U.S. Army Medical Department, Office of Medical History
Skip Navigation, go to content

HISTORY OF THE OFFICE OF MEDICAL HISTORY

AMEDD BIOGRAPHIES

AMEDD CORPS HISTORY

BOOKS AND DOCUMENTS

HISTORICAL ART WORK & IMAGES

MEDICAL MEMOIRS

AMEDD MEDAL OF HONOR RECIPIENTS External Link, Opens in New Window

ORGANIZATIONAL HISTORIES

THE SURGEONS GENERAL

ANNUAL REPORTS OF THE SURGEON GENERAL

AMEDD UNIT PATCHES AND LINEAGE

THE AMEDD HISTORIAN NEWSLETTER

Chapter 17

Contents

Part VI

ASIA


CHAPTER XVII

China-Burma-India Theater

Kirk T. Mosley, M. D., and Captain Darrell G. McPherson, MSC, AUS

ORGANIZATIONAL BACKGROUND

The CBI (China-Burma-India) Theater was created on 4 March 1942 when the U. S. Forces Commander, Lt. Gen. (later Gen.) Joseph W. Stilwell, established his headquarters in Chungking, the wartime capital of China. As the theater was being organized, it consisted of a Theater Headquarters, SOS (Services of Supply), the Army Air Forces, and the Air Transport Command. Major responsibility for civil public health activities fell to the Theater Surgeon, Col. (later Brig. Gen.)Robert P. Williams, MC, and the Services of Supply Surgeon, Col. John M. Tamraz, MC.1

The Theater Surgeon's staff operated two headquarters, the "forward echelon" at Chungking and the "rear echelon" at New Delhi, India, until August 1944. At that time, the SOS Surgeon was named Deputy Theater Surgeon as an additional duty and headed a combined staff of theater and SOS personnel, already located in New Delhi (map 21). Col. Alexander O. Haff, MC, was named to this Deputy position, having replaced Colonel Tamraz when the latter rotated to the United States in the spring of 1944.

After General Stilwell's recall in October 1944, the CBI was split into two theaters: the China Theater commanded by Lt. Gen. Albert C. Wedemeyer, and the India-Burma Theater headed by Lt. Gen. Daniel I. Sultan. Thereafter, Col. (later Surgeon General of the Army) George E. Armstrong, MC, directed medical activities in China. Colonel Williams continued as Theater Surgeon in India-Burma until February 1945, when Brig. Gen. James E. Baylis, MC, was named Theater Surgeon and SOS Surgeon, replacing both Williams and Haff. General Baylis returned to the United States in September 1945. Col. Karl R. Lundeberg, MC, who had headed Preventive Medicine activities in India-Burma, served as theater surgeon until December, when Lt. Col. Howard A. Van Auken, MC, succeeded him.

During the war, the primary concern of American military personnel in China and northeastern India was the development of an effective Chinese fighting force while, elsewhere in India, attention was focused on the development and use of U.S. service, air, and ground combat troops. Although medical officers throughout the CBI, especially in India, became

1(1) History of the United States Army Medical Service in the War Against Japan, ch. X. [In preparation.] (2) Medical Department, United States Army. Organization and Administration in World War II. Washington: U.S. Government Printing Office, 1963, ch. XII.


634

MAP 21.-China-Burma-India Theater.


635

involved with specific civil public health activities, no special organization for directing civil public health functioned anywhere in the area until after October 1944. Then, a G-5 Section was organized as part of the General Staff of the newly created China Theater, and within the section, a Civil Affairs Branch outlined provisions for health activities for civil populations in reoccupied areas. However, since the potential reoccupied areas in the theater were to be returned to China, an Allied power, the direct responsibility for restoring civil administration rested with the Chinese Government, and the Civil Affairs Branch acted in an advisory capacity only.2

After the Japanese surrender in September 1945, forces in both theaters were reduced rapidly, and civil public health activity ceased almost immediately in the India-Burma area. Medical activities in the China Theater were moved to Shanghai, where, for the first time in the whole area, civil public health planning and activity involved a considerable share of the effort devoted to Preventive Medicine. By that time, however, forces had been drastically reduced, and in April 1946, the China Theater was closed, which was followed 1 month later by the inactivation of the India-Burma Theater.

CIVIL PUBLIC HEALTH PROBLEMS

The overwhelming problems of disease and malnutrition among the millions in the China-Burma-India area during World War II might lead one to believe that the U.S. Army could have fulfilled a civil public health function of lasting historical importance. Yet, for reasons which become obvious after a brief examination of the factors involved, the Army's role in promoting the health of civilians there was minimal.

Diseases.-In these three countries which encompassed about twice as much land as the United States, and where transportation and communication were extremely limited and out-of-date, the population totaled more than 790 million. Among these millions raged epidemics of diseases that most American physicians in the theater had only heard about. Plague, cholera, epidemic typhus, scrub typhus, and malaria were common in many parts of the theater, and the spread of these and other diseases was increased by the hardships of war and the erratic and uncontrolled movements of millions of refugees.3

Other endemic diseases included various types of worm infections, tetanus, rabies, leprosy, venereal diseases, yaws, encephalitis, poliomyelitis, meningitis, diarrhea, dysentery, typhoid and paratyphoid fevers, dengue, tuberculosis, diphtheria, measles, smallpox, and various types of animal diseases affecting humans. Many of these diseases became epidemic at frequent intervals. Their spread and the possible spread of some diseases not endemic in the three countries were made possible by the overabundance of peo-

2Mosley, Kirk T.: History of the G-5 Section, China Theater, 21 December 1945. [Official record.]
3Simmons, James Stevens, Whayne, Tom F., Anderson, Gaylord West, Horack, Harold MacLachlan, and collaborators: Global Epidemiology, A Geography of Disease and Sanitation. Volume I. Philadelphia: J. B. Lippincott Co., 1944, pp. 1-16, 34-76, 105-130.


636

ple, filth, rats, fleas, mites, flies, lice, bedbugs, ticks, and scores of varieties of mosquitoes.

Civilian health services, clean water, and safe sewage disposal facilities were totally inadequate throughout the area.

Army responsibilities.-The number of American Army medical personnel assigned to the CBI (few of whom were Preventive Medicine specialists) reached a peak of 20,025 in May 1945, having gradually built up from only 119 in March 1942.4 These persons were kept busy trying to bring down the high rates of malaria, and venereal and enteric diseases among U.S. troops, as well as to meet extensive responsibilities for the health of the Chinese armies in training and in combat. In these circumstances, and with the threat that epidemics of plague, cholera, typhus, or other diseases might engulf the military at any time, the Army's prime responsibility was to make certain that areas where troops were concentrated were relatively free of health hazards. To do this, medical personnel maintained liaison with civil and military authorities of Allied powers and, in confined areas, carried out civil public health procedures, such as mosquito control, rodent control, and sanitation activities. Such public health procedures were carried out in areas in which the health of the troops was actually endangered. Generally, they were reactions to health hazards as they occurred rather than well-coordinated and carefully weighed programs planned for the benefit of the civilian population.

Subjects which became of specific concern to the Army in its attempts to make areas safe for troops included political and social complications, liaison, direct medical aid to civilians, sanitation problems, and some of the more important diseases endemic and epidemic in the three countries.

Political and Social Complications

Not only was China divided between the Japanese and Chinese, but also those regions still held by the Chinese were split further by warring political factions, of which the followers of Gen. Chiang Kai-shek and the Communists were the strongest. That portion of Burma not occupied by the Japanese was torn between nationalist and pro-British natives, with some of the nationalists preferring the Japanese to the British. Similarly, India was in the midst of a nationalist struggle with Britain and this situation was complicated further by internal struggles between Hindu and Muslim groups. Indian nationalists regarded the arrival of Americans in the theater as reinforcement for the British and, therefore, were not disposed to be cooperative when cooperation was necessary to carry out civil health measures.

India was divided into 12 British provinces and some 560 Indian states; the latter enjoyed local self-government but were bound by British treaties. A complicated hierarchy of British, national, district, municipal,

4Medical Department, United States Army. Personnel in World War II. Washington: U.S. Government Printing Office, 1963, pp. 347 and 360.


637

and local officialdom made up the health administration. A similar situation existed in China, where the central government, headed by General Chiang, maintained general political supremacy in some areas, but where provincial officials had almost absolute power locally. Burma was a combat zone. Civil public health machinery in all three countries had been inadequate in controlling diseases through the years and could offer only a limited amount of effective cooperation to the military.

All but a small percentage of the immense population of the theater were poor, illiterate, and unorganized peasants. Disease and famine reaped fantastic mortality rates while the great majority of the living existed only a few mouthfuls of food away from death. The size of the populations was almost equaled by their great diversity in cultural, racial, and linguistic characteristics.

Religious and cultural traditions combined with the other conditions to reduce further the effectiveness of attempts by U.S. Army personnel to improve health within the theater. For example, one religious sect in India so objected to the taking of life that antimosquito measures were considered to be murder. Some of these people would cover their noses with cloth to avoid breathing in and killing any tiny form of life. Among the Hindus at that time, it was important that food be prepared by a member of the same or a higher caste, while contamination by flies or vermin was considered relatively unimportant. The filthy waters from sacred rivers were considered pure and beneficial to drink. Attempts by outsiders over a period of months to change such conditions, even on a small scale, could not make any impression on the traditions and habits of centuries.5

Liaison and Command Relations

China.-Most official contact with other governments was handled through command channels. As part of the mission to increase the combat efficiency of the Chinese Army, the Theater Surgeon, Colonel Williams, held regular conferences with the Surgeon General of the Chinese Army Medical Administration, the Director General of the National Health Administration (China), and the Director General of the National Red Cross Society of China.6 The National Health Administration was the chief official civilian agency concerned with medicine. The U.S. Army coordinated plans with the agency when a plague epidemic threatened the civilian population in 1944. The Theater Surgeon also helped to arrange for the postgraduate training in the United States of some 20 members of the National Health Administration and subsequently arranged for their transportation to America.7 Red Cross supplies allotted to the National Health Administra-

5(1) Stone, Lt. James H.: The Organization and Administration of the Medical Department in the China-Burma-India and India-Burma Theaters, 1942 to 1946, pp. 20-21. [Official record.] (2) Ross, Lt. Col. Stuart T.: History of the U.S. Army Medical Department in Delhi, India, 1945. [Official record.]
6Annual Reports of Medical Department Activities, Surgeon, China-Burma-India Theater, 1943 and 1944.
7Annual Report, Surgeon, China Theater, 1944.


638

tion were transported within China by Fourteenth Air Force planes on some occasions though the general policy was that supplies for civilian agencies should be carried by Chinese planes, using the facilities at U.S. bases, but not American planes.8

Personnel from the Theater Surgeon's office communicated regularly with representatives of the United China Relief, British and Canadian Red Cross organizations, and other agencies to advise them on financial assistance, to preclude duplication of effort, and to keep their aims pointed toward winning the war. Civilian agencies in China, particularly the National Epidemic Prevention Bureau, provided laboratory services for the U.S. Army, and the Army reciprocated by furnishing transportation when the agency was forced to evacuate before the advancing Japanese.9 Some sort of contact was made with scores of missionary and relief organizations operating in the theater; however, the efforts of many of these organizations were curtailed somewhat during the war, and no extensive cooperation between them and the Army was reported.

India.-The SOS Surgeon, Colonel Tamraz, worked on a more informal level with British and Indian officials and made several inspections of civilian hospitals in India, in part for possible American military use should that become necessary. The British and Americans freely exchanged hospitalization at the local level when there was a need. Colonel Tamraz also worked directly with Indian officials in obtaining the admission of U.S. Medical Corps officers to the School of Tropical Medicine at Calcutta,10 and also arranged with the Indian Medical Service for a course of instruction in tropical diseases to be given to some American officers at Bombay.

Medical Corps officers maintained informal contact at the local level with civilian hospitals and officials. Health institutes and medical schools in the area were sometimes consulted on diseases of local importance, and statistics concerning the health of civilians were gathered from local governmental and military officials. However, the U.S. Army Medical Department did not use local agencies extensively as advisers on an official and standing basis.11 A limited number of cooperative measures on sanitation and antimalaria procedures were worked out with local authorities (see pp. 642 and 647).

Direct Aid to Civilians

In Burma, Army medical personnel gave treatment and emergency aid to native tribesmen who visited the several aid stations set up to provide care for troops constructing the Ledo Road, for patrols, and for Chinese sol-

8Letter, Maj. Gen. T. G. Hearn, GSC, Chief of Staff, China Burma-India Theater, to H. Hughes Wagner, D.D., 1 Apr. 1944.
9Letter, Robert M. Drummond, Special Red Cross Representative, Kweiyang, to John D. Nichols, Director, China Unit, American Red Cross, 15 Dec. 1944, subject: Trip to Kweiyang and Report on the Kweiyang Situation, November 21st-December 5th.
10See pages 185-186 of footnote 5 (1), p. 637.
11See pages 185-186 of footnote 5 (1), p. 637.


639

diers being trained nearby. Provision of such aid to civilians was certainly unofficial, but sanctioned, and came about of necessity as a means of insuring the natives' tolerance of Allied military activity. The aid proved to be an excellent means of securing good will and helped make possible the acquisition of guides, laborers, housing, and other necessities, as well as information about enemy movement and assistance in rescuing downed airmen.12 Unofficial aid to civilians was also offered by the many native nurses working with the Army and by personnel of medical units accompanying combat forces in the area (fig. 83).

In India and China also, American personnel sometimes offered unauthorized emergency medical aid directly to civilians, or transported the injured or sick to a civilian hospital, thus involving the U.S. Government in some responsibility for the hospitalization.13Problems arose because civilian hospitals sometimes refused to admit patients injured by American personnel or equipment unless the individual deposited funds in advance. Sometimes, bills were sent to the U.S. Government.

Employees.-Conditions varied so greatly that a general theater policy on the treatment of civilians employed at U. S. military installations was not considered practicable until January 1944. At that time, the CBI Theater Surgeon pointed out that medical officers should not compete with local practitioners, but that, in accordance with Army Regulations No. 40-505, dated 1 September 1942, the Army could provide medical aid for civilian employees at stations where other medical attendance was not available The failure of civilian contractors, authorities, and relief agencies to provide medical facilities for locally procured civilian employees led Adm. Louis Mountbatten, the South East Asia Theater Commander, to announce in May that the Army would provide medical treatment for such employees at military works in Assam and Ceylon.14

Dependents.-The question of providing care for dependents of employees at Ramgarh arose early in 1944. The Theater Surgeon, Colonel Williams, decided that, because the unskilled laborers, sweepers, constables, and other civilian employees were necessary for the operation of the training post, because the families of these employees were already living there, and because no other medical facilities were available for their use in that part of India, the United States was obligated to care for them.15

In May 1945, the China Theater commander spelled out exactly how much and to which civilians medical care or expenses for medical treatment

12Stone, Lt. James H.: The Hospitalization and Evacuation of Sick and Wounded in the Communications Zone, China-Burma-India and India-Burma Theaters, 1942-1946, p. 39. [Official record.]
13Essential Technical Medical Data Report, Rear Echelon, Headquarters, United States Forces, China Theater, Office of the Chief Surgeon, 30 May 1945, p. 3.
14(1) First endorsement, Theater Surgeon, China-Burma-India, 3 Feb. 1944, to letter, Col. Elias E. Cooley, MC, Rear Echelon, Headquarters, USAF, China-Burma-India, to Theater Surgeon, 17 Jan. 1944, subject: Policy of Medical Treatment for Civilian Employees. (2) Memorandum, Supreme Allied Commander Advance Headquarters, South East Asia Theater, to General Headquarters, India, 26 May 1944.
15First endorsement to memorandum, Assistant Theater Surgeon, Rear Echelon, USAF in China-Burma-India, to Theater Surgeon, 9 Feb. 1944.


640

FIGURE 83.-Maj. Seldon O. Baggett, MC, examines natives typical of those who flocked daily to the 46th Portable Hospital in Hsipaw, Burma, in April 1945.

could be offered.16 Any civilian injured by personnel or equipment of the U.S. forces, or any employee becoming ill as a result of employment, was eligible for care. Civilians employed by contractors (who were obligated to provide their own medical care for employees) or individuals picked up and taken to hospitals by Americans for humanitarian reasons were not considered eligible. Contracts to provide aid to authorized persons at U.S. Government expense were signed with specific civilian hospitals.

Contractors in the India-Burma Theater were also obligated to provide their own medical care for civil employees. However, in at least one instance, the Army stepped in to provide inoculations. In May 1945, General Baylis, India-Burma Theater Surgeon, pointed out to Brig. Gen. Joseph A. Cranston, Intermediate Section commander, that smallpox, cholera, and typhoid fever were common among the natives in his section. General Baylis suggested that the native drivers for several civilian motortruck units destined for duty along the railway in that section be vaccinated as a protective measure for American troops who would be in contact with them. General Cranston ordered the vaccinations immediately, but pointed out that the con-

16Circular No. 73, Rear Echelon Headquarters, U.S. Forces, China Theater, 22 May 1945.


641

tractors again would be obligated to provide their own vaccine and other medical services as soon as they received their own supplies.17

Refugees.-Efforts of the U.S. Army to help some of the civilian population in closest contact with American troops involved considerable expense and time. Little in supplies and personnel was allotted to the CBI during most of the war in relation to the hundreds of millions of civilians living in the area and the huge numbers of civilian refugees on the move. These refugees always streamed in front of advancing forces in the combat zones. More than 200,000 came into Kweiyang during the first evacuation of Kweilin in July 1944. In the last 2 months of the year, millions of homeless refugees trudged on foot out of Kweilin, Liuchow, Ishan, and Tushan, clogging all roads. During one 10-hour jeep trip from Tushan to Kweiyang, Americans observed 800 bodies, stripped of everything useful, along the shoulders of the road.18 Of course, disease was common among the millions of homeless. Chinese relief agencies did what they could. DDT was requisitioned to delouse civilians in close proximity to U.S. camps, but it was not available for such use in that area during the war. The Army did provide a limited amount of truck space, on already scheduled trips, to haul supplies for civilian relief agencies.19

Sanitation and Veterinary Problems

Typical conditions in the CBI theater during the war are reflected in descriptions of some of the travel experiences of Colonel Tamraz. Despite all his precautions, Colonel Tamraz was undergoing a siege of diarrhea contracted while on a tour of inspection in India, when his train pulled into a station in August 1942. "The filth, dirt, and smell in most of the railroad stations is appalling," he recorded in his diary. "It is a frequent sight to see children being allowed to defecate right on the platforms. Vendors of food are dirty and messy, and yet they are allowed to sell contaminated and filthy food to passengers."

Later that year, Colonel Tamraz wrote, "One of the most disgusting sights while traveling is to see passengers rush out immediately on the stopping of the train to urinate and defecate in plain view of all the passengers. This may be done right near a brook or a river where other passengers are filling their canteens with water for washing their faces or scrubbing their teeth. It is no wonder that infection and contagious diseases run rampant in this country * * *"

The British, even in their newer hospitals, had not installed flush-type

17(1) Letter, Theater Surgeon, India-Burma Theater, to Commanding General, Intermediate Section, 16 May 1945. (2) Letter, Commanding General, Headquarters, Intermediate Section, SOS, U.S. Forces in India-Burma Theater, to Theater Surgeon, Headquarters, U.S. Forces, India-Burma Theater, 18 May 1945.
18Annual Report of Medical Activities, Headquarters, Services of Supply Area Command, U.S. Forces in China Theater, 1944, p. 5.
19(1) See footnote 9, p. 638. (2) Letter, Robert M. Drummond, Kweiyang, to John D. Nichols, Director, China Unit, American Red Cross, 9 Oct. 1944, subject: Trip to Ishan.


642

sewage disposal facilities but used the "sweeper" system in which feces were collected by low-caste Indians and disposed of in septic tanks.20

The water supply throughout the theater was usually polluted; cities were fantastically overcrowded; the habits of the native populations were highly insanitary; human excreta was used as fertilizer; refrigeration facilities were meager and, where ice was available, it was often polluted. Even in New Delhi, considered a favored area, the restaurants, markets, and food transportation facilities (bullock carts) were dangerously filthy. Samplings of milk from pasteurizing plants showed bacterial counts approximating those for raw sewage. Disease was everywhere.

If similar conditions were not complained of as often in China as they were in India, it was only because there were fewer troops in contact with the local inhabitants.

U.S. Army personnel in both China and India were billeted at times in local hostels, some food had to be procured locally, and the Americans traveled and traded within the local economies and came regularly into close contact with the native populace. The Army restricted and supervised the use of native labor in messhalls and assigned the few Veterinary and Preventive Medicine personnel available for such duty to inspect civilian hotels, cafes, and food selling establishments. "In-bounds" and "out-of-bounds" procedures were the only control the Army had over local businesses. A Medical Department inspection mission in India in 1944 reported that the in-bounds control policy was very limited in its success because all restaurants were so filthy that any attempt to bring them up to occidental standards would simply result in "placing all restaurants out-of-bounds and create a hopeless morale and police problem for military authorities."21

Sanitation.-In some areas of India, responsibility for control of sanitation was shared, from time to time, with the British, or divided between the British and Americans, on either a formal or an informal basis. In places like Karachi and Calcutta, Allied Sanitary Commissions or Allied Hygiene Committees were formally organized to give direction and order to combined efforts. When the two forces disagreed, as they sometimes did, about such policies as putting a particular restaurant out-of-bounds, the overall sanitation program suffered.22

The Indian Government assumed a limited amount of responsibility for sanitation near Army installations, such as reducing fly breeding in designated villages. However, the problem of sanitation was enormous, and the

20Tamraz, Col. John M.: History of the Medical Department Activities in India, pp. 15, 59, and 86-87. [Official record.]
21Report, Brig. Gen. Raymond A. Kelser, Col. Robert H. Kennedy, and Col. Karl R. Lundeberg, to Commanding General, U.S. Forces, India-Burma Theater, 9 Nov. 1944, subject: Report of Medical Department Mission, p. 18.
22(1) Letter, Col. Karl R. Lundeberg, SOS Medical Inspector, to Surgeon, SOS, U.S. Forces, India-Burma Theater, 21 Dec. 1944, subject: Field Trip-Sanitary Inspection of Bombay, Lake Beale, and Camp Kalyan. (2) Van Auken, Lt. Col. H. A., MC: A History of Preventive Medicine in the United States Army Forces of the India-Burma Theater, 1942 to 1945, dated 8 Dec. 1945 (section, "History of Restaurant Sanitation in the Calcutta Area"). [Official record.] (3) See page 51 of footnote 5 (2), p. 637.


643

Indians did not have effective laws or procedures to enforce sanitation regulations. For example, a health officer was a licensing authority, but withholding a license for lack of proper sanitation did not close a business. A food processing organization, such as an ice cream plant, could easily absorb the small fine imposed daily for operating without a license, and continue in business, no matter how filthy the surroundings.23 In addition, the Indian governmental health organizations were so entangled in bureaucratic red tape and their limitations were so great that neither attempts at cooperation nor attempts by the Indians to meet commitments for sanitation were satisfactory.24 No sanitation efforts were ever successful enough to protect troops from repeated attacks of diarrhea and dysentery.

Procurement of food-Early in the war, the Army had to rely, for the most part, on locally procured food. Meat for the troops was slaughtered in local abattoirs. However, the short supply of Veterinarians who could be used to inspect local food sources; the questionable sources and quality of all food of animal origin; the lack of storage and refrigeration facilities; the hot, muggy weather; and the filth in local markets and abattoirs quickly led to the condemnation of local procurement.25 In 1942, the base section Veterinarian at Karachi inspected the local abattoir, iceplant, and dairy. He condemned them all and recommended that SOS build and operate its own food-processing plants, a step which later became standard at all large U.S. troop concentrations.26

Animals to be slaughtered were often so emaciated that it was doubtful that the flesh contained enough nutriments to be of benefit. Sometimes whole herds were observed with rinderpest, foot-and-mouth disease, or anthrax. An Indian law protected working bullocks under 10 years of age as well as pregnant cows and cows in milk, further decreasing available beef.27 Generally, safe pork products were lacking. In some areas, Veterinary personnel could only select the best from very poor quality food and determine whether or not it was safe for consumption. By 1945, however, the Army had built many of its own facilities, and a few more Veterinarians were available. Only about one-sixth of the meat used by the U. S. military in the Delhi area, for instance, was slaughtered locally, and this under the direct supervision of a Veterinary officer; the remainder was imported.28

23See page 42 of footnote 5 (2), p. 637.
24(1) Letter, S. N. Russell, Deputy Secretary to the Government of India, to Commanding General, U.S. Forces, India-Burma Theater, 29 May 1945, subject: Anti-Infection Measures Around USAAF Installations. (2) Letter, D. G. Bhore, Under Secretary to the Government of India, to Commanding General, U.S. Forces, India-Burma Theater, 7 July 1945, subject: Anti-Infection Measures Around USAF Installations.
25(1) Essential Technical Medical Data From Overseas Forces, Rear Echelon Headquarters, U.S. Army Forces, China-Burma-India, 6 Sept. 1943, pp. 7-8. (2) Jennings, Lt. Col. William E.: Report of Medical Department Activities in China-Burma-India, dated 5 Feb. 1945.
26For a complete discussion of veterinary responsibilities for food inspection and animal care in the CBI theater, see Medical Department, United States Army. United States Army Veterinary Service in World War II. Washington: U.S. Government Printing Office, 1961, pp. 340-379.
27Essential Technical Medical Data From Overseas Forces, Rear Echelon, Headquarters, USAF, CBI, 13 Dec. 1943. 
28
See page 56 of footnote 5 (2), p. 637.


644

In India, attempts to improve the food supply for the protection of the military may have led to some small improvements in the civilian food supply.

U.S. Army Veterinarians worked closely with civil and military authorities in the three countries of the CBI theater concerning the procurement and care of pack animals.29 In rare instances, U.S. aid may have helped keep animal diseases from spreading to human populations,30 but, on the whole, the health of the civil populace was not affected.

DISEASE PROBLEMS

Cholera

Sanitary deficiencies were the main cause for the frequent cholera outbreaks among civilians in the CBI theater during the war. The Army's action against these conditions was limited, as described, but the incidence of cholera among U.S. troops was kept to a minimum as a result of onpost sanitation programs, educational campaigns, and immunization procedures, as well as frequent inspections of those civilian eating establishments most frequented by Americans.

Inoculation policies.-American troops going into the theater were inoculated with cholera vaccine, and inoculations were repeated in local areas when an outbreak was reported. Within the civilian population of India, outbreaks were reported by doctors in the cities or by village headmen to the nearest civil medical officer who, in turn, sent out technicians to inoculate the residents of the affected area.31 The Army task in strictly civilian epidemic areas consisted mostly of keeping informed of the extent and direction of the epidemics.

Typical of problems connected with cholera were the insanitary conditions at Chittagong, East Bengal, in 1943. The Fourth Combat Cargo Group occupied quarters near an abandoned prison where some dilapidated mud-walled buildings still stood. Some of the old buildings were occupied by Indian laborers working for the Army while other buildings served as latrines. Most were dirty and fly filled; all were honeycombed with ratholes. In cooperation with local Indian authorities, the laborers were removed and the buildings demolished. Housing for the laborers was then provided in tents.32 Similarly, when cholera reached epidemic proportions in native villages near American installations, Army engineers razed the villages with

29Pyle, Lt. Col. Norman J., VC: Report of Mission to China, 29 June 1944. [Official record.]
30Letter, Col. George E. Armstrong, Surgeon, China Theater, to Maj. Gen. Norman T. Kirk, The Surgeon General, 31 Aug. 1945.
31Report, Col. Elias E. Cooley to Theater Surgeon, U.S. Army Forces, China-Burma-India, 7 Dec. 1943, subject: Report on Cholera in Lakhimpur District, Assam, and Dacca District, Bengal.
32Essential Technical Medical Data, Headquarters, India-Burma Theater, 1 June 1945. (Enclosure: Mosley, Maj. Kirk T.: Investigation of Three Cases of Suspected Cholera Reported by the Fourth Combat Cargo Group.) 


645

the cooperation of the Indian Government. In other instances, the U.S. bases had to be moved to another area.33

Out-of-bounds procedures were the most common weapon of Army cholera fighters. During a 1945 epidemic of cholera in Calcutta, the Allied Hygiene Committee made more frequent and stricter restaurant inspections34 and required during the epidemic that: all restaurant employees be immunized, only hot cooked foods be served, water be sterilized, and no ice be used in drinks. Sometimes, whole cities had to be put out of bounds, as Old Delhi was in 1944.

Other procedures usually put into effect by the Army during epidemics included inoculating all Indian servants and releasing those native bearers and food handlers who came from epidemic villages. Also, the hiring of native personnel was suspended during epidemics.

Direct assistance.-On at least one occasion, medical officers from Army malaria groups were directed to lend assistance to local health officials, who conducted educational campaigns in affected villages.35 These campaigns emphasized the boiling of water and the burning of dead bodies rather than their disposal in rivulets and tanks to become further sources of disease.

In China, the Army sent officers to observe firsthand the efforts by the National Health Administration and other Chinese agencies to stop epidemics which might affect military operations. A thorough check was made on what was being done by the civilian agencies, and epidemic areas were inspected, but little more than encouragement could be offered.36 Cities such as Liangshan were put out of bounds during epidemics while preventive measures on post were tightened.37 Cholera was widespread among the thousands of refugees in China, and the U.S. Army's localized efforts may have had a slight effect on the problem of cholera among the millions throughout the theater.38

Plague

Plague had been reported regularly from China, Burma, and India for more than 20 years before 1945. The disease became of increasing concern to the military in 1944 and 1945 as more and more outbreaks were reported,

33Essential Technical Medical Data From Overseas Forces, Rear Echelon, Headquarters, U.S. Army Forces, China-Burma-India, 12 Aug. 1943.
34See footnote 22 (2), p. 642.
35Letter, Surgeon, 7th Bombardment Group, to Commanding Officer, 7th Bombardment Group (H), AAF, Panda, India, 16 June 1943, subject: Cholera Epidemic Among Natives in Panda.
36(1) Annual Report, Medical Department, India-Burma Theater, 1944, pp. 44-45. (2) Memorandum, Lt. Col. Marcus D. Kogel for Theater Surgeon, China Theater, 7 July 1945, subject: Trip to Chungking and Environs to Estimate Cholera Situation and Recommend Protective Measures for Our Troops.
37Annual Report, Medical Department Activities, Fourteenth Air Force, 1 Apr.-30 Nov. 1945, p. 9. 
38For additional information about cholera in the CBI, see Medical Department, United States Army. Preventive Medicine in World War II. Volume IV. Communicable Diseases Transmitted Chiefly Through Respiratory and Alimentary Tracts. Washington: U.S. Government Printing Office, 1958, pp. 455-460.


646

especially in connection with the movement of refugees in China.39 Medical personnel inoculated American and Chinese military personnel as well as civilian laborers working for the Army. Colonel Armstrong, the China Theater Surgeon, kept in close contact with the Chinese National Health Administration about the progress of the disease. He also detailed some American military personnel, including a Sanitary Corps officer, to maintain liaison and to help civilians trying to stamp out the disease in local communities.40 Colonel Armstrong reported to The Surgeon General in August 1945 that "American military supervision in western Yunnan Province has squelched two plague epidemics in that area."41 Actions taken by the governmental agencies, with which the military cooperated, consisted of the inoculation of civilians and the execution of a vigorous rodent extermination program (fig. 84). Civilian ambulance units attached to a Chinese division sometimes assisted the National Health Administration in its civilian inoculation program.

China Theater personnel carried out a rodent survey and control program in 1945. The lack of trained personnel and the immensity of the rodent problem in many areas limited the Army's activities to protecting the military. Thus, the program had but little effect in civilian communities.42

Malaria

Malaria was an especially difficult problem in refugee and combat areas, and where great numbers of civilian laborers were used; it was always a threat to American troops billeted in, or passing through, the endemic and epidemic areas throughout the theater. An estimated 100 million to 200 million of India's 388 million people had malaria in 1941. In Burma, the death rate from malaria was 214 per 100,000 population in the towns alone.43 Malaria was a serious problem in China also, but statistics concerning its incidence there are not available.

Only a few U.S. Public Health Service officers (assigned to the Army) and a relative handful of supplies were available to fight the disease in 1942; but by 1943, a malariologist and a number of antimalaria units were requisitioned from the United States, and a control program, headed by Lt. Col. (later Col.) Earle M. Rice, MC, was underway. The personnel situation improved steadily thereafter and several officers were sent to be trained at the Calcutta School of Tropical Medicine and the Malaria Institute in Delhi.

39Letter, Surgeon, China Theater, to The Surgeon General, 2 Dec. 1944.
40(1) Letter, Surgeon, China Theater, to The Surgeon General, 27 Jan. 1945. (2) Pin Hui Teng: Report of Plague Control Work in the Tengchung Area and Along the Burma Road, Yunnan Province, China, 16 January-20 April 1945. [Official record.]
41See footnote 30, p. 644.
42(1) Report, Surgeon, China Theater, to The Surgeon General, attention: Army Committee for Insect and Rodent Control, 31 Aug. 1945, subject: Rodent Survey and Control. (2) For additional information on rodent control in the CBI theater, see Medical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955.
43(1) War Department Technical Bulletin (TB MED) 174, July 1945, subject: Medical and Sanitary Data on India. (2) War Department Technical Bulletin (TB MED) 77, 2 Aug. 1944, subject: Medical and Sanitary Data on Burma.


647

FIGURE 84.-Rats, caught alive in Nantien, China, for examination and experimentation, February 1945.

Before the end of the war, malaria rates among U.S. troops were down to an insignificant level. In addition to Malaria Survey and Control Units with theaterwide responsibilities, antimalaria details (fig. 85) were formed in all companies and other organizations throughout the CBI theater by direction of War Department Circular 223, dated 21 September 1943, and theater circulars.

Spraying.-After small quantities of DDT arrived in the theater in 1944 and first tests indicated that the insecticide was much more effective than any other agent then available,44 residual spraying became the top priority job of all vector control work. By agreement with local governments, all native dwellings within a control zone, usually a 1-mile radius of an installation, were also sprayed.45 Many U. S. installations were surrounded by agricultural villages and paddy fields. Local economic conditions made it impossible to move the natives or to drain the fields, but by killing the mosquitoes, a gap was made in the chain of transmission of the disease

44Report, Col. J. W. Scharff, 17 July 1944, subject: First Report on Operational Air Spray Experiments with D.D.T. [at Charbatia, Sunakala, and Sananairi].
45Annual Report of Medical Activities, Base Section No. 1, SOS, India-Burma, Office of the Surgeon, 1944.


648

FIGURE 85.-Natives in Calcutta sweep the water's surface clear of vegetation before spreading oil to kill larvae.

and other attempts to rid an area of malaria were strengthened. At the same time, residual spraying killed other insects and helped improve the health of people generally.

At the outset, it was believed that control measures could not always be carried out by American authorities because of such complicating factors as the unusual relationship between central and provincial governments, language and dialect problems, and certain religious and social difficulties. Religious customs among the Muslims, for example, prohibited the spraying of Muslim homes by American soldiers. In 1943, Army representatives contacted officials of provincial governments, some of whom agreed to institute sanitation control around many of the larger U.S. installations. In actuality, however, the Army assumed antimosquito and other sanitation responsibilities in some of these areas.46 Those programs which the Indians did conduct, and which were of great help to the Army within confined areas, were discontinued in late 1945, when evacuation of the India-Burma theater began.

Informing civilians.-Some Army antimalaria procedures, such as per-

46See Part I of footnote 22 (2), p. 642. (2) Medical Department, United States Army. Preventive Medicine in World War II. Volume VI. Communicable Diseases: Malaria. Washington: U.S. Government Printing Office, 1963, pp. 347-398.


649

sonal protective measures, had no effect on civilians. Others had some effect, however; for instance, before movies at army camps, slides were shown illustrating how malaria was acquired and how it could be avoided. Arrangements were made with the British in Delhi to show these slides at civilian theaters. The Army also supplied antimalaria propaganda for broadcast by a local radio station and, during "special weeks" in at least one civilian area, the Army displayed posters, airdropped leaflets, demonstrated airplane DDT spraying, and exhibited antimalaria devices in an attempt to better inform the civilians about malaria.47

All work with civilians, including the malaria surveys in which mosquitoes were collected and blood smears were taken from civilians in selected areas, had the primary purpose of protecting the soldier and reducing noneffective rates. Antimalaria work in areas near concentrations of U. S. troops did have an effect on civilians, as illustrated by a study of certain native groups in northern India. After an 18-month period of living in areas where spraying and other antimalaria procedures were carried out, some of those tested showed reductions in spleen rates of as much as 80 percent.48 These occurrences were in confined areas, however; outside of these areas, malaria raged with its usual uncontrolled fury.49

Venereal Diseases

In India, a land of many contrasts, the venereal disease problems were serious and difficult to combat. In one region of Assam, near an SOS rest camp, the attractive light-skinned women of a hill tribe were anxious to introduce white blood into their families and further lighten their skins. Not only the women, but also their families, openly solicited among the white soldiers, meanwhile discouraging the use of prophylactics and increasing disease rates. The native area was put out of bounds, and other measures to reduce rates were tried, but unsuccessfully.50 At the same time, venereal disease rates in India among Negro soldiers were much higher than among other soldiers, apparently because the Negroes did not find the racial barriers to sexual contacts that others found with some Indians. According to a study on the problem, venereal disease rates among Negro soldiers were higher not because the individual Negro was less careful in the use of prophylactic procedures, but because the number of exposures among Negro soldiers was about four times as great.51

47See page 19 of footnote 5 (2), p. 637.
48Mantz, Maj. F. A., MC: A History of Malaria Control Activities in the CBI Theater From July 1942 Until July 1944, p. 28. [Official record.]
49For additional information on malaria in the CBI, see footnote 46 (2), p. 648.
50(1) See footnote 22 (2), p. 642. (2) Letter, Headquarters, U.S. Army Rest Camp No. 5, to Venereal Disease Control Officer, CBI, 29 Apr. 1944. (3) Report, Headquarters, U.S. Forces, India-Burma Theater, to Surgeon, USFIBT, 21 May 1945, subject: Investigation of Venereal Disease Control Activities at Air Crew Rehabilitation Center, Army Air Forces, with enclosure, subject: Venereal Disease Survey of Shillong, India, conducted 10 to 13 May 1945.
51Essential Technical Medical Data for Overseas Forces, India-Burma Theater, 4 Dec. 1944. Enclosure, subject: A Study of Attitudes, Actions, and Knowledge Related to Venereal Disease Among Two Groups of Soldiers in CBI.


650

Conditions in India-More U.S. troops were stationed in India than in China or Burma, and rest areas for all CBI soldiers were concentrated there. As a result, most theater venereal disease problems, early in the war, originated in India.52 The low educational and economic levels in India, the unique and diversified religious and social customs, and widespread prostitution in filthy surroundings made preventive measures among the civil populace almost impossible. Brothels with better sanitary conditions, housing women who were under some degree of medical supervision and which provided good prophylactic procedures, did exist, but prices for patronage were usually in the $10 to $20 range. Soldiers indicated that they would prefer to atronize such places, but economic factors and the brain-clouding effect of alcohol all too often led the men to visit cheap, infected, easily available women in hovels, carts, or fields.53

At the civilian national level in India, the Public Health Commission supervised measures for the protection of health, but very little progress had been made toward any effective program as a result of insufficient personnel and a lack of local cooperation. Civilian police would not cooperate to control prostitution and, although British military authorities did join the U.S. forces in providing some prophylactic stations, they usually went no further than that.54

In the absence of effective cooperation from local authorities, the U.S. military venereal disease control program, in addition to the usual educational program and appeals to morality, became one of placement of prophylactic stations and enforcement of off-limits regulations. Even the provision of prophylactic stations was difficult because local property owners did not like to rent buildings for such use. The reasons for this were probably the same moral and religious reasons which made the problem of venereal disease generally more difficult.

Religious groups felt that attempts to inaugurate venereal disease control programs insinuated promiscuity which the religions prohibited. Promiscuity did exist, however, but the moralists refused to let anything be done about it. The same ideas would not permit surveys or the collection of data regarding rates. Treatment facilities were available for the natives but were little used. Meanwhile, the caste system strengthened the practice of prostitution. Prostitutes were so low in caste that religious sects would have nothing to do with them, and all female children of prostitutes were destined for the same means of livelihood.

Venereal disease control officers spent much time traveling throughout their theaters, investigating trouble spots, and consulting with officers of

52For an overall picture of the antivenereal disease campaign in the CBI theater and elsewhere, see Medical Department, United States 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, ch. X.
53Report, 188th Engineer Aviation Battalion, Office of the Surgeon, 13 Jan. 1945, subject: Special Report on Venereal Diseases.
54Letter, Capt. Malcolm A. Bouton, MC, CBI Venereal Disease Control Officer, to Theater Surgeon, CBI, 21 Feb. 1944.


651

units having high rates. Venereal disease work was often involved more with treatment than with prevention. However, after the initial outbreak, venereal disease rates in general were brought down in the CBI theater, and noneffective rates resulting from venereal diseases were not serious.

Conditions in China and Burma-Prostitution was uncontrolled throughout China.55 Because there were no laws against prostitution, civilian authorities had no means of suppressing it. Apart from prophylactic means, military authorities had to rely on off-limits procedures, recreation facilities, and education in their efforts against the spread of venereal diseases. Although troops in China were few, rates among white soldiers were higher in China than in India, apparently because of the multiplicity of contacts and the attractiveness of the women.56

In Burma, venereal disease control, as well as civil public health in general, was considered to be of little importance throughout most of the war because many areas occupied by U.S. engineer and combat forces were sparsely populated by headhunting Naga tribesmen. Upon the opening of the Burma Road, a venereal disease problem developed along convoy routes because female "hitchhikers" would pay for a ride in a manner acceptable to both parties.57 However, venereal disease was mainly contracted by men while they were in rest areas in India.

Other Diseases

Epidemic typhus-After Brig. Gen. Leon A. Fox, MC, Field Director of the United States of America Typhus Commission, visited China in September and October 1943, some 1.4 million doses of typhus vaccine were sent to China, of which 500,000 ml. were for use by civil agencies in the immunization of medical and essential personnel. Arrangements for the Lend-Lease transfer of vaccine were renewed from time to time later in the war.58 Some vaccine was used to inoculate transportation personnel at Chinese roadside stations, but how much the civilians were finally benefited was not determined.

In India, several outbreaks of epidemic typhus occurred among the civil population and among Chinese troops training there during the war. The Typhus Commission and the Theater Commander arranged for the distribution of vaccine and louse powder to civilian groups as well as to British troops in affected areas.

Scrub typhus.-The Typhus Commission set up a laboratory and mite-collecting stations to acquire data on scrub typhus in the theater, and there

55(1) Essential Technical Medical Data Report, Rear Echelon, Headquarters, U.S. Forces, China Theater, Office of the Chief Surgeon, 4 July 1945, p. 8. (2) Derr, Capt. Russell H., VC: History of Venereal Disease Control in China, p. 6. [Official record.]
56Recorded interview, Deputy Chief, Operations Service, to Historical Division, Office of the Surgeon General, 4 Apr. 1945, subject: Report of Medical Department Activities in China and India-Burma Theaters by Capt. Malcolm A. Bouton, MC.
57See footnote 55 (2).
58For additional information on epidemic typhus in the CBI theater, see Medical Department, United States Army. Preventive Medicine in World War II. Volume VII. Communicable Diseases: Arthropodborne Disease Other Than Malaria. Washington: U.S. Government Printing Office, 1964, p. 196.


652

was some contact with civilians in this work. However, the object of all activity was the ultimate protection of American and Allied soldiers.59

Yellow fever and other diseases-Although yellow fever was not to be found in India, the Aedes varieties of mosquitoes, vectors of the disease, were abundant. Representatives of the civil government had reason to fear the extremely serious situation which might have developed if the disease had been introduced from Africa or elsewhere. Therefore, Indian immunization and quarantine requirements for yellow fever were more stringent than those prescribed by international convention. These requirements, in turn, caused serious delays in troop movement and supply shipments by Allied powers through India and became a serious handicap to the war effort. From 1941 through 1943, the U.S. State Department made several attempts to get Indian regulations changed, but no settlement was reached until February 1944, when negotiations through military channels resulted in the reduction of Indian requirements.60

The Army did not become formally involved in civil public health programs for China, Burma, or India other than those described elsewhere in this chapter. However, as a byproduct of such activities as malaria control and sanitation procedures, the risk of contracting certain diseases, such as sandfly fever or typhoid fever, was reduced for the civilian population in some areas.

CLOSING OF THE THEATERS

India-Burma Theater

Before the end of 1945, the strength of the forces in the India-Burma Theater had been reduced to about one-third of their peak; in 1946, the reduction of forces continued at a fast pace until the theater was inactivated on 31 May 1946. Malaria control units and food inspection units were inactivated as soon as they were no longer needed by the Army. Remaining troops were concentrated in large cities and the required disease-control personnel were absorbed into headquarters units at such locations.

With the exception of personnel who contracted venereal diseases, the percentage of personnel going on sick call rapidly declined as soon as the war ended. More free time and a general atmosphere of relaxation combinded with increased sex contacts caused VD (venereal disease) rates to climb abruptly. However, the usual procedures for VD control were maintained and no new civil public health measures were introduced.

The Army also took precautionary measures to protect the Military Establishment against epidemics of poliomyelitis and smallpox which broke out in the civil population during the closeout period.

59For a complete discussion of scrub typhus in the CBI theater, see pages 292-301 of footnote 56, p. 651.
60For more complete information on yellow fever and quarantines, see pages 304-307 of footnote 42 (2), p. 646, and pages 357-370 of footnote 58, p. 651.


653

China Theater

After the Japanese surrender, the U.S. Army began phasing out activities in China, the most significant exception being the Shanghai metropolitan area, where theater headquarters and most theater personnel were relocated. Fewer than 10,000 American soldiers remained in China by the end of 1945.61 This number was reduced each month until 30 April 1946, when the theater was closed and a small overall headquarters called Headquarters, USAF, China, and an operating agency, the China Service Command, were created to conclude American business in the area.62

As the influx of American troops into Japanese-held Shanghai began in September 1945, the China Theater medical inspector, Col. Marcus D. Kogel, went there to conduct a sanitary survey and check on potential disease problems. He found that the general health of the people in the city of more than 4 million was fair, the sewage plant modern, and the municipal abattoir in moderately good condition. Cholera was endemic in the city and malaria was common in the outskirts. An outbreak of virus encephalitis occurred during the summer, but it was dying out by the time Colonel Kogel began his inspection. He immediately detailed a Navy lieutenant to make a preliminary inspection of dairies, iceplants, restaurants, hotels, and drinking water.63

During Colonel Kogel's inspection, 15 American prisoners of war were released, eight in good condition and seven hospitalized for pulmonary tuberculosis. Some 6,000 civilian internees, mostly British and American, were in good condition and anxious to leave camp to take over their business interests from the Japanese. About 15,000 "stateless" refugees, mostly Jews who had fled before the Nazis, had been badly treated, packed together in a ghetto during their internment. Their health was poor and they were vermin infested. Typhus, typhoid, and other diseases were still taking their toll.

Office of Preventive Medicine.-As soon as medical personnel arrived in early October 1945, the medical sections of the theater and of the local base command were combined under Colonel Armstrong. Army and Navy medical personnel immediately formed a consolidated preventive medicine section, known as the Office of Preventive Medicine,64 which consisted of the following divisions: Epidemiology; Sanitary Engineering; Venereal Disease Control; Malaria, Rodent, and Insect Control; Laboratory; and Sanitary Inspection.

Colonel Kogel directed the office and served as Officer-in-Charge of the

61Medical History of the China Theater for Month of January 1946, Headquarters, U.S. Forces, China Theater, Office of the Surgeon, 1 Feb. 1946, pp. 1, 2, and 12.
62Medical History of the China Theater for Month of April 1946, Headquarters, China Service Command, Office of the Surgeon, 1 May 1946, pp. 1-2.
63Memorandum, Col. Marcus D. Kogel, MC, to Theater Surgeon, Headquarters, SOS, U.S. Forces in China Theater, 14 Sept. 1945, subject: Inspection Trip to Shanghai.
64(1) Essential Technical Medical Data Report, China Theater, 14 Nov. 1945, pp. 2-4. (2) Annual Report of Medical Activities, China Theater, 1945.


654

Epidemiology Division. He and the senior naval representative in the office met frequently with the Commissioner of Health of Shanghai and arranged for such activity as the air spraying of the older sections of Shanghai, and of airfields, internment camps, and dock areas.

Preventive Medicine personnel conducted a weeklong educational program for the benefit of Municipal Health Department employees and gave talks at various times on new methods of disease prevention before such groups as the Shanghai Medical Society. They demonstrated the proper use of DDT while spraying the chief detention prison in Shanghai (fig. 86). Some Chinese generals, a District judge, and a large number of medical and laboratory personnel from the local health department attended. Army medical personnel inspected and sprayed some civilian hospitals and also deloused stateless refugees who, it was thought, might constitute a health hazard to U.S. forces.65

Sanitation.-Other activities coordinated with the city health department included sanitary inspections of restaurants and hotels and the establishment of in-bounds and out-of-bounds procedures to protect the health of troops. In addition to military inspectors, the armed forces hired five civilian inspectors, former employees of the Shanghai Municipal Council, to help with this work. Lists of out-of-bounds establishments were sent to the municipal council, and frequent meetings were held with the council to work out a policy on sanitation inspections and areas of responsibility. Civilian representatives of the city government then began accompanying the armed forces inspectors, thus adding the stamp of civilian authority to the recommendations and actions of the military. These city representatives were even empowered to close businesses to civilian patronage should that be considered necessary, but the Army did not involve itself in license procedures.

The close cooperation between the Army and the city also produced other mutual benefits. One example was the removal, at city expense, of a dump which had been too close to a dairy products processing plant having a contract with the Army.66 Then, in the spring of 1946, a local labor strike caused a garbage disposal problem and the immediate threat of disease, and the mayor of Shanghai called on Colonel Armstrong for help. Colonel Armstrong, with the concurrence of G-5, authorized the immediate air spraying of the city with DDT. Increased efforts on the ground also helped to eliminate flies and mosquitoes, and the problem was resolved.67

Venereal diseases.-The venereal disease problem in Shanghai proved to be as difficult as anticipated. Many young white Russian girls, as well as Orientals, were actively engaged in prostitution, and procurers were everywhere. In addition to the usual measures, 11 prophylactic stations were

65Daily Reports, Preventive Medicine Section and Veterinary Section to Shanghai Base Command Surgeon, subject: Activities for 11, 27, 29, and 30 October and for 6 and 7 November 1945.
66Daily Reports, Preventive Medicine Section and Veterinary Section to Shanghai Base Command Surgeon, subject: Activities, 22 October 1945.
67Govern, Col. Frank W.: Personal Experiences in the CBI. [Official record.]


655

FIGURE 86.-Capt. Lyle Smith supervised the delousing of a prisoner as part of a demonstration and lecture given on 6 November 1945 at the Shanghai Detention Prison.

soon established in the city. Also, representatives of the Office of Preventive Medicine, after consultations with the Municipal Council, worked out a plan to establish a special clinic to which infected women would be referred for treatment. The Municipal Board of Health furnished facilities and doctors and nurses for the clinic while the Army and Navy supplied drugs and lent nonexpendable equipment to help carry out the program. The project promised to be such a tremendous undertaking that the armed forces officers contacted officials of UNRRA (United Nations Relief and Rehabilitation Administration) to see if it could furnish additional supplies. However, there was a problem in actually getting women to go to the clinic, and this project never succeeded as well as had been hoped.68

Work with other agencies.-Army medical personnel also maintained close liaison with representatives of UNRRA and the USPHS (United States Public Health Service) on other matters. For example, UNRRA provided the Army with information about the epidemiologic experience among civilians in Shanghai and made special daily reports on the admission of cholera patients to the local isolation hospital.69 The Army fur-

68(1) See footnote 61, p. 653. (2) Daily Reports, Preventive Medicine Section and Veterinary Section to Shanghai Base Command Surgeon, subject: Activities, 19-20 October and 5 November 1945.
69Daily Report, Preventive Medicine Section and Veterinary Section to Shanghai Base Command Surgeon, subject: Activities, 19 October 1945.


656

nished medical supplies and equipment to UNRRA for civilian use, turning over more than $500,000 worth in November 1945 alone. Many of these supplies were used to treat liberated military and civilian internees, and the remaining supplies were used to treat indigenous civilian employees of the Army or other civilians who had been injured in connection with military activities. Contracts were also negotiated with local hospitals to provide care for the latter groups.70

During the months after the end of the war, serious outbreaks of plague, cholera, typhus, and smallpox occurred among civilians and repatriates in China. Some cities, such as Hankow and Canton, had to be put out of bounds during epidemics. Medical personnel went to various parts of the country to investigate these outbreaks and offer advice to civilian medical authorities, and the Army funneled some medical supplies to civilian areas through UNRRA in an attempt to control the diseases and prevent their spread to U.S. personnel.71

The theater medical organization provided supplies and personnel for Personnel Recovery Teams responsible for recovering liberated prisoners of war and repatriation groups working with the Japanese, and also gave extensive support to G-5 and Offices of Strategic Services' operations involving prisoners and internees. Liaison was continued with the Chinese Army; medical services were provided for U.S. Army groups working with the Chinese, such as the Army Advisory Group and a team working as arbiters between the Communists and Central Government troops. Such activities created a drain on medical strength, which was already being steadily diminished by evacuation. By the time the theater was closed, almost all Army civil public health activities had been discontinued.

SUMMARY

The need during World War II for an effective civil public health program was evident in every corner of the expansive China-Burma-India region with its millions of people and its overwhelming disease problems. The small number of U.S. Army Medical Department personnel stationed in the area, whose primary mission was to keep the troops in good health, could become involved in civil public health activities only to a very limited extent. Some activity among local civilians was necessary, however, to protect the health of the troops. In mosquito control to combat malaria, for instance, spraying, ditching, and other procedures were carried out in communities near troop concentrations, producing beneficial results for the civilians as well as for the military and providing the knowledge of how to carry out mosquito control work for future generations. This work, the cooperative efforts to clean up civilian food-dispensing establishments, the medical aid to tribesmen in Burma, the work against plague and cholera, and efforts to control disease among refugees, beneficial as they were, were

70See footnotes 61 and 62, p. 653.
71See footnotes 61, 62, and 64 (1), p. 653.


657

necessarily limited in scope and were carried out only during the few years that American troops were stationed in the theater. No theaterwide, coordinated civil public health program was ever attempted, and the only time the Army could devote the efforts of more than a handful of men to one civil public health activity was in Shanghai after the war had ended. At that time, preventive medicine specialists from the various armed forces stationed in the city joined local health officials in a concentrated campaign against filth and disease in the final months before the theater was closed.

No measurement of the total effect on civilians of Army civil public health activities in the CBI theater was ever attempted, but the relatively low sick rates of U.S. troops stationed in the midst of unbelievably bad conditions indicate that the immediate objectives of the time were met.

RETURN TO TABLE OF CONTENTS