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Contents

Part V

THE PACIFIC


CHAPTER XV

Australia and New Zealand

Lieutenant Colonel Eugene T. Lyons, MSC

Section I. Australia

INTRODUCTION

The first U.S. troops to arrive in Australia landed in Brisbane on 22 December 1941 from ships of the Pensacola convoy, which had been en route from Hawaii to the Philippines when Pearl Harbor was attacked on 7 December 1941. Aboard the ships of the convoy were 4,600 troops, airplanes, ammunition, and other materiel dispatched to strengthen Gen. Douglas MacArthur's force. Following the Japanese attack, the Joint Army and Navy Board first voted to order the convoy's return to Hawaii to prevent possible loss of its now doubly valuable cargo. Fearing the implications of this seeming abandonment of the Philippines, President Franklin D. Roosevelt, however, ordered the board to reconsider its recommendation, and the convoy was subsequently diverted to Australia. It was hoped that the reinforcements and supplies could safely be sent north from there.1

Upon debarkation, the troops were billeted in existing camps of the Australian Army. These contained all facilities necessary including five fully equipped dispensaries. Arrangements had also been made to hospitalize U.S. troops in Australian military and civilian hospitals.2

Until 7 December 1941, Australia had been considered only as a possible point on an air ferry route to the Philippines. Consequently, no carefully considered and fully coordinated plans had been made to use an Australian base and it was necessary for a plan to be hastily improvised. This envisaged the establishment of a supply base in Australia and the operation of a line of communications northward to the Philippines, along which supplies and reinforcements could be sent, beginning with those carried aboard the Pensacola convoy. Personnel from the convoy were to man this line of communication. Maj. Gen. (later Lt. Gen.) George H. Brett was named to undertake this task. His command, USAFIA (U.S. Army Forces in Australia), was organized on 22 December 1941, at Lennon's Hotel, Brisbane, the same date the convoy arrived at that port.3

1Morton, Louis: United States Army in World War II. The War in the Pacific: The Fall of the Philippines. Washington: U.S. Government Printing Office, 1953, p. 146.
2Medical Diary, 10 December 1941-30 June 1942, of Col. P. J. Carroll, MC, Chief Surgeon, Headquarters, U.S. Army Service of Supply, SWPA, p. 3.
3Barnes, Brig. Gen. Julian F., Report of Organization and Activities of United States Forces in Australia, Dec. 7, 1941-June 30, 1942, dated 6 Nov. 1942.


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Many agreements were necessary to establish and operate American medical activities in Australia and these were arrived at through negotiation with Australian civilian authorities. Since no Civil Affairs/Military Government Division existed in General MacArthur's headquarters to handle such negotiations until preparations were being made to retake the Philippines in 1944, each staff surgeon found himself conducting his own negotiations with his Australian civilian counterpart.

THE LAND AND THE PEOPLE

The Australians warmly welcomed American troops not only because they were traditionally hospitable but also because their country was relatively undefended except by some small naval and air forces. Since almost all of the Australian Army was fighting in North Africa, in the Middle East, and in Malaya, few troops were left to defend the continent. Hence, although the Americans viewed Australia, initially at least, as a base from which to support General MacArthur's troops in the Philippines, the Australians saw the Americans as the force to defend their continent from the Japanese invasion.4

Australia, which many American soldiers came to know during the next 4 years, is a land of extreme contrasts, not the least of which are the reversed seasons. Men who had left the States, with winter fast approaching, found the summer just beginning. The continent is roughly rectangular in shape; its population is concentrated along the eastern and southern coasts, leaving a rather barren and relatively undeveloped interior. The northern coast, facing towards the route of Japanese attack, is highly humid tropical jungle. Largest among the few settlements was Port Darwin. The eastern coast, facing the Americas across 7,000 miles of almost empty ocean, ranges from tropical in the north to temperate in the more heavily populated south. Sydney is situated on this coast, as are Brisbane, Townsville, and Cairns. Melbourne and Adelaide are southwest of Sydney, but on the southern coast.

Transportation over great distances was quite difficult because of the lack of roads in the interior and because the railroad system, generally confined to the coastal area from Cairns in the north to Perth in the Southwest, has five changes in gage of track over that distance. Additionally, Darwin, only a small undeveloped port at the war's beginning but the closest port to the Japanese line of advance, had no railroad connection with the populous and highly industrialized southeast. The extreme danger of Japanese air attack, combined with the general shortage of port facilities in the north, necessitated that American bases be widely scattered along the coast from Darwin to Adelaide, a distance of approximately 6,000 miles by water. This dispersion had the practical result of confronting the U.S. Army Medical Department with the complete spectrum of diseases endemic to Aus-

4Brereton, Lewis H.: The Brereton Diaries. The War in the Air, in the Pacific, Middle East, and Europe; 3 October 1941-8 May 1945. New York: William Morrow and Co., 1946, p. 81.


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tralia. For civil affairs, it multiplied the number of civilian communities and governments to be dealt with.

From the public health standpoint, Australian morbidity rates compared favorably with those of the United States in most respects. Diseases considered of special importance included malaria, typhoid, amebic dysentery, hookworm, scrub typhus, endemic typhus fever, Q fever, dengue fever, diphtheria, filariasis, yaws, leptospirosis, and undulant fever.5

Sanitary practices, except in the largest cities, were comparable to those found in rural areas of the southwestern United States at that time. For the most part, public health measures were behind the modern trend, only a few cities and towns having sewage disposal plants or water treatment facilities. There were not many septic tanks in the small towns. The pan system of night soil collection was most frequently used, with subsequent disposal either in the sea or in trenches. As in the United States, pit latrines were used in most rural areas. In those regions occupied by aborigines, it was common to find the ground widely contaminated by human excrement.

The Commonwealth of Australia is composed of six states and two territories. Paralleling the structure of the Commonwealth Government, each state has an executive, a parliament, and a judiciary. Relationship of the state to the federal government is quite similar to that in the United States; the Commonwealth holds jurisdiction over interstate and international affairs, and all residual powers not delegated to the states. In public health, the Commonwealth usually confined its activities to national organizations such as the Quarantine Service, while the active, protective, investigative, and educational aspects of health work are carried on by the individual state health departments. The significance of this is that the laws concerning control of various diseases differ in each state, sometimes to a considerable extent.

Political subdivisions below the state government are cities, towns, and boroughs. The borough or shire, as it is sometimes called, is quite similar in function and form of government to the American county. All three of these political subdivisions are governed by elected councils.

This, then, was Australia as the first American soldiers found it in late 1941.

U.S. ARMY COMMAND STRUCTURE

On 5 January 1942, General Brett assumed command of the U.S. Army Forces in Australia and immediately activated a number of base sections, each assigned the responsibility of overseeing U.S. Army activities within a specified area of Australia. By mid-April, seven base sections covered all the continent and an ADSEC (advance section) in New Guinea.6

5(1) Army Medical Bulletin No. 63, July 1942, Medical and Sanitary Data on Australia, pp. 28-32. (2) For further details concerning these diseases, see volumes on communicable diseases in this series.
6General Orders Nos. 1, of 5 Jan. 1942, and 38, of 15 Apr. 1942, Headquarters, USAFIA.


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This number changed several times and boundaries were realined; however, base section functions did not change nor did that of the overall command, even under the reorganizations which took place (map 16).7

Medical Organization

The initial medical staff for Headquarters, USAFIA, and for each of the base sections was selected from among the nine medical officers and four dental officers traveling as casuals in the Pensacola convoy. Additional personnel were assigned to the organic medical detachments of units with the convoy; however, most of these individuals remained with their units. Until the arrival of Col. (later Brig. Gen.) Percy J. Carroll, MC, from the Philippines and his designation as Surgeon, USAFIA, on 7 February 1942, a rapid succession of officers was assigned to this position. Among these were Lt. Col. (later Brig. Gen.) George W. Rice, MC, Maj. (later Lt. Col.) George S. Littell, MC, and Maj. Jesse T. Harper, MC.

For the first few weeks, medical personnel were concerned with establishing base section dispensaries, removing supplies carried aboard the ships of the convoy, setting up medical supply depots, and establishing contact with Australian medical authorities, both civilian and military. The immediate goals, of course, were to forward as quickly as possible the supplies now vitally needed by General MacAuthur and to prepare hospital beds for casualties imminently expected from the battle area.

More formality in coordinating and planning medical support for USAFIA was achieved on 15 January 1942, when the Chief of Staff and the Surgeon took part in a meeting of the Hospitals Subcommittee of the Australian Planning Committee. At this meeting, the Australians agreed to provide medical supplies for an estimated 25,000 American troops and to furnish hospitalization for them in Australian Army and civilian hospitals. These arrangements were expected to continue for about 3 or 4 months until hospitals and medical supplies could arrive from the United States.8 A Joint Hospitals Subcommittee was formed "* * * to examine requirements and existing resources in respect of both hospital and medical equipment in relation to the requirements of U.S.A. Forces now in Australia and prospective U.S. casualties from the theatre of war operations."9

Meanwhile, the establishment of the surgeons' offices in the various base sections continued. The "pick and shovel work" of all aspects of medicine was to be done by these base surgeons who, with a few enlisted assistants, had to open dispensaries, find medical supplies, accomplish medical surveys in areas which were equivalent in size to several western states combined, and establish contact with local hospitals and public health

7For a detailed discussion of the organizational changes in Australia, see Medical Department, U.S. Army. Organization and Administration in World War II. Washington: U.S. Government Printing Office, 1963, pp. 410-429.
8See footnote 2, p. 533.
9Memorandum, Headquarters, USAFIA, for Heads of General and Special Staff Sections, 20 Feb. 1942, subject: Planning for Australian-American Cooperation.


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MAP 16.-Routes of communications in Australia.

officials. Their establishments seemed to spring up overnight; problems bewildered Americans and Australians alike. In Base Section 4, for example, Maj. John R. Finkle, MC, accompanied the commander to the building chosen for base section headquarters, the "Mission to Seamen," in Melbourne, a large modern building with clubrooms, a chapel, and a parsonage. Major Finkle reported that several seamen who came in during the inspection were disappointed not to be permitted to play billiards on the still remaining tables. The medical section eventually used the parsonage for office and dispensary space, where, for several weeks, the parson remained in residence after the building was taken over, and his wife served tea in the Eng-


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lish manner to the delighted Americans who "found this not inconvenient." Major Finkle's mention of success in locating several microscopes, bottles of pills, a package of tongue depressors, and some office furniture only served to illustrate the overall supply problems.10

The primitive, sparsely populated area comprising Base Section 1 offered limited choice in surroundings or facilities. Headquarters, Base Section 1, was first located in Darwin, but after Japanese bombings began in February 1942, it moved out into the nearby bush and subsequently to Birdum, the southern terminus of the railroad from Darwin to the interior. Offices of the Base Section Surgeon, still in a tent in mid-1943, had, at one time, been on the open porch of the Birdum hotel.11

Medical activities to support the rapidly growing contingent of U.S. Army troops became more fully organized in April 1942, following the arrival of a group of medical, dental, and veterinary officers, sufficient in number to staff USAFIA and the various Base Section Headquarters.12

Coordination With Civil Authorities

Preventive medicine problems in Australia were concentrated in three general categories: (1) control of communicable diseases such as dengue and malaria, which were endemic in some areas; (2) improvement and maintenance of hygienic standards in water supply, waste disposal, and processing of foodstuffs; and (3) suppression of venereal disease. Medical staff officers soon discovered that little or no progress was to be made in any of these areas without the active cooperation of civil officials at all levels of government. They found that problems such as control of malaria was national in scope and that coordinated action was required at that level. VD (venereal disease) control and tuberculin testing of cattle were problems of the state and ultimately required coordination with each state and territorial government; others, such as water supply and human waste disposal, were within the jurisdiction of the local town council.

For various reasons, but chiefly for lack of direction from higher headquarters, civil affairs, particularly in the realm of preventive medicine, usually were undertaken at the base section and station level. The lack of direction was caused by the unorthodox command structure established in the SWPA theater which, for a time, left U.S. Army forces with no single commander below Allied GHQ headed by General MacArthur.13

Since no Preventive Medicine Division was directing effort at the theater level, coordination in preventive medicine planning was not achieved until March 1943, when General MacArthur established the Combined Advisory Committee on Tropical Medicine, Hygiene, and Sanitation, composed

10Letter, Headquarters Base Section No. 4, USASOS SWPA, to The Surgeon General, U.S. Army, 13 Jan. 1943, subject: Report for the History of Medical Activities, Base Section 4.
11Letter, Headquarters, Base Section 1, to The Surgeon General, U.S. Army, 5 Apr. 1943, subject: Report for History of Medical Activities, SWPA.
12See footnote 7, p. 536.
13See footnote 7, p. 536.


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of American and Australian specialists. The three American members were Colonels Howard F. Smith, USPHS, SWPA malariologist,14 Beacon C. Wilson, MC, and Maurice C. Pincoffs, MC, also committee secretary. This committee was given broad authority to develop plans, measures, and policies to be followed by Allied Forces. Their recommendations to General MacArthur usually were implemented in the form of a directive from his headquarters to the subordinate commanders. Through its Australian members, the committee coordinated preventive medicine matters with civil public health officials who were particularly watchful of the malaria menace from the military source and vigorously protested to Headquarters, SWPA, whenever a malarial soldier was allowed to enter potentially malarious districts. Largely through the efforts of this committee, steps were taken by all agencies towards control of malaria and other tropical diseases. This resulted in both civilian health protection and reduction of the military malaria rate to the point where it no longer endangered combat operations.15

The absence of early command guidance, the difficulty in communicating over long distances, the diversity of problems, and the urgency of the situation forced each surgeon to work out his own problems with civil authorities. To do this, he often joined forces with his Australian military counterpart whose command health hazards were usually identical to his own. Thus, committees, such as the Allied Services Health Council in Perth and the Cooperative Allied Sanitation Committee in Townsville, were formed to take measures necessary to protect the Allied serviceman from local health hazards. Each military service having troops in the area was represented on the committee by a medical officer and sometimes by a veterinary and a military police officer. They worked closely with civilian officials to improve restaurant sanitation, control prostitution, improve waste disposal, and develop approved food sources. Many projects required U.S. contributions in labor, materials, and funds, especially extensive drainage improvement to eliminate mosquito breeding places. In Cairns, for example, a project was undertaken jointly with Commonwealth, Queensland, Cairns, and Australian Army health officials to provide permanent drainage improvements designed to completely eliminate malaria in the vicinity (fig. 71). The U.S. Army Engineers agreed to cut drains through the town and to furnish equipment for other digging and drain construction.16

14Dr. Howard F. Smith was one of six U.S. Public Health Officers serving in the Philippine Islands when war began. He was appointed aide-de-camp to General MacArthur on 12 December 1941 and accompanied him to Australia in March 1942. He was subsequently named SWPA Malariologist, in which capacity he worked to lower the incidence of malaria among Allied troops in Australia, Borneo, and New Guinea. See William, Ralph Chester, M.D.: The United States Public Health Service, 1798-1950. Washington: Commissioned Officers Association of the United States Public Health Service, 1951, p. 712.
15Medical Department, U.S. Army. Preventive Medicine in World War II. Volume VI. Communicable Diseases: Malaria. Washington: U.S. Government Printing Office, 1963, pp. 536-542.
16(1) Letter, Brigadier N. H. Fairley, Allied Land Forces Headquarters, to Col. Howard Smith, 25 Feb. 1944, subject: Mosquitoes in Cairns. (2) Report, AMF Headquarters 17L of C Sub-area, 21 Sept. 1943, subject: Brief Notes of Conference Held on 16 Sept. 43 to Discuss Drainage Scheme. (3) Sanitary Report of Medical Inspector, USAFIA, on Cairns area, July 1942, subject: Malaria at Cairns and Proposed Methods of Control.


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FIGURE 71.-Military personnel conduct tests and spray for mosquitoes, Queensland, Australia, August 1942.

In most instances, local officials were willing to correct any conditions dangerous to health that were pointed out to them. Naturally, there were also instances of individuals' refusing to cooperate, such as the operator of a hotel in Mount Isa who refused to drain a large pool into which effluent from the hotel was discharging. The town authorities had tried for 2 years to force this hotel to comply with local sanitary laws. The fact that the husband of the hotel operator was a representative on the Cloncurry Shire Council perhaps had something to do with its lack of success. This filthy, fly breeding ground was not eliminated until waterborne sewage facilities for the entire town were completed.17

At other times, although the local authorities recognized the existence of health hazards, they had insufficient resources to make necessary improvements or they were reluctant to correct, at their own expense, a situation not considered dangerous during normal times when fewer people were living in the community. When confronted by these situations, medical officers had the choice of offering help within their resources, which was often done

17Informal Sanitary Report, Headquarters, Motor Transport Command No. 1, USASOS, SWPA, 31 Oct. 1942.


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and accepted, or they had to appeal to higher authority. These appeals usually were directed to the Base Section Surgeon or, less often, to the state DGMS (Director General of Health and Medical Services). The Base Section Surgeon worked closely with the state DGMS, who was his counterpart in the civilian government. Any problem that could not be solved by the military alone was taken up with the DGMS, and many agreements were made at this level for joint action to alleviate bad conditions.

The state DGMS had legal authority to order compliance of local communities with state sanitation laws. When compliance was not forthcoming, he was empowered to make necessary improvements and charge the cost to the local government. This drastic step was seldom required since these conditions were usually corrected upon the DGMS' recommendation. The role of the DGMS, however, was not just that of enforcement. His knowledge of local conditions and his professional advice were invaluable to both the civil populace and U.S. medical personnel. Further, he had funds and resources at his disposal to help the community pay for improvement projects and could gain additional support through the Commonwealth DGMS.

Sir Raphael Cilento, DGMS in Queensland, was particularly helpful to the U.S. forces in their relations with civilian communities in this state. His assistance and cooperation were important since Queensland, the state closest to the fighting, contained most of the American bases. The extent of his contribution can best be judged by his actions while on an inspection tour of North Queensland during the dengue fever epidemic in April 1942. On this tour, he visited Townsville, Rockhampton, and Charters Towers, all sites of American installations in the process of being established. In Townsville, he conferred with Lt. Col. (later Col.) Carl R. Mitchell, MC, surgeon of Base Section 2 and, then, commander of the 12th Station Hospital. He discussed medical and hygienic problems of North Queensland with Colonel Mitchell and later addressed the hospital staff.

Since Aedes aegypti was the primary vector of dengue in that country, Sir Raphael vigorously attacked the problem of mosquito destruction in each locality where the fever was epidemic. He toured the towns in company with local officials, pointing out mosquito breeding places, and instructed them in methods of eliminating such places by either drainage or oiling. He also directed health officers in the larger town to report dengue fever rates regularly. Reporting of dengue previously had not been required, but in recognition of its military importance, the Commonwealth had appropriated money for this purpose. Finding Rockhampton more heavily infested with mosquitoes than it had been in previous years, Sir Raphael called a meeting of the city council to intensify a program of extermination. He warned the council that failure to institute an effective program would result in his department's taking the work over directly and carrying it out at the expense of the city. He took this approach because a considerable body of nonimmune American troops was to arrive soon at Rockhampton.18

18Report, Sir Raphael Cilento, April 1942, subject: Visit to North Queensland.


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COMMUNICABLE DISEASES

Malaria

Malaria was the most significant communicable disease encountered by American forces in SWPA. Until effective control measures were taken, it threatened to make combat operations a practical impossibility. In January 1943, the malaria attack rate per 1,000 troops per annum was 3,308 for U.S. troops at Milne Bay, New Guinea.

Before the war, malaria was practically nonexistent in Australia, being endemic only around Cairns, with a few indigenous cases occurring over a wide area. Anophelines, however, could be found along the north and northeast coast in the vicinity of Darwin, Townsville, and Cairns. Therefore, the potential for spread of malaria existed, only awaiting the arrival of the human host, which now appeared in the form of evacuees from the malarious combat regions of the Philippines and Dutch East Indies.

There was little serious official concern, even on the part of the Commonwealth Government, until May 1942 when three original cases of malaria occurred in American troops at Townsville. At about the same time, 52 cases were reported among the civilian population at Cairns. Beginning on 7 May 1942, a series of meetings were called by Australian officials, at which the problems of mosquitoborne diseases were discussed, plans were made to insure proper communicable disease reporting, and measures were proposed to control the spread of these diseases. Presiding at these conferences was Col. N. Hamilton Fairley, Australian Army Medical Corps, an eminent specialist in tropical medicine, who was later appointed chairman of the Combined Advisory Committee on Tropical Medicine, Hygiene, and Sanitation. Malariologists, parasitologists, entomologists from the Australian Army, and health officers from the states of Queensland and New South Wales attended the meetings. The U.S. Army Medical Department was represented by Col. Howard F. Smith, malariologist, and Maj. James W. Bass, MC, Chief, Sanitation and Vital Statistics Division, USAFIA. Persons attending these meetings functioned as an informal committee which investigated reports of epidemics, determined their causes, developed plans for curtailing and avoiding epidemics, and implemented control measures through the agencies of its various members (fig. 72).19

During the ensuing months, Australian concern mounted over the spread of malaria. The Cairns area was overrun by mosquitoes, their numbers swollen by an unusually wet season, and the number of malaria cases there rose to more than 600. The cases discovered at Townsville were confirmed as originating there, thus indicating the presence of malaria-bearing

19(1) Report, Maj. J. W. Bass, MC, 7 May 1942, subject: Meeting Held at Royal College of Surgeons Building. (2) Letter, Maj. James W. Bass, MC, Headquarters, USAFIA, Office of the Surgeon, to Colonel Carroll, 8 June 1942, subject: Report of Inspection Trip and Conferences With Australian Medical Officers, May 26 to June 6, 1942. (3) Letter, Maj. James W. Bass, MC, Headquarters, USAFIA, Office of the Surgeon, to Colonel Carroll, 13 June 1942, subject: Inspection, Base Sections 2 and 3. (4) See page 578 of footnote 15, p. 539.


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FIGURE 72.-Army preventive medicine personnel spray a stagnant pond with kerosene guns to destroy mosquito larvae, part of the malaria control program.

mosquitoes. Further, beginning in July 1942, heavily seeded Australian troops began returning in large numbers from the fighting in New Guinea. The concern spread to Parliament, which prescribed that nostrum of all democratic governments, a Parliamentary investigation, to be carried out by Sir Earle Page, MP. Among other recommendations, such as the quarantine of malaria-seeded troops, Sir Earle proposed that the Federal Government implement a complete drainage scheme of all swamps in Cairns capable of breeding Anopheles mosquitoes. His report was reviewed by the Combined Advisory Committee on Tropical Medicine, Hygiene, and Sanitation and, upon their recommendation, General MacArthur directed that U. S. Army projects underway or planned at Cairns be coordinated with measures undertaken by Australian civil or military authorities.20 By the time this investigation was completed in mid-1943, however, most of his recommendations had already been adopted

In the interim, Australian and American military medical staff officers worked together, eliminating mosquito breeding grounds, resettling and segregating the infected native population, treating and evacuating recurrent cases to nonmalarious areas, quarantining and sending south new arrivals from the north, and implementing personnel protective measures,

20(1) Letter, Capt. Frank K. Powers, MC, to Division Surgeon, 41st Infantry Division, 27 Aug. 1942, subject: Final Report of Mosquito and Sanitary Survey. (2) See footnotes 16 (2) and (3), p. 539. (3) Letter, Brig. Gen. L. S. Ostrander, USA, to Commanding General, USASOS, 12 July 1943, subject: Malaria Control in Cairns Area.


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such as the use of netting and suppressive drugs. To prevent an influx of infected hosts into potentially malarious areas, the Australian Army Director of Hygiene proposed, in November 1942, that troops returning from New Guinea or Guadalcanal be barred from that part of the continent north of 19° S. latitude. The bases for determining an area to be potentially malarious were the presence of anopheline mosquitoes (fig. 73), a warm, humid climate, and low-lying land containing swamps and stagnant water. Only after 6 months had elapsed, during which all recurrent malaria cases were removed, were units to be permitted to return to potentially malarious areas. Deviations from this policy necessitated by military emergency were to be reported immediately to the Australian Army, and the personnel involved were to be given suppressive drugs.

This policy was adopted in December 1942 by General MacArthur's headquarters.21 It was made applicable to troops in the Allied Forces throughout SWPA and continued without significant change until the war ended.

The record seems to indicate that the dividing line was established by the Australian Army without consultation with the Commonwealth Government. On 11 January 1943, the Commonwealth Director-General of Health, Dr. J. H. L. Cumpston, in reply to an inquiry from Colonel Carroll, suggested keeping malaria-infected troops south of 25° S. latitude, a move that would have denied them almost the whole northern half of the continent. The tone of his letter suggested that he was unaware of the previously made decision to establish the line at 19° S. latitude. The demarcation line was never changed, however, so apparently Doctor Cumpston accepted the decision of the military. The point to be made here is that the further south these troops were kept, the more difficult it became to stage them for further invasions of Japanese-held areas.22

In February 1943, the first malaria survey and control team arrived from the United States. These teams were given the task of eliminating anopheline mosquitoes in areas occupied or visited by American troops. They worked closely with local authorities to conduct malaria surveys in the civilian communities. Their purpose was to identify mosquito vectors and breeding places, and to treat with larvicide stagnant waters which could not be drained. The arrival of these teams, the growing effectiveness of the Combined Advisory Committee on Tropical Medicine, Hygiene, and Sanitation, the establishment of an efficient malaria control organization, and enforcement of a strict malaria control program all contributed towards overcoming the crippling effect of malaria on military operations. By the end of 1943, this problem had been substantially solved.23

21Letter, Col. B. M. Fitch, AGD, to Commanders, Allied Naval and Air Forces, and Commanding Generals, I Corps and USASOS, 6 Dec. 1942, subject: Malaria Control in Australia.
22Letter, J. H. L. Cumpston, Department of Health, Commonwealth of Australia, to Col. P. G. Carroll, MC, 11 Jan. 1943, subject: Malaria.
23See footnote 15, p. 539.


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FIGURE 73.-Identifying breeds of mosquitoes, Brisbane, Australia, January 1943.

Dengue Fever

Dengue fever was the first disease of military consequence to be encountered by American forces.24 Maj. Henry C. Johnson, MC, Surgeon, Base Section 1, reported an epidemic of a mild form of dengue in February 1942 in the vicinity of Darwin, where it was endemic. On 27 March 1942, the American Consul in Brisbane advised Capt. N. J. Serlin, MC, then Chief of Sanitation, USAFIA, that there were several thousand cases of dengue fever in the Townsville area and that it was spreading into Brisbane and Cloncurry.

This outbreak was a serious danger to American forces since they were situated mostly within the area covered by the epidemic and had not acquired immunity against the causative organism. Dengue fever was extremely debilitating, having the potential of hospitalizing whole units at the same time. Just before the Battle of the Coral Sea, the outcome of which caused the Japanese to abandon their plan for a seaborne invasion of Port Moresby, more than 80 Army Air Force pilots and crewmembers in one unit were afflicted at the same time with this illness which grounded flying personnel for an average period of 3 weeks. Fortunately, with the arrival of

24For a more detailed discussion of the occurrence of dengue, scrub typhus, and other communicable diseases among the U.S. forces in Australia, see Medical Department, U.S. Army. Preventive Medicine in World War II. Volume VII. Communicable Diseases: Arthropodborne Diseases Other Than Malaria. Washington: U.S. Government Printing Office, 1964, pp. 29-32, 124, 275-286.


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cooler weather by late April, the incidence had begun to decline and the Air Forces had sufficient aircrews able to fly the numerous reconnaissance missions dispatched to locate the Japanese invasion fleet.25

Until the onset of the dengue epidemic, discussions and coordination between American and Australian medical authorities had been concerned mostly with allocation of supplies, equipment, and facilities. They now realized that coordination and cooperation would have to go much farther. From this time on, both worked together to reduce mosquito breeding places, improve water supplies, and raise sanitary standards. Efforts to coordinate health activities on the local level were made in every community having American troops located nearby.

Venereal Diseases

In May 1942, venereal disease among U.S. military personnel in Australia reached its highest point: 45.8 per 1,000 troops per annum. By November 1944, the rate had fallen to 4.2. This remarkable 90-percent reduction was achieved only through the vigorous combined efforts of military and civilian agencies.26

Although venereal disease rates among the civilian population had been low for some years, the beginning of war in 1939 precipitated a gradual rise in the rate until it became evident, in 1942, that more effective control measures were necessary. The Commonwealth then passed a law authorizing chief public health officers in each state to order the apprehension and testing of any person suspected of having a venereal disease (fig. 74). If diseased, the person was to be detained until cured. Later, in 1943, this authority was extended to any medical practitioner, including Allied medical officers who, of course, exercised this authority through the civil courts. This last change provided a speedier and more effective system for detention of female venereal disease carriers identified by soldiers reporting for VD treatment.27

A coordinated command program to control venereal diseases began in July 1942, when the VD Control Section was organized in the Office of the Chief Surgeon, USAFIA. Lt. Col. Ivy A. Pelzman, MC, was designated SWPA VD Control Officer, and officers were appointed to similar positions in each base section. This is not to imply that there were no such programs before that, but establishment of this formal structure allowed development of programs which were more closely coordinated with the community or the state. Because the source of infection was usually within the civilian

25(1) Johnson, Maj. Henry C., MC, Office of the Surgeon, Base Section No. 1, to Commanding Officer, Base Section No. 1, 28 Feb. 1942, subject: Sanitary Report for the Month of February 1942. (2) Letter, J. P. Ragland, American Consul, Brisbane, to Capt. N. J. Serlin, USA, Chief of Sanitation, Office of the Surgeon, Headquarters, USAF1A, 27 Mar. 1942, with enclosed copies of Consular Sanitary Reports. (3) Kennard, Lt. Col. William J., MC, Report on Philippine and Australian Activities, p. 21.
26Medical Department, U.S. Army. Preventive Medicine in World War II. Volume V. Communicable Diseases Transmitted Through Contact or by Unknown Means. Washington: U.S. Government Printing Office, 1960, p. 290.
27Headquarters, Base Section No. 2, Sanitary Report for July 1943, dated 5 Aug. 1943.


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FIGURE 74.-Laboratory technicians at the 3d Medical Laboratory, Brisbane, Australia, determine the results of a Kahn test.

community, the support of local health and law enforcement officials was essential to the success of the program. Concern over venereal disease was not confined to the military, of course. In July 1942, Sir Raphael Cilento, reflecting civilian concern, held a conference to consider the rising incidence of venereal disease in Queensland. At this meeting which was attended by Col. George W. Rice, representing the Surgeon, USAFIA,28 a three-way drive to suppress venereal disease was launched. Other programs organized later usually followed the same pattern. First was the matter of education. Both soldiers and civilians had to be told what venereal diseases were, how they were transmitted, and how to recognize them. The main emphasis here was placed on continence. Widespread publicity among civilians was difficult at first because of extreme delicacy which forbade even mention of the subject in public print. However, with American assistance, information campaigns marked by good taste eventually were conducted by various state and local governments. Often the posters and bulletins used were copied from those developed previously in the United States.

28Minutes, Conference on the Public Health Aspects of Venereal Disease in Queensland, 30 July 1942, Brisbane, Australia.


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Second, prophylactic stations were to be established in cities and towns frequented by Allied troops and they were to remain open constantly. Soldiers on leave or pass were to be thoroughly familiarized with the location of prophylactic stations in the area. An agreement was also reached whereby U.S. troops could patronize stations operated by Australian defense forces and vice versa.

The third, and perhaps most important effort in the program's development, was the system of obtaining identification of contacts from infected soldiers. For this to be effective, such soldiers were required immediately to provide all information known about the contact; such as, name, address, and where met. At most bases, a Provost Marshal investigator worked closely with VD clinics. He interviewed infected soldiers, then turned over to the civil authorities the information gained concerning the contact together with the physician's certificate to the effect that there was reasonable assumption that the contact had venereal disease. On the basis of this certificate, the stipendiary magistrate issued an apprehension order to the civil police.29 Apprehension, testing, and detention usually followed when sufficient identifying information was given to the police. Of course, this was done with varying degrees of efficiency, but by 1945, over 50 percent of contacts reported were traced by the civil police. In Townsville, which had an outstanding record in this regard, over 95 percent of contacts were located.30

The effectiveness of these measures is illustrated by the low incidence rate achieved by the war's end. This rate was among the lowest for U.S. troops stationed anywhere in the world.

SANITATION

Sanitation and the maintenance of high sanitary standards sufficient to protect United States troops were major problems in relatively unpopulated northeastern Australia where most bases were established. Part of this area was desert where almost no water could be found, and part was tropical jungle with stagnant, polluted water. Waste disposal in the few towns was exceedingly primitive, and the local supply of fresh food was completely inadequate for the large numbers of troops stationed there.

Each U.S. Army base had problems peculiar to it alone; however, a brief look at the sanitation difficulties faced at Cloncurry, Queensland, will serve to illustrate those encountered at almost all bases near small Australian towns. In early 1942, when it was decided to establish an American airbase nearby, Cloncurry was a typical farm town of about 1,600 people. A U.S. Army engineer survey made on 28 March reported that the town water supply was inadequate. This water had a high coliform count, and typhoid occurred at the rate of about two cases each year. The pan system of

29Headquarters, Base Section No. 6, USASOS, SWPA, Medical History to September 30, 1942, dated 30 Oct. 1942.
30Base Section No. 2, Quarterly History of Medical Activities, 1 July-30 Sept. 1943, pp. 66-68.


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human waste disposal was most common except for the few septic tanks, all of which discharged their effluence into the ground. Used water was run out onto the ground. The inspector immediately arranged with the District Health Officer for chlorination of the town water supply by the U.S. Army. He also judged that water from the well being dug at the airbase would have to be completely sterilized as it was in an area receiving drainage from the town.31

On 30 March, Colonel Rice sent the following message to the Commanding General, USAFIA: "Urgently recommend no further troop movement to Cloncurry Air Field, camp facilities inadequate, city water supply untreated, sanitation in city and camp poor, mosquitoes and flys [sic] numerous and dangerous to health of command, recommend sending at once an Army engineer and senior medical officer."32 Apparently as a result of this message, a sanitary survey was made on 4 April by 1st Lt. Donald D. Davis, MC, Flight Surgeon, 30th Bombardment Squadron, in which he made many recommendations for improvement. Chief among these were:

1. Immediate installation of water purification system, together with periodic testing and bacteriologic control by the U.S. Army Medical Department. At the same time, he condemned water from an airbase well, then being dug, as unfit for drinking since it was located in the town drainage area.

2. Screening and flyproofing buildings of Cloncurry District Hospital where 10 beds had been allocated for U.S. Army patients. Replacement of open pail latrines in the hospital by a closed sewer system with a septic tank, and draining of stagnant pools of waste water in which mosquitoes were breeding. He deemed conditions so poor here that he requested a clearing station unit be provided to care for and feed Army patients.

3. Improvement of sanitary conditions within the camp. He found these appalling due to stagnant water, the presence of animal excreta all over the ground, and a superabundance of flies and mosquitoes. Conditions were so serious here that he also recommended that "enlisted men" be ordered to use face nets constantly.

4. The immediate institution of a townwide campaign for eradication of fly and mosquito breeding places. He judged town conditions thus: "No attempt whatsoever is being made by the general public of Cloncurry to control the breeding of mosquitoes * * *. Open water pails and water tanks exist everywhere and are not protected by oil film. * * * U.S. Army troops * * * subjected to the dangers of diseases endemic and epidemic in this area * * *. At present time Dengue Fever is epidemic. Malaria is endemic, as is typhoid fever."33

His progress report 2 weeks later revealed how much it was necessary

31Letter, A. E. Kelso to Commanding General, USAFIA, 31 Mar. 1942, subject: Report of Inspection, Cloncurry Water Supply, 28-29 March 1942.
32Radiogram, Col. George W. Rice, MC, to Commanding General, USAFIA, 30 Mar. 1942.
33Letter, 1st Lt Donald D. Davis, MC, Flight Surgeon, 30th Bombardment Squadron, to Senior Flight Surgeon, USAFIA, 4 Apr. 1942, subject: Sanitary Survey of Cloncurry Camp.


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for the Americans to do. Actions were taken with at least the tacit consent of the civilian authorities who had little manpower, funds, and material at their disposal, and seemed quite willing for the Americans to step in and take charge, as long as the United States paid the bill.

Lieutenant Davis reported that both civilians and soldiers had been forbidden to swim in the Cloncurry River because of the pollution found there. He had also enlisted the help of Australian VAD (Volunteer Aid Detachment) nurses to impress upon the local residents the need for eliminating mosquito breeding places. Concurrently, to conserve water, the VAD nurses were canvassing all homes to locate any leaking tanks, pipes, or faucets which they then reported to Lieutenant Davis. Not all improvements recommended for the hospital were yet being made, but construction of a closed sewer system for the hospital had started, with the work being done by a detail of men from the 394th Quartermaster Battalion (Port). Advertising and publicity were begun throughout Cloncurry to enlist support in fighting flies and mosquitoes. Handbills were dropped from airplanes and were given to schoolchildren to take home, advertisements were placed in the newspaper, and notices were flashed nightly on the local theater's screen. These actions were only hasty beginnings in the effort to establish a safe environment for American troops. As time passed, more permanent and lasting improvements were made through joint Australian-American cooperation.34

Experiences similar to those in Cloncurry took place in many other communities, some with even more extensive American participation, such as the use, in Rockhampton, of U.S. Army troops as agents of the town council in making a house-to-house search to locate and eliminate mosquito breeding places. Cairns was the scene of many cooperative projects, all designed to end epidemic malaria in this region.35

FOOD INSPECTION

Since Australia was a food-exporting nation and food shipped from the United States took up valuable hold space in the too few cargo ships, it was soon decided that Australia would supply meat, dairy products, and other foods to the American Army in a reverse Lend-Lease program. While this decision was logistically sound, it posed extremely grave problems in preventive medicine since food-handling sanitary standards were appallingly low when compared with those in the United States. This was particularly true of the small marginal producers who were suddenly required to increase production manyfold and could not hire trained personnel, expand their plants, or buy modern equipment. Sanitary reports repeatedly described the lack of cleanliness and inspection standards in slaughterhouses, dairies, and food-processing plants. Lt. Col. C. W. Cowherd, VC, appointed

34Letter, 1st Lt. Donald D. Davis, MC, Flight Surgeon, 30th Bombardment Squadron, to Senior Flight Surgeon, USAFIA, 21 Apr. 1942, subject: Progress Report on Sanitary Survey, Cloncurry.
35See footnote 20, p. 543.


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chief of the USAFIA Veterinary Section in April 1942, estimated that 5 to 10 percent of the cattle had tuberculosis and found little evidence of a tuberculin-testing program.36

Initially, because U.S. Army troops were grateful for any food furnished, medical and veterinary officers confined their inspections to delivered food products. This food was the regular ration used by the Australian Army with some adjustment to accommodate the difference in diet between the two armies. Because it was procured and issued to American units by Australian Army quartermasters, there was some doubt among American inspectors of their authority to condemn or reject rations issued by the Australian Army. However, in early 1943, this system ended, and food was purchased directly from the producer. Subsequently, as procurement became better organized and was formalized by contract with suppliers, preventive medicine and veterinary officers were able to expand their inspections to food sources, rejecting products from all suppliers who failed to maintain adequate sanitary standards. Through this method, satisfactory standards were achieved.

At no time, of course, did the American forces have any lawful basis to force maintenance of good sanitary conditions among suppliers except through contractual penalty clauses which included the right to inspect food at any point in its processing. Contract cancellations, of course, produced no food; therefore, American inspectors much preferred to advise and help the producers rather than to threaten or penalize them.

Some meat and dairy products already met U.S. standards. Foods of animal origin destined for export were processed under supervision of the Department of Commerce, Commonwealth of Australia. The standards of this agency were such that food prepared under its supervision was acceptable to the U.S. Army without further inspection except upon receipt. Unfortunately, the Department of Commerce was not sufficiently well staffed, nor in a legal position, to inspect food for domestic consumption. This was the states' domain, and their laws were not so stringent nor their inspections so careful as those of the Commonwealth.

This is not meant to imply that local health officials were indifferent to adequate public health measures. They were fully aware of deficiencies but were hampered by shortages of personnel, equipment, and funds, not to mention the indifference of local officials and politicians.37

American officers assisted the producers in many ways, such as obtaining priority in delivery of pasteurization equipment and securing refrigerated railroad cars for shipping milk. Realizing that public health in all Australia would be enhanced by the adoption of sanitary measures, suppliers usually were willing to accept American Standards when given the guidance and the wherewithal. Particular impetus toward improved milk han-

36Stauffer, Alvin P.: U.S. Army in World War II. The Technical Services. The Quartermaster Corps: Operations in the War Against Japan. Washington: U.S. Government Printing Office, 1956, pp. 99-120.
37Memorandum, O. St. J. Kent, Senior Dairy Technologist, to Director of Dairying, Department of Agriculture and Stock, 16 Aug. 1942, subject: Townsville Milk Supply.


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dling was generated in March 1943 when a cholera epidemic occurred among the civilian population of Melbourne, and cost 28 lives in 500 cases. This epidemic, traced to the consumption of contaminated raw milk, resulted in establishment of more sanitary milk-handling programs.38 Although no U.S. military personnel contracted cholera, its appearance in epidemic form illustrated the absolute necessity for the U.S. inspectors' insistence upon high sanitary standards and made their task somewhat easier. Undoubtedly, this insistence had a permanent effect on Australian public health. At the least, it gained, through voluntary cooperation of the suppliers, safe and edible foodstuffs for the U.S. soldier. In milk, particularly, the improvement was remarkable. While Army standards required a bacteria count of less than 50,000 per cc., samples of milk taken at the point of consumption by preventive medicine personnel sometimes contained up to 196 million bacteria per cc., all with colon aerogenes present.39 Nevertheless, by 1943, with American assistance, the dairy industry was able to produce sufficient milk meeting Army standards to supply all American troops except for a few in remote areas. This was a remarkable achievement, even considering the advice and assistance given by U.S. inspectors.

There was also the problem of protecting the health of soldiers eating in civilian milk bars and cafes, many of which were unsanitary or whose food did not come from U.S.-approved sources. In some instances, Allied sanitary committees or similar groups were formed which outlined sanitary requirements to restaurant owners, gave them a period of time to meet the standards, and then inspected the premises. Submission to this program was completely voluntary on the part of owners; however, desiring the soldiers' patronage, they were usually eager to cooperate.40

Approved establishments were given signs to display in their windows, which indicated that U.S. troops were permitted to trade there. The soldiers were instructed to consider as "off limits" all places not displaying such a sign.41

 MISCELLANEOUS CIVIL AFFAIRS

Quarantine

Commonwealth quarantine regulations governing the importation of American foodstuffs for the Army were initially waived but were partially reimposed in January 1943, when importation of uncooked meat products was banned. This order, to which General MacArthur strongly objected, was issued following an outbreak of hog cholera, which had not occurred in

38(1) Miller, Everett B.: Medical Department, U.S. Army. Veterinary Service in World War II. Washington: U.S. Government Printing Office, 1961, pp. 303-331. (2) Headquarters, 22d PORT (TC) and Base Section No. 4, USASOS, SWPA, to The Adjutant General, 8 Apr. 1943, subject: Sanitary Report for Month of March 1943.
39Headquarters, Base Section No. 2, USASOS, SWPA, to The Adjutant General, 3 Mar. 1943, subject: Sanitary Report for the Month of February 1943.
40See footnote 29, p. 548.
41See footnote 39.


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Australia since 1928. The Commonwealth investigator named as the source a cold storage shipment of spareribs brought aboard the Pensacola convoy which was not consumed until August or September 1942.42

Animals accompanying the U.S. forces were never permitted to enter Australia, but, inevitably, some troops hid pets and brought them ashore surreptitiously. Even such animals as war dogs and pack artillery mules, destined for important use in tactical operations, were barred so as to prevent the entry of equine encephalomyelitis and infectious anemia, both epizootic in the United States. Despite a direct appeal from General MacArthur to the Prime Minister, this ban was never relaxed.43

Commonwealth quarantine officials permitted U.S. medical officers to inspect personnel debarking from either ships or aircraft. In effect, they were expected to act as agents of the Chief Quarantine Officer to prevent the unauthorized entry of persons with smallpox, plague, cholera, yellow fever, typhus fever, or leprosy. Any person discovered with symptoms of these diseases was required to be placed in one of the quarantine stations operated by the Commonwealth.44

Public Health Laboratories

Until U.S. Army hospitals and laboratories began arriving from the United States in mid-1942, medical officers had no facilities under their control for bacteriologic examination of water and food specimens or to accomplish serological tests for tropical diseases. To remedy this, Dr. Cumpston, the Director-General of Health, permitted American medical officers not only to submit specimens for examination but also to use personally the laboratory facilities to conduct necessary research. Twenty public health and university laboratories were designated to provide the assistance desired. The fact that working space was offered in these important installations is characteristic of the harmony and general spirit of cooperation existing between the Australian and American medical officers and physicians.45

Professional Relationships

In reviewing the various reports submitted by medical units and individuals, one is impressed by the many references to the cordial relations enjoyed with Australian members of the medical, dental, and allied professions. There was a substantial friendly exchange of information, supplies, and support. This cross-fertilization of medical knowledge, techniques, and

42Medical Department, U.S. Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955, p. 323.
43Letter, GHQ, SWPA, Office of the CinC, to The Right Honourable John Curtin, Prime Minister, 23 Jan. 1943, subject: Quarantine Restrictions.
44Letter, Paul Mitchell, Chief Quarantine Officer (General), to Colonel Rice, Base Section No. 3, USASOS, SWPA, 30 May 1942, subject: Quarantine and Air Navigation.
45(1) Memo, J. H. L. Cumpston, Director-General of Health, to Secretary, Department of Defense Co-ordination, 20 Apr. 1942, subject: Permission to Use Laboratory. (2) Letter, J. P. Abbott, Chairman, Administrative Planning Committee, to Capt. Nathan J. Serlin, MC, 9 Apr. 1942, subject: Use of Laboratories.


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schools of thought proved of permanent value to both nations. It took tangible form in such matters as the passage of the Commonwealth Act for better control of venereal disease carriers, which was earnestly supported by medical personnel of both nations, and in the training given American physicians through courses of instruction at such schools as the Sydney University School of Tropical Medicine and Hygiene. Even more important but less tangible was the exchange of information gained at professional meetings, where each attended the other's functions as welcome, distinguished guests and lecturers.

SUMMARY

Wartime conditions dictated the concentration of U.S. troops in the steamy, unhealthy jungles of northern Australia, not in the pleasant cities nor fertile farm lands further south. Hence, disease problems were multiplied. Small towns, near which the troops were concentrated, were healthful enough for the small number of inhabitants but simply did not have the pure water supply nor waste disposal facilities to cope with a large influx of soldiers; nor was there time, equipment, money, or manpower to build them. Unsanitary conditions in food processing were the inevitable results of hastily expanded wartime production. Small rural slaughterhouses had to produce huge quantities of meats without the equipment or facilities to do so under sanitary conditions, nor did the people operating them have the requisite training or experience. The public health agencies were simply too undermanned because of increased wartime demands to solve these difficulties quickly.

At the same time, however, one should not overlook the remarkable accomplishments of U.S. Army medical personnel. Their task was difficult. Australia presented unfamiliar disease problems. There was, to begin with, no agency to maintain liaison with local civilian authorities, and U.S. Army facilities, such as hospitals, medical depots, and laboratories, were at first nonexistent.

The remarkable fact is that so much was done. The health of our troops was protected, adequate quantities of wholesome food were produced to feed the fighting forces, and many other vexing problems were solved. These positive achievements are permanent monuments to the cooperation between Australians and Americans.

Section II. New Zealand

INTRODUCTION

New Zealand had been at war with Germany and Italy since September 1939 when its government declared war on Japan on 9 December 1941. New Zealand forces, fighting as part of the British Commonwealth, had


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been driven out of western Europe, Greece, and Crete and were, even then, fighting a seesaw battle in North Africa to save Cairo and the Suez Canal. The Japanese blow at Pearl Harbor and the swift advance through southeast Asia brought a new opponent, and this one much closer. New Zealand, with fewer than 2 million people and most of its armed forces serving many thousands of miles away, felt vulnerable indeed at this time. However, its location only 1,200 miles east of the Australian Continent, was of extreme strategic importance to the Allies because it secured Australia's flank against further Japanese incursion, and was also on the line of communications from the United States (map 17). Quickly, therefore, the U.S. Navy was given the mission of securing this line of communications, thus becoming responsible for New Zealand's sea defenses but not its land defense, which remained under the control of New Zealand. Later, although both Australia and New Zealand preferred to be included in the same theater of operations, New Zealand fell within Adm. Chester W. Nimitz' Pacific Ocean Areas, a Navy command, while Australia became part of General MacArthur's Southwest Pacific Area, an Army command. Consequently, all U.S. Army activities in New Zealand were under Navy control.46

Strictly speaking, there were no formally designated U.S. Army Civil Affairs/Military Government activities in New Zealand because the regular government remained in authority. Thus, all public health activities and problems which arose as a result of U.S. troops' being in that country were arranged and solved through negotiation and agreements between the two governments. These activities, of course, were Civil Affairs, regardless of their name.

THE NATION

New Zealand is composed principally of two large islands, North Island and South Island, which together form the bulk of the landmass. On them are located most of the inhabitants, industries, and farms. Auckland and Wellington, both on North Island, are the largest cities and the major ports. The country is spectacularly beautiful, with many mountains and much vegetation. Abundant streams provide an ample supply of hydroelectric power; however, the absence of large mineral deposits made New Zealand primarily an agricultural rather than an industrial society. Blessed with a temperate climate and rich grazing land, it had become one of the world's leading exporters of mutton, lamb, wool, butter, and cheese.

Dominion status was not granted to New Zealand until 1904 although it had been self-governing since 1852. The Labour Party, which first came to power in 1935, had sponsored a program of liberal economic and social measures which culminated in the socialization of medicine in 1941. It was carrying forward a tradition of social welfare legislation that began as ear-

46Morton, Louis: United States Army in World War II. The War in the Pacific. Strategy and Command: The First Two Years. Washington: U.S. Government Printing Office, 1962, pp. 203-204 and 244-252.


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MAP 17.-Allied shipping and airlines from the United States to Australia and New Zealand.

ly as 1898 when the dominion was the first to adopt noncontributory old-age pensions. In 1907, a national infant welfare system was established and, in 1938, the Social Security Act provided greater old-age benefits, widows' pensions, family benefit payments, care of orphans, minimum wage levels, a 40-hour week, and unemployment and health insurance.

Generally, health conditions in New Zealand were excellent, the recorded death rate being among the lowest in the world, and there was a well-organized public health service. The Department of Health of New Zealand was headed by a Director-General; and the nation was divided into health districts, each under the direction of a physician qualified in public health work.

U.S. ARMY COMMAND STRUCTURE

Although the U.S. Navy began using New Zealand ports almost immediately, the threat of an early Japanese invasion was remote; hence, no im-


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mediate effort was made to dispatch U.S. Army troops there. But early in March 1942, Winston Churchill, hopeful that he could retain in the Middle East the experienced troops these countries wanted brought home for their protection, asked President Roosevelt to send a division each to Australia and to New Zealand. This Roosevelt agreed to do, and ordered the 37th Infantry Division to New Zealand.47 On 30 May 1942, the advance party of this Division landed at Auckland, together with Headquarters, and Headquarters Company, 1st Port of Embarkation, which was sent to establish port facilities for the main body of the 37th Division. Shortly thereafter, the 1st Marine Division, destined for early combat, also began to arrive. By early August, however, both divisions had departed, the Marines to prepare for their Guadalcanal invasion and the 37th Division to the Fiji Islands to relieve the New Zealand troops there. Allied planners, by this time, had realized that New Zealand was too remote from anticipated combat areas in the South Pacific for use as an advanced base for American military forces. Subsequently, large United States combat units were stationed there only for reorganization and rehabilitation following combat.

U.S. Army troops, which were soon stationed on many of the islands in the South Pacific area, did not come under a single Army commander until 14 July 1942 when Maj. Gen. Millard F. Harmon was named to command USAFISPA (United States Army Forces in the South Pacific Area). The USAFISPA Surgeon was Col. (later Brig. Gen.) Earl Maxwell, MC.

Headquarters, USAFISPA, was first located in Auckland but moved to Nouméa, New Caledonia, in November 1942. The Army command remaining became Headquarters, Service Command, and USAFINZ (United States Army Forces in New Zealand).

Several officers served as Surgeon, USAFINZ. Lt. Col. (later Col.) Amos R. Koontz was in this position for 2 years, succeeding Lt. Col. (later Col.) Wallace S. Douglas, who moved on to New Caledonia in March 1943.

U.S. Army Hospitals

The first U.S. Army hospital to arrive in New Zealand, the 18th General Hospital with 1,000 beds, landed at Auckland on 12 June 1942, together with the main body of the 1st Port of Embarkation which had an organic medical section sufficiently large to staff a port dispensary and a Surgeon's office. An infirmary had already been established on an Auckland pier by members of the advance cadre of the 1st Port, and hospitalization had also been arranged at various military and civilian hospitals in and about Auckland.

Auckland was only a temporary stop for the 18th General Hospital, which soon went to the Fiji Islands. But while in New Zealand, this unit established a 30-bed casualty clearing hospital at Camp Papakura where the

47See page 220 of footnote 46, p. 555.


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male personnel lived in New Zealand Army barracks. No facilities were available, however, for nurses who were housed in private homes.48

In July 1942 upon the establishment of U.S. Naval Mobile Hospital No. 4 at Hobson Park, Auckland, and, later, Hospital No. 6 at Wellington, hospitalization of U.S. service personnel was fully assumed. In the interim, hospitalized troops primarily were under the care of New Zealand physicians although U.S. Army medical officers did make daily ward rounds. Here these medical officers first learned "that all nurses were 'sisters' and that even medical activities wait on morning and afternoon tea."49

On 28 October 1942, construction was begun on a 1,000-bed hospital plant which was subsequently to be staffed by the 39th General Hospital (fig. 75) upon its arrival in November 1942. Until their building was ready, personnel of that hospital were loaned to the U.S. Navy hospitals to help care for the casualties then beginning to arrive from Guadalcanal, and some even went on duty at the Auckland City Hospital to help relieve the shortage of civilian physicians.50

The U.S. Army Medical Department finally started "taking care of its own" on 7 February 1943, when the first Army patients were transferred from the Navy hospital to the 39th General Hospital. The new hospital had been built by the New Zealand Government and lent to the Army in a reverse Lend-Lease transaction. Located just outside Auckland, it was intended for use as a veterans' hospital after the war and was substantially constructed. Throughout the war, the 39th General Hospital was the only U.S. Army hospital to function as such in New Zealand although a center consisting of two 1,000-bed general hospitals had initially been planned. Two other hospitals, the 18th General and the 37th Station, were in New Zealand for short periods but were never fully operational. Despite the failure to establish the center and another hospital, the number of beds planned was reached and exceeded by the 39th General Hospital alone, which maintained 2,536 beds at one time. In addition, the 39th operated a convalescent hospital.51 Hospitalization for U.S. personnel ended as it had begun, with the transfer, on 20 November 1944, of 12 patients to an Auckland civilian

48(1) Douglas, W. S., M.D., Summary of My Military Experiences (With Special Remarks Concerning New Zealand), December 1964. (2) Tilgham, R. Carmichael, M.D.: L.O.D-Yes: An Odyssey of the Army's 18th General Hospital. The Johns Hopkins Alumni Magazine XXXVI, Nos. 1, 2, and 3, November 1947, January and March 1948.
49See footnote 48 (1).
50(1) Army Medical Bulletin No. 63, July 1942, pp. 41-70. It was estimated that almost one-third of the New Zealand physicians were serving overseas with their armed forces. (2) Letter, Capt. John H. Robbins, Commanding Officer, U.S. Naval Mobile Hospital No. 4, to Rear Adm. Luther Sheldon, BUMEDS, Navy Dept. 9 Jan. 43. The following quotation from this informal report reveals that help from the 39th General Hospital was both significant and appreciated by the Navy: "You probably did not know that we had made some use of the personnel of the U.S. Army General Hospital No. 39, * * * they were a God-send as at that time we had only 290 corpsmen and the patients were well over the thousand mark. Today we have 414 corpsmen on duty and 28 nurses (Navy) plus 143 Army corpsmen, 45 Army nurses and 14 Army officers." (3) History, 39th General Hospital July 15th, 1942-June 30, 1943. This report states also that 25 nurses were lent to USNMH No. 6 at Wellington.
51(1) Memorandum, Maj. Gen. Thomas T. Handy to Commanding Generals, AGF and SOS, 19 July 1942, subject: Army Hospital Center for Auckland, New Zealand. (2) Annual Report of Medical Department Activities, South Pacific Area 1943, 12 Feb. 1944. (3) Annual Report and Medical History, 39th General Hospital, 1943.


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FIGURE 75.-Aerial view of the 39th General Hospital, near Auckland, New Zealand.

hospital from the 39th General Hospital preparatory to its closing. During its 21 months in operation, the hospital admitted 23,411 patients, most of them sick and wounded from the Solomons Campaign.52

Preventive Medicine Activities

Unlike Australia where it was necessary to create bases in unsettled or rural areas, the U.S. Army in New Zealand went into more or less established military installations near large, modern cities. Thus, a potable water supply was available and adequate waste disposal systems usually existed without augmentation. Further, when new construction became necessary, such as the hospital plant for the 39th General Hospital, the New Zealand Government developed the plans and supervised the construction although modifications or alterations suggested by U.S. staff officers often were accepted.53

No venereal disease problems of consequence were encountered. The usual educational campaigns were conducted among U.S. forces and a number of prophylactic stations were operated in or near the metropolitan

52Annual Report and Medical History, 39th General Hospital 1944.
53Interview, Lt. Col. Eugene T. Lyons, MSC, with Col. Frederick Freese, Jr., MC, USAF, 11 Dec. 1964.


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areas on a 24-hour basis. When the name and address of a suspected venereal disease contact were given to the local health authorities, they cooperated in apprehending and hospitalizing her until treatment had rendered her noncontagious. Another aspect of cooperation began in 1944 when penicillin was administered to infected female contacts by U.S. Army medical personnel. At that time, penicillin was not available to civil public health officers for their use.54

COMMUNICABLE DISEASES AND SANITATION

New Zealand had none of the tropical diseases found on those South Pacific islands located closer to the Equator nor were the important tropical diseases found, such as cholera, plague, smallpox, epidemic typhus fever, and yellow fever, which are subject to quarantine laws. However, it did have all the diseases that commonly occur in temperate climates, and these in about the same proportion as on the North American Continent.

The venereal disease rate was not high because of a well-organized venereal disease control service. Enteric diseases, including typhoid and paratyphoid fevers, amebic dysentery, and bacillary dysentery, occurred sporadically and in small epidemics. It was estimated that 44 percent of the sheep and cattle were infested with Echinococcus, minute tapeworms which are transmissible to man and cause hydatid cysts. Other transmissible diseases included dengue fever, infantile paralysis, leptospirosis, undulant fever, anthrax, tetanus, tuberculosis, helminthiasis, and acute infectious respiratory diseases. Principal insect disease vectors were houseflies and mosquitoes of genus Aedes.

Screening of morbidity reports from U.S. Army units in New Zealand did not reveal the occurrence of Echinococcus amongst Army personnel, nor any cases of undulant fever, at least in 1942 and 1943 when New Zealand was included in the South Pacific Island Command. In 1944, the South Pacific Island Command was combined with the Central Pacific Island Command to form the Pacific Ocean Areas Command, after which separate records for New Zealand could not be traced. Tuberculosis incidence is available for 1942 and 1943; however, there are no separate figures on the incidence of bovine tuberculosis amongst Army personnel.

Before the war, only a few cases of malaria were reported each year, perhaps from among travelers abroad, and there were no reports of the presence of anopheline mosquitoes in New Zealand. Regardless, precautions against importation of anophelines were adopted. Besides routine spraying or fumigating of aircraft and vessels to kill adult mosquitoes, their potential breeding places in uncovered water reservoirs, such as lifeboats, were washed down with seawater or treated with insecticide, and stagnant water around airfields was either drained or treated.

Servicemen returning from islands where malaria existed were permit-

54Thompson, Capt. Arthur I., Surgeon, Section SPBC: History of Venereal Disease-South Pacific Area, 24 Jan. 1946. [Official record.]


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ted to go anywhere in New Zealand without fear of introducing the disease. This differed from the situation obtaining in Australia where they were barred from potentially malarious areas on the continent. The problem existing in New Zealand was not to control the spread of malaria but only to treat the malaria existing among troops returning there for hospitalization, rest, or rehabilitation (see p. 564). Ordinarily, this would not have concerned civilian hospitals and medical practitioners because there were sufficient military hospitals to care for military patients. But civilian physicians often were called upon to treat the many U.S. servicemen who suffered malaria attacks while on leave. When the 1st Marine Division returned from Guadalcanal in December 1942, leaves and passes were given liberally to the combat-weary men, who promptly spread throughout the Islands. Suppressive quinine or Atabrine doses were immediately discontinued for some of these men while others were given up to 30 grains of quinine sulfate to be taken over a 3-day period. Shortly, wherever they were and at more or less the same time, many of them collapsed with severe malaria attacks. Surprisingly, a large number of physicians treating the stricken soldiers were no more familiar with malaria than their American colleagues. While Colonel Douglas was USAFINZ Surgeon, he often was called by physicians who were reporting that a U.S. soldier was sick with pneumonia. Almost invariably, when blood examinations were completed, it proved to be malaria. Occurrences like this ceased when the necessity for continuing suppressive drugs was recognized.55

Except for a few regions where irrigated farming was practiced, water was plentiful. That for human consumption was generally from rivers, deep wells, and impounded surface water. Only a few of the larger cities filtered and chlorinated their water. Where flush toilets were in use, their untreated effluent emptied directly into streams or the ocean.

Despite the exportation of dairy products in large amounts, dairy facilities in New Zealand were not modern and epidemics frequently were caused by milkborne diseases. Undulant fever and tuberculosis were widespread among dairy herds, but there was only limited veterinary inspection of meats and dairy products.56

FOOD PROCUREMENT AND INSPECTION

Food Procurement

More than 500 million pounds of foods of animal origin were procured in New Zealand by the JPB (Joint Purchasing Board), an agency having U.S. Army representation but under U.S. naval control. This amounted to almost half the food consumed by American forces in the South Pacific Area during the war. This board was not permitted to buy products directly from the source but, instead, had to order from the Dominion Government,

65See footnotes 48 (1) and 50 (1), p. 558.
66See footnote 50 (1), p. 558.


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which then placed its own contracts with the producers for delivery to JPB warehouses. This procedure hopefully would avoid competition for the available food, unwarranted price increases, and unequal distribution. Praiseworthy though its goal may have been, the procedure, throughout the war, clouded the right of U.S. procurement officers to inspect food during its processing and to reject any not meeting U.S. standards. Not until 1944 were Veterinary Corps officers permitted to begin large-scale inspection of plants and food products although development of adequate inspection services had been advocated as early as 1942 by unit officers who inspected food upon issue to the using unit.

According to medical and veterinary personnel, the need for inspection was acute despite the high reputation New Zealand food exports had enjoyed before the war. Most food destined for export was produced by large food and meat processors in modern, efficient plants whose output was inspected by a national agricultural agency recognized by the U.S. Department of Agriculture. Wartime demands for food production brought unprecedented expansion of existing plants and the establishment of additional slaughterhouses, dairies, and canneries. Many of the new producers were basically unfamiliar with required sanitary practices. Further, their plants and machinery were either antiquated or makeshift. Dominion veterinary inspectors were both few in number and rarely well qualified, which was not surprising since New Zealand had no school of veterinary medicine and the ratio of veterinarians to domestic farm animals was less than one-tenth that of the United States.

Even when the necessity for inspection was fully recognized by the Joint Purchasing Board, there were never enough personnel to perform a continuous inspection during foodstuff processing nor did those present have authority to threaten contract cancellation for noncooperating producers, as was done so effectively in Australia. By persuasion and instruction, however, inspectors did succeed in improving food quality and raising sanitary standards in most plants supplying products to the Board. This was usually done by showing the producer that better sanitation and more modern processing methods meant fewer losses by contamination or spoilage.57

Inspection of Eating Establishments

The many civilian restaurants and dairy bars offered a welcome diversion from Army messes for the large numbers of soldiers sent to New Zealand for rest, rehabilitation, and convalescence. On the whole, these eating places were reasonably sanitary; the few maintaining less than acceptable standards were placed "off limits" to our troops after inspection by U.S. personnel who, at least in Auckland, were able to inspect cafes and restaurants through the cooperation of the Public Health Officer. Dairy bars

57(1) Moore, Col. H. K., MC: History of the Army Veterinary Service With the United States Joint Purchasing Board, New Zealand, 29 Oct. 1945, ch. II. (2) See footnote 38 (1) p. 552. (3) Medical Department, United States Army. Organization and Administration in World War II. Washington: U.S. Government Printing Office, 1963, pp. 391-392.


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proved the most troublesome from the preventive medicine standpoint because pasteurization was rarely accomplished and raw milk was often mixed with pasteurized milk. Only one of the three large Auckland dairies produced milk which met U.S. standards, and the small amount of milk purchased for troop messes was bought from that dairy. Not until quite late in the war did the other two dairies qualify. Milk was not the same desirable beverage to the typical New Zealander that it was to the American. The New Zealander much preferred tea, and fresh milk's reputation for periodically causing typhoid epidemics caused many to shun it in favor of evaporated milk. Home-delivered milk was carried on carts in large, often uncovered containers, and poured, or dipped, into vessels the purchasers brought themselves. The entire transaction took place on streets both paved and unpaved. Containers were seldom sterilized, and the average person working with milk was unschooled in the need for cleanliness. One U.S. medical officer recalls that "the milk bars did not seem clean, were odorous and sour smelling." He also reported that at least one New Zealand public health officer, in despair over the unsanitary milk handling conditions, "thought that milk should not be permitted as a beverage."58 Under these conditions, it was decided that milk bars would be placed "off limits" to U.S. troops. Despite many discussions between American and New Zealand public health officials, progress in improving the product was slow and never accomplished to the full satisfaction of U.S. officials.

MISCELLANEOUS CIVIL AFFAIRS

Quarantine

Responsibility for enforcement of New Zealand quarantine regulations rested with the Port Health Officer at each port of entry until 13 September 1943 when U.S. authorities were permitted to inspect vessels and airplanes. Discussions to this end had begun between public health officials and military officers as early as November 1942. The long interval between the beginning of discussion and the final enactment of enabling legislation would indicate some reluctance to delegate the inspection function. This is borne out further when one considers that even the New Zealand armed forces were not permitted to conduct their own inspections until this time.

The new regulation permitted the military medical officers of either nation to inspect and disinsectize their own ships and aircraft. They were also required to report any suspicious illness or disease among passengers to the civil public health officer. In the same regulation, civilian harbormasters were directed to keep down the rat and mosquito populations at ports, and military airbase commanders were told to establish mosquito control measures for a distance of 1 mile outside their bases.

58(1) See footnote 48 (1), p. 558, and pages 164-167 of footnote 57 (1), p. 562. (2) Koontz, Amos R., M.D., unpublished manuscript, 1964, subject: Civil Affairs-Military Government Public Health Activities, New Zealand.


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Enforcement of disinsectizing regulations in actual practice was somewhat less than perfect as is evidenced by the adoption in August 1944 of an amendment to the quarantine regulations, providing that a fine of LNZ 50 ($160.30) be assessed against any person leaving an aircraft or taking anything from it less than 5 minutes after fumigating or spraying. Although this regulation specifically applied to military personnel and aircraft, there is no record of an actual levying of the fine against any U.S. military personnel.59

Professional Relationships

Rapport between U.S. medical personnel and their New Zealand counterparts, both civilian and military, was excellent. On numerous occasions, American servicemen were admitted to civilian hospitals and placed under the care of staff physicians. Conversely, to the great appreciation of the Auckland Hospital Board, seven medical officers served the staff of Auckland City Hospital for about 3 months to help alleviate the shortage of civilian physicians while the 39th General Hospital was awaiting construction of its buildings. Civilian physicians and personnel of allied professions were extremely anxious to help their American counterparts. They eagerly shared their knowledge of South Pacific tropical diseases, their resources and equipment, assisting in every way possible. This was reciprocated whenever practicable, such as in the administration of penicillin to civilians. Illustrative of the mutual respect existing were the monthly meetings of Auckland members of the British Medical Association with the combined staffs of the 39th General Hospital and the U.S. naval hospitals. Case studies and papers were presented at these meetings and joint clinics were held at both military and civilian hospitals.60

59(1) Notes of conference held on 2 September 1943 at the Department of Health, Wellington. These notes refer to a previous meeting on the subject of quarantine, at which a resolution was passed recommending certain changes in quarantine procedures. (2) Memorandum, Office of Minister of Health, Wellington, to Minister of Defense, 16 Dec. 1942, subject: Quarantine Responsibilities of Military Forces (NZ and US). (3) The Quarantine (Armed Forces) Emergency Regulations 1943 and Quarantine Regulations 1921, Amendment No. 3, effective on 21 August 1944.
60(1) See footnotes 50 (3) p. 558, and 58 (2) p. 563. (2) History of the 39th General Hospital, quarterly period 1 April-1 July 1944.

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