a patient may be cared for in a general hospital or on his 
premises under suitable regulation. Release from isolation should not 
be granted until a condition of arrest has been present for at least 6 
months as determined by clinical observation and absence of the acid- 
fast bacilli on repeated examination. Released patients should be 
reexamined periodically, the suggested interval being 6 months. Con- 
current disinfection should be carried out on all discharges and articles 
soiled with discharges from the patient. Investigation of the source of 
infection should be undertaken in cases of apparent recent origin, 
although determination of the source is often a matter of difficulty. 
In areas where leprosy is endemic, care should be exercised in billeting 
of troops. (See SGO Cir. Ltr. 180—Leprosy.) 
Malaria 
Distribution and prevalence. Malaria occurs in practically all parts 
of Japan proper but is most common in the low-lying districts of 
Kyoto, Niigata, Gumma, Tochigi, Mie, Aichi, Shizuoka, Shiga, Gifu, 
Aomori, Fukui, Kochi and Okinawa prefectures. It is stated that the 
disease is common in Korea constituting one of the leading causes of 
death. In Formosa, the disease is especially prevalent in the low- 
24 lying lands of the west coast. In Japan, Ryukyu Islands, Formosa, 
and Korea, A. hyrearms var. sinensis is the most important vector with 
A. acomtus of secondary importance. 
Epidemiology. Plasmodium vivax type of malaria is the most com- 
mon in Japan proper; in Formosa and Ryukyu Islands P. falciparum 
type prevails. Data on types are not available for Korea. The etio- 
logical agents are protozoan parasites of the class Sporozoa and the 
family Plasmodidae. The common human infections are caused by 
P. vivax (vivax malaria), P. Falciparum (falciparum malaria), and 
P. malaria (malariae malaria). This disease is spread from man to 
man through the agency of specific Anopheline mosquitoes. Normally 
one species of Anopheline transmits malaria in a given area, but occa- 
sionally two species may be involved among the many species of 
Anophelines present. A part of the life cycle of the parasite occurs 
in the mosquito and approximately 2 weeks must elapse before the 
mosquito can transmit the disease to a new susceptible. The incuba- 
tion period between the bite of an infected mosquito and appearance 
of clinical symptoms is 8 to 21 days. Diagnosis is established by 
presence of clinical symptoms and demonstration of the parasite in 
the blood. 
Recommended control program. Existing malaria control pro- 
grams should be reestablished but it is not considered practicable to 
attempt an extension of control measures except so far as health of 
troops may be affected. Civil Affairs officers should establish liaison 
with surgeons of Army installations and assist the local commanders 
in the selection of troop encampment sites; selected sites should be at 
least 1 mile from important Anopheline breeding areas. In endemic 
malarious areas, it may be advisable to evacuate civilians from a 
radius of 1 mile of troop encampments. The most valuable method 
of control for immediate results is the elimination of adult mosquitoes 
from the houses of the natives by spraying with insecticides. In areas 
adjacent to semipermanent encampments, engineering or 'larvicidal 
control is justifiable if the breeding places of the malaria vector is 
known. (See Mosquito Control, under Sanitary Engineering.) If 
the breeding places of malaria vectors are not known, they should be 
determined by survey. 
Potential conditions for a large scale outbreak of malaria are created 
when malaria carriers from an endemic area are transported to districts 
where Anopheline vectors are present in large numbers. Under such 
circumstances, large numbers of new susceptibles are infected and a 
true epidemic may occur. Construction incident to military opera- 
tions or destruction of present drainage systems by bombing may at 
times create a more favorable environment for the Anopheline mos- 
quito and in such instances, malaria incidence may rise precipitously 
because of increased number of Anophelines. 
618146—44 3 
25 In certain groups, such as refugees or working parties, suppressive* 
treatment may be indicated. Atabrine 0.1 Gm. (1.5 grains) daily 
after the evening meal should be given for 2 weeks prior to, during, 
and for 2 weeks after exposure. If atabrine is not available, quinine 
sulphate 0.64 Gm. (10 grains) daily after the evening meal may be 
substituted. (See TB MED 6 and 42, Data from the field on Malaria 
Control; TB MED 65, Drug suppressive treatment of malaria; and 
TB MED 72, Treatment of Clinical Malaria and Malarial para- 
sitemia.) 
Plague 
Distribution and 'prevalence. Epidemics of plague have occurred 
occasionally in Japan proper; no cases have been reported in the 2. 
years preceding the war, although sylvatic plague is frequent in the 
southern islands. The disease has not been reported in Korea since* 
1919 or in Formosa since 1928; it is endemic in Manchuria, The rat 
population in many areas of the empire is great and is likely to be 
augmented by break-down in sanitary control. 
Epidemiology. The disease is caused by Pasturella pestis. In the* 
bubonic form, it is transmitted from rat to man by the bite of fleas,, 
genera Xenopsylla and Ceratophyllus. The pneumonic form is trans- 
mitted directly from man to man by discharges from the nose and 
throat. Accidental transmission (autopsy, surgery) may occur. 
Plague is an epizootic among domestic rats. Sylvatic plague exists 
as a disease of rodents, ordinarily remaining endemic. Sudden in- 
creases in the number of susceptible rodents may allow development of 
a rodent epidemic. Upon death of rodents from plague, the infected 
fleas seek new hosts, often man. The incubation period is commonly 
3 to 7 days, occasionally as long as 14 days. 
Recommended program of control. Determination should be made 
of prevalence of human cases in the area in recent years. Estimates of 
rat populations, particularly in seaports, should be made from time to 
time. Police and other civil officials should be instructed to notify 
authorities of unusual numbers of dead rats in the area. Rats found 
dead should be subjected to autopsy for evidence of plague. Live rats 
should be trapped at regular intervals and examination made for 
infected fleas. Careful supervision of rat control in harbor areas 
should be exercised. Physicians should promptly report suspected 
cases of either pneumonic or bubonic forms. 
In epidemics and extensive program of rodent extermination should 
be instituted, care being taken to protect personnel against infection. 
All methods of proved efficiency should be used. Extensive rat proof- 
ing of buildings will probably *mt be feasible. Insecticides, as 
DDT, should be used on property that is flea-infested. Particularly 
strict isolation and quarantine of pneumonic cases are indicated; the 
26 contacts of pneumonic cases should be quarantined for 5 days. Pa- 
tients should be hospitalized if practicable; all patients should be in 
screened, vermin-free rooms. Concurrent disinfection should be done 
of sputum and articles soiled therewith in pneumonic type of the 
disease. Disinfection by thorough cleaning should be done, with 
fumigation to kill rats and fleas. The bodies of persons dying of 
plague should be handled with strict antiseptic precautions. Personal 
prophylaxis to avoid droplet infection must be carried out by those 
who come in contact with the sick. Masks of closely woven cloth with 
mica windows should be worn over the head and to the shoulders. A 
large gown and rubber gloves drawn over the sleeves of the gown should 
be provided. These articles should not be removed from the sickroom 
until disinfected. Travel into and from plague areas should be rigidly 
restricted. Immunization for plague has proved increasingly effec- 
tive. For persons subjected to unusual exposure (physicians, nurses) 
prophylactic sulfadiazine is recommended. The dose suggested is 4 
grams daily (1 gram every 4 hours). 
Schistosomiasis 
Distribution and 'prevalence. This infestation is common in Japan 
Proper, being especially prevalent in the southern part, the prefecture 
of Hiroshima, and the village of Katayama. The disease is common in 
Korea and a few cases have been reported from southern Formosa. 
Epidemiology. In Japan the Schistosoma japonicum is the etiologi- 
cal agent, the source of infection being fresh water containing the 
intermediary snail host contaminated by human excrement contain- 
ing the ova of the parasite. The ova hatch in the water and enter the 
snail host; there multiplication occurs and swimming larval forms 
called “cercarae” develop. Cercarae leave the snail and upon contact 
with the skin, penetrate it to gain access to the blood stream. At least 
1 month and usually 3 elapse before that person is excreting ova. In- 
fected persons remain infectious as long as ova are contained in the 
stool. Diagnosis depends on clinical symptoms, history, and demon- 
stration of ova in the stools. 
Recommended program of control. Control consists in breaking the 
chain of man to snail to man. This can be accomplished by proper 
regulation of sewage disposal, restriction of drinking or swimming in 
infected water, or the elimination of snails from these waters. In- 
fected snails do not occur in salt waters, only in fresh water. During 
the period of military government it is not considered feasible to 
initiate a long term project for elimination of this disease. Troops 
should be warned of the dangers inherent in swimming or wading in 
fresh water in endemic areas and they should be prohibited from en- 
tering water known to be infected. 
27 Smallpox 
Distribution and prevalence. Smallpox is occasionally encountered 
in all parts of the Japanese Empire; in Korea, epidemics were re- 
ported in 1921, 1936, 1937, and 1910. In Japan Proper, compulsory 
vaccination in infancy and again at about 10 years of .age has probably 
kept the incidence of the disease relatively low. 
Epidemiology. The disease is caused by a specific filterable virus, 
which is contained in the discharges of skin lesions, feces, and urine. 
Transmission from person to person is by contact, which need not be 
intimate. Cases are infectious from onset of symptoms until the 
complete disappearance of all skin lesions. Incubation period of 8 to 
16 days. 
Recommended program of control. Reinstitute and support com- 
pulsory and preexisting programs of vaccination. The goal of such 
programs shall be to secure a proportion of immunes in the population 
sufficient to prevent epidemic spread. This proportion will vary, de- 
pendent upon such factors as overcrowding, migration of populations, 
previous incidence of the disease, and distribution of the population 
as regards rural and urban areas. Initiate measures necessary to 
insure prompt and efficient reporting and isolation of cases. 
The ocurrence of the disease in unusual incidence in an area should 
prompt immediate investigation by the medical officer. To determine 
the extent of the disease, search should be made for unreported and 
undiagnosed cases. Isolation and quarantine should be instituted. 
Mass immunization should be done, starting with all contacts and ex- 
panded to include entire populations in sections where epidemic out- 
break is threatened. Restrictions on travel into and from infected 
areas may be indicated. 
Trachoma 
Distribution and prevalence. Trachoma is common throughout the 
Japanese Empire and accounts for widespread blindness. 
Epidemiology. The etiological agent is a filterable virus and the 
sources of infection are secretions and purulent discharges from the 
conjunctive of infected persons. Transmission is by direct contact 
with infected persons and indirectly by contact with articles freshly 
soiled with the infective discharges. The incubation period is un- 
determined. Cases remain communicable during the persistence of 
conjunctival lesions. Diagnosis is made from clinical findings. 
Recommended program of control. Cases should be reported and 
children should be excluded from school. Isolation of the patient is 
not practicable but each patient should be instructed in precautions 
against spread of secretions of the eye to others by common use of 
articles. Concurrent disinfection of discharges and articles soiled 
28 therewith should be carried out. Investigation of the source of in- 
fection should be undertaken by examination of the family and in- 
timate contacts of the patient. The use of public towels or toilet arti- 
cles should be eliminated. Routine examination of the eyes should be 
done on all children admitted to camps or institutions. Troops should 
be informed of the importance of personal cleanliness and the avoid- 
ance of direct or indirect contact with the discharges of patients. 
Tuberculosis 
Distribution and 'prevalence. This disease is one of the major pub- 
lic health problems in the Japanese Empire and is a leading cause of 
death. Human types occur throughout and bovine types where cattle 
are raised. 
Epidemiology. The etiological agent is Mycobacterium tuberculosis 
(hominis or bovis). Sources of infection are discharges from nose, 
mouth, bowels, and urinary tract of human cases; the discharging 
lesion of bone, joints, and lymph glands; articles freshly soiled with 
such discharges, or milk from tuberculous cattle. Transmission is 
direct, or through contaminated articles, or milk. The incubation 
period is variable dependent on the type of the disease, dosage, age, 
and other factors. Cases remain communicable as long as the specific 
organism is eliminated by the host. Diagnosis is made from clinical 
findings, roentgenographically, and by demonstration of the organism. 
Recommended program of control. All milk products should be 
pasteurized. It is unlikely a program of elimination of tuberculous 
cattle can be initiated soon enough for beneficial results during the 
period of military government. Existing programs for tuberculosis 
control and the care of tuberculous patients should be reactivated, but 
it will probably not be feasible to attempt an increase in this program 
during the period of military government. 
Typhoid-Paratyphoid Fever 
Distribution and prevalence. These diseases are very prevalent in 
all parts of the Japanese Empire due to the universal practice of 
fertilization with night soil. In Formosa, typhoid is reported to 
reach epidemic proportion every summer, especially in the urban 
areas. 
Epidemiology. The etiological agent for typhoid is Eberthella 
typhi; Salmonella paratyphi, schottmulleri and hirshfeldi are the 
agents of paratyphoid. The incubation period for typhoid is usually 
7 to 14 days, for paratyphoid, from 4 to 10 days. Persons remain 
infectious during the entire course of the disease and approximately 
2 percent of typhoid patients become chronic carriers. The diseases 
618146—44 3 
29 are diagnosed by clinical symptoms and findings, demonstration of the 
organisms in stool, urine, or blood, and by agglutination reactions. 
Recommended program for control. Principal reliance should be 
placed on the sanitation program to keep these diseases at low levels 
of incidence. An adequate system of reporting should be developed 
to keep the civil affairs officer currently informed so outbreaks may 
be anticipated and appropriate control measures instituted. Native 
eating establishments should be placed “off limits” for troops and 
routine stool examinations should be done on all native food handlers 
in Army messes. 
In an area threatened with an epidemic of typhoid, a prompt in- 
vestigation should be instituted. Examination should be made of 
water supply, milk supply, and food-handling establishments, as indi- 
cated, to determine the source of infection. Search should be made 
for unreported cases. Isolation of patients and thorough disinfection 
of dejecta is essential. Vaccination of all contacts, and, in serious 
epidemics, mass immunization of populations may be indicated. The 
public should be instructed that drinking water should be boiled and 
food thoroughly cooked. Epidemiological investigations should be 
continued throughout an epidemic to determine new sources of 
infection. 
Typhus Fever 
Distribution and prevalence. Disease statistics in the past for 
typhus fever in Japan do not differentiate the three principal types: 
epidemic typhus, tsutsugamushi disease, and murine typhus. The 
last two are definitely known to occur and the first (epidemic typhus) 
very probably does. 
Epidemic typhus. The large increase of typhus cases, reported as 
type unspecified, totaling 864 for the first 6 months of 1941, suggests 
a spread of epidemic typhus since the other two typhus fevers do not 
occur in epidemic proportions. Sporadic cases and small, limited 
outbreaks of probable epidemic typhus in the Japanese have been 
previously described due to the disease being brought into Japan by 
infected Koreans and Manchurians. Lousiness is known to be present 
among Japanese living in the colder mountainous regions. Increased 
malnutrition and poor sanitation because of the war would tend to 
cause a greater number of cases. Although no definite epidemics of 
epidemic (louseborne) typhus have been reported, it is safe to assume 
the presence of epidemic typhus in Japan. 
Murine typhus. From 25 to 50 cases per year of murine typhus have 
been reported in Japan up to 1940, distributed in the following locali- 
ties: Kagoshima, Kumamoto, Nagasaki, Tukuoka, Shimane, Okayama, 
Kagawa, Hyogo, Osaka, Kyoto, Shiga, Gifu, Aichi, Nagano, Shizuoka, 
Tokyo, and Chiba. As expected, it is much more prevalent in urban 
30 seaport communities where man and rats are in closer and more 
frequent contact. 
Tsutsugarrmshi disease (scrub typhus). Approximately 200 cases 
of tsutsugamushi disease occurred yearly in the period from 1908 to 
1935 and 50 or less per year until 1940, the last year reported. It is 
confined to the northwestern part of the island of Honshu. The 
endemic foci are restricted to the flood areas of the Sinano and Akano 
rivers in Niigata prefecture, the Omono in Akita Prefecture, and the 
Mogami in Yamagata Prefecture. Most of the cases occur in hemp 
workers during July and August after the river waters recede and 
the hemp is being harvested. 
Control measures. Of the three diseases, epidemic typhus presents 
the most pressing health problem because it is likely to flare up into 
widespread epidemics unless rigorously controlled. 
Epidemic typhus. Preventive measures are directed toward de- 
struction of the louse which transmits the causative rickettsia from 
man to man. Dusting the louse infested persons, and his clothes,, 
belongings, and dwellings with DDT powder has been found not only 
to destroy the lice present, but in addition will prevent reinfestation 
because of residual insecticidal properties of the DDT powder. Un- 
less removed by washing or laundering, this dusting will prevent louse 
infestation for 3 or 4 weeks. Methyl bromide fumigation employing 
a specially made fumigation chamber or plasticized bag is useful for 
delousing clothes and equipment. Since methyl bromide is an odor- 
less, colorless gas poisonous to man, it must be used with certain 
precautions and only by personnel familiar with its properties and use. 
It is important to realize that DDT does not kill louse eggs or 
rickettsiae and methyl bromide does not destroy rickettsiae or pre- 
vent reinfestation with lice. It is desirable to steam sterilize the- 
clothing of hospitalized patients to insure death of the causative 
rickettsiae. The judicious use of one or a combination of methods 
should be adopted depending upon the situation. Vaccination with 
typhus vaccine at least 1 month prior to infection protects by at least 
making the disease much less severe, if not completely preventing its 
development. For all personnel likely to be exposed to typhus cases 
or louse infested persons, immunization with typhus vaccine, followed 
by a stimulating dose every 2 or 3 months during exposure is required.. 
Personal cleanliness, frequent washing of clothes, elimination of 
overcrowding, and adequate nutrition are important secondary 
measures in the control of lousiness and consequently the spread of 
typhus. 
Murine typhus. Kickettsiae causing murine typhus fever are 
transmitted from infected rats through fleas to man with the reser- 
voir of infected rats being maintained by the cycle, rat to flea to 
31 the rat. The prevention of the disease in humans depends essentially 
on rat-control measures such as poisoning, trapping, and starvation 
of the rats. Destruction of fleas infecting homes, pet animals, etc., 
by DDT may play a minor role in prevention. Fortunately, the 
disease is mild and never spreads to great numbers of people because 
of the mode of transmission. 
T sutsugamushi disease. To control the spread of tsutsugamushi 
disease, main reliance is placed upon protection against the bite of 
the larval form of the mite which transmits the etiological agent 
■of the disease. Exposure of the human skin to the larval mites 
should be avoided whenever possible. The body must be well covered 
with clothes impregnated with mite repellants, sleeves rolled down, 
trouser legs tucked into shoetops, shirts and collars buttoned before 
entering mite infested areas. Anti-mite fluids (dimethyl phthallate 
of dibutyl phthallate) which repel and kill mites by contact are 
available. They are applied by hand or spray to'the clothes, par- 
ticularly around the outer surface of all openings, such as. sleeve and 
trouser cuffs, fly, shirt collar, etc. Lying or sitting down on mite- 
infested grasses must be avoided. Pillows and mattresses should not 
be stuffed with grasses which may harbor mites. Camp sites should 
be cleared of vegetation down to the bare earth by mowing, scraping, 
and burning. As soon as practicable after any possible exposure, a 
bath using plenty of hot water and soap with scrubbing of the skin 
to dislodge attached mites and a complete clothes change afterwards 
are strongly advisable. (See TB MED 45, Notes on Certain Infec- 
tious Diseases; and TB MED 31, Scrub Typhus fever.) 
Venereal Disease 
Distribution and prevalence. Venereal diseases including syphilis, 
gonorrhea, and chancroid are prevalent throughout the Japanese 
Empire. 
Epidemiology. Infected persons transmit the disease to others by 
sexual contact. Prostitution, legalized in Japan, is an important 
method of spread. 
Recommended program of control. Emphasis should be placed on 
control measures for syphilis. 
2. Provisions should be made for the collection of data concerning 
the incidence of the venereal diseases. These data may be derived 
by compulsory individual case reporting by physicians, clinics, and 
hospitals, and periodic questionnaires as to total number of cases 
under treatment. 
3. Treatment facilities must be provided in hospitals, clinics, or 
outpatient services. 
32 4. Free distribution of drugs to physicians together with suggested 
outline of treatment. 
5. Measures for case finding previously used by the health depart- 
ment should be reestablished, but primary attention should be di- 
rected to location of sources of infections of military personnel, 
particularly sources of syphilitic infection. 
6. Within the continental United States, the Army is committed 
to the policy of repressing prostitution. Such a policy is commend- 
able and should be carried out whenever possible. In Japan no> 
attempts have been made to repress prostitution. Instead, it has- 
been the policy to segregate and “regulate” prostitution through 
routine periodic examinations. It is very doubtful that a program 
of repression will succeed. Repression has been extremely difficult 
and not altogether successful in the United States where public 
opinion backs it. It will be even more difficult and less effective 
where civil authorities and the public are not sympathetic. Not only 
will the efforts fail, but the attempt to impose policies in opposition 
to the population’s usual way of life will result in hostile attitude 
toward the military government. 
It is not believed, however, that anything can be accomplished by 
periodic examinations of prostitutes. The military government 
should not interfere with the policies of the civil authorities with 
respect to the prostitution problem as it affects the civil population. 
However, specific measures for the protection of troops should be 
imposed. 
7. It should be the responsibility of the military authorities to 
place all segregated prostitution districts “off limits” and institute 
military policing of streets to reduce clandestine prostitution to a 
minimum. Legal measures should be taken against prostitutes found 
soliciting military personnel. Existing laws and regulations should 
be used as the basis for legal action if these regulations will accom- 
plish the results expected. However, should local laws prove in- 
effective, ordinances or orders may be published by appropriate 
military government authorities. 
Military government authorities should assist commanding officers, 
of troops stationed in the area in the establishment of prophylactic 
stations as conveniently as possible to the principal places of exposure. 
If penicillin is available in sufficient quantity, its use in rapid treat- 
ment centers for civilians should be authorized. This would be of 
particular importance in “leave areas” to reduce the level of civilian 
infection. 
Coincident with the above measures, it is expected that local com- 
manders of troops will stress venereal disease control measures, such 
as the issuing of individual prophylactic packets free of charge to all 
33 personnel upon request, the promoting of an intensive education pro- 
gram among troops warning them of the dangers of venereal disease 
and advising them of the methods of prevention, and the adequate 
provision for recreation on military reservations, to lessen the desire 
to visit civilian communities. 
8. During the planning phase, a venereal disease control plan should 
be carefully prepared. The plan should include a study of the laws 
and regulations affecting prostitution and a draft of the necessary 
revisions to be published. 
34 NUTRITION 
The nutrition of civil populations will be a primary concern of 
the public health section in civil affairs. The relationship of nutri- 
tion to the maintenance of health and to diseases of endemic and 
epidemic character is well recognized. The responsibility of the 
medical department in prevention of epidemic diseases directs the 
attention of all medical officers to the nutritional deficiencies which 
induce decreased local resistance and predisposition to epidemics. 
It is probable that the general health of populations is more affected 
by inadequacies of food and food supply than any other factor. 
Moreover, such inadequacies are of a character likely to produce 
civil unrest and dissatisfaction prejudicial to the military effort. 
Foods locally available and necessary supplements from Army 
sources should be provided in adequate quantities to meet the per 
capita caloric level as predetermined by higher authority. Certain 
limitations of food supplies and problems of transportation impose 
restrictions on the level of calories per capita which can be pro- 
vided. Consequently, with restricted'caloric levels, a system of judi- 
cious and effective distribution is essential for carrying out an ade- 
quate nutrition program. The public health officer should act in an 
advisory capacity to other civil affairs officers charged with respon- 
sibility of provision and distribution of foods for civil populations. 
Effective liaison will insure distribution in accordance with needs. 
Assessment of Nutritional Status 
A survey of the quantities of local foodstuffs and the nutritional 
status of the population should be accomplished as early as is prac- 
ticable. The presence or absence of starvation and nutritional defi- 
ciency diseases should be a guide to the types and quantities of 
foods needed, and programs for their distribution. The frequency 
and location of food thefts may provide information indicative of 
local conditions of nutrition. Checks of the nutritional status of 
such special groups as infants, children, adolescents, and pregnant 
women should be done as early as possible. These groups demon- 
strate early the results of food inadequacy and consequently require 
special consideration in plans for feeding. 
35 Adequacy of diet may be determined by reference to various 
tables of established requirements for the variety of nutrients. A 
number of requirement levels have been established, but the most 
suitable is the “Minimum Allowances of Dietary Essentials” pre- 
pared by the Food and Nutrition Board of the National Research 
Council. 
The assessment of the nutritional status of individuals in a popu- 
lation may be made by physical examination (including dietary his- 
tories), laboratory methods, or by a combination of both methods. 
The methods selected may be made simple or detailed and complex; 
the extent and exactness of the survey should depend on the object 
of the survey, the availability of appropriate laboratory equipment, 
factors of time, and the availability of competent personnel. In 
general, the more simple procedures should be the only ones re- 
quired. Various symptoms and physical findings of nutritional 
deficiency have been indicated in tabular form. (See Table 1 and 
Table 2, App. C.) The various symptoms and physical findings are. 
rarely specific or diagnostic alone, and should be considered as sug- 
gestive only. A few well-established symptoms and findings, how- 
ever, as night blindness and typical skeletal changes, are reliable 
and diagnostic of vitamin A and D deficiencies, respectively. In 
general, a combination of symptoms, physical findings, and per- 
haps laboratory studies, may be essential for definitely classifying 
the nutritional deficiencies. Special laboratory facilities for diag- 
nosis of nutritional deficiencies will probably not exist under many 
circumstances. 
Prevention of Dietary Deficiency 
Prevention is the maintenance of normal nutritional health in 
average individuals by means of a natural diet. The components of 
a natural diet should be varied since variety tends to insure quali- 
tative adequacy. Each public health officer in plans for feeding 
should consider the availability and cost of foods and the dietary 
customs and habits of the people who are to consume the foods. 
Conclusions that dietary habits and customs exert an unfavorable 
influence on nutritional status should be made only after careful 
observation and consideration, since it has been shown that natural 
selection often results in adequate dietaries. Acceptable and ade- 
quate substitute foodstuffs should be available before questionable 
native food practices are discontinued, since as a rule food habits 
are deeply ingrained in the people. Not uncommonly, the deficien- 
cies resulting from habit and custom are related to modern develop- 
ments of processing and preservation. The preference for a highly 
milled and polished rice by the peoples in certain areas of the orient 
has been productive of a high incidence of beriberi and for this 
36 reason in Japan legislation has been instigated pertaining to the 
milling of rice so as to preserve the anti beriberi factors in the 
grain. 
Protection Against Dietary Deficiency 
Protection against nutritional inadequacy applies to particular 
classes or groups of individuals, especially susceptible to nutritional 
deficiency disease. It includes infants and young children, adoles- 
cents, pregnant and nursing mothers, the aged, certain groups of 
workers exposed to occupational hazards, and persons with disease 
predisposing to nutritional deficiency. The circumstances and pre- 
disposition of these groups to nutritional deficiency may require the 
addition of special food supplements or chemical preparations to 
their dietaries. The use of special kinds of natural foods and natu- 
ral concentrates is preferred to the use of chemical preparations. 
Relief of Dietary Deficiency 
The relief or treatment of nutritional deficiencies belongs to the 
realm of chemical medicine in all but the milder deficiency states 
which are amenable to simple dietary measures. These mild defi- 
ciencies should be relieved by an adequate natural diet. The severe 
deficiencies are specific medical problems to be treated medically as 
indicated, often with pure vitamins or chemical products. The 
basic principle of returning to a natural diet as soon as is possible 
applies, however, even in these florid cases; such diets protect 
against recurrence of the deficiency state and the appearance of 
other nutritional disorders. 
37 MATERNAL AND CHILD HEALTH 
Expectant and nursing mothers, infants, and children below 15 
years of age, are groups in civil populations which will require special 
consideration in the planning and administration of a civil affairs 
program. It is unlikely that any other groups in a population will 
be affected as adversely by prolonged dietary restriction, destruction 
of homes and sanitary facilities, lack of medical care, and the psycho- 
logical trauma of modern warfare. Existing services for maternal 
and child health should be reviewed in the light of policies established 
by higher authority. 
Maternity care in Japan is provided largely by well-trained mid- 
wdves who visit the patient in her home during pregnancy, deliver her 
at home, and provide post partum care. Midwives refer all compli- 
cated cases to physicians. The more than 60,000 certified midwives 
are carefully supervised by several hundred official and circuit mid- 
wives. There are relatively few prenatal clinics in Japan—less than 
100 in 1938. The midwives and more than 5,000 public health nurses 
provide prenatal care and give advice in home visits. If maternal 
mortality statistics are a reliable index to the effectiveness of maternity 
care in Japan, it can be considered as good as in the United States. 
The provision of adequate food for mothers may be the most important 
health measure need for this special group. Inquiry should immedi- 
ately be made of leading nutrionists and obstetricians in Japan 
concerning the nutritional deficiencies observed in pregnant women 
in various parts of Japan. Special allowances of certain foods of 
supplementary vitamins may be indicated. If special allowances are 
to be made, all midwives and public health nurses should be so advised 
in order that they can notify their patients. 
Infant Care 
Most Japanese babies (85 percent plus) are breast-fed, usually for 
approximately 2 years. Advice on infant care is provided by the 
midwives, public health nurses, and in several hundred infant health 
centers. The number of infant health centers (250) reported in 1938 
would make it appear that they are only located in a few of the larger 
38 cities. Milk is difficult to obtain in Japan, and is probably urgently 
needed by infants not breast-fed, and by the younger children. 
Methods of distributing dried or canned milk provided by Civil Affairs 
along with simple instructions for proper preparation will most likely 
be urgently needed. It is reported that many Japanese mothers begin 
the feeding of solid foods to their babies at about 1 year of age by 
chewing rice and then giving it to the baby. This habit may explain 
some of the numerous cases of infant gastro-intestinal infections. 
Fruits or vegetables as used by adults are usually added to the infant’s 
diet before 2 years of age. Nutritional deficiencies of infants and 
young children including rickets were reported in 1938 to be fairly 
common in some parts of Japan. Special allowances of food and sup- 
plementary vitamines for children may be indicated. The methods of 
distributing such allowances will probably vary with areas depending 
on the number of health centers in operation and the efficiency of the 
“neighborhood associations” used by the Japanese for food rationing. 
There are more than 1,000 permanent nurseries and almost 6,000 
seasonal nurseries in Japan. Information concerning the occupancy 
and use of these nurseries is not available. 
Immunization 
Vaccination for smallpox is compulsory—reports as to whether 
given during first year of life or upon entrance to school are con- 
flicting. The established procedures are believed to have been effec- 
tive and should be continued. Typhoid and diphtheria immuniza- 
tions are not compulsory. In the communicable disease control sec- 
tion of this guide it is recommended that immunization for diph- 
theria be given to as many children as possible at approximately 9 
months of age. Typhoid immunization of contacts is recommended, 
and in serious epidemics, mass immunization. 
The most important cause of death of infants and young children 
is diarrhea and enteritis; 74,812 deaths under 2 years of age occurred 
from this cause in 1938. Ekiri, a disease resembling infantile dy- 
sentery, is often confused with similar diseases, and has persistently 
prevailed in various parts of the country from ancient times. Victims 
of Ekiri are principally children from 2 to 6 years of age. Epidemics 
are frequent in summer and autumn. The chief nurse of a Tokyo 
hospital reports that mothers are taught to give their children a dose 
of castor oil as soon as diarrhea or drowsiness are observed and im- 
mediately to bring the child to the hospital. Hospital treatment by 
colonic irrigations, intravenous fluids, and a second dose of castor oil 
after 12 hours was a successful treatment for cases detected early. 
For neglected cases the mortality was high. 
39 Information concerning control of diarrheal diseases, especially the 
preparation of food and fly-control will probably be the most im- 
portant health education for mothers of young children. 
Shelters 
Season, climate, composition of the population as to age and sex, 
and extent of destruction will determine the need for shelters in 
bombed-out areas. In selecting available structures for shelters, suit- 
ability will depend upon location, sanitary aspects, fire hazards, and 
facilities for providing heat, ventilation, toilets, laundry, and water 
supply. Groups requiring shelter may include families, infants, chil- 
dren, or adolescents separated from their parents, persons with com- 
municable disease, persons with mental disease, and pregnant women. 
The staff and equipment required for each shelter will depend upon 
its purpose and the composition as to age and sex of its occupants. In 
shelters for children, attendance by a staff member throughout the 
whole day and night is essential; moreover, certain safety devices to 
protect children from injury, and certain conveniences for children's 
care should be included. 
Additional Services for Children and Mothers 
Care of orphaned and lost children, restoration of lost children to 
their parents, and control of unemployed and predelinquent adoles- 
cents are problems which may arise. The problems cannot be divorced 
from general aspects of maternal and child health; consequently, plans 
;and organizations to handle them could be consolidated with the other 
material and child health services. Displaced persons present a spe- 
cial problem as regards feeding and medical care. 
40 SANITARY ENGINEERING 
The purpose of this section is to outline general procedures to be 
followed by Civil Affairs Medical Officers with reference to water 
supply and purification, sewerage and excreta disposal, mosquito con- 
trol, refuse disposal, and other sanitary engineering matters in the 
Japanese Empire. 
The extent to which such procedures are undertaken should be de- 
pendent upon minimum requirements for adequate protection of occu- 
pying troops of the United Nations, the prevention of threatened epi- 
demics, and the preservation of the health of the civilian populationi 
at the level prevailing before occupation. Unless extensions or per- 
manent improvements to water supplies and sewerage or waste dis- 
posal facilities are necessary for United Nations troop installations* 
satisfactory operation of hospitals or refugee camps, or to prevent 
major epidemics, the required funds, materials, and labor should be 
entirely from local sources. 
Water Supply and Purification 
Maximum health protection should be accomplished by 
use of existing facilities. It is not intended to install water systems 
or treatment plants in areas not previously served by such 
except as considered essential for the activities of the armed forces. 
The work of rehabilitation of water systems should be under the super- 
vision of a trained sanitary engineer. 
In initial stages where a water supply installation has been rendered 
inoperable and retail distribution of water is nesessary, 5 gallons per 
person per day of safe water should be provided. When existing, 
public supply and purification facilities are operable* operation rate- 
should be at normal or less than plant design capacity. 
Where an existing public water supply system is unable to function,, 
water distribution should be by tanks, Lister bags, or carts, pending, 
repair of supply and treatment facilities under supervision of a trained! 
sanitary engineer. When no public supply existed in the prewar pe- 
riod, and wells, springs, or similar sources of supply were used, fixed 
treatment plants nor distribution systems should not be provided. 
When tanks, Lister bags, or carts are used for distributing, water, one 
41 water point should normally be established for each 300 actual popu- 
lation. Under these conditions, adequate facilities for dispensing 
water to individuals should be provided. 
Where facilities for bacteriological examination are available, the 
bacteriological standards of the U. S. Public Health Service will be 
followed. Otherwise, water conforming to the requirements for chlo- 
rine residuals should be considered potable. Except where and to the 
extent that they interfere with effective chlorination or other necessary 
treatment, color, turbidity, iron, or other dissolved materials should 
not be removed or pH modified unless facilities are already available 
in an existing plant 
In all facilities of an occupied area, a chlorine residual of 0.4 parts 
per million should be maintained following an initial contact of not 
less than 30 minutes in the commonly used portions of water distribu- 
tion systems which draw water from properly operated filter plants 
or from subsurface water sources. All unfiltered surface waters should 
be chlorinated to maintain 1 part per million residual chlorine as pro- 
vided in existing U. S. Army directives; exception to this may be made 
when in the opinion of the public health officer amoebic dysentery is a 
hazard. Under such circumstances, a chlorine residual of 2 p. p. m. 
should be maintained for 30 minutes (the pH of the water being 7.5 
or less), whether the water is distributed by pipe lines or from water 
points. 
The simplest types of water treatment should be provided. Mobile 
and portable U. S. Army filter units are suitable for emergency in- 
stallations pending reestablishment of service by public plants. In 
areas in which amoebic dysentery is prevalent, the rate of filtration 
through the above units should be limited to 6 gallons per square foot 
of filter surface per minute and filtration must be preceded by coagu- 
lation and settling. 
Preference should be given to subsurface water supplies. 
Pipe sizes, motor and other electrical equipment characteristics are 
usually at variance with United States standards. Maximum use 
should be made of industrial or war materials plants, to obtain pipe, 
pumps, motors, and engines. 
Excreta and Sewage Disposal 
Wherever troops are stationed or hospitals or refugee camps are 
located, or wherever there is justification because of disease, facilities 
for excreta or sewage disposal should be installed. Elsewhere, such 
facilities as previously used should be utilized with minimum 
modification. 
Usually pit latrines, constructed in accordance with FM 21-10, 
should be standard in unsewered areas. When conditions for their use 
42 are unsuitable, pail latrines may be utilized. Collections should be in 
tight tank wagons or by replacement of used pails by clean, empty pails. 
Disposal of pail contents should be by burial, incineration, discharge 
into sewers, or other approved means. 
Except in troop installations, construction of new sewage collection 
and disposal facilities should be provided entirely by local funds, labor, 
and materials. Existing sewerage systems and treatment plants should 
be repaired and placed in service, making maximal use of local re- 
sources. Chlorination should not be utilized as a method of sewage 
treatment except under unusual conditions and then only on the advice 
of a qualified sanitary engineer. The facilities for sewage treatment 
for hospitals, refugee camps, and troop encampments should be of the 
simplest applicable type; these should ordinarily consist of a septic 
tank of local materials, designed in accordance with the Engineering 
Manual, OCE, by which disposal of the effluent is into the soil or body 
of water of adequate volume to prevent nuisance. 
Refuse Disposal 
In populated areas, existing facilities for refuse disposal should be 
utilized to the fullest, without change, unless modification is fully justi- 
fied by the presence or threat of disease. 
The sanitary fill method of disposal (TB ENG 1,28 December 1943) 
should be used, where soil conditions permit. Elsewhere, the methods 
described in EM 21-10 will be followed. 
Technical supervision by a qualified sanitary engineer should be 
provided, in communities of large population, to insure adequate collec- 
tion and disposal of wastes. 
Mosquito Control 
Policies regarding mosquito control should be based on the prevalence 
of diseases transmitted by mosquitoes. In general, mosquito-control 
measures should be instituted under the direction of a qualified sanitary 
engineer only for the protection of occupational installations, including 
hospitals and refugee camps, or to prevent or control serious epidemics. 
It is probable that both anopheline and culicine control will be necessary 
in some areas. 
Major drainage should be held to a minimum, reliance being placed 
on minor drainage and larviciding. Control measures should be ex- 
tended over areas sufficient to provide adequate protection of personnel, 
generally to a distance of at least 1 mile. 
Special attention should be given to the location of all installations 
in reference to the prevalence of mosquitoes, both anopheline .and 
culicine. 
43 Surveys to determine the type and prevalence of disease-bearing 
mosquitoes should be made. Experience and knowledge gained by 
Army medical officers and malaria survey units of the IT. S. Army 
should be utilized to the maximum in obtaining data on which to base 
control measures. 
Malaria control units, similar to those of the U. S. Army should be 
organized utilizing so far as possible local personnel, labor, equipment 
and material. The program of control should be closely coordinated 
with the U. S. Army units working in the same area, and these Army 
units should be utilized, so far as military conditions permit, for gen- 
eral correlation and supervision of the mosquito control work. 
Rodent Control 
Bubonic plague is endemic in the Japanese seaports. Seaport pre- 
fectures from which plague is most frequently reported are Osaka, 
Hyogo, Kakawa, Nagasaki, and Tokyo. There have been no epidemics 
since 1910, but sporadic cases occur almost yearly. Sylvatic plague is 
reported frequently from southern Kyushu. Endemic typhus fever 
(murine typhus) and Japanese river fever (tsutsugamushi fever), 
spread by a mite which infests rodents, occur. There are some 32 
species of rats reported in Japan. The prevalence of flea-infested rats 
makes epidemic outbreaks a potential hazard. 
Routine catches and examination of rats to determine the presence 
of infected fleas are desirable. In all cases where plague is found or 
whenever there is evidence of excessive deaths among rat populations, 
a vigorous rodent control campaign should be initiated to protect all 
occupational installations, shipping and port areas. When rodent- 
borne disease constitutes a definite threat to the public in areas other 
than those occupied, rodent control measures should be initiated, 
utilizing local funds, labor, and material when available. 
All rodent control programs should be under the direction of a quali- 
fied rodent control officer. 
44 FOOD SANITATION 
General sanitation in Japan Proper is not comparable to that of 
Western Europe or North America. The frequency of enteric diseases 
is indicative of lack of application of modern concepts and of adequate 
facilities for proper food and sanitation. 
The standard of living in Japan is considerably lower than that in 
the western world but, as compared to most other areas of the Far 
East is relatively high. The bulk of rural and urban dwellers live in 
clean, crowded, cheaply constructed houses; the diet is simple and 
Spartan, consisting mainly of rice, various vegetables, fish, and a 
little meat. Extremely small incomes and a certain lack of general 
knowledge has inhibited the introduction of modern sanitation to 
most Japanese homes. 
Local production of food is insufficient to provide an adequate diet, 
and large quantities of food are imported. To maintain maximum 
productivity of gardens and farms, fertilization by use of night soil 
is common practice. Therefore, all vegetables and many fruits may 
be considered contaminated. This is obviously the reason for the fre- 
quency of typhoid fever, amoebic and bacillary dysentery, and many 
parasitic intestinal diseases. Water supplies, particularly in rural 
districts, are frequently contaminated by ground water. Conse- 
quently, washing of foods cannot be considered protection against 
contamination. 
Fish and other sea foods are common items of diet. However, war- 
time curtailment of the fishing industry has undoubtedly decreased 
the supply of such foods. Flukes and other parasites not uncommonly 
infest the sea foods, and the native custom of eating fish raw is respon- 
sible for many human infestations with flukes and tapeworms. 
Since the number of locally raised cattle is small, considerable beef 
has been imported. Some veterinary control of animal diseases has 
been exercised and veterinary inspection at the time of slaughter of 
animals is usual. The extent and efficiency of veterinary services are 
not known. Further reference is made to the inspection of meat, 
meatfoods, and dairy products under the section on Veterinary 
Services. 
618146—44 4 
45 The dairy industry is very limited and largely confined to the vicin- 
ity of cities; the largest herds of cattle are reported to be on the island 
of Hokkaido. Methods of milk production and the enforcement of 
sanitary measures to provide a safe fluid milk supply do not conform 
to approved sanitary procedures. Pasteurization is not the common 
practice. Bacteriological examinations of milk are made infrequently. 
It is reported that some animal disease control work has been per- 
formed in milk producing herds. 
Civil Affairs officers shoudl recommend that all native eating estab- 
lishments initially be placed “off limits” for troops. Later an ap- 
proved list may be compiled of those places which maintain satisfac- 
tory standards of sanitation. Before any native establishments are 
allowed to serve food to troops, an examination of food handlers, in- 
cluding stool examination, should be performed. 
46 MEDICAL SUPPLY 
The importance of the medical supply problem to civil affairs public 
health personnel in an occupied area cannot be too forcibly em- 
phasized. The success of control programs for infectious and com- 
municable disease, including malaria and veneral disease, will be 
greatly dependent upon the availability of medical supplies. With- 
out essential vaccines, drugs, and chemicals, successful control of 
typhus, typhoid, smallpox, gonorrhea and syphilis cannot be effected 
and adequate provision cannot be made for care of the sick and 
wounded. 
Both the quantity and variety of medical supplies to be furnished 
in an occupied area will be the minimum amounts considered essential 
to meet the basic needs of that area. In arriving at the types or variety 
of medical items to be furnished, consideration has been given to the 
preexisting status of medical care in the area to be supplied. This 
should indicate to Civil Affairs public health officers the necessity for 
precautions to protect medical installations and to prevent dissipation 
of medical supplies in the country being occupied. 
Public health officers should become familiar with the medical items 
which are to be made available for care of the civilian population; 
also these officers should have a knowledge of the preexisting status 
of medical care in the area. Such knowledge should facilitate judi- 
cious use of available supply items and should prevent the establish- 
ment of medical programs or practices which increase the status of 
medical care above prewar levels and for which supplies have not been 
allotted. This should not deter the use of any necessary immunizing 
procedures or other indicated methods for control of communicable 
disease endangering the health of occupying troops, though such prac- 
tices may not have been in force under preexisting medical care pro- 
grams. The paramount concern of the public health officer at all times 
should be the protection of the health of Allied troops in the area. 
At the earliest possible time, the officer responsible for medical 
supplies for the occupied area should make available to other public 
health officers the following data: 
1. A list showing items of medical supplies which will be available 
in the area and the landed cost price for each item. 
47 2. An allowance list, either by item or by unit, indicating the 
quantity which has been provided for 100,000 civilian population per 
month. 
3. A listing of veterinary and dental items indicating the same 
factors as in (1) and (2) above. 
4. An instruction memorandum or civil affairs order outlining the 
system of distribution to be used by the headquarters, with the neces- 
sary forms to be used for proper bookkeeping and accounting. 
5. Necessary translations in the native language of all lists, orders, 
or instructions pertaining to medical supplies which wdll be used by 
the civilian medical personnel or the recognized government of the 
country. 
In preparing the above lists of allowances and costs by item, the 
senior public health supply officer should bear in mind that the sev- 
eral packed units to be supplied, for example, basic medical unit, sup- 
plemental tropical unit, are designed to care for 100,000 persons per 
month. The allowance for each country has been calculated from 
factors based on the general level of medical care in the country and 
the availability of local medical supplies. These factors are shown 
in the lists published by Army Service Forces, Subject: “Civilian 
Supplies in Occupied Territories—Medical Supplies.” With these 
factors, it is possible to prepare an individual list showing the allow- 
ance of each item for 100,000 population per month in each country. 
In theaters of operation in which civil affairs will operate, it is 
assumed that the various areas to be occupied by Allied Forces will be 
subdivided for administrative purposes using probably either geo- 
graphic or preexisting political boundaries to determine the various 
subdivisions. The civil affairs public health officer for each subdivi- 
sion should be responsible to the chief civil affairs public health officer 
of the area for distribution of medical supplies in his particular sub- 
division. It is also assumed that in each area strictly under civil af- 
fairs control there will be a supply officer to handle details of medical 
supply under the chief civil affairs public health officer. 
In every area which has been occupied, the availablity of local medi- 
cal supplies will be an important consideration. As soon as possible 
after the occupation, the medical supply officers should determine the 
availability of local sources of supply and through proper channels 
should make arrangements for rehabilitation of those facilities capable 
of producing medical supply items. The early reestablishment of 
biological producing concerns is most important and should receive 
early consideration. 
In every area, the medical supply officers should familiarize them- 
selves with the problems of disease endemic to the area and insure sup- 
plies adequate to combat epidemic outbreaks of such disease. 
48 Iii the organization of the Medical Supply Service in every area, 
each chief medical supply officer should consult with the civil affairs 
finance officer in establishing the types of supply accounting and book- 
keeping to be used. As guides which may be helpful, memorandum 
and forms on supply issued in the Italian Theater are included. 
(See app. D.) 
In liberated areas of friendly or allied governments, assistance may 
be expected from the medical representatives of those governments. 
In such areas, the greatest use of normal channels of distribution of 
medical supplies should be made; civil affairs public health personnel 
should act under such circumstances in supervisory or control capaci- 
ties. It may be possible to use medical wholesale firms for distribution 
of supplies if such methods are satisfactory to both civil affairs au- 
thorities and the local government. 
Effort should be made as soon as possible to change the distribution 
of supplies from automatic issuance by units to individual requisitions 
by items. Every effort should be made to accomplish this by the end 
of the first 6 months of occupation. 
The medical supply officer should become familiar with Army medi- 
cal supply installations in the area of operations and maintain liaison 
with the appropriate base medical officers of the area. 
49 DENTAL SERVICE 
Dental surveys in camps for Japanese prisoners have indicated that 
the incidence of dental disease in Japan is less than that in the United 
States. The less refined diets in Japan may account for a smaller in- 
cidence of dental decay and pyorrhea. Based on this information, it 
may be presumed the dental problems in the Japanese Empire will be 
less than in many other countries. 
In the initial phases of occupation, dental work should be of emer- 
gency type. If indicated, dentists should assist physicians in care of 
casualties; other types of emergency dental care including removal 
of infected, abscessed teeth, removal of cysts, treatment of cellulitis 
and osteomyelitis of dental origin, treatment and reduction of frac- 
tured jaws and treatment of acute mouth infections may be undertaken. 
In later phases where the numbers of dentists are limited and dental 
supplies are inadequate, restorations should be limited to oxyphosphate 
of zinc cement. Restoration of Japanese soldiers’ teeth with oxyphos- 
phate cement is common practice at the present time. It is recom- 
mended that no attempt be made to continue prophylactic dentistry 
and that only larger cavities should be restored. If local personnel 
and dental supplies are adequate, there is no reason for limitation of 
the type of dental service offered to civilians. Bridge work and 
dentures should be done only under such circumstances. 
50 VETERINARY SERVICES1 
Important factors in the ability of populations now included in 
the Japanese Empire to be self-sustaining, so far as food is concerned, 
will be the number and condition of the livestock in that Empire. 
Unless sufficient healthy animals are available both for food and 
work purposes, a large part of the foodstuffs necessary for the 
subsistence of the civilian population must be supplied. Adequate 
provisions for the control of animal diseases is, therefore, funda- 
mental in the civil affairs program. 
Aside from the conservation of food through the control of dis- 
eases of food-producing animals, the civil affairs administration will 
also be concerned with those diseases of animals transmissible to 
man either directly or through the agency of meat, meat-food, and 
dairy products. Thus, civil affairs authorities will be concerned 
with those diseases which are (a) directly transmissible to man, thus 
endangering the health of troops and the civilian population; (b) dis- 
eases not transmissible to men, but which may deplete the livestock 
population and markedly impair local sources of meat, meat-food, and 
dairy products; (c) diseases not necessarily of importance as regards 
transmission to man, or from the food supply standpoint, but which 
occur among draft animals, thus impairing the transport system in 
places where animal draft is essentially the only means of transpor- 
tation. The veterinary part of the civil affairs program should 
include full consideration of all matters concerned with the produc- 
tion and handling of meat, meat-food, and dairy products for human 
consumption. This, of course, involves methods, procedures, and 
sanitary conditions in connection with the production and handling 
of foodstuffs. The more commonly reported bacterial, virus, and 
protozoan diseases of animals found in this locality are briefly 
discussed in the following paragraphs. 
Anthrax 
Distribution and prevalence. The disease is common throughout 
the world and is especially prevalent in Asiatic countries where 
3 Prepared by The Veterinary Division, Office of The Surgeon General. 
51 sanitary science is not advanced. While practically all mammals 
are susceptible to some degree, herbivorous animals are the most 
susceptible. Swine and man possess a greater degree of natural 
resistance. 
Epidemiology. The etiological agent is Bacillus anthracis. In its 
spore stage, it is one of the most resistant of pathogenic organisms 
and has been reported by Japanese workers to survive in a dry state 
for at least 40 years. The source of the agent is usually soil. Damp, 
marshy, or periodically flooded areas favor the growth of the 
organism. The disease is commonly spread by contamination of the 
soil, drinking water, and forage with the excreta and discharges of 
infected animals. Infected animals are particularly susceptible to 
attack by blood-sucking flies, principally of the Tabanidae group, 
which may in turn transmit the disease. Animals and birds which 
may feed on infected carcasses are potential spreaders. In certain 
areas, the disease appears enzootically nearly every year, usually in 
the warm months. 
The period of incubation may vary from 1 to 14 days but is seldom 
less; than 3 days. The duration of the disease before death super- 
venes is usually 2 to 5 days, although many animals die within 1 to 2 
hours after the first appearance of symptoms. 
Recommended program of control. Carcasses of infected animals 
should be burned or buried deeply without opening as spores are not 
readily formed in the absence of oxygen and the vegetative forms 
of the anthrax organisms are easily destroyed. Areas contaminated 
with the excreta and discharges of infected animals should be disin- 
fected or burned over. An anthrax spore vaccine in saponin known 
as “Carbozoo” has been shown to confer a high degree of immunity 
when administered by the intradermal route. Anti-anthrax serum 
is of value in promptly conferring passive immunity to animals on 
premises where the disease is present, and, when administered very 
early in the disease, is of therapeutic value. It is not practicable or 
desirable, however, to endeavor to control anthrax in lower animals 
by attempting to treat all cases of the disease. Infected animals 
should be destroyed to prevent spread of the disease. 
Brucellosis 
Distribution and prevalence. The disease is known to be present 
in China, the Philippines, and the Dutch East Indies. The disease 
is not seasonal, but occurs throughout the year. 
Epidemiology. It is a disease of animals and man caused by one 
of the three species of Brucella, namely Brucella melitensis, Brucella 
abortus, and Brucella suis, the chief hosts of which are the goat, 
cow, and hog, respectively. The disease in man is commonly known 
52 as “undulant fever." The disease in animals has no pronounced 
clinical symptoms other than those associated with the act of abort- 
ing. In man there is usually continued fever, profuse perspiration, 
frequent relapses, and rheumatic pains, although no one of these 
symptoms can be said to be typical of the disease. 
Recommended program of control. The agglutination test should 
be conducted on blood serum from cattle that are to be used for milk 
production and the reactors eliminated. Further, all milk for human 
consumption, including that for butter and cheese production, should 
be properly pasteurized. 
Sanitary control by providing a maternity barn distant from the 
herd for isolation of cows until abortion or calving has occurred and 
discharge has ceased is indicated. Preventive vaccination, especially 
of calves, with a low-virulent, living culture of Br. abortus provides 
an effective means of combating the disease. 
Blackleg 
Distribution and prevalence. This disease is prevalent throughout 
the Japanese Empire although it has not been a very serious disease 
problem in recent years. This is mainly due to vaccination which 
gives protection for at least 12 to 18 months, after which time the 
animal acquires natural immunity. 
Epidemiology. Blackleg is caused by an anaerobic spore forming 
organism, Clostridium chauvoei. The disease affects young cattle be- 
tween 6 months and 2 years of age. Other susceptible animals are 
sheep and goats. The organism occurs in the soil and when pastures 
once become infected, the disease will appear yearly in susceptible 
animals. Infection may occur through the digestive tract or by wound 
infection. 
Recommended program of control. Treatment of affected animals 
is unavailing and not recommended as they may be the means of dis- 
seminating infection. Blackleg bacterins for protection against the 
disease give excellent results. In herds where losses have occured 
susceptible animals should be removed from the infected area for 4 to 
7 days following vaccination to allow time for development of im- 
munity. 
Glanders 
Distribution and prevalence. Glanders is widespread throughout 
the Far East and is a scourge that has caused tremendous losses of 
horses and mules, especially when concentrated under wartime con- 
ditions. 
Epidemiology. # Glanders is caused by Malleomyces mallei, and is 
primarily a disease of members of the horse family, although it occurs 
53 occasionally in man. The infection in horses and mules may be either 
acute or chronic with the acute form being more frequent in mules 
than in horses. Infection is usually acquired by ingestion, or less 
frequently by inhalation of contaminated material and through wounds 
of the skin. Human infections may occur in those in close association 
with diseased animals, or among individuals conducting autopsies on 
glanderous animals. Infections have also been reported in man fol- 
lowing the ingestion of improperly cooked meats from glanderous 
animals or exposure in the laboratory. The highly infectious nasal 
discharges of horses which contaminate the surroundings, especially 
feeding and watering troughs, are responsible for most of the 
infections. 
Recommended program of control. Attempts to protect horses and 
mules against glanders by use of biologies have thus far proved unsuc- 
cessful. Eradication of the disease may be achieved by holding all 
susceptible animals in an area under strict quarantine pending the 
outcome of diagnostic procedures such as mallein testing and the com- 
plement-fixation test, and the reactors killed and disposed of by cre- 
mation or burial. Testing should be repeated at 21-day intervals in 
regions where the disease is known to exist. 
Hemorrhagic Septicemia 
Distribution and 'prevalence. Hemorrhagic septicemia is a collec- 
tive term for certain diseases of various animals characterized by the 
presence in the blood of bacteria and toxins of the Pasteurella groups. 
Hemorrhages in the body tissues and organs occur frequently. The 
diseases are world-wide in distribution, have a high mortality rate, 
and affect horses, cattle, sheep, buffalo, and swine. 
Epidemiology. The etiological agents are small Gram-negative, 
ovoid to elongated nonspore-forming rods belonging to the Pasteurella 
group. Since their cultural and biochemical reactions are essentially 
identical, it has been proposed that they be recognized as a single 
species. Organisms of the Pasteurella group are found frequently in 
the upper air passages of normal animals. Apparently these organ- 
isms become pathogenic when the normal resistance of the animals has 
been lowered as a result of exposure to cold rains, long shipments by 
rail, etc. 
Recommended program of control. The employment of bacterins 
prepared with the specific organism involved is indicated for the pre- 
vention and control of hemorrhagic septicemia in cattle and horses. 
Immune serum is useful to protect cattle that have been exposed and in 
treating animals in the early stages of the disease. The elimination 
of predisposing factors such as overexertion and lack of proper 
amounts of feed and water will tend to reduce the incidence of the 
disease. 
54 Tuberculosis 
Distribution and prevalence. Tuberculosis is widespread through- 
out the Japanese Empire and presents one of that nation’s major public 
health problems. It was introduced into the livestock population of 
the country some 30 years ago through the importation of cattle and 
today is found wherever cattle are raised. 
Epidemiology. This part of the subject has been previously 
discussed. 
Recommended program of control. In the United States, the plan 
for controlling the disease is the testing of animals, using intradermic 
tuberculin and slaughtering reactors. While this method may not be 
practical during the period of military occupation, nevertheless, herds 
from which milk for troops is to be used should be tested and the 
reactors removed. Milk, of course, should be pasteurized. 
Tularemia 
Distribution and 'prevalence. Tularemia may be considered a new 
disease, as it has only been recognized as such since 1921. It was first 
reported in Japan in 1925, where it is known as “Ohara’s disease.” 
Epidemiology. The etiological agent is Bacterium tvlarense or, as 
designated in Bergey’s Manual, Pasteurella tularensis. The disease 
occurs in nature as a fatal bacteremia of wild rodents, especially rab- 
bits and hares. It is transmitted from the lower animals to man by 
the bite of blood-sucking insects or from handling infected animals. 
The incubation period in man is usually 3 to 9 days. The initial 
lesion usually develops into a sore, following which the associated 
lymph glands become enlarged and tender. 
Recommended program of control. Approximately 90 percent of 
human infections are reported to have been acquired from skinning 
and dressing infected wild rabbits. The wearing of rubber gloves 
when handling rabbits should be encouraged, since the organism is 
known to penetrate the unbroken skin. Thorough washing of the 
hands and the application of tincture of iodine to scratches and 
abrasions are recommended. 
Equine Encephalomyelitis 
Distribution and prevalence. Equine encephalomyelitis is enzootic 
in North and South America, and Europe, and there is suggestive evi- 
dence that the disease is present in parts of Asia now under Japanese 
domination. It is possible that some of the ill-defined encephalomye- 
litides and so-called “forage poisoning” are cases of this disease. It 
is the most important equine disease in the United States; it is esti- 
mated that since 1930 approximately a million horses and mules.have 
been affected. 
55 Epidemiology. The etiological agent is a filtrable virus which oc- 
curs in four immunologically distinct types: the Eastern and Western 
types, enzootic in parts of North and South America; the Venezuelan 
type, enzootic in Venezuela, Colombia, and Trinidad; and the Borna 
types, enzootic in Europe, The equine encephalomyelitides of the 
Americas differ from the European Borna type in two respects. 
Those of the Americas are known to produce a fatal encephalitis in 
man, and are transmitted by blood-sucking anthropods, mainly mos- 
quitoes. On the other hand, no human infections with Borna disease 
have been reported, and its seasonal incidence does not suggest insect 
transmission. In the United States, in addition to equines and man, 
natural infections have been reported in pigeons, pheasants, a prairie 
chicken, and deer. It is essentially a disease of pastured animals and 
adult male farm workers. In North America, outbreaks reach their 
peak in late summer and disappear with the coming of killing frosts. 
Recommended program of control. In regions where equine 
encephalomyelitis occurs, horses, mules, and burros should be actively 
immunized against the disease by the use of chick-embryo vaccine pre- 
pared with the indigenous type of encelphalomyelitis virus. The 
vaccine should be administered intradermically in two doses 7 days 
apart and the vaccination repeated annually. Mosquito-control meas- 
ures, proper screening of barracks, and the use of misquito repellents 
are indicated for protection of personnel. Vaccination of persons un- 
usually exposed to danger of infection should be considered. 
Foot-cmd-Mouth Disease or Aphthous Fever 
Distribution and prevalence. The extent of foot-and-mouth disease 
in the Japanese Empire is unknown, but it is an established fact that 
two outbreaks of the disease which occurred in the United States were 
traced to the importation of contaminated cowpox vaccine virus from 
Japan. 
Epidemiology. The etiological agent of the disease is filtrable 
virus. Cross immunization tests indicate that there are at least three 
types of the virus. The three types are designated “A,” uO,” and 
“C.” Transmission is usually by the direct or indirect transfer of the 
virus in saliva admixed with fluid from ruptured vesicles of the oral 
cavity. Milk, urine, and excretions from infected animals may also 
contain the virus. Meat or other parts of animals slaughtered in the 
febrile stage of the disease may be infectious, and feeding of such prod- 
ucts to susceptible hogs often results in a spread of the infection. The 
disease spreads rapidly and has an incubation period varying from 1 
to 7 days. The disease occurs readily in all cloven-footed animals and 
infrequently in man. The horse is not susceptible and is used as a test 
animal to differentiate the disease from vesicular stomatitis. 
56 Recommended program of control. The slaughter of infected and 
contact animals may be used in the beginning of the outbreaks. If 
this procedure is not successful in curbing the disease, then rigid 
quarantine methods should be instituted. Passive immunization with 
antiserum may be indicated for the prevention and treatment of the 
disease in certain instances. Active immunization by means of the 
simultaneous administration of the indigenous type of virulent virus 
and its antiserum might be considered if the immunizing agents are 
available, but the results by no means are markedly satisfactory. 
Quarantine should not be lifted until 90 days after all evidence of the 
disease has disappeared. Animals have been known to be carriers 
of the virus for 8 months after clinical recovery. Special care should 
be taken to prevent transmission of this disease to other places or coun- 
tries, including the United States, through shipments of material 
exposed to contamination with the virus of foot-and-mouth disease. 
Hog Cholera 
Distribution and 'prevalence. Hog cholera is a devastating disease 
that has caused considerable annual losses in Japan in recent years. 
Epidemiology. The etiological agent is a filtrable virus which is 
pathogenic only for swine. In most instances the virus is accom- 
panied by pathogenic bacteria. While hog cholera is transmitted 
principally by direct contact with sick animals or their excretions, 
many outbreaks have been attributed to the feeding of infected un- 
cooked pork trimmings. The latter is always a hazard where civilians 
are permitted to collect garbage from Army messes. The disease is 
highly contagious. The incubation period is usually 5 to 6 days. The 
disease is first manifested by a high fever, lassitude, inappetence, and 
a tendency for the animals to crowd together. 
Recommended program of control. Due to the high mortality rate 
of the disease, serious losses can only be avoided by immunization of 
the animals. The recommended methods are the simultaneous use of 
immune serum and virulent virus, or the use of crystal-violet vaccine. 
The latter type vaccine contains inactivated virus and eliminates the 
danger of spreading the disease, which may occur from the use of the 
virulent virus. The simultaneous method of vaccination produces a 
lifelong immunity, whereas the crystal-violet vaccine produces an 
immunity lasting for only approximately 6 months. 
Rabies 
Distribution and prevalence. Babies is a specific encephalitis caused 
by a virus which has a strong affinity for nerve tissues. 'It is world- 
wide in distribution, and has-for years been a scourge of the Asiatic 
countries, especially the Philippines. In Japan, through the exten- 
57 sive use of prophylactic vaccination of dogs, the disease is not usually 
found in epizootic proportions although it continues to be a serious 
public health problem. It is often spread over great distances by the- 
transportation of stray dogs in the incubation stages of the disease. 
Rabies is not a seasonal disease. When the disease occurs among wild 
animals, its eradication becomes difficult. 
Epidemiology. The virus of rabies produces the disease in all 
warm-blooded animals, including man. Transmission is usually 
through the bite of a rabid animal of the carnivora type. The virus 
may be present in the saliva of rabid dogs 6 to 8 days before the 
clinical symptoms appear. The incubation period in natural infec- 
tions is variable, and may be as short as 14 to 16 days or as long 
as 5 to 6 months; bites on the head and neck resulting in a shorter 
period of incubation than those on the extremities. 
Recommended program of control. The destruction of all stray 
dogs should be the first step in the control of the disease. Other dogs 
should be restrained to the owners’ premises or if on a public high- 
way should be on a leash or effectively muzzled. Vaccination of 
dogs against rabies with one injection of an approved vaccine is of 
practical value, but should not be accepted as sufficient in itself to con- 
trol the disease. Any animal that has bitten a person or is suspected 
of being rabid should be kept in confinement under observation for 
14 days, or until symptoms appear. If no symptoms have developed in 
this time, the animal may be regarded as having been incapable of 
transmitting the disease. The brains of all suspect animals which 
have died or been destroyed should be examined for the presence of 
Negri bodies. If Negri bodies are not found, a 10 percent suspension 
of the brain tissue in hormone broth should be inoculated intracere- 
brally in 0.03-cc portions into several young white mice for diagnostic 
purposes. 
Rinderpest 
Distribution and 'prevalence. Rinderpest is enzootic in practically 
all parts of Asia, and for years was the most important livestock 
problem in the Philippines. 
Epidemiology. The disease is an acute febrile affection of rumi- 
nants characterized by a croupous, diphtheritic inflammation of the 
mucous membranes of the alimentary tract, usually accompanied by 
a profuse bloody diarrhea. The etiological agent of rinderpest is a 
filtrable virus which is commonly spread from animal to animal by 
contact, and through contaminated food and water. The incubation 
period of the disease varies from 3 to 9 days. 
Recommended program of control. Immune serum may be used 
on recently infected herds for animals in the incubation stage, but it 
58 has little value for treating animals manifesting clinical symptoms 
of the disease. Methods of immunization include the simultaneous 
use of immune serum and virulent blood, or better, the use of tissue 
vaccines in which the virus has been inactivated chemically. One of 
the latter types of vaccines that has proved successful is the Kelser 
tissue type vaccine which is inactivated with chloroform. 
Trypanosomiasis 
Distribution and 'prevalence. A trypanosomiasis known under the 
name of surra is common in South China, Burma, India, the Philip- 
pines, and other southern Asiatic countries. 
Epidemiology. The cause of the disease is Trypanosoma, evansi. 
It is usually transmitted by blood-sucking flies, principally of the 
Tabanidae group. It is always fatal for the equine species and dogs, 
but infrequently for cattle, water buffalo, elephants, and camels. The 
low fatality rate for cattle and water buffalo makes them important 
factors as carriers. Since potential vectors are present in all countries, 
the introduction of animals in the carrier state into areas free of 
the disease is always a great hazard. 
Recommended program of control. There is no known method for 
the immunization of animals against surra and treatment of infected 
animals with the available trypanocides is usually discouraging. The 
disease in horses can usually be diagnosed through microscopic demon- 
stration of the organism in wet blood preparations. Several exami- 
nations may be necessary, especially in cases in the early stages of 
the disease. To detect carriers, the complement-fixation test for try- 
panosomiasis should be applied, when possible, to the serum of all 
animals prior to movement from an infected area into an area free 
from the disease. Failure to find trypanosomes in fresh blood prepa- 
rations is insufficient evidence to rule out carrier animals. In known 
infected regions, horses should be stabled in areas free from trees and 
underbrush and distant from cattle and water buffalo. Fly repellents 
effective for at least 24 hours and nontoxic to mammals should be 
employed. 
Piroplasmoses 
Distribution and prevalence. The piroplasmoses are a group of 
diseases caused by a genus of sporozoans (Babesia), parasitic in the 
red blood corpuscles of cattle, horses, sheep, and dogs. The diseases 
are transmitted by ticks and are enzootic in all tropical and subtrop- 
ical countries. 
Epidemiology. The principal symptoms of the disease are progres- 
sive anemia, hemoglobinuria, and icterus. 
59 Animals surviving an acute attack usually remain carriers for long 
periods of time, and as such are capable of infecting ticks. Infection 
immunity continues as long as the animals remain carriers. However, 
under adverse conditions, resistance of the carrier animals may be 
lowered to such an extent that latent infection flares into the acute 
form. Further, recovering from one type of infection does not 
confer immunity against other types to which the animal is susceptible. 
Bovine piroplasmoses, or the so-called tick fevers, are indigenous 
to all tropical and subtropical regions of the world and are caused by 
either Babesia bigemina or Babesia bovis. 
Equine piroplasmosis caused by Babesia equi is known to be present 
in India. 
Canine piroplasmosis caused by Babesia canis has been reported 
from India, China, the Philippines, and .other Asiatic countries. It 
proves fatal in a considerable percentage of cases. 
Ovine piroplasmosis caused by Babesia ovis is known to be present 
in China. 
A definite diagnosis should be based upon detection of the specific 
Babesia in the red blood corpuscles. 
Recommended program of control. Disease-free animals should 
not be pastured in tick-infested areas, nor fed fodder originating 
from such areas. Animals introduced into tick-free areas should be 
received only after disinfestation. 
Anaplasmosis 
Distribution and prevalence. Anaplasmosis is generally regarded 
as a tropical or semitropical disease, but it also occurs in regions 
having low winter temperatures. It has been reported from the 
following Asiatic countries: Cochin-China, Java, the Philippines, and 
Formosa. It is primarily a disease of cattle, although buffalo, sheep, 
and camels are reported to be susceptible. The death rate in cattle 
may vary from 25 to 60 percent. 
Epidemiology. The etiological agent, Anaplasma marginale, in- 
vades the red blood cells and causes a febrile disease characterized 
chiefly by symptoms of anemia and icterus. Another variety, 
Anaplasma central'e, has been reported and is claimed to produce 
a more benign form of the disease than Anaplasma marginale. 
Anaplasmosis is transmitted by ticks, blood-sucking flies and mosqui- 
toes; moreover it may be transmitted by the infected dam to the 
unborn calf. 
Recommended program of control. No effective therapy for this 
disease is known. Cattle which survive an acute attack usually remain 
carriers. Susceptible cattle should be pastured in tick-free areas. 
60 Parasitic Conditions Encountered in Meat Inspections 
In addition to the animal diseases mentioned above, several para- 
sitic general diseases of animals—echinococcosis, beef measles, pork 
measles, and trichinosis—will be of particular importance from a 
meat inspection standpoint, as they are transmissible to man. Be- 
cause of lower standards of sanitation, the incidence of parasitis 
disease is much higher than in the United States. 
Due to the perishable nature of meat, meat-foods, and, dairy 
products, and to the difficulties in connection with their transportation 
and storage, an urgent demand for the use of such locally produced 
foods by both the occupying military force and the civilian population 
may be expected. Immediate steps should therefore be taken to 
survey the facilities of the meat and dairy industries and the pre- 
existing inspection agencies. Based on the findings of this survey, 
and in conformity with the policies and procedures discussed in the 
section on Communicable Disease Control, an adequate plan for the 
production and inspection of these products should be instituted. 
The ante-mortem and post-mortem inspections, as far as practicable, 
should be performed in accordance with the principles of the 
“Regulations Governing the Meat Inspection of the United States 
Department of Agriculture.” 
The processing, handling, and inspection of meat and dairy sup- 
plies intended for the use of troops should, whenever possible, be 
supervised by veterinary personnel attached to organizations. Local 
supplies of fluid milk, ice cream, and other dairy products for the 
us© of troops should not be used unless properly pasteurized. 
618146—44 5 
61 NARCOTIC CONTROL 
The problem of illicit trade and use of narcotics in countries of 
the Far East will demand prompt action by civil affairs officials 
upon occupation. In most areas, the monopoly system of selling 
tax-paid opium to smokers has been adopted; the Far East is tra- 
ditionally the area from which quantities of narcotic drugs find 
their way into the illicit drug markets of the world. 
Unless effective and prompt action to establish narcotic control i& 
taken by military government authorities, there is grave danger of 
recrudescence in illicit traffic, increase in addiction, and the possi- 
bility of addiction among personnel of the occupying military 
forces. 
Control measures should be directed by an officer whose qualifica- 
tions include broad experience in narcotic control. Upon libera- 
tion or occupation of a country or part thereof, and concurrently 
with the taking over of the civil administration, certain regulations 
should be put in force: 
1. Require that all stocks of narcotics in civilian hands be re- 
ported to the military government authorities; all stocks should be 
placed under military government control. 
2. No narcotics should be imported for civilian use, except under 
licensure of the military government. 
3. Distribution of narcotics for civilian needs should be controlled 
by issuance only through relief organizations, wholesale firms, and 
pharmacies approved for the purpose. 
4. Narcotics for civilian use should be supplied solely on the pre- 
scription of qualified medical practitioners. This requirement should 
be enforced by— 
a. Periodically submitting to the civil affairs authorities a report 
on all narcotic supplies and transactions by relief 
and wholesale firms. 
h. Periodic inventories of narcotic stocks by qualified officials. 
5. Factories for the manufacture of narcotics should be placed 
under the control of the military government and the establish- 
ment of new factories should not be permitted. 
62 6. Supplies of raw materials from which narcotics are manufac- 
tured, as opium, poppy straw, crude morphine, cocao leaves, crude 
cocaine, Indian hemp, should not be imported except under licen- 
sure. The production of raw materials in the country should be 
placed under control of the military government. 
7. In order to make possible the full functioning of a system for 
international control of world traffic in narcotics and raw materials 
as established by the international conventions of 1912, 1925, and 
1931, certain procedures are indicated. Reports should be submit- 
ted by military government officials to the Permanent Central 
Opium Control Board.1 The reports should include quantities of 
each drug and the raw materials imported or exported during the 
preceding quarter, indicating the source of imports and the desti- 
nation of exports; also the amounts of each drug manufactured dur- 
ing the quarter, and stocks in hand at the end of the quarter. 
8. Export from, the country of narcotics or raw materials should 
not be allowed except under military government licensure, and 
then only upon certificate from authorities of the importing country 
that the import is within the previously estimated requirements: 
submitted by that country to the Permanent Central Opium Control 
Board. In addition, transactions in manufactured drugs should be 
approved by the Supervisory Body of the Board and shown in its 
Statement of Estimated World Requirements of Dangerous Drugs 
for the year in which the transaction will take place. 
9. All opium shops should be closed and opium pipes and other 
paraphernalia seized. Opium addicts, as determined by competent 
medical authorities, who require morphine should be supplied on 
prescription. Existing facilities for the treatment of addicts may 
require expansion and additional facilities may be required. If for 
any reason, immediate closure of these shops is not considered feas- 
ible, they should be placed “off limits” for troops. 
10. Adequate records should be maintained of all narcotic drugs 
for civilian use drawn from military supplies. 
] Branch office temporarily located at: 1322 18th St. NW., Washington, D. G. 
63 VITAL RECORDS 
Vital records may be termed the biological bookkeeping of public 
health and they are a basic requirement for planning, operation, 
and evaluation of health program. 
All satisfactory and essential preexisting systems of records and 
reporting maintained by local public health organizations should be re- 
established. Reports through appropriate Civil Affairs channels 
should be required from local, regional, and national health depart- 
ments. Such reports permit Civil Affairs medical personnel to 
evaluate the work of the civilian health departments and to supply 
essential data for reports to higher headquarters. In general report- 
able data should include— 
1. A resume of numbers, qualifications, and distribution of such 
qualified medical personnel as physicians, nurses, midwives, labora- 
tory technicians, dentists, pharmacists, and veterinarians in the 
area. 
2. The initial report should outline the organization and func- 
tional structure of the civilian health department. 
3. Special reports should be required for disease of major impor- 
tance, those occurring in epidemic incidence, and those particularly 
endangering health of troops. Hospitals and physicians should 
report immediately occurrence of disease of epidemic type or un- 
usual numbers of undiagnosed febrile conditions. Major methods 
of control adopted should be stated. Reports of the nutritional 
status of civilians should be submitted at intervals. 
4. Initial reports should include the status of such existing facil- 
ities as hospitals, sanatoria, asylums, convalescent homes, and labo- 
ratories. Estimates of anticipated requirements of equipment and 
personnel for adequate reestablishment of such institutions should 
be stated. Reports pertaining to occupied and vacant beds in hos- 
pitals and similar institutions for the sick should be made to the 
chief Civil Affairs public health officer at specified intervals. 
5. An early inventory should be made of stocks of available med- 
ical supplies and a report submitted to Civil Affairs public health 
officers. Distribution should be on requisitions approved by Civil 
Affairs medical officers. Emergency issue of supplies coulcl be done 
64 without awaiting approval; under such circumstances, a report 
should be rendered immediately. (See Medical Supply.) 
6. Each hospital should submit an emergency plan for expansion 
of medical facilities if warranted. 
7. Reports should be submitted on sources, potability, and ade- 
quacy of water supply. Damage to public systems and estimations 
of equipment and time required for repairs should be outlined. 
Reports should be submitted following inspection by Civil Affairs 
public health officers, on medical installations, facilities, and per- 
sonnel. 
65 HEALTH PROBLEMS OF DISPLACED PERSONS 
In certain instances, the health of large numbers of people displaced 
from their home communities may present a major problem to Civil 
Affairs administration. Such groups may include persons who have 
fled or have been evacuated from areas of combat, forced laborers, 
individuals who left home under political duress, and expatriates who 
may have been in present residence for varying periods. The num- 
bers and general health of displaced persons, medical facilities re- 
quired for their care, and the attitude of native inhabitants to these 
refugees are factors for consideration in planning. 
It may be expected that many persons of the displaced population 
will return home at the earliest possible moment. Dangers to pub- 
lic health throughout a wide area will result from unrestricted move- 
ment of refugees. Consequently, such movements should be delayed 
until they are considered expedient; systematic planning for such a 
procedure is essential. 
An attempt should be made therefore to guide the movement of 
displaced persons, and to maintain some degree of surveilance from 
the standpoint of epidemic control over their movement. It should 
be recognized, however, that measures which lead to undue restric- 
tion of movement may defeat the purpose for which designed by pro- 
moting clandestine travel and the use of unsupervised routes of travel. 
Program of immunization and disinfestation should be developed 
with a view to expediting rather than hampering the movement of 
returning refugees. 
Public health services for displaced persons should be of the same 
type provided natives in the area. Inadequate facilities to care for 
this superimposed population may necessitate construction of addi- 
tional shelters and require expansion of organizations for feeding and 
medical care. The circumstances of refugees will augment difficulties 
and problems in administering to their relief; the problems of women 
and younger age groups may deserve special consideration. When 
indicated, special camps should be established to segregate displaced 
populations from the native population for purposes of general sani- 
tation, or to prevent the spread of epidemic diseases prevalent in an 
area through which the transient groups have passed. Segregation 
66 or detention for purposes of care, quarantine, and delousing may be 
indicated under certain circumstances. At times, routine immuniza- 
tion of refugees who are to pass through epidemic areas may be 
indicated. 
A public health plan for the movement of displaced persons should 
take into consideration*the following factors: 
1. Endemicity or epidemicity of disease in the area from which 
and to which they are to be moved. 
2. Medical facilities en route and at the terminal area for medical 
care of refugees and for isolation of suspected cases of communicable 
diseases. 
3. Facilities for disinfestation, bathing, and immunization of the 
group. 
67 FOREIGN QUARANTINE 
Foreign quarantine includes all those procedures employed to pre- 
vent the introduction of important epidemic disease from one country 
or area into another. This effort, while restricted to international or 
interterritorial travel, may at times be of extreme importance in pre- 
venting the introduction of disastrous epidemic*disease and in avoiding 
criticism, restriction, or indemnification as a result of the preventable 
introduction of disease. 
Quarantine properly may pertain to man, animals, or plants. While 
the disease of man may be the more impressive at the moment, the 
diseases of animals and plants may be of even greater importance. 
Thus, the introduction of rinderpest into the Philippine Islands in 
the first decade of this century caused the loss of 90 percent of the 
native cattle with resultant nutritional deficiency and starvation 
among the population; the cotton boll weevil in southern United States 
imperiled the economy of that section of the country. Important in 
many diseases is the control of insects and the prevention of their in- 
troduction into areas where they did not previously exist. Such in- 
sects with reference to these areas, are termed “exotic.” Malaria, 
...7 • 7 
carried by a new vector in Brazil, killed 25,000 people in 3 years; the 
Mediterranean fruitfly has endangered the citrus industry of Florida. 
Quarantinable Diseases 
The diseases of man of importance in foreign quarantine are gen- 
erally those which history has proved significant. These by interna- 
tional convention (International Sanitary Code, League of Nations, 
Pan-American Sanitary Code) are smallpox, plague, typhus (epidemic 
or louseborne type), cholera, and yellow fever. Certain countries by 
national legislation have made other disease quarantinable, as leprosy 
in the United States and influenza in Australia. International quar- 
antine procedures are directed exclusively against diseases thus speci- 
fied, action in the case of others usually being limited to notification of 
local authorities. Careful reexamination of this list of diseases has not 
indicated that modification is required in the interest of public health 
at this time, for while other diseases may be acutely contagious, their 
68 danger to the public health as a whole does not require world-wide 
measures. 
Definition of Quarantine 
“Quarantine” is a collective term, frequently used loosely, and other 
terms should be used for the specific components of quarantine. The 
removal of a case of quarantinable disease from contact with all sus- 
ceptible individuals is termed “isolation.” “Detention” is the term for 
segregation under medical observation of an individual thought likely 
to develop a quarantinable disease. In some instances, a suspect or 
contact may be allowed considerable liberty of action with only pe- 
riodic examination to assure freedom from disease; this is termed 
“medical surveillance.” It is apparent that for military personnel, the 
constant availability of medical supervision, the holding of sick call, 
and restriction of movement constitutes medical surveillance, and un- 
der conditions permitting this management of exposed or suspected 
persons no special additional steps need be taken. 
Foreign Quarantine in War and Peace 
In the literature on quarantine, many impressive references are 
made to historical epidemics which at times decided wars and the 
future of nations more potently than did force of arms. Due to im- 
proved sanitation and other factors of preventive medicine, the 
peacetime requirements of international quarantine have become 
greatly reduced. This does not indicate they are nonexistent. During 
wartime, with unprecedented travel of personnel, the problem has 
required reexamination and some reorientation. 
Variation in Quarantine Problems 
It should be emphasized that the quarantine problems on one area 
are usually not the same as of another and a universal code of quar- 
antine regulations must express principles at the time rather than 
fixed detail. The greatest concentration of quarantinable disease is in 
the Far East where plague, epidemic typhus, cholera, and smallpox 
are endemic. Yellow fever, of paramount importance in Central 
Africa and Northern South America, is lacking in this section of the 
world. Such differences determine international policy, which for 
instance in the United States and Australia requires precautions 
against all of the diseases with a given level of intensity to assure 
effectiveness. In the Philippine Islands, the level of intensity is neces- 
sarily higher in some respects than in the Continental United States 
because of proximity to all of the quarantinable diseases except yellow 
fever. In India, however, foreign quarantine is directed solely to 
69 prevention of the introduction of yellow fever since all the other 
important quarantinable disease are endemic. 
Variation in Insect Control Problems 
Similar local considerations modify insect control. Two distinct 
problems are presented. The first is the introduction of a disease 
which can be carried by insects already present in the area. Under 
these circumstances, the more important factor is the human or ani- 
mal cases of the disease from which local insects might be infected. 
The second problem is the introduction of new insects which might 
be more efficient vectors of diseases already present. This is par- 
ticularly important in malaria. Climatic factors greatly influence 
insect control. Thus the introduction into the United States of a 
case of yellow fever must be carefully guarded against south of a line 
roughly from Philadelphia to Los Angeles, where breeding of the 
vector insect is favored; north of this line exposees may be allowed full 
liberty. In Australia, the policy has been adopted that military 
personnel from malarious islands to the north should be repatriated 
only into the southern third of the continent where proper conditions 
do not exist for generalized prevalence of an efficient vector. 
Responsibility for Quarantine 
In the United States and most other countries of the world, the 
responsibility for foreign quarantine has been placed with the 
national public health service, and in the case of animals and plants, 
with the national agricultural agency. Military interest has required 
adjustment of policy in this regard since the Army is charged with 
the medical protection of its personnel and of the populations of 
occupied territories. Thus, in some areas it carries out the functions 
or meets the requirements of the civil government as it may mutually 
be agreed they shall apply to military operations. It is to be pointed 
out that the term “as they apply to military operations” does not 
necessarily imply the full application of the civil code, certain allow- 
ances being commonly agreed upon in view of military immuniza- 
tions, control of personnel, and expediency of action. The extremes 
of adjustment in this regard are shown by Australia which has 
reserved to the Commonwealth quarantine authorities full control 
over all national quarantine, and by New Zealand where Parliament 
specifically relieved the national authority from the responsibility 
and gave it'to their own and to the United States military organiza- 
tions with reference to military traffic. The policy in the United 
States is midway between these extremes, over-all supervision being 
reserved for the Public Health Service and the Department of 
70 Agriculture in their respective spheres, but the execution of many 
functions being the duty of the armed forces. The closest liaison 
with coexisting public agencies should be maintained in the interest of 
quarantine without friction or recrimination and, with proper but 
not excessive consideration of military convenience and necessity. 
At a rule, preexisting civil quarantine codes will have been adjusted 
to local problems, and should be continued as far as practicable until 
specific provisions can be carefully reexamined. 
Basis for Quarantine 
With reference to quarantinable diseases of man, quarantine has 
in the past been based upon consideration of exposure of the indi- 
vidual to disease and upon examination to determine presence of the 
disease. The first has been accomplished by considering certain 
areas and ports of the world to be infected, and all persons from such 
places to be suspects. This supervision was usually applied rigidly 
to persons of lower economic class, while first cabin and aircraft 
passengers were generally assumed to be excusable from close quar- 
antine supervision. Information as to the infected status of areas 
was ordinarily obtained through reports by consuls sent to the parent 
country through the Department of State. Such officials also sent 
information with each vessel by means of the Bill of Health, the 
usefulness of which has however become seriousy challenged so that 
it has been discontinued in many countries and probably will be so 
shortly in the United States. In peacetime, international epidemi- 
ological reports were broadcast through international health agencies 
such as the Office of Public Hygiene at Paris, the League of Nations 
at Geneva and Singapore, and the Pan-American Sanitary Bureau at 
Washington. This practice is, of course, restricted during the war. 
Physical examination of suspects was ordinarily accomplished by 
“physical inspection,” a rapid observation of individuals to determine 
freedom from quarantinable disease. The efficiency of this examina- 
tion has been challenged and its application to large numbers of 
refugees or troops may be difficult. Thus, with reference to military 
personnel and others traveling under military jurisdiction, it has 
become apparent that quarantine may more efficiently be based upon 
broad immunization for the quarantinable diseases and upon military 
status which, as noted before, constitutes a continuing medical sur- 
veillance. Much quarantine detail can be eliminated by assurance 
that military criteria for immunization are followed out. Detailed 
investigation of exposure to quarantinable disease within their incu- 
bation periods may, therefore, be contemplated only in individuals 
not so immunized. 
71 Flexibility of Quarantine Control 
This will not set aside intelligent modification of policy as may be 
required by occurrence of quarantinable disease, and no policy can 
be expressed which will replace the intelligent application of meas- 
ures of preventive medicine in the hands of competent medical 
officers. It may be noted that the value of immunization, as accepted 
by the military and civilian health agencies of the United States, is 
not recognized by all countries. Thus, Australia has refused to 
modify quarantine procedures on the basis of immunization, and the 
immunization of some armed forces of the United Nations is 
incomplete. 
An attitude of critical realism should be maintained in quarantine 
so that negligence is avoided as well as quixotic overemphasis. 
72 APPENDIX A 
ORGANIZATION OF CIVIL HEALTH SERVICES IN 
JAPAN PROPER 
Japan Proper consists of a long narrow group of islands, the most 
important of which are Hokkaido, Shikoku, Honshu, and Kyushu, 
lying off the east coast of China, between 25° and 50° north latitude. 
The land area of Japan proper is 148,756 square miles. The popula- 
tion, according to estimate for 1940, was 73,000,000. Japan is therefore 
among the most densely populated countries in the world. The ap- 
proximate populations of the six largest cities in 1940 were as follows: 
Tokyo, 6,778,800; Osaka, 3,252,300; Nagoya, 1,328,000; Kyoto, 1,089,- 
700; Yokohama, 968,000; Kobe, 967,000. The next largest city has a 
population of approximately 344,000 and there are 32 cities with popu- 
lations between this figure and 100,000. For administrative purposes, 
Japan proper is divided into 47 Ken or Prefectures, including the three 
urban prefectures of Tokyo, Kyoto, and Osaka. 
National Health Department 
There is a strong central health authority under the Ministry of 
Health and Welfare, highly complex in its organization and exercising 
control over many functions which are not ordinarily the concern of 
health departments in the United States, Authority and responsibility 
in health, and sanitation stem from this organization through the pre- 
fectural governors to a prefectural health department in each of the 47 
prefectures. 
Prior to 1938, the central health authority was the Sanitary Bureau 
which comprised four main divisions, designated respectively, hygiene, 
acute infectious disease prevention, .chronic infectious disease preven- 
tion, and medical affairs; a division of planning was added in 1937. 
By Imperial Ordinance dated 11 January 1938 the central health 
authority was reorganized bringing together a number of related 
agencies and bureaus to form the Ministry of Public Health and Wel- 
fare, which is presided over by a cabinet member, the Minister of 
Health. Subsequently certain changes in organization were effected, 
so that in 1941 the ministry comprised five principal bureaus with 
several divisions each, three branches, and a number of institutes and 
other institutions related to health or welfare. The revised organiza- 
tion of the Ministry of Public Health and Welfare is shown below: 
73 Administrative: 
Secretariat Division 
Document Division 
Fiscal Division 
Bureau of Population: 
General Affairs Division 
Administration Division 
Maternal and Child Division 
Physical Training Division 
(The Bureau of Physical Education was abolished and its duty was 
transferred to this bureau). 
Bureau of Hygiene and Sanitation: 
Administration Division 
Medical Affairs Division 
Sanitation Division 
Drugs Division. 
Bureau of Preventive Medicine: 
Chronic Infectious Disease Prevention Division 
Acute Infectious Disease Prevention Division 
Tuberculosis Division 
Bureau of Livelihood : 
Livelihood Division 
Housing Division 
Protection Division 
(The Bureau of Social Affairs was abolished and its duty was 
transferred to this bureau). 
Bureau of Livelihood: 
Efficiency Division 
Labor Policy Division 
Labor Wages Division 
Supervision Division 
Vocation Branch: 
Vocation Division 
Directory Division 
Employment Division 
Registration Division 
Unemployment Adjustment Branch: 
General Affairs Division 
Transfer Division 
Project Division 
Temporary Military Relief Branch: 
Division for Military Assistance 
Division in Aid of the Families of Deceased Soldiers 
74 Institutes Under the Public Health and Welfare Department 
Institute of Insurance. Established in 1938. This institute is 
composed of the following bureaus: 
Bureau of General Affairs 
Bureau of Social Insurance 
Bureau of Post Office Insurance 
Institute for the Protection of Wounded Soldiers. This institute 
was established in 1937. It is composed of one office and two bureaus: 
Office of the President 
Bureau of Planning 
Bureau of Service 
Organizations Related to Public Health 
All of the following organizations are under the supervision of the 
Ministry of Public Health and Welfare. Some of these organizations 
have undergone a change of name since establishment. The date 
under each indicates the year in which it was first established. 
Hygienic Laboratories: 
Tokyo Hygienic Laboratory, 1874 
Osaka Hygienic Laboratory, 1875 
Government Institute of Nutrition, 1920 
Institute of Public Hygiene, 1938 
National Leprosarium, 1927 
National Tuberculosis Hospital, 1937 
Institute for Infectious Diseases, 1892 
National Parks Committee, 1931 
Board for Investigation of Physical Training, 1932 
Board for the Investigation of the People’s Physical Condi- 
tions, 1938 
Central Board of Health, 1880 
Board for the Investigation of the Japanese Pharmacopoeia, 
1900 
Board for the Investigation of National Hygiene, 1916 
Opium Committee, 1931 
Committee for the Examination of Medical Practitioners, 1916 
Committee for the Examination of Dental Surgeons, 1916 
Committee for the Examination of Pharmacists, 1896 
Board for the Investigation of Medical System, 1938 
In 1938, the situation with reference to hospitals was as follows: 
Hospital Bed Capacity 
Government y 38 15, 669 
Public 683 48,297 
Private 3,190 116, 401 
Total 3,911 179,367 
75 In 1938, there were approximately 53,000 physicians engaged in 
practice, or about 8.64 per 10,000 population. It is supposed that the 
number of physicians engaging in civilian practice has declined 
coincident with extension of military operations. 
Prefectural and City Health Departments 
In Japan there are four units of local administration, the prefecture, 
which may be either rural or urban, the city, the town, and the 
village. Only the prefectures and the more important cities have 
full-time health departments. The prefectural sanitary bureau dates 
back to 1879. For many years it has been organized under the police 
department and it is presumed that this system still prevails in most 
prefectures. Considerable expansion in the size and functions of 
prefectural and city health departments has occurred in recent years, 
and it is probable that in the more important urban centers the health 
department functions as an autonomous unit. 
In the urban Prefecture of Osaka, for example, the health depart- 
ment in 1940 comprised a Prefectural Sanitary Bureau with a director 
and 20 professional and technical assistants, a Health Insurance 
Bureau with a chief, 1 full-time assistant and 4 part-time assistants, 
a Public Health Institute with a director and 1 assistant, and 4 
prefectural hospitals. For the city of Osaka there is a City Public 
Health Division with a director and 41 staff members, a City Hygienic 
Laboratory with a director and 9 technical assistants, and 7 city 
hospitals. 
To cite another example, the Kanagawa Rural Prefecture had the 
following organization: Prefectural Sanitary Bureau with a chief, 
5 physicians full-time for preventive medicine, 20 sanitarians and 
assistant sanitarians full-time, and 14 physicians part-time; a Prefec- 
tural Health Insurance Bureau with a chief, one technical assistant 
and 2 part-time physicians; 6 prefectural hospitals and clinics. In 
addition, cities within Kanagawa Prefecture had organizations as 
follows: Yokohama, population 968,091, a city sa’nitary bureau with 
a director and 17 full-time and part-time staff members, 5 city hospi- 
tals and clinics; Yokozuka, population 193,358, 3 city hospitals and 
clinics; Kawasaki, population 300,777, a city sanitary bureau with a 
staff of 4 sanitarians and 5 assistant sanitarians, 1 city hospital; 
Hiratsuka, population under 100,000, 1 city hospital. 
In 1937 a program was initiated which envisaged the establishment 
of “hygiene centers” (Hokenjo) throughout Japan on the basis of 1 
for each 120,000 inhabitants. It is not known how many of these are 
in operation; 50 were said to have been established in 1937 (Bull. 
Office d Hygiene Internationals). 
76 APPENDIX B 
Organization of Health Services in Other Parts of the 
Japanese Empire 
The organizational structure of the health departments of Formosa, 
Korea, Karafuto, and the Kuriles is similar to that of Japan Proper. 
All are ultimately responsible in matters of general policy to the 
Ministry of Health and Welfare of Japan. 
Formosa 
Formosa is an island the form of an elongated oval with a 
NNE-SSW axis approximately 225 miles in length. The breadth 
varies from 60 to 80 miles, and the total land area is 13,429 square 
miles. A lofty mountain axis occupies the central and eastern part 
of the island, the water shed being near the east coast. There is 
a western plain about 20 miles in width. The island is bisected by 
the Tropic of Cancer and has a distinctly tropical climate. The rain- 
fall is high and well distributed throughout the year, although the 
southern parts become relatively dry in winter. 
The population of Formosa is estimated to be 5,747,000, of which 
about 150,000 are aborigines of Malay extraction, between 250,000 and 
500,000 Japanese, and the remainder Chinese. There are 8 prefec- 
tures including the Pescadores islands which lie between Formosa 
and the mainland of China. The largest city is Taihoku, situated 
near the northern tip, with a pre-war population of about 340,000. 
Other principal cities and towns with their estimated population are 
as follows: Tainan, 131,000; Takao, 118,000; Keeking, 100,000; Kagi, 
90,000; Taichu, 81,600; Mako, 69,000; Shinchikin, 60,000; Shoka, 
58,500; Keito, 54,000. 
Formosa has been under Japanese rule since 1895. It is governed by 
a governor-general who is under the Department of Overseas Affairs 
of Japan. For local administration, Formosa is divided into five 
prefectures (Schinichiku, Taichu, Tainan, Taihoku, and Takao) and 
three districts. The districts are located in the less well-developed 
regions of the east and the Pescadores Island. 
The health services of Formosa are supervised by a central board, 
the Sanitary Bureau, which is administered through the police depart- 
ment. The Sanitary Bureau has supervision over sanitation, quaran- 
77 
618146—44 6 tine, infectious disease control, and to a considerable degree over 
medical care, in that hospitals generally are government controlled. 
The staff of the central board and prefectural departments is re- 
ported to include physicians, sanitary engineers, nurses, and labora- 
tory personnel, but no recent organizational chart is available. 
Medical facilities include 235 hospitals of which 15 are govern- 
ment-operated, 18 public and 202 private. Not more than 20 hospitals 
exceed a bed-capacity of 80 and the majority are small units of 10- 
to 50-bed capacity. In 1938 the total bed-capacity was about 4,000, 
exclusive of 4 military hospitals with a total capacity of 2,000. There 
were about 2,000 physicians or approximately 3.4 per 1,000 popula- 
tion ; 407 dentists; 213 pharmacists; 170 nurses; and 1,800 midwives. 
Among the principal causes of death were malaria (7.3 per 10,000), 
tuberculosis (13.7), and pneumonia (42.4). (See TB MED 30, Medi- 
cal and Sanitary Data on Formosa). 
Korea 
Korea is a peninsula of Asia extending southward from Manchu- 
kuo. Its length is approximately 600 miles; its width is approxi- 
mately 135 miles at the base; its area is 86,000 square miles. 
The population (1930) was 21,058,305 including approximately 
633,000 Japanese and 68,000 Chinese. It is primarily an agricultural 
country; some mineral resources have recently been developed. 
The capital of Korea is Keijo (Seoul), an inland city with a pop- 
ulation of 737,214. The port city is Chemulpho, population 108,744. 
Other large cities are Phyongyong (Heijo), population 234,728; Fusan, 
213,744; and Taikyu, 172,040. The population is largely concentrated 
in the southern portion of the peninsula. The climate is dry and 
bracing. The mean summer temperature of Keijo is about 75° F., that 
of winter 33° F.; the average yearly rainfall is 36.3 inches and of the 
rainy season, 21.8 inches. The rains come in July and August on 
the west and northeast coasts and from April to July on the south 
coast. 
Korea has been under Japanese rule since 1910 and efforts have 
been made to create a true Japanese state. The money, postage 
stamps, newspapers, institutions, and administration are modeled 
along Japanese lines. Most of the important administration and 
professional posts in the Korean administration are filled by Japanese. 
Public health is under the direction of the Sanitary Section of the 
Police Bureau of the Government General. Plans are made in the 
Government General’s office and channeled down through provincial 
and country officials to the local police. A civilian health officer 
and 2 assistants, usually, are assigned to each of the 13 provinces. 
One or more physicians and a number of nurses are stationed at each 
78 provincial hospital, and such work as is not handled by the local 
police and police physicians is carried on by this provincial health 
staff. The officially defined duties of the provincial health staff, 
working with the police, include arrangements for clinical tours by 
provincial hospital physicians, quarantine inspection at all ports, in- 
spection of water, food, and drugs, control of epidemic and endemic 
diseases, and measures dealing with the control of opium, leprosy, 
and veterinary problems. In practice, though regular tours by the 
full-time provincial physicians are carried out at intervals through 
the year, the greatest contact with the bulk of population is made by 
so-called “police physicians.” These physicians receive about 100 yen 
per month for part-time official services, and are allowed to carry on 
private practice at the same time; usually police doctors are found 
only in county seats. Practically all doctors engaged in public health 
work are Japanese. 
The Japanese have done much to control epidemics by establish- 
ment of various laboratories for examinations of water, food, and 
drugs; by establishment of strict quarantine regulations; by enforce- 
ment of vaccinations against smallpox, typhoid, and cholers; by at- 
tempts to isolate lepers; by giving health courses in schools; and by 
overseeing thorough semiannual housecleaning of homes, stores, 
schools. The program has not yet reached the desired goal. Tuber- 
culosis, venereal diseases, intestinal diseases, and leprosy are wide- 
spread. The chief faults have been that all programs are Japanese 
directed, enforced, and centered. The Koreans have small part in ad- 
ministration of the program, and little has been done to improve gen- 
eral health of native Koreans. One observer has stated that if the 
Japanese were removed, the entire public health structure would 
collapse. 
Fresh water is plentiful in Korea. The rural communities and 
smaller towns use water from springs, wells, creeks, and rivers, and 
since night soil is used for fertilizer, most water is contaminated. 
Recent Japanese reports indicate 74 Korean towns now have modern 
water plants. Official statistics for 1938 pertaining to the 10 leading 
cities indicate, however, that modern water facilities supply only be- 
tween 21 and 61 percent of the population of the 10 communities. All 
water, regardless of its source, must be considered unsafe and should 
be consumed or used for bathing only after proper treatment or after 
repeated bacteriological tests by Army personnel have approved its 
safety. 
The night soil from most homes in Korea is collected from pails and 
poorly protected privies, stored in crude, leaky cisterns, from which it 
is removed from time to time to be used as fertilizer. The waterborne 
sewerage systems of Keijo, Fusan, Heijo, and Jinsen serve only small 
portions of the population of these cities. The same is reported to be 
79 true in the other cities which have waterborne sewerage systems. 
Often, in houses connected with the sewers, the night soil is not dis- 
charged into the sewers, but rather is collected separately and taken 
to rural areas for fertilizer. There are only a few private septic tanks. 
A program has been instituted whereby night soil from inns and public 
hostels is gathered each day, and material from the private homes in 
the cities is collected once every 10 days. Such a system of night soil 
disposal results in widespread soil pollution and in increased prev- 
alence of disease-carrying insects. 
Medical personnel include 3,250 physicians of which approximately 
half are Japanese, half Korean. There are 2,200 nurses, 950 dentists. 
550 pharmacists, and 1,935 midwives. There are approximately 149 
hospitals with a total capacity of 6,500 beds; of these, 16 maintain 100 
to 200 beds and only 3 have more than 200 beds. 
Kuriles 
The Kuriles are a chain of small volcanic islands stretching in a 
northeasterly direction from Hokkaido. Their area is 6,159 square 
miles; their total number is 32; present population about 17,000. The 
principal island is Etorofu and its chief port is Shana in Rubetsu Bay. 
The climate corresponds to that of northern Japan proper and the 
average annual temperature is 38° F. This island is divided into 4 
provinces for administrative purposes. The islands are believed to 
have belonged to Japan at a remote date but at the beginning of the 
18th century the Russians, having conquered Kamchatka, found their 
way to the northern port of the Kuriles and gradually pushed farther 
south. In 1875, the Russians relinquished their claim to all parts of 
the Kuriles. 
The Health Department organization is under the jurisdiction of 
the Hokkaido prefecture. The Kuriles lie within the jurisdiction of 
the Nemuro branch which has its central office in the town of Nemuro. 
Organized local governments are found only in the 3 southernmost 
islands. Public health is directed by the mayor who in turn is under 
the jurisdiction of the prefectural governor. There is 1 hospital at 
Rubetsu on Etorofu but no information is available as to its bed-ca- 
pacity. In 1933 there were 10 doctors in the islands but there were no 
laboratories or nurses. (See TB MED 24, Medical and Sanitary Data 
on the Kurile Islands.) 
80 APPENDIX C 
NUTRITION TABLES 
Symptoms of deficiency 
Calories 
Protein 
Vitamin A 
Thiamin 
Niacin 
Riboflavin 
Ascorbic acid 
Vitamin D 
Calcium 
Iron 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X* 
X 
X 
X 
X 
Table 1. Symptoms of Nutritional Deficiencies 
♦Children, 
81 Table 2. Physical Signs of Nutritional Deficiencies 
System 
Physical finding 
Calories 
Protein 
Vitamin A 
Thiamin 
Niacin 
Riboflavin 
Ascorbic acid 
Vitamin D 
Calcium 
Iron 
General 
Under weight-loss of sub- 
cutaneous fat. 
Atony : 
X 
X 
Skin 
Eyes . . 
Dermatitis — pellagrous, 
slight or severe, acute or 
chronic. 
Seborrheic dermatitis about 
nasolabial folds, etc. 
Perifollicular hyperkeratotic 
dermatosis. 
Aeneform dermatosis 
X 
X 
X 
X 
Purpura and petechiae 
X 
Pallor 
X 
Head sweating. _ _ 
X 
Praexerosis and xerosis 
X 
X 
Mouth and mucus 
membranes. 
Nerves: Muscular 
and extremities. 
Dryness of conjunctiva 
Lacrimation 
X 
X 
X 
Conjunctivitis 
X 
Corneal vascularization . 
Night blindness . . .. 
X 
X 
Photophobia 
X 
Cheilosis 
X 
X 
Fissures at angles of mouth 
Glossitis, acute or chronic, 
with or without papillary 
atrophy. 
Stomatitis. 
X 
X 
Gingivitis, acute or chronic . 
X 
Dental caries and malforma- 
tion. 
Proctitis 
X 
X 
X 
X 
X 
Vaginitis 
Weakness, especially distal 
extremities. 
Muscle tenderness 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
Paresthesia _. 
X 
Altered reflexes. 
Lost vibratory sense 
Hypesthesia. 
Anaesthesia... _. 
Bilateral polyneuropathy .. 
Psychosis 
X 
X 
Minor mental changes 
Edema, especially extremi- 
ties. 
X 
X 
X APPENDIX D 
MEDICAL SUPPLY 
(Forms Used in Italian Theater—for Illustration Purposes Only) 
EXECUTIVE MEMORANDUM NUMBER 34 
Instructions for Handling Medical Supplies 
I. The following instructions have been drawn up in order to stand- 
ardize the methods of receiving, storing, distributing, and account- 
ing for the medical supplies being brought into Italy. * * * The 
Regional Commissioner will be responsible for carrying out these 
instructions, and whatever duties or responsibilities are indicated 
as the responsibilities of the Regional Public Health Officer, it is 
assumed that these duties and responsibilities will be delegated to 
him by the Regional Commissioner. 
II. General. 
A. A Central Medical Depot (ACC) for Medical Supplies has been 
set up in the vicinity of Naples under the control of the Supply 
Section of the Public Health Sub-Commission. Supplies * * * 
will be received at this depot, stored, and distributed to the Regional 
Warehouses on requisition (indent). Occasional shipments may be 
received at ports other than Naples, in which case, they will be 
deal with as explained in Paragraph III, A.7. 
B. Regional Warehouses will be set up under the direction of the 
Regional Public Health Officer. These warehouses will receive sup- 
plies from Central Depot, store and sell them to the Medici Provin- 
ciali. All supplies will cease to be the property of Allied Military 
Government/Allied Control Commission (AMG/ACC) when they are 
shipped from the Regional Warehouse to the Italian agency to which 
they are sold. 
C. All supplies purchased by a Province will be taken into a pro- 
vincial storehouse and will be distributed throughout the Province 
under the direction of the Medico Provinciale with the approval of 
the Regional Public Health Officer. One system which has been 
found to work very well and is recommended for use in every Prov- 
ince is for the Medico Provinciale to hire such personnel as may 
be needed to operate his own wholesale establishment; operating it 
on Provincial funds without profit. 
83 D. In communes located in forward areas * * * local govern- 
mental official or unit is functioning, medical supply officers may 
make free issues of limited quantities of medical supplies in emer- 
gency cases (sufficient only to meet the needs of the immediate occa- 
sion) , provided a certificate citing the emergency is made on the related 
issue vouchers. 
III. Responsibilities. 
A. Regional Public Health Officer (R. P. H. O.). 
1. Set up, staff, equipment, and operate at least one Medical Supply 
Warehouse for the Region. 
2. Maintain accounts and submit reports as specified in the account- 
ing section of these instructions. 
3. Submit long term requirements for the Region to the Public 
Health Sub-Commission every 6 months * * * Public Health 
Sub-Commission will submit information of combined requirements 
to Industry and Commerce Sub-Commission 15 days prior to deadline 
date for each period. 
4. Submit to the Public Health Sub-Commission by the 10th of each 
month, requests for the delivery of supplies to cover the following 
month. * * * All regions will submit emergency requisitions 
(indents) when ever necessary. 
5. Sell such supplies as are requested by a Province to the Province. 
In this respect, sales will be made “Ex Regional Warehouse.” The 
R. P. H. O. will not be responsible for delivering the supplies to the 
Provinces (see III B. (3)). 
6. Control prices both to the hospitals and pharmacies, and to the 
ultimate consumera. Prices of imported American supplies and sup- 
plies obtained from the United States Army will be charged to the 
first Italian agency as per the Schedule in Appendix “A.” The prices 
of Italian supplies still in the hands or under the control of the Regions 
or Provinces will be established by the R. C. P. O. of the various 
Regions. The sale of these drugs should be encouraged by setting 
a fair price on them. The Pharmacist should be allowed approxi- 
mately a 33 percent profit on the selling price (50 percent on cost) on 
patent medicines, package drugs, dressings, etc., and 50 per cent profit 
on selling price (100 percent on ingredient cost) on items which must 
compound for prescriptions. 
7. Receive, tally-in, store, and notify this Headquarters of the con- 
tents of any direct shipments of supplies which may be shipped to a 
port in the Region directly from * * *. 
8. Assist reputable manufacturers of essential drugs and biologicals 
to resume production, reporting to the Public Health Sub-Commission 
the productive capacity available by each item manufactured. This 
84 Headquarters will render such assistance as possible in the rehabilita- 
tion of reputable firms. 
9. Authorize the warehouse under his control to prepare any addi- 
tional copies of reports and documents which may be needed for ad- 
ministrative purposes. 
B. Medico Provincial. 
1. Submit to the Regional Warehouse requests for such supplies for 
his Province as are authorized and necessary at such intervals and 
times as the R. P. H. O. may determine. 
2, Have deposited with the local Sub-Accountant or into the proper 
bank to the credit of Allied Finance Agency’s (AFAs) account funds 
for the purchase of the supplies. The correct AFA bank account 
number will be designated by AFA for each Region. 
3, Pick up or arrange for the delivery of supplies from the Regional 
Warehouse to the Province. His responsibility for the supplies will 
start when they leave the Regional Warehouse. 
4. Distribute supplies throughout the Province by his own method 
of distribution, but with the approval of R. P. H. O. Regardless of 
the system of distribution which may be used, the following priorities 
will apply: (1) Hospitals and clinics, (2) doctors and midwives, 
(3) pharmacies and other retail channels. 
IV. Accounting. 
A. Sources and types of supplies. There are several probable 
sources of medical supplies. Supplies from each source must be segre- 
gated, both physically in the warehouse and on all accounting records 
and documents. The following accounting code letters, placed after 
the U. S. A. item number, will be used on all records and documents to 
identify the supplies by types and sources: 
Type of source Code letter 
1. U. S. A. Imports * 
2 * * * * 
3. U. S. A. Army * 
* * * * 
5. Captured or confiscated Italian Supplies * 
6. Captured or confiscated German Supplies * 
7. Purchased Supplies (Specify Source) * 
8. Miscellaneous (Other Allied Nations). Specify 
Examples of the use of the above accounting codes are as follows: 
10110-A Acid, Boric, USP (U. S. A. Imports) 
10110-B Acid, Boric, USP (U. K. Imports) 
10110-X Acid, Boric, USP (U. S. A. Army) 
B. Basis of accounting. The cost or value of Medical Supplies re- 
ceived will not appear on accounting records and documents kept or 
prepared at the Medical Supply Warehouse for supplies imported, 
confiscated, or obtained from the Armies of the U. S. A. * * * 
85 Cost will be reflected for supplies acquired by direct commercial pur- 
chase from Italian or other sources. The prices at which supplies are 
sold will be reflected on pertinent documents and records prepared or 
kept at the issuing warehouse. 
C. Requisitioning {indents). Requisitions (indents) for supplies 
will be forwarded from the Regional Warehouses to the Public Health 
Sub-Commission Supply Section by the 10th of the month for the 
following month. Requisitions (indent) will be Submitted from 
the Provinces to such places and at such intervals and times 
as the R. P. H. O. may stipulate. These requisitions (indents) 
will be prepared in triplicate on ordinary stationery and will give 
the following information: (1) where and how the supplies are 
to be shipped, (2) the basis for the requisition (indent) that is 
the population of the Region or Province or an adequate reason for 
requisitioning more than the allowance as set forth in the C. A. D. 
Basis Cost and Allowance Schedule, (3) the item number, (4) nomen- 
clature, (5) unit, (6) quantity of the item required. The original 
and one copy will be forwarded to the Public Health Sub-Com- 
mission Supply Section, in the case of the Regions; to the Regional 
Warehouse, in the case of the Provinces. The triplicate will be re- 
tained by the originating agency. Regions which receive supplies 
direct from the U. S. A. will submit only emergency requisitions. 
D. Sales. Sales, based on an approved requisition, will be pre- 
pared on “Issue Voucher” F/F 18 in triplicate. (See Appendix 
“B”.) The form will show the item number, nomenclature, unit, 
quantity, unit and total sales price for each item, the instructions 
concerning how and where payment is to be made. In order to 
facilitate the preparation of monthly reports (see pars. I and J below) 
separate Issue Vouchers will be prepared for sales from each source 
of supply in cases where a single requisition (indent) is filled from 
more than one source of supply. The amount involved in the sales 
will be covered by full payment into a bank for AFA, with a notation 
that the collection is on account of Public Health Division. Copies 
of the bank deposit slips will be obtained and attached to the monthly 
report of sales. To facilitate identification of specific items, each 
Issue Voucher will be paid for separately, and an individual deposit 
thereof made in the bank. In forward areas this procedure may 
not be possible, in which case, payment will be noted on the duplicate 
and triplicate of the Issue Voucher. The purchaser or his repre- 
sentative must present a signed copy of a bank deposit slip, sign the 
receipt certificate, and the Warehouse Officer must sign the issue cer- 
tificate on the duplicate, and triplicate copies. The duplicate will 
be retained at the warehouse as a medium for posting to the Store 
Ledger. The triplicates will be accumulated until the end of the 
86 month: and then forwarded in accordance with instructions in para- 
graph I below. 
Issue vouchers F/F 18 for any free issues of supplies in emergency 
cases (as provided in par. IID) shall contain the following certificate 
over the signature of the issuing officer: “Emergency free issue—No 
organized local governmental unit in vicinity.” 
E. Transfers. Transfers of supplies between warehouses will be 
prepared on “Transfer Voucher” F/F 17 in triplicate. (See Ap- 
pendix “C”.) This form will show the number of boxes shipped and 
the same information that is on the “Issue Voucher,” except that the 
prices will not be shown, and the certificate of receipt need not be 
signed by the receiving officer. The distribution of the copies will be 
the same as the distribution of the “Issue Voucher.” 
F. Receiving reports. When Medical Supplies are received at the 
warehouse, either directly or by transfer, they will be tallied-in and 
entered on the “Receiving Report” F/F 13 in triplicate. (See Ap- 
pendix “D”.) This form will show (1) the source of the supplies, 
(2) the markings on the cases (this applies only to supplies when they 
first come into the country), (3) the quantities received, (4) comments 
as to the nature and apparent cause of any damage or shortages. It 
is unnecessary to fill in the quantities called for on the delivery note, 
B/L, or equivalent document. The total number of pieces received 
will be reported at the top of the page. The form will be signed by 
the Receiving Officer. The original will be retained at the warehouse 
as a medium for posting to the Store Ledger. The duplicates will be 
accumulated until the end of the month, and then forwarded in ac- 
cordance with instructions in Paragraph I below. The triplicate will 
be used to support claims for shortages or damage. 
G. Store Ledger. A Store Ledger will be maintained at each ware- 
house on “Store* Ledger” F/F 15. (See Appendix “E”.) Quantities 
only will be recorded in this ledger, A separate page will be kept 
for each item by source of supply as prescribed in Paragraph IV A. 
On this record will be entered the date, from whom and to whom 
receipts or issues were made, the quantity issued or received, the 
voucher number, and the balance. When a physical inventory is 
taken, a notation will be made on the next vacant line to the Store 
Ledger showing the date, the remark “As per physical inventory,” 
and the physical quantity. Adjusting entries for inventory differences 
should be made as outlined in Paragraph IV H before the physical 
figure is entered. 
H. Inventories: overages and shortages. A physical inventory of 
each item will be taken at each warehouse at least once a month. If 
the physical inventory discloses differences, the overages will be 
written up on a “Receiving Report” in duplicate, and the shortages on 
87 an “Issue Voucher” in triplicate. The facts pertaining to the case 
will be noted on the documents, which will be signed by the Warehouse 
Officer. The original and duplicate of the “Receiving Report” will 
be disposed of in the customary manner. The copies of the “Issue 
Vouchers” showing shortages will be distributed as follows; (1) the 
original will bp retained at the warehouse except where there is a 
shortage of any item in excess of Lire 10,000 in which case it will be 
forwarded to the R. P. H. O. for review and decision, (2) the duplicate 
will be retained at the warehouse as a medium for posting to the Store 
Ledger (shortages in excess of Lire 10,000 will be entered in pencil 
only until they are approved by the R. P. H. O.), (3) the triplicate 
will be disposed of in the customary manner. If it is decided by either 
the R. P. H. O. or the Warehouse Officer, as may be appropriate, that 
any particular individual or individuals are responsible for the short- 
ages or damages, payment for such shortages or damages will be 
collected and will be deposited to the correct AFA bank. 
I. Monthly stock reports. At the end of each month summary 
reports up the transaction on each item, by source of supply, will be 
submitted to the Public Health Sub-Commission through the R. P. 
H. O. A separate report in the form of Appendix “F” will be pre- 
pared from the Store Ledger for each source of supply. These re- 
ports will be accompanied by the duplicate of the “Receiving Reports” 
and the triplicates of the “Issue Voucher.” The reports and support- 
ing ducuments will be dispatched by the warehouse to reach the 
R. P. H. O. by the 8th of the month, and will be forwarded by him 
to reach the Public Health Sub-Commission by the 15th of the month. 
J. Monthly Report of Sales. At the end of each month, reports 
of sales will be prepared from “Issue Vouchers” in the form shown in 
Appendix “G”; the report will consist of a list of issue vouchers with 
copies of the bank payment slips referred to in Paragraph IV D, A 
separate report will be prepared for sales made from stocks of each 
source of supply. Individual issue vouchers will be listed; but spe- 
cific items thereunder will not be listed. These reports will be sent to 
the Regional Chief Accountant by the 8th of the month, who will 
verify that the proceeds of all sales have been credited to the appro- 
priate AFA bank account. Also at the end of each month a report 
of free issues will be prepared similar to the form shown in Appendix 
“G”, consisting of a list of the related issue vouchers showing the 
medical supply and quantity. 
Command of 
Executive Commissioner. 
88 Appendixes herein referred to will be supplied in sufficient copies on 
request of officers concerned. 
Appendix A—CAD Basic Cost and Allowance Schedule. 
B—F/F 18 Issue Voucher. 
C—F/F 17 Transfer Voucher, 
D—F/F 13 Receiving Report. 
E—F/F 15 Store Ledger. 
F—Monthly Stock Report. 
G—Monthly Report of Sales. 
Note.—Portions deleted and indicated by * * * refer to local organiza- 
tion in the Italian theater. 
89 ALLIED MILITARY GOVERNMENT OF OCCUPIED TERRITORY 
Division 
Issue Voucher 
No. 
SOLD/ISSUED TO: 
Description of articles 
Unit 
Quan- 
tity 
Price 
Amount 
Issuing Warehouse: 
Payable at: 
Sale/Issue approved by: 
(Signature and rank) 
Date , 194 
(1) I certify that the articles described above were received by me on the 
day of . , 194 
(2) I certify that the articles described above were issued by me to the person (s) 
entitled to receive them on the 
. day of 
, 
194 , 
and that evidence of payment of the above total 
amount of . 
. was 
produced to me in the form of Bank Deposit Receipt No. 
(Receipt voucher) 
issued 
by .. under date of 
, 194 
(Signature and rank of issuing officer) 
Head: 
Sub-Head: __ 
Store-Ledger Folio: 
Tally Card No.: 
90 AMG 
. _ Division 
Transfer Voucher 
No 
Transferred from: . - - ------ - _ - - 
Transferred to; - - ------ - -- _ __ 
Articles transferred 
Unit 
Quantity 
Selling price 
Rate 
Amount 
(1) Above transfer approved. 
. Date; 194 
(Signature and rank) 
(2) 1 certify that the above articles were issued to the person (s) entitled to 
receive them on the day of ____ __ 194 
(Signature and rank of issuing officer) 
Tally Card No: . . Store Ledger Folio (issue); 
(3) I certify that the above articles were received by me on the day 
of 194 
(Signature and rank of receiving officer) 
Tally Card No; Store Ledger Folio (receipt): 
91 AMG 
Date 
Shipment No. 
Received from 
Civilian Supplies Division 
RECEIVING REPORT 
Report No. 
Convoy No. 
Description, grade, etc. 
Number 
of bags, 
boxes, etc. 
Unit 
Quantity 
per B/L or 
delivery 
note 
Quantity 
actually 
received 
REMARKS (nature and cause of damage, etc., 
if any): 
ARE GOODS OF STATED QUALITY (if not, state reasons"on reverse) 
MARKINGS ON CASES, ETC 
SIGNATURES: 
(Officer of supplying service) (Receiving officer of CSD) 
BIN CARD NO STORE LEDGER 
?i“N° Folio 
Article Unit _ _ 
Date 
From whom received or to whom 
issued 
Voucher 
number 
Receipts 
Issues 
Bal- 
ance 
93 MONTHLY STOCK REPORT 
Item numbers 
*53 
o 
Nomenclature 
<r+- 
cr 
CD 
0 
0 
p 
P- 
cd 
P 
& 
P* 
aq 
1 
i 
i 
i 
• 
• 
• 
i 
i 
i 
i 
i 
Unit 
i 
i 
Beginning stock 
i 
i 
Imports 
CO 
O 
Transfers 
cs 
3 
from other 
W 
O 
SB 
warehouses 
8 
CD 
CD 
Others (spec- 
S' 
O 
P4 
ifl cation 
w 
CO 
£ 
Overages in 
£ 
CD 
warehouses 
Sales for cash 
1 
1 
Transfer to 
1 
other ware- 
1 
houses 
w 
Others (spec- 
C 
CD 
1 
iflcation) 
1 
Shortages in 
1 
1 
warehouses 
1 
1 
Ending stock 
1 
1 
94 MONTHLY REPORT OF SALES 
----- - Warehouse 
For the month ending _ . Source of Supply .- - - 
Issue 
voucher 
number 
Date 
Name of purchasers 
Amount 
Date 
paid 
Place of 
payment 
95 APPENDIX E 
BIBLIOGRAPHY 
1. TB MED 6 Data from the Field of Malaria Control 
2. TB MED 11 Influenza 
3. TB MED 23 Food and Nutrition 
4. TB MED 24 Medical and Sanitary Data on the Kurile Islands 
5. TB MED 25 Classification of Foods and Factors for Conver- 
sion of Unit Packages to Pounds for Use in Dietary Analysis 
of Kations 
6. TB MED 30 Medical and Sanitary Data on Formosa 
7. TB MED 31 Scrub Typhus Fever (Tsutsugamushi Fever) 
8. TB MED 42 Data from the Field on Malaria Control 
9. TB MED 45 Notes on Certain Infectious Diseases 
10. TB MED 47 Control of Disease of Respiratory System and 
other Diseases Transmitted by Discharge From Kespiratory 
Tract 
11. TB MED 53 Emergency Feeding of Infants, Children and 
other Special Groups of Civil Populations. 
12. TB MED 65 Drug Suppressive Treatment of Malaria 
13. TB MED 72 Treatment of Clinical Malaria and Malarial Para- 
sitemia 
14. SGO Cir. Ltr. 33 Treatment and Control of Certain Tropical 
Diseases 
15. SGO Cir. Ltr. 180 Leprosy 
16. FM 21-10 
17. The Control of Communicable Diseases. Report of a Committee 
of the American Public Health Association, Reprint 1697 from 
the Public Health Reports (Revised 1940) 
18. Civilian Supplies in Occupied Territories—Medical Supplies 
Army Service Forces 
19. Bigwood, E. J.: Guiding Principles for Studies of the Nutrition 
of Populations, League of Nations, Health Organization, Tech- 
nical Commission on Nutrition, 1939, Geneva. 
20. Engineering Manual OCE 
21. TB Eng. 1, 28 December 1943 
96