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Chapter 4

Contents

Part II

THE AMERICAS


CHAPTER IV

The United States, Its Territories and  Possessions, and the Panama Canal Zone

Stanhope Bayne-Jones, M.D., Ira V. Hiscock, M.P.H., M.D., and 
Major General Morrison C. Stayer, MC, USA (Ret.)

Section I. The United States

Stanhope Bayne-Jones, M.D.

In the continental United States, from 1939 through 1945, there were two main types of operations in civil affairs and military government and its associated public health activities. One type was the deliberative, policymaking, planning, and directive activity carried on at the highest levels of the Government and its principal agencies, among which the War Department and the U.S. Army were especially important. This type constituted the central source and authority where ideas and requirements were received and from which operational directives were sent to all appropriate Army services throughout the world, wherever U.S. and Allied military organizations were either directly or indirectly engaged. The other type was represented by the civil affairs and military government public health activities which took place on an operational level within the continental United States, and its territories and possessions, because of the Nation's military activities at home. Although not always so labeled, these operations had many of the characteristics of civil affairs and military government public health activities, and they furnished valuable information and experience for similar work overseas. The purpose of this section, and the two succeeding it, is to present examples of what might be called domestic civil affairs and military government public health activities, which developed somewhat unexpectedly to fairly large dimensions in some instances. As in foreign countries, so also on the homefront, these activities involved collaboration among military and civilian authorities and agencies; liaison between military and private organizations; public relations; legal, economic, and social questions, and logistics They also imposed some restrictions upon individual liberties.

Turning first to those examples that occurred in the continental United States, consideration is given in this section to: (1) extra-military area sanitation and disease control, (2) maneuvers, and (3) enemy alien supervision and control, including the evacuation of Japanese from California and other areas along the West Coast.


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SANITATION AND DISEASE CONTROL OUTSIDE
MILITARY AREAS

Since ancient times, potential health hazards have been shared mutually by a military post and its surrounding civilian community. The natural environment, if it contains endemic diseases or is the habitat of vectors of infectious agents, is a source of sickness among soldiers and civilians. Furthermore, the environment may become contaminated by either element of its human population. Hence, the application of general and specific measures of preventive medicine and public health, routine in peacetime, becomes urgent in wartime.

The extraordinary conditions that developed in regions and communities in the vicinity of both old and new Army posts and camps, and around induction centers, training centers, and maneuver areas, required not only the enforcement of routine measures for health protection but also the invention and use of novel methods and new types of organizations. In response to these needs, a high degree of collaboration, based upon World War I experience, developed between the Army and the U.S. Public Health Service; the public health officials of States, counties, and municipalities; and private civilian organizations concerned with the health and welfare of both citizens and soldiers. All worked together in the system which became known as extra-military area sanitation or extra-cantonment sanitation.

Accounts of this system have been published by two representatives of the Army, Col. (later Brig. Gen.) James S. Simmons, MC,1 chief of the Preventive Medicine Service, and Lt. Col. (later Col.) William A. Hardenbergh, SnC,2 chief of the Sanitary Engineering Division, Surgeon General's Office; and by the historian and Assistant Surgeon General of the U.S. Public Health Service, Ralph C. Williams, M.D.3

In areas surrounding the usual military reservations and both within and outside the vast maneuver areas, sanitation and sanitary engineering under this system accomplished prodigies despite conflicts involving divergent personalities, interests, jurisdictions, and philosophies. Water supplies were improved, enlarged, and purified. Sewerage disposal systems and waste disposal plants were installed. Food supplies and food services were inspected, cleaned where necessary, and supervised. Insect and rodent control was effectively carried out. All the usual methods, plus some new ones, were applied for the prevention and control of communicable diseases. Accident prevention was attempted on roads and highways. Military police, as an arm of military government, affected the behavior of soldiers and

1Simmons, J. S.: The Preventive Medicine Program of the United States Army. Am. J. Pub. Health 33: 931-940, August 1943.
2Medical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955. 3Williams, Ralph Chester: The United States Public Health Service, 1798-1950. Washington: Commissioned Officers Association of the United States Public Health Service, 1951, pp. 322-326, 625-629.


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their companions outside Army installations. New legislation was enacted, notably the May Act, for the control of venereal diseases. Of all these undertakings, three deserve special consideration because they brought to bear upon the problems most of the elements of domestic civil affairs and military government public health activities: (1) venereal disease control, (2) malaria control in war areas, and (3) extra-cantonment environmental sanitation, especially as related to establishments serving food and beverages.

Venereal Disease Control

The closest possible cooperation and collaboration among the Army, the U.S. Public Health Service, civilian agencies and organizations, and the communities were required to attain a measure of control over venereal diseases among troops in the continental United States. The activities and achievements of these organizations are discussed frankly and in detail by Lt. Col. Thomas H. Sternberg, MC, and associates in another volume of the history of the Medical Department in World War II.4

During 1939-40, as the probability of U.S. involvement in the European war increased, the military services, the U.S. Public Health Service, and the American Social Hygiene Association, recalling their joint action in World War I, met to revive their collaboration for the control of venereal diseases. Out of their conferences emerged a joint resolution, formally titled, "An Agreement by the War and Navy Departments, the Federal Security Agency, and State Health Departments on Measures for the Control of the Venereal Diseases in Areas Where Armed Forces or National Defense Employees are Concentrated." The resolution was more commonly known as the Eight-Point Agreement. Its main objective was the suppression of commercialized prostitution. This agreement was adopted by the Conference of State and Territorial Health Officers, held from 7 to 13 May 1940, and was promulgated to the Army by The Adjutant General on 19 September 1940. "Throughout the war, with minor exceptions, the close liaison and cooperative relationship established by this agreement between the Army, the U.S. Public Health Service, the American Social Hygiene Association, and, later, the Social Protection Division of the Federal Security Agency [under the direction of its initiator, Mr. Charles P. Taft (and the State Health Departments)], operated effectively to produce an integrated civilian venereal disease [control] program."5

Suppression of prostitution was the policy of the War Department throughout the war. But it was often difficult, sometimes impossible, to bring some of the commanding officers and certain medical and public health officials into line with the official policy. In addition, its requirements were

4Medical 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, pp. 139-331.
5See pages 140-141 of footnote 4.


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resisted by soldiers, prostitutes, pimps, panderers, and other moneymaking exploiters. Despite much effort, it became evident by late 1940 that local law enforcement facilities were inadequate in many communities.

This deficiency of enforcement became conspicuous when Army maneuvers became more frequent, deployed larger and larger forces, and occupied more and more land. To strengthen the means for enforcement, a bill was introduced on 20 January 1941 by Congressman Andrew J. May, chairman of the House Committee on Military Affairs. This bill, H.R. 2475, was passed on 11 July 1941, and was officially known as the May Act. It was designed "to prohibit prostitution within such reasonable distance of military and/or naval establishments as the Secretary of War or the Secretary of the Navy or both should determine to be needful to the efficiency, health, and welfare of the Army and/or Navy, it became more than the policy of the armed services: it was national policy."6

In practice, however, many differences of opinion had to be compromised and a number of legal, political, and economic questions had to be resolved before pressures for the invocation of the May Act became strong enough to push it into effect. It was invoked in only two areas during the war. The first, on 20 May 1942, was in the region surrounding Camp Forrest, Tenn., and the second, on 31 July 1942, was in the area around Fort Bragg, N.C. As a result, some prostitution was suppressed; how much is uncertain. Thereafter, the threat of Federal intervention was sufficient to cause local communities to take positive action.

During the first 2 years of increasing military activity, 1939-41, the preventive medicine organization (under various designations) in the Surgeon General's Office was engaged constantly in strengthening its Venereal Disease Control Division and in working through corps area surgeons and preventive medicine officers in tactical units to develop and implement a comprehensive control program. At the same time, the advantageous liaison with the U.S. Public Health Service expanded. Dr. Thomas Parran, the Surgeon General of that Service, and Dr. Raymond A. Vonderlehr, his Assistant Surgeon General, detailed very able public health service officers to many Army organizations to conduct special sanitary surveys, to report on conditions and performance, and to serve as links between the Army and State health officers. In the Army Surgeon General's Office, there was a sense of progress.

Unexpectedly, however, the working relationship between the Army and the U.S. Public Health Service was seriously disturbed in 1941 by the publication of a book by Drs. Parran and Vonderlehr7  in which they criticized the Army for what they regarded as its failure to take sufficiently drastic action against commercialized prostitution around cantonment areas. "Charges and countercharges were made, and eventually, on 27 November

6See page 143 of footnote 4, p. 61.
7Parran, Thomas, and Vonderlehr, Raymond A.: Plain Words About Venereal Disease. New York: Reynal & Hitchcock, Inc., 1941.


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1941, Mr. [Paul V.] McNutt [Federal Security Administrator] wrote to the President about the matter. Shortly afterwards, however, the attack on Pearl Harbor occurred. With the American declaration of war, what had threatened to precipitate a serious break in mutual confidence between the Army and the U. S. Public Health Service faded into insignificance in the face of the new responsibilities and problems facing both services."8

The effects of this book were felt in several directions. Undoubtedly, its publication expedited and enlarged efforts to suppress commercialized prostitution around military areas. The passage of the May Act and its subsequent invocation in Tennessee and in North Carolina were hastened. Several new governmental committees were established, one of which was the Interdepartmental Committee on Venereal Disease Control, formed early in 1942 by an agreement between the Federal Security Administrator, the Secretary of War, and the Secretary of the Navy, to meet informally and consider condensed overall reports from competent advisers and establish closer liaison between various departments concerned with venereal disease control problems. In addition to the three cabinet officers and other members, two War Department representatives were designated to serve on the committee. It is of special interest that the representative from the Surgeon General's Office was Colonel Simmons (fig. 6), Director, Preventive Medicine Division, who, in collaboration with Lt. Col. (later Col.) Ira V. Hiscock, SnC, and Lt. Col. (later Col.) Albert W. Sweet, SnC, had already prepared a plan for the administration of a civil affairs and military government public health program. On 7 February 1942, Colonel Simmons was replaced by Lt. Col. (later Col.) Thomas B. Turner, MC, Chief, Venereal Disease Control Subdivision. The representative from the War Department General Staff was Brig. Gen. (later Maj. Gen.) John H. Hilldring.

The effort sustained from 1940 through 1945 to prevent and control venereal disease among U.S. Army troops in the Zone of Interior was clearly zealous and intensive, and it brought to bear upon the problems many elements and powers characteristic of civil affairs and military government public health activities although the program was not so designated.

During the war, and afterward, the question was asked: What was accomplished? Despite strenuous exertions for control, the incidence (total cases acquired after induction) and rates (per 1,000 average strength per annum) were high. For troops in the continental United States, the figures were as follows:9

Gonorrhea-1942-45: a total of 464,962 cases, with an annual rate per 1,000 average strength of 31.52 (maximum rate, 43.21 in 1945; minimum rate, 23.91 in 1943).

Syphilis (including neurosyphilis)-1942-45: a total of 230,405 cases, with an annual rate per 1,000 average strength of 15.63 (maximum rate, 20.04 in 1944; minimum rate, 7.19 in 1942).

8See page 158 of footnote 4, p. 61.
9See page 473 of footnote 4, p. 61.


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FIGURE 6.-Brig. Gen. James Stevens Simmons, USA. (Photograph, courtesy of National Library of Medicine.)

Admittedly, it is difficult to state exactly how much was accomplished through the program of prevention and control. Nevertheless, the general and reasonable opinion of those who administered the program is that if such a program had not been in operation there would have been a much higher incidence of venereal disease among troops in the continental United States.

Malaria Control in War Areas

Activities for the control of malaria in areas surrounding military and defense-production installations in the continental United States from 1940 to 1945 were vast, both in scope and in benefits attained. While they have been described in several publications by a number of authors,10 some

10(1) Williams, Ralph Chester: The United States Public Health Service, 1798-1950. Washington: Commissioned Officers Association of the United States Public Health Service, 1951, pp. 308-309, 397-399, 648-655. (2) See pages 201-202, 333-334 of footnote 2, p. 60. (3) Medical Department, United States Army. Preventive Medicine in World War II. Volume VI. Communicable Diseases: Malaria. Washington: U.S. Government Printing Office, 1963, pp. 73-112, 202-240.


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discussion of malaria control in populated areas surrounding military and defense establishments in the United States and in Puerto Rico is essential here because it comprised a number of elements common to all civil affairs and military government public health activities. Because the operation took place in the continental United States, it was not officially regarded as a civil affairs and military government undertaking although it furnished experience and trained personnel which were useful later in carrying out similar civil affairs and military government public health activities in overseas theaters of operations.

Continental United States-Malaria prevention and control around military areas in the United States proceeded simultaneously with venereal disease control efforts and employed, in general, most of the basic methods, principles, authorities (such as the Eight-Point Agreement between the War Department and the National Security Administration), and means of collaboration among various agencies. The resulting malaria control program was a joint product of the remarkably close and effective collaboration between the Army and the U.S. Public Health Service.

The pattern had been set as early as March 1927, when Dr. Louis L. Williams, Jr., malariologist and medical director in the U.S. Public Health Service, began to devise and supervise programs which contributed importantly to the development of the South by anticipating and finding solutions to civilian problems which had much in common with military problems of malaria control encountered later. By 1937, Dr. Williams was advocating that State health departments in the malarious South organize malaria control units composed of physician-entomologist-engineer teams, and that the final attacks of single group teams be pressed against malarious foci, using all appropriate biological, clinical, sanitary engineering, logistical, and educational means and methods. This general type of organization and plan of operation, adopted by civilian, U.S. Public Health Service, and military agencies, did much to break the hold of malaria upon the South and ultimately contributed to the virtual eradication of malaria from the United States. Furthermore, as World War II progressed, the malaria control units became malaria survey and control organizations in the military preventive medicine program. They were used in overseas theaters of operations where malaria was a problem throughout the war. The basic concept has persisted in the preventive medicine company.

In the spring of 1941, Dr. Williams, who had been detailed as U.S. Public Health Service liaison officer to Headquarters, Fourth Corps Area, Atlanta, Ga., drafted the plan for malaria control in extra-military areas and assisted in the formulation of military policies for local malaria control.

At the end of 1941, when U.S. Public Health Service funds for malaria control had been curtailed by the Congress and the Bureau of the Budget, it became clear that the Work Projects Administration could not meet the needs. Early in 1942, with the backing of the deeply concerned War De-


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partment, advised by the Preventive Medicine Service, Surgeon General's Office, the U.S. Public Health Service received an appropriation for an independent malaria control program in areas surrounding military and defense establishments in 15 southeastern States, Puerto Rico, the Virgin Islands, and in other Caribbean areas controlled by the United States. The resultant office, established in the States Relations Division of the U.S. Public Health Service to administer the program, was first designated as Malaria Control in Defense Areas, and later as Malaria Control in War Areas. Although the latter implied a concern with malaria in combat areas overseas, it was not so intended.

The policy of the Malaria Control in War Areas organization was to undertake operations only where the prevalence of malaria-transmitting mosquitoes indicated a risk of the spread of malaria. Mosquito-free zones, 1 mile wide (the flight range of Anopheles quadrimaculatus), were set up and maintained around each military and war industrial establishment. No control of pest mosquitoes was undertaken except upon special military request. The basic objective was vector control by ditching, draining, oiling, larviciding with paris green, and later by spraying with DDT (dichlorodiphenyltrichloroethane) to kill adult mosquitoes. By agreement, these teams were to remain outside the military installations and the military sanitarians were to remain within their posts, camps, and stations. However, some overlap in responsibility was sometimes necessary. Colonel Hardenbergh stated:

While the military reservation boundary was usually meticulously observed as the dividing line between Army mosquito control work and Public Health Service operations, there were numerous local adjustments whereby the areas in which work was necessary were allotted, irrespective of location, to the organization best fitted to accomplish control. The aim was to insure effective mosquito control at the lowest cost. In a few instances, the services of Army sanitary engineers and entomologists were made available to Malaria Control in War Areas, and the converse was equally true. The close cooperation and the excellent personal relationships that existed between both organizations were of great value in insuring effective work.11

A good idea of the scope and complexity of the program, and an intimation of the civil affairs aspect of it, can be derived from the following listing, compiled by Dr. Justin M. Andrews.

* * * In the States where malaria had been endemic in the past, there were in 1942 some 900 so-called war establishments to be protected; by January 1945, the total had risen to approximately 2,000. These included military posts, camps, stations, bases, hospitals, depots, airfields, Navy yards, other military port areas, staging areas, prisoner-of-war camps, maneuver areas, access highways, extramilitary recreational centers, shipyards, airplane factories, ordnance works, other essential war industries, and housing developments for war workers. These war establishments were grouped, according to location and the nature and extent of the problem into some 250 war areas, and an area supervisor, usually an engineer, was placed in charge of the malaria control activities to be carried on around each group of war establishments. He worked closely with

11See pages 201-202 of footnote 2, p. 60.


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the sanitation officers on adjacent military installations and with the local health officers. Thus, the war area was the geographic unit of operations  * * *.12

Puerto Rico.-Among the war areas of concern to the Malaria Control in War Areas group, Puerto Rico, as an American possession, was naturally the center of the military organization and administration of the Antilles Department (map 1). The Army had installations at Borinquen Field, Camp Tortuguero, Fort Buchanan (where the Antilles General Depot was located), Fort Brooke, Camp O'Reilly, Losey Field, Henry Barracks, and Fort Bundy, together with a large number of lesser installations used largely for coastal defense or antiaircraft batteries. Camp Ensenada Honda was an example of the latter. In 1942, malarious conditions in all areas ranged from unsatisfactory to "distressingly bad." In April 1942, the malaria rate among Army personnel in Puerto Rico was 73 per 1,000 per annum. There were many contributory factors. Within the Army units, there were poor organization for malaria control and prevention, assignments of personnel unsuited for control work, and a lack of proper planning of campsites. Environmental factors were unseasonable rains, flooded fields, blocked ditches, poor drainage, and an increase in native troops drawn from an infected population. During the critical period, 1942-43, Malaria Control in War Areas groups rendered highly important corrective services both to military personnel and civilians. The Army did not achieve a proper organization for malaria control until late in 1943, and preventive medicine units did not move into action in Puerto Rico until 1944. Later, malaria rates among troops decreased until they were of secondary importance while rates among the civilian population remained high.

Experts who evaluated the malaria control program within and near military areas in the continental United States, as well as in Puerto Rico, from 1942 through 1945, concluded that a capable job was done by both the military personnel concerned with the former and the civilian organization developed for the latter. Among trainees and troops, malaria morbidity was held to unprecedented low levels during the last 3 years of the war. In addition, great benefits accrued to civilians both in the United States and overseas.

MANEUVERS

Inherent Civil Affairs and Military Government Elements

Although a vast amount of thought and effort was devoted by Gen. George C. Marshall, Brig. Gen. (later Lt. Gen.) Lesley J. McNair, the General Headquarters Staff, and hundreds of officers to the planning, conduct, and critique of Army maneuvers in the United States from 1939 to 1944, little attention was paid directly to the elements of civil affairs and military government public health activities which were inherent in those

12See page 91 of footnote 10 (3), p. 64.


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MAP 1.-Antilles Department, 1944.


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operations. As these elements were not identified as such, they either were not generally recognized at the time of their appearance or were noted by only a few specially informed persons. Inevitably, however, activities in this category occurred in exercises simulating warfare because the troops involved moved through homeland territories, occupied large public and private lands possessed by their own people, and committed acts which impinged upon the behavior of their own national kinsmen, sometimes taking or destroying property, occasionally restricting liberties, and often conferring sanitary benefits upon communities. Army maneuvers in the continental United States, creating in a domestic setting a situation somewhat similar to that of a theater of operations, resembled the type of military occupation of friendly or liberated countries that occurred overseas as the war progressed. An analysis of these activities distinguishes them clearly from those of routine preventive medicine programs.

As the usual military preventive medicine programs are covered in other volumes in this series, this section will discuss some of the public health activities having characteristics appropriate to civil affairs and military government as they were carried out in certain Army maneuvers. The maneuvers to be considered here were those that took place in Wisconsin in 1940, in the Carolinas in 1941, in Louisiana and Texas in 1940-41, and in Tennessee in 1942.13

Background and Concomitants

Because of their bearing upon the development and conduct of Army maneuvers in the United States, it is well to recall the following events:

(1) On 8 September 1939, in view of the state of war in Europe, the President proclaimed a limited national emergency, and on the same day, by Executive Order No. 8244, he increased the strength of the Army by 17,000 men. These additional troops, bringing the total strength of the Regular Army to about 190,000, made it possible to rearrange a number of units and to create a standard Army Corps and a field army. Their creation, and certain other authorizations, permitted a few months later the first genuine corps and army maneuvers in the history of this nation. Before the end of 1941, the organization of the four armies had been brought to a point which made it possible to put all of them through maneuvers and in September of that year to pit two of them [the Second and Third], fully organized, against each other in the field.14

13(1) Greenfield, Kent R., Palmer, Robert H., and Wiley, Bell I.: The Organization of Ground Combat Troops. United States Army in World War II. The Army Ground Forces. Washington: U.S. Government Printing Office, 1961. (2) Palmer, Robert R., Wiley, Bell I., and Keast, William R.: The Procurement and Training of Ground Combat Troops. United States Army in World War II. The Army Ground Forces.  Washington: U.S. Government Printing Office, 1948.
14(1) Watson, Mark S.: Chief of Staff: Prewar Plans and Preparations. United States Army in World War II. The War Department. Washington: U.S. Government Printing Office, 1950, pp. 156-159. (2) See page 10 of footnote 13 (1).


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(2) Extra-military area sanitation and disease control were established formally in May 1940 by the Eight-Point Agreement (p. 61) which was the basis for extensive cooperation between the Army and the U.S. Public Health Service in carrying out prevention and control of venereal diseases in areas around Army and defense establishments, Malaria Control in War Areas, and many joint undertakings in the field of public health. As a further means for enforcement of regulations and procedures for venereal disease control among civilians, Public Law 163 (the so-called May Act) was passed by the 77th Congress on 11 July 1941.

As a major contribution to this work, the U.S. Public Health Service detailed a large number of its high-ranking specialists as liaison officers to the Army. These liaison officers made useful, broad surveys; prepared detailed reports on conditions and events of public health significance in the maneuver areas; and greatly assisted both civilian and military public health organizations in those areas.

The relationships among the cooperating organizations, and their fields of special concern, varied from place to place. In all, however, the focus of interest was in the commingling of activities of military and civilian preventive medicine and public health.

(3) In 1939 and 1940, Colonels Hiscock and Sweet, working under the direction of Colonel Simmons, initiated studies which resulted in "A Plan for the Military Administration of Public Health in Occupied Territory."15 The interest of these and other officers, and of the Preventive Medicine Division, in the public health aspects of civil affairs and military government, both in the United States and overseas, was intense and continuous from the beginning. Their early ideas, policies, and plans were applied later during maneuvers. The Provost Marshal General's School of Military Government, Charlottesville, Va., and the Civil Affairs Division, War Department Special Staff, included sections for dealing with the public health aspects of civil affairs and military government, and drew upon the experiences gained, and observations made, in Army maneuvers.

Wisconsin, 1940

During August 1940, the Second U.S. Army held maneuvers in a 1,000-square-mile area of southwestern Wisconsin, La Crosse, Monroe, Juneau, Jackson, and Wood Counties, with headquarters at Camp McCoy, near Tomah. The troops engaged numbered 59,750, with a mean average strength of 32,950 for the maneuver period. There was excellent cooperation between the Second U.S. Army; the commanding general of the Sixth Corps Area (Lt. Gen. Stanley H. Ford), who thoroughly supported the chief surgeon of the Sixth Corps Area (Col. Paul W. Gibson, MC); the Wisconsin

15A Plan for the Military Administration of Public Health in Occupied Territory, submitted to The Surgeon General, 26 June 1940, by Lt. Col. Ira V. Hiscock, SnC, and Lt. Col. A. W. Sweet, SnC.


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State Board of Health (Dr. C. A. Harper, State Health Officer); the U.S. Public Health Service (Dr. Vonderlehr); and the State, county, and municipal governments. A sound pattern was set in this and other early maneuvers as the sanitary and medical plans adopted and the policing arrangements devised were found to be equally effective where local authorities could be organized to work with military authorities.

Surgeon General Parran and Assistant Surgeon General Vonderlehr regarded the venereal disease control measures taken during this maneuver period as one of the few praiseworthy examples of coordinated attack by the Army and local health and police authorities which had occurred up to the time of the writing of their book, "Plain Words About Venereal Disease." From their commendation, which includes some historical details, the following is quoted:16

Wisconsin gave an effective demonstration last year of what can be done to protect the troops from venereal disease. A thousand square miles * * * were designated for August [Camp McCoy] maneuvers of 60,000 regulars and national guard troops. The Surgeon of the Sixth Army Corps Area, being a competent and experienced medical officer, realized the need of advance planning for prevention of disease among the troops. In a letter addressed to the Public Health Service, he requested certain measures to be taken having to do with sanitation of food and water, disposal of sewage, control of flies and mosquitoes, and control of all communicable diseases with a specific request for repression of prostitution, especially of the expected influx of itinerant prostitutes.

Financial assistance and technical consultation was offered the State Health Department by the Public Health Service and a meeting was called at Sparta early in June to which were invited to meet with the Provost Marshal and Chief Corps Area Surgeon, not only the state and local health officers having responsibility for conditions in the area, but also the judges, mayors, police officers and city attorneys of the larger cities. Wisconsin is a state in which the problem of venereal disease has been under constant attack for more than 20 years, as evidenced by its low prevalence. Consequently, the meeting was well attended and its purpose thoroughly understood. Plans to protect both soldier and citizen from infection were drawn up well in advance of the maneuvers and approved by the Governor.

Making use of a relatively new type of medicolegal agent, the Wisconsin Board of Health appointed additional deputy health officers who were also commissioned as deputy sheriffs. They remained under the State Health Department but were also under the sheriff's jurisdiction; however, their duties were medical, not of a law enforcing nature. Their main purpose was to assist in the control of communicable diseases, especially venereal diseases, by arresting and detaining infected prostitutes. These agents were called "deputies of the Board of Health instead of special investigators because the law [of Wisconsin] outlines fully the duties and powers of deputy health officials."17 Later, in other maneuver areas, somewhat similar use was made of health department deputies with certain medicolegal powers.

16See pages 153-154 of footnote 7, p. 62.
17Letter, Dr. C. A. Harper, State Health Officer, Wisconsin, to Surg. Gen. Thomas Parran, USPHS, 9 Aug. 1940, and reply to Dr. Harper from Asst. Surg. Gen. R. A. Vonderlehr, 16 Aug. 1940.


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The Carolinas, 1941

The First U.S. Army opposed the IV Corps (reinforced by the I Armored Corps) in a General Headquarters directed free maneuver in the Carolinas from September to November 1941. The maneuver area, about 60 miles wide, extended from Columbia, S.C., to Southern Pines, N.C. Area headquarters was at Monroe, N.C., and Corps headquarters were at Columbia and Fort Jackson, S.C. Many problems of public health and civil affairs were encountered by large troop units "fighting" through this region, which contained sizable modern cities and thinly populated rural districts. A few excerpts from the report of the medical inspector, Lt. Col. Isadore Schayer, MC, will illustrate some of the pertinent relationships, problems, and events.18

4. Cordial and valuable contact was made with the especially assigned Representative of the South Carolina State Board of Health at Chester, South Carolina. This contact was maintained throughout the Maneuvers for the purpose of obtaining:

(a) daily reports of prevalent infectious diseases among civilians in the Maneuver Area

(b) information about the various municipal water-supplies

(c) reports as to sanitary conditions of lunch-stands, cafeterias, etc.

(d) cooperation in the control of venereal disease.

Supervision of locally purchased foodstuffs and of public eating places, in an effort to prevent or check outbreaks of diarrhea and dysentery, involved military inspection and sanitary policing of stores, cafes, and restaurants in towns in the maneuver area. Obviously, when it became necessary either to put unsanitary eating places "off limits" or to close them, the resulting military-civilian relationship had jurisdictional, commercial, political, and personal implications.

In an unexpected and disturbing manner, the depressed economic status of civilians in impoverished districts in the maneuver area directly affected intertroop relationships and the military sanitation of campsites. In referring to the policing of campsites and to the scavenging by hungry animals and humans, the medical inspector reported:

In many instances, almost immediately upon the departure of troops [from an encampment], dogs and hogs would enter, dig and up-root hastily covered garbage pits, cans, turning up and scattering about, can, particles of food, etc. in a manner that upon a hastily drawn conclusion by an inspector, would be a great discredit to troops concerned. This Inspector, himself, on several occasions, when going into a site just evacuated by troops, would find negro men, women and boys with sticks etc., digging up garbage pits, hoping to find some edibles or other usable materials. Such incidences would also be noted by other units entering such upturned and defiled places, causing, to an extent, the attitude in the troops of-discouragement and discontent concerning "policing."

18Report of Medical Inspector on First U.S. Army Maneuvers, September-November 1941, Headquarters, I Army Corps, Office of the Surgeon, Fort Jackson, S.C., to Surgeon, I Army Corps, Columbia, S.C., 9 Dec. 1941.


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As usual, the program for the control of venereal disease among troops involved the most extensive coordination of military and civilian authoritative actions. In the maneuvers in the Carolinas, "venereal infections * * * were reduced to a surprising and gratifying minimum * * * by eliminating or restricting the sources of infection and, by strategically establishing prophylactic stations in many communities within the maneuver area * * * and also by offering the men an easily obtained supply of rubber protectives." Colonel Schayer's report continues graphically:

The State of South Carolina possesses no specifically aimed law against prostitutes, nor does it have any specifically assigned structure for the detention and treatment of diseased individuals. With the great influx, in "trailers", by railroad trains, in private cars, etc., of an appalling large number of itinerant prostitutes, the grave potential menace of such influx was realized and the Commanding General advised of this problem. Upon the representation of this problem by the Commanding General to the South Carolina State authorities, the latter promptly afforded all available aid possible. These authorities authorized the use of a woman's building, part of the State Penitentiary, as a house for detention and treatment of diseased women, and the Chief of State Constabulary visited Headquarters I Army Corps at Chester, South Carolina for further consultation. A conference was then held, in the office of the South Carolina State Board of Health in Chester, South Carolina, composed of the acting State Health Officer, the Chief of State Constabulary, the acting Chief of South Carolina State Highway, the Corps' Provost Marshal and Corps Medical Inspector. The Medical Inspector stated that while this I Army Corps appreciated the higher ethical phase of educational and moral prevention of sexual-promiscuity, this was a problem of an emergency, and the I Army Corps was chiefly concerned with the prevention of venereal disease among its men. The law authorizing the detention and isolation of any person having or, suspected of having, a communicable infectious disease was invoked and carried out according to the following plan:

All Sanitary Inspectors (additional ones were placed on duty) of the South Carolina State Board of Health were sworn in as Deputy Constables and they with the regular Constabulary and members of the South Carolina State Highway, would apprehend any diseased or apparently diseased prostitute, have her physically, microscopically and serologically examined and, if she proved to be diseased, sent to the temporary house of detention for treatment and cure. This plan proved very effective * * * and, together with other methods mentioned above, produced the low total of venereal disease in this Corps.

It is interesting to note that, as in the Wisconsin maneuvers in August 1940, Board of Health sanitary inspectors were commissioned also as deputy constables with certain police powers. As sanitary policemen, they definitely strengthened the joint military-civilian effort to prevent and control communicable diseases in the maneuver area.

Louisiana and Texas, 1940-41

In the 2 years immediately before the United States entered World War II, there were two extensive Army maneuvers in the Sabine River area in northwestern Louisiana and northeastern Texas-one in April-May-June 1940 and the other in August-September 1941. This great "Louisiana maneuver area" was a part of the domain of the Third U.S. Army, which,


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with headquarters at Fort Sam Houston, Tex., became the largest training Army in the United States. Its zone, extending from Mississippi to Arizona and from Arkansas to the Mexican border, included hundreds of units, from corps to small detachments; numerous posts, camps, and stations; and several maneuver areas. At times, its monthly troop strength averaged more than 750,000.

The Sabine River maneuver area, lying between the Sabine and Red Rivers, was "a 40- x 90-mile sparsely settled, chigger- and tick-infested bayou and pitch-pine section," sandy, denuded, and rugged.19

Before the 1940 maneuvers began, health conditions were surveyed by Army medical officers and by U.S. Public Health Service liaison officers. Cooperation was secured from the Louisiana and Texas State Health Departments and from the public. The majority of the parishes and counties had no full-time health services. The major problems were venereal diseases, malaria, and diseases transmitted through milk, water, and food. Plans were made to devise the direct control measures against these diseases in the civilian population, and to attempt to advance a general health program throughout the area which would afford maximum protection to the military and civilian populations. Obviously, such an attempt involved programs in the general field of civil affairs and military government public health activities although they were not specifically termed as such.

Of the two maneuvers in the Sabine River area, the second, held in August-September 1941, in which the Second U.S. Army was pitted against the Third U.S. Army, involved more than 350,000 men and was the largest ever conducted in the United States in peacetime.20

Many strategic, tactical, logistical, and professional lessons were learned from this large maneuvers-exercise, and the experience gained in the practice of military preventive medicine under field and simulated combat conditions was extremely valuable. On the other hand, not much that was new or highly important from the point of view of civil affairs and public health was developed. Nothing was lost, but the groundwork had been laid in the maneuvers in Louisiana and Wisconsin in 1940. Since the development of interested and competent personnel is on a par with plans and operations, it should be noted that two military commanders who had great influence in succeeding years upon civil affairs and military government rose to national prominence during these maneuvers. One was Lt. Gen. (later Gen.) Walter Krueger, who, in 1943-45, was to command the Sixth U.S. Army in its drive from the eastern tip of New Guinea to Luzon, in a campaign frequently concerned with problems of civil affairs and military government, particularly in the Philippine Islands. Commanding the Third U.S. Army, General Krueger drove the Second U.S. Army, under the com-

19Allen, Robert S.: Lucky Forward-The History of Patton's Third U.S. Army. New York: The Vanguard Press, Inc., 1947.  20See page 45 of footnote 13 (1), p. 69.


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FIGURE 7.-Maj. Gen. George C. Dunham, USA.

mand of Lt. Gen. Ben Lear, out of Louisiana into Arkansas, and "became a national figure overnight in the great Louisiana war games of September, 1941." The other was General Krueger's Chief of Staff, "a then unknown, newly made Brigadier General, Dwight D. Eisenhower."21 General Eisenhower, recognizing the problems and responsibilities, set in motion the activities of the Army as the primary agent for the conduct of civil affairs and military government in North Africa in 1942. As Supreme Commander, Allied Expeditionary Force, in 1944, he provided for and expanded the work in this field in Europe.

As a source of ideas and new practices, the maneuvers in the Sabine River area in April-May-June 1940 were more important than the larger maneuvers of August-September 1941, chiefly because one of the most eminent and thoughtful military preventive medicine leaders of that time, Lt. Col. (later Maj. Gen.) George C. Dunham, MC (fig. 7), was the medical inspector of the Third U.S. Army and participated in the Louisiana-Texas maneuvers. He was directly concerned with military and civilian public health activities in the maneuvers area and, on 24 June 1940, wrote a

21See page 9 of footnote 19, p. 74.


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characteristically perceptive report, recording his observations, opinions, and recommendations, as follows:22

2. In a maneuver area, the senior medical inspector, either Army or Corps, is concerned with the public health activities of a large area. This area will consist of several counties containing a number of small towns and villages. The tactical methods used in training at the present time are such that sanitation on the military reservation, or reservations, within the maneuver area, plays a relatively minor role in protecting the health of the troops.

The public health conditions in the towns, villages and rural districts of the maneuver area outside the military reservations are, on the other hand, of major importance in their effect on the health of the troops. As the Army medical inspector has no jurisdiction outside the military reservation he must, in order to protect the health of the troops, obtain the full cooperation of and work with the state, county and municipal health and police authorities.

3. It is recognized that the Office of The Surgeon General of the Army, being a Federal agency, can deal directly only with another Federal agency, which in this case is the U.S. Public Health Service. This is being done [according to the cooperative relationship established in 1940 between the U.S. Public Health Service and the Office of The Surgeon General of the Army] and, on request from the states concerned, the U.S. Public Health Service is placing officers in the maneuver areas. It can be assumed that requests by the states for officers of the U.S. Public Health Service will always be forthcoming, because the Federal Government is in a position to grant certain funds to the states for health work. Theoretically, the U.S. Public Health Service officer will act as a liaison agency between the Army or Corps surgeon, as represented by the Army or Corps medical inspector, and the local civilian health agencies. In practice, if the Army or Corps medical inspector is trained in public health work, and is willing and capable of cooperating with the civilian officials, the state, county and municipal health officers will work directly with the medical inspector, rather than through an officer of the U.S. Public Health Service. The officer of the Public Health Service functions as an advisor to the civilian health officers and cooperates with the medical inspector in coordinating civilian and Army health activities, and in this connection he renders invaluable service. However, an officer of the U.S. Public Health Service cannot be held responsible by the Army or Corps surgeon for obtaining quick and efficient action on the part of civilian officials or for coordinating the work of the latter with the activities of the Army. As a matter of fact, the Army or Corps medical inspector becomes the leader of a group of civilian health officers which includes the U.S. Public Health Service officer, provided, of course, that he has the necessary qualifications. Actually, the Army or Corps medical inspector, within the sphere of his health activities-that is, in connection with the local water supplies, food establishments, control of venereal diseases, etc.-becomes the health officer of the maneuver area for the duration of the maneuver.

4. * * * all the civilian health officers of the state or states concerned and the county and municipal health officials of the maneuver area are imbued with a desire to help the Army to protect the health of the troops. * * * they quite naturally look to the Army medical inspector for instructions regarding the health work that the Army wishes to have done in their respective communities. In Louisiana, the state assigned sanitary engineers, an entomologist, a director of a parish health unit, and a number of sanitary inspectors to the maneuver area to work with the Army in the execution of health measures throughout the area. These workers, together with the local public health personnel asked for, and followed, instructions given by the Army medical inspector.

22Letter, Lt. Col. G. C. Dunham, MC, Medical Field Service School, Carlisle Barracks, Carlisle, Pa., to Col. Albert G. Love,  MC, Office of the Surgeon General, U.S. Army, Washington, D.C., 24 June 1940, subject: Health Work in Maneuver Areas.


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5. The Army or Corps medical inspector in a maneuver area will work with county officials, the mayors of towns concerned, and with the municipal and state police. In Louisiana all of these officials were found to be anxious to do anything the Army desired to protect the health of the troops but they wanted, and it was necessary to give them, instructions as to just what the Army did want them to do.

6. In large maneuver areas such as the Louisiana-Texas area, Minnesota-Wisconsin area, or the New York area, the health work of the medical inspector and his staff can be of great educational value in demonstrating to civilian health officials the nature of the work that would be required of them in the event of mobilization. Furthermore, the maneuvers now being carried out, because of the large areas utilized, and the number of troops involved, offer a splendid opportunity for developing methods and procedures of coordinating Army and civilian health activities.

7. * * * it is urgently recommended that a regular Army officer who has had some special training in public health work be assigned as medical inspector to each of the Army or Corps maneuvers to be held in the future. It is further recommended that in each instance this officer arrive in the maneuver area at least two weeks before the beginning of the maneuvers in order that he may be able to work with the local health officials, and become familiar with the public health situation in the area, before the maneuvers begin.

The Third U.S. Army maneuvers in the general area of the Sabine River continued throughout 1942, 1943, and early 1944, and the concepts expressed earlier by Colonel Dunham were carried out.

Camp Forrest Area, Tenn., 1942

Of the numerous field training exercises held from 1940 to 1943 in the Camp Forrest area in central Tennessee, the Second U.S. Army maneuvers, commanded by General Lear, during the period September to December 1942, were most significant as a demonstration of military and civilian cooperation in public health work under simulated warfare conditions. In the following description and commentary, attention is focused on the early patterns of civil affairs and military government public health activities developed by these maneuvers.

The impressive finished product of the 1942 maneuvers had an earlier smaller model that was fashioned in the 2-28 June 1941 maneuvers of the Second U.S. Army held in a portion of the Camp Forrest area. This region, southeast of Nashville, was centered on Camp Forrest and Tullahoma and bounded by Shelbyville, Murfreesboro, Manchester, Cowan, and Lynchburg. Apparently, the need to institute new methods and a new type of organization to solve the problems of controlling food sanitation led to original, comprehensive, and effective developments. These developments are described in a paper presented before the Food and Nutrition Section of the American Public Health Association at its October 1944 meeting by three former civilian health officials.23 The following is quoted from their paper:

With the inauguration of the Second Army Maneuvers in Middle Tennessee, the sanitation of food handling developed as a public health responsibility of primary im-

23Morgan, H. A., Jr., Muse, T. B., and McKellar, A.: Making Food Handlers Health Conscious. Am. J. Pub. Health 35: 28-34, January 1945.


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portance. This importance was emphasized by five factors: 1. The large number of troops served in public eating places 2. The increase in war workers eating out, due to both husband and wife working in defense plants 3. The number of transients either directly or indirectly related to the war effort 4. The necessity for adjustment of small establishments to be able to handle large increases in patronage 5. The large number of novices in the business of feeding the public.

In order better to meet the problems posed by this overwhelming demand on public eating places, as well as other public health problems of the maneuvers, a district health department was organized by the Tennessee State Health Department in the area immediately surrounding Camp Forrest [italics added]. Six counties with organized health units were combined with one unorganized county into one large district with about 113,000 population. Since the district organization is unique in its arrangement and lends itself well to the solution of the problem to be solved, it will bear a brief description. A district director is in charge of the program planning and execution for the district as a whole, assisted by a nursing supervisor, sanitation supervisor, health educator, venereal disease investigators, and clerical supervisor. The six organized counties are divided into three two-county units, * * *. The existence of the district staff in addition to the regular county staffs is one of the important factors in making our approach to the control of food sanitation possible.

In carrying out the food sanitation control program and other public health connected programs during maneuvers, preventive medicine officers and other military personnel collaborated with the civilian health authorities.

During the next year, several important changes occurred. The maneuver area was enlarged, and in an even larger portion of the State surrounding Camp Forrest, the May Act (p. 62) was invoked on 20 May 1942 to limit prostitution near Army establishments.24 The area in which this law took effect in Tennessee comprised 27 counties; and in these counties, Federal agents, including military units and personnel, reinforced local civilian law enforcement agencies in efforts to prevent and control venereal disease.

The next maneuvers of the Second U.S. Army in the Camp Forrest area were held during the period September-December 1942 in a roughly rectangular area of 3,400 square miles-40 miles in an east-west direction and 85 miles in a north-south direction. The maneuver headquarters was at Lebanon, about 30 miles east of Nashville. The phases of this operation that were concerned with matters relating in principle and fact, if not in name, to civil affairs and military government public health activities greatly impressed one of the chief participants, Dr. W. Carter Williams, who was then commissioner of health of the State of Tennessee and coordinator of State services in the Second Army maneuver area. His summary and comments were recalled in a letter to Col. John Boyd Coates, Jr., MC, in 1961.25

* * * Historically, perhaps one of the most extensive and successful programs of military, state and local government cooperation in all aspects of preventive medicine

24War Department Bulletin No. 24, 20 May 1942.
25Letter, W. C. Williams, M.D., Director, Veterans' Administration Hospital, Nashville, Tenn., to Col. John Boyd Coates, Jr., MC, Director, The Historical Unit, U.S. Army Medical Service, Walter Reed Army Medical Center, Washington, D.C., 9 May 1961.


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was developed in the * * * [27] counties included in the maneuver area. The liaison between all military units through Second Army Headquarters (Major General Ben Lear Commanding) and an established office for all state and local services was direct and most effective. All state and local services were coordinated under one person (the writer), designated by the Governor of Tennessee as "Coordinator of State Services in the Second Army Maneuver Area." Personnel included Public Health physicians, nurses, sanitarians, highway patrol, food and restaurant inspection, welfare, and other concerned local and state activities. As I recall, this was the first area in the U.S. where the May Act was invoked-and quite successfully. The low incidence of communicable diseases, including venereal diseases, justified the efforts * * *

* * * Dr. G. Foard McGinnis represented the Commissioner of Health for the State of Tennessee as "Deputy Director of the Maneuver Area Program" and did an outstanding job * * *. This particular project represented exceptional organization, cooperation and accomplishment by all agencies concerned and at all levels of government.

Dr. Williams, in his letter, also cites the contributions made by Dr. G. Foard McGinnis. Additional information about the remarkable functions of Dr. McGinnis is given in a report by one of The Surgeon General's maneuvers observers, Capt. (later Lt. Col.) Francis B. Carroll, MC:26

On September 22, we had a conference with Dr. G. F. McGinnis, Liaison Officer between the State governmental agencies and the Army. Dr. McGinnis is not only an employee of the State Department of Health and a United States Public Health Service consultant, but he is actually a coordinator of all State agencies, such as secret service, state police, agriculture, conservation, labor and industry, etc., with considerable authority vested in him by the Governor. Dr. McGinnis' staff functions almost as a small state government in the twelve counties involved in this maneuver area. The Federal Security Agency, recreational agencies, and all other civilian agencies are housed in the same building.

Shortly after the end of these maneuvers, W. Carter Williams was commissioned a lieutenant colonel in the Medical Corps of the Army of the United States. It was natural that his interests, talents, and experience should lead to his assignment in the field of civil affairs and military government public health work overseas. In 1943-44, Colonel Williams served with distinction as a staff member of the Public Health and Welfare Division, Allied Military Government (later Allied Commission (Italy), in Italy, in the Mediterranean Theater of Operations, U.S. Army.

Sanitary and Epidemiological Surveys

Experiences during maneuvers in the United States from 1939 to 1943, from the first maneuvers at Pine Camp, N.Y., to the last in Louisiana and Tennessee, revealed that medical, sanitary, and demographic problems in civilian communities were related to the domestic economy, to shortages of medical, laboratory, and sanitary personnel, and to limitations in health and hospital programs. These experiences suggested problems that would be encountered in overseas theaters of operations. They were small prototypes of large problems of civil affairs and military government public

26Letter, Capt. F. B. Carroll, MC, to The Surgeon General, 2 Oct. 1942, subject: Report on Observations Made on Second Army Maneuvers in Tennessee, September 21 to September 27, 1942.


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health activities that had to be faced and solved. They emphasized the importance of surveys, of estimates of situations, and of plans geared to local and emergency conditions.

To gain knowledge of conditions, and to make such information available, a new type of survey and report was needed. A few Army medical officers and the liaison officers of the U.S. Public Health Service readily perceived the characteristics of this new requirement and responded appropriately. As previously mentioned (p. 76), Colonel Dunham, in a report to the Surgeon General's Office, pointed out that the current "tactical methods used in training" were not broad enough to cover civilian situations that were much larger and more complex than those of military reservations. The matters to be examined and reported upon according to the requirements of Army Regulations No. 40-275 (Medical Department-Sanitary Reports, 15 November 1932) were important but not sufficient for the kind of report that was developing, unofficially, for civil affairs and military government purposes. Colonel Dunham emphasized also the need to study such comprehensive reports as existed and for on-the-spot inspections, when possible, in advance of a maneuver. Later, overseas, it was found essential for all such information to be checked by personal inspection and for a limited sanitary-epidemiological survey and medical intelligence report to be made within the first few hours after the entrance of medical and nonmedical civil affairs officers into an area.

Incidentally, while problems of this nature were under consideration in maneuvers, the first forerunner of a comprehensive medical intelligence program in the U.S. Army was initiated in May 1940 by an oral request to The Surgeon General for information about the general functions of a health department. This information was to be incorporated in a War Department basic field manual on military government, then being prepared by the Judge Advocate General's Office.

Although this information was readily furnished by Lt. Col. (later Brig. Gen.) James S. Simmons, MC, then chief of the Preventive Medicine Subdivision (later Preventive Medicine Service), the task called attention to the need for detailed planning for civil public health in such areas and for data regarding local health problems and facilities. Accordingly, two Reserve officers, Colonel Hiscock, professor of public health at the Yale University School of Medicine, and Colonel Sweet, of the New Jersey State Health Department, were called to active duty * * * to prepare a more detailed plan. The finished report, submitted on 26 June 1940 entitled "A Plan for the Military Administration of Public Health in Occupied Territory," was general in scope, attempting to delineate principles applicable to all countries. A suggested sanitary code containing detailed regulations was appended.27

While participating in maneuvers in the United States, Colonel Hiscock noted the inadequacy of the ordinary military sanitary survey to meet the needs of possible future public health activities in connection with civil affairs and military government. He thereupon attempted to broaden the

27Medical Department, United States Army. Preventive Medicine in World War II. Volume IX. Special Fields. Washington: U.S. Government Printing Office, 1969, pp. 252-253.


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scope of survey methods and the content of the reports. He assisted in expanding the scope of the teaching along these lines at the School of Military Government at the University of Virginia and at the Civil Affairs Training Schools at the University of Pittsburgh and at Yale University in 1943. Changes proved difficult, however, and pressures to follow established patterns in meeting "military necessity," as more generally understood and applied, left much to be desired for civil affairs and the office of the newly established Assistant Chief of Staff, G-5, in theaters of operations. In fact, the goal had not been reached even after the end of World War II and shortly before the beginning of the action in Korea. As a member of an Army advisory committee, Colonel Hiscock observed that the older insufficient survey and report procedures were used in Operation PORTREX, the large Army-Navy amphibious exercise held from 25 February to 11 March 1950 on Vieques Island 9 miles off the southeastern coast of Puerto Rico.

Although no official War Department  form of survey or report was adopted generally for the public health phases of civil affairs and military government, models were available in the comprehensive reports issued by the Medical Intelligence Division, Preventive Medicine Service, in 1943-44. These reports, in the form of summaries of medical and sanitary data about various countries, were published as War Department Technical Bulletins, Medical. Information on the types and content of these reports can be gained by consulting any of the chapters in the three volumes of "Global Epidemiology."28 Recognizing both the military and civil aspects of these situations, the authors of this work stated in the Introduction to Volume I:

The information assembled has been primarily that which would be valuable in planning for the health protection and medical care of troops. Secondarily, information of essentially civil value has been included, as the military force so often must furnish care to the civil population. Moreover, it must be recognized that the health of a military force is vitally affected by the health of the civil community in which it is stationed, whether stationed on a belligerent or a friendly basis. In many respects, the friendly basis favors closer contact with the civil population than does the belligerent so that the health problems of the civil community may be more readily reflected in military experiences.

Time is a limiting factor with regard to the comprehensiveness of initial surveys. Therefore, those items that require immediate attention, those that may be left for a short time, and those that may be delayed for later consideration must be determined.

As a result of experience on maneuvers and familiarity with situations in theaters of operations, a "sanitary-epidemiological survey outline" was developed by Colonel Hiscock and others. Their adaptation was based upon the discussion and outline of sanitary surveys presented by Colonel Dunham

28Simmons, James S., Whayne, Tom F., Anderson, Gaylord W., Horack, Harold M., and collaborators: Global Epidemiology: A Geography of Disease and Sanitation (3 volumes). Philadelphia: J. B. Lippincott Co., 1944, 1951, and 1954.


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in his volume entitled, "Military Preventive Medicine."29 In various versions, it was used by Dr. Davenport Hooker in the Civil Affairs Training School at the University of Pittsburgh, and by Colonel Hiscock at the Civil Affairs Training School at Yale University and at the School of Military Government at the University of Virginia. The outline suggests the coverage needed, as well as a rating of items which, under emergency conditions, may be considered chronologically as of primary (**), secondary (*), and tertiary (unmarked) importance on the basis of what can and cannot be done in the time available. Although tentative and unofficial, the following outline is a useful guide in the conduct of sanitary and epidemiological surveys.

SANITARY EPIDEMIOLOGICAL SURVEY OUTLINE
(Adapted to civil affairs and military government public health activities.)

A.     Population.

1. Density.
2. Social and racial status.
3. Principal occupations and industries.
*4 Living conditions.
*5 Funds, sources, amounts and availability.
6. Vital statistics (birth and death rates, causes of death, etc.).
7. Transportation and communication facilities, etc.

B.     Environmental features.

1. Topographical and meteorological conditions.

**a. Nature of terrain.
**b. Character of topsoil and subsoil.
**c. Water table.
**d. Amount of rainfall and snowfall.
     e. Mean temperature and humidity.
     f. Winds, fogs, and seasonal variations in climate; earthquakes.

        **2. Water supply.

a. Sources (such as, dug wells, springs, driven wells, etc.).
b. Methods of purification (chlorination, boiling, fixed or portable purification units, etc.).
c. Methods of distribution.

3. Waste disposal.

a. Kinds of wastes.
b. Methods of disposal and salvage.

**(1) Human and animal dead (burial, cremation, etc.).
**(2) Human excreta (treatment plants, sewers, septic tanks, cesspools, privies, latrines, collection, etc.).
*(3) Animal wastes (composting, sanitary fill, etc.).
*(4) Garbage (sanitary fill, feeding, incineration, etc.).
*(5) Rubbish (burning, sanitary fill, etc.).
(6) Tin cans (perforation, etc.).

4. Housing.

*a. Kinds of shelter.
b. Ventilation, heating, and lighting.
c. Persons per room, etc.

29Dunham, George C.: Military Preventive Medicine. 3d edition. Harrisburg, Pa.: Military Service Publishing Co., 1940, pp. 1052-1058.


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5. Food supplies (including milk).

a. Sources.
b. Effectiveness of inspection methods.
c. Storage and protection.
d. Methods of distribution.
e. Operation of bread lines, soup kitchens, bakeries, etc.
f. Training and supervision of foodhandlers.
g. Character of public restaurants and their operation.
h. Adequacy of diet available.

*6 Insect control.

a. Kinds of disease-bearing insects.
b. Control methods employed and their effectiveness.
c. Civilian groups active in control measures.

C. Disease prevalence, hospital and medical facilities, and health agencies.

1. Morbidity rates.

a. Average total sick rate, specific diseases, geographic distribution.
b. Average daily incidence for communicable disease.
c. Prevalence of deficiency diseases.

2. Communicable disease.

**a. Epidemics existing.
*b. Epidemic, endemic, or sporadic prevalence.
**c. Foci of infection.
*d. Control measures.
*e. Venereal diseases and prostitution.

(1) Extent and control
(2) Laws relating to prostitution and their enforcement.

3. Hospital and medical facilities.

*a. Capacity of local hospital installations.
*b. Availability of additional space and equipment for emergencies.
*c. Facilities for segregation and isolation.
**d. Physicians, nurses, midwives, sanitarians and related personnel available, and facilities for training.
*e. Medical supplies, chemicals, drugs, etc., sources and availability.
*f. Laboratories, etc., available.
*g. Maternal and child welfare facilities.

4. Local health agencies, health laws, and regulations.

*a. Nature, operation, availability and distribution.
b. Laws and regulations.

(1) Character and adequacy.
(2) Enforcement in general.
(3) Enforcement in regard to food, foodhandlers, restaurants, etc.
(4) Enforcement in regard to crowding of public facilities, etc.

c. Type of health department of municipalities.
*d Health centers and administration.
e. Welfare organizations, Red Cross, etc.


* *Primary: May require immediate attention.
* Secondary: May be delayed for a short time.
Unmarked: May be delayed for later consideration.


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EVACUATION OF THE JAPANESE FROM THE WEST COAST, 1942

Alien Control Program

In the continental United States and its Territories, from early 1940 to the end of hostilities in 1945, the supervision and control of potentially dangerous aliens (called "enemy aliens" in wartime) involved the Military Establishment in civil affairs and in civilian public health activities. The enforcement of the enemy alien control program required the assertion of military authority in domestic situations, resulting in the regulation of some civil affairs. To serve joint interests, such as protecting the health of both aliens in custody and civilians in adjacent communities, military and civilian organizations worked together. Other examples of cooperation were anti-sabotage measures to protect sources of drinking water and to safeguard foodstuffs, both raw and processed. These activities were not specifically identified as pertaining to civil affairs and military government except in two important instances. The first occurred under the conditions created by the invocation of martial law in the Territory of Hawaii in 1941; the second developed in March 1942 in the Western Defense Command evacuation of the Japanese from the West Coast, when the first Civil Affairs Division in the Army was established on a staff level at a military headquarters-a year before the establishment of the Civil Affairs Division of the War Department Special Staff.

In April 1940, The Adjutant General became responsible for providing through local Army commanders for the custody of aliens ordered by the Department of Justice to be interned. The arrests were made usually by the Federal Bureau of Investigation. During the years 1941-43, The Provost Marshal General and the Corps of Military Police exercised administrative supervision over this program.

In the early stages of the war, before the arrival of large numbers of prisoners of war from overseas, the chief internment function of the Provost Marshal General's Office was staff supervision over the detention, in War Department internment camps of more than 4,200 civilian internees, most of whom had been arrested in the continental United States and a minority of whom had been received from Alaska, Hawaii, and the Panama Canal Zone. In 1941-42, the section of The Provost Marshal General's organization which was concerned with these matters was called the "Aliens Division." With the great influx of Italian and German prisoners of war from the North African Theater of Operations, U.S. Army, the attention of The Provost Marshal General turned from civilian internees to prisoners of war, and the name of this unit was changed to "Prisoners of War Operations Division." In 1943, all civilian internees, except the Japanese who were under the control of the War Relocation Authority of the


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Office of Emergency Management, were turned over to the Department of Justice.30

Western Defense Command and Fourth U.S. Army, 1941-43

Since 1932, the Fourth U.S. Army had been stationed in the Seventh and Ninth Corps Areas, with a mission "to deal with the Pacific Coast." In 1940, under the command of Lt. Gen. John L. DeWitt, this Army was deployed throughout the Ninth Corps Area, which, also under the command of General DeWitt, encompassed Washington, Oregon, California, Idaho, Montana, Nevada, and Utah. Arizona was added to this group in 1941. On 17 March 1941, this region and its military organizations became the Western Defense Command, with General DeWitt as commander. Its main troop component was the Fourth U.S. Army, and its primary mission was: "Responsible in peacetime for planning all measures against invasion of area under command, and in case of invasion of area, responsible for all offensive and defensive operations until otherwise directed by War Department." On 11 December 1941, the Western Defense Command, with Alaska included, became the Western Theater of Operations. Its headquarters, combined with those of its major constituent units, was at the Presidio of San Francisco. It was under the command of General Headquarters, War Department, and General DeWitt was theater commander. Actually, in 1942, the top staff of the Western Defense Command, in conjunction with certain officers in the G-1 section of the General Staff, influenced the development of the national policy governing the dealings with aliens on the West Coast, and the Fourth U.S. Army furnished troops and support that carried out the War Department's alien control program in that area, including the evacuation of the Japanese.

In 1941, the Fourth U.S. Army conducted highly instructive command post exercises at the Hunter Liggett Military Reservation, Calif. (with troops which included the III Corps under the command of Maj. Gen. (later Gen.) Joseph W. Stilwell), and army maneuvers in Washington and Oregon. These maneuvers, as well as the static disposition of units, involved all the elements of extra-military area sanitation and control of communicable diseases, except malaria, that have been discussed previously. Aspects of civil affairs and military government public health activities, conspicuous and prophetic in the maneuvers conducted in the eastern, northern, and southern regions of the United States, were equally notable in the Fourth U.S. Army maneuvers.31

30(1) Historical Monograph, Prisoner of War Operations Division, Office of The Provost Marshal General, 1945. [Official record.] (2) Lewis, George G., and Mewha, John: History of Prisoner of War Utilization by the United States Army, 1776-1945.  Department of the Army Pamphlet No. 20-213, 24 June 1955.
31(1) See footnote 13 (1), p. 69. (2) History of the Fourth Army, Study No. 18, Historical Section, Army Ground Forces, 1946. [Official record.] (3) The status of the Western Defense Command as a theater of operations was terminated on 27 October 1943, and the Western Defense Command was discontinued on 6 March 1946. The Fourth U.S. Army moved its headquarters from the Presidio of Monterey, Calif., to Fort Sam Houston, Tex., on 7 January 1944, to assume duties of Headquarters, Third U.S. Army which in turn proceeded to the European theater. Continuing as a great training Army, the Fourth U.S. Army formed two combat armies in 1944, the Ninth and Fifteenth U.S. Armies; and late in 1944, it was supplying at least half of the combat units shipped overseas.


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Through its location in the Pacific Coast States, the Western Defense Command, since late 1941, had been concerned in activities which involved the Army with various civilian and governmental agencies. These interests were represented by the war disaster relief plans, which were a responsibility of the Ninth Corps Area. The plans included such matters as bomb disposal, camouflage, shelters, antisabotage, and general disaster relief. In April 1942, this responsibility was transferred from the Ninth Corps Area to the Western Defense Command, which soon prepared a "War Disaster Relief Plan-Western Theater of Operations, 1942." In this plan, provision was made for cooperative effort by troops of the Western Defense Command and Fourth U.S. Army with local, State, and other Federal agencies. Detailed plans were prepared for each geographic subdivision of the command. In 1943, these responsibilities were returned to the Ninth Service Command, and the Western Defense Command was relieved of them.32

Civil Affairs Aspects of the Japanese Evacuation

During the period from 2 March to 3 November 1942, the Western Defense Command and Fourth U.S. Army gradually became engaged in an operation which has been characterized as "one of the Army's largest undertakings in the name of defense during World War II." This undertaking was the relocation of approximately 110,000 persons of Japanese ancestry from California, southern Arizona, and the western halves of Oregon and Washington. Some persons of Japanese ancestry were removed from Alaska, and a beginning was made on a proposed transfer of such persons from Hawaii to the continental United States. German and Italian residents of these areas were allowed to remain there. Only the Japanese, regardless of American citizenship and without benefit of legal trials, were evacuated. They were moved first to assembly centers under control of the Western Defense Command, in California, Washington, Oregon, and Arizona, and thence transferred to relocation centers under the control of the War Relocation Authority, in dispersed places throughout the country. Mass exclusion was directed and continued until late in 1944. Nearly all the interned Japanese were held in custody until the last months of 1944 when a few were allowed to return to the "restricted areas." The majority were retained at the relocation centers and were to be released between January and June 1945.33

This mass evacuation of the Japanese was a controversial issue from the start, and continues to be criticized. Conflicting opinions as to its

32History of the Western Defense Command, 17 Mar. 1941-30 Sept. 1945, vol. II. Prepared under the direction of Maj. Gen. H. C. Pratt, U.S. Army. On file, Office of the Chief of Military History, Special Staff, U.S. Army. [Official record.]
33(1) Conn, Stetson, Engelman, Rose C., and Fairchild, Byron: The Western Hemisphere. Guarding the United States and Its Outposts. United States Army in World War II. Washington: U.S. Government Printing Office, 1964. (2) See footnote 32.


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"military necessity" were held by both individuals and agencies. The War Department was convinced that it was essential to the national security; the Department of Justice, on the other hand, wished to protect the civil rights of individuals within reasonable provisions for national security. Economic and political factors influenced decisions. Public opinion was manipulated, and the fact that the Japanese in the Pacific States, and especially in California, had been targets of hostility and restrictive action for several decades was a factor that unquestionably influenced the measures taken against them following the attack on Pearl Harbor.

After much debate and maneuvering had occurred among his advisers, President Franklin D. Roosevelt, on 19 February 1942, signed Executive Order No. 9066, which authorized the Secretary of War to exclude "any or all persons" from areas to be designated by him, and to use the Army and other agencies of the Government to carry out the edict. This Executive order provided for the acceptance of assistance of State and local agencies, as well as for the use of Federal troops. It further authorized and directed "all Executive Departments, independent establishments and other Federal Agencies, to assist the Secretary of War or the said Military Commanders in carrying out this Executive order, including the furnishing of medical aid, hospitalization, food, clothing, transportation, use of land, shelter, and other supplies, equipment, utilities, facilities, and services." This laid the foundation for the mass evacuation of the Japanese from the West Coast.

On 20 February 1942, the Secretary of War authorized General DeWitt to exercise all the powers which the Executive order conferred upon him and upon any military commander designated by him. General DeWitt's first evacuation proclamation, putting these powers into effect, was issued on 2 March 1942. Congress passed Public Law 503 on 19 March 1942, and the President signed the act 2 days later, thus, in an ex post facto manner, giving the program legislative authority. Two years later, in the midst of the war, the evacuation of the Japanese was tested in the courts as an unconstitutional invasion of the rights of individuals. On 18 December 1944, the Supreme Court of the United States upheld the constitutionality of the evacuation by its decision rendered in the case of Korematsu v. United States.34

Among the individuals concerned with this unprecedented undertaking were General DeWitt, a vigorous and versatile commander who, although originally not in favor of evacuating Japanese-American citizens, yielded to this demand in the end. Another was the able Maj. (later Col.) Karl R. Bendetsen, GSC. Major Bendetsen, with the Office of the Assistant Chief of Staff, G-1, War Department General Staff, and Chief of the Aliens Division of the Provost Marshal General's Office, and later Assistant Chief of Staff for Civil Affairs, Headquarters, Western Defense Command and Fourth

34(1) Final Report: Japanese Evacuation From the West Coast, 1942. Washington: U.S. Government Printing Office, 1943, pp. vii-x, 522-525. (2) Grodzins, Morton: Americans Betrayed. Chicago: The University of Chicago Press, 1949, pp. 274-322.


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U.S. Army, had such a strong influence upon events that his biographical sketch in "Who's Who in America," 1944-4535, contained the statement: "* * * organized Civil Affairs Division and Wartime [Civil] Control Administration of Western Defense Command; conceived method, formulated details and directed evacuation of 120,000 persons of Japanese ancestry from military areas." This statement was shortened in the 1950-51 edition to: "Directed evacuation of Japanese from West Coast, 1942." According to the analysis by Dr. Stetson Conn:36 "The decision to evacuate the Japanese was one made at the highest level-by the President of the United States acting as Commander in Chief."

Civil Affairs Division, Western Defense Command

In American history, neither pattern nor precedent existed for an undertaking of this magnitude and character, and European precedents were unsatisfactory. Among the many qualities of leadership required for the successful conduct of the operation were firmness, foresight, energy, ingenuity, administrative creativity, and as much humane mitigation of the harshness of the dislocation as circumstances permitted. From the start, particular attention was paid to the hitherto unexperienced relation between the civil affairs of the local Japanese and American populations and the military government to be exercised by the Western Defense Command and the Fourth U.S. Army. Among the new administrative organizations invented to deal with the consequent problems was a Civil Affairs Division, established at the combined headquarters.

Although policy contemplated that a staff section charged with the responsibility for civil affairs would be created only when military forces were in actual occupation of enemy territory, or in other instances involving full military government, a novel and unexpected situation confronted the commanding general of the Western Defense Command. To cope with the new developments, General DeWitt, on 10 March 1942, issued General Order No. 34, by which the Civil Affairs Division of Western Defense Command and Fourth U.S. Army was created. The Assistant Chief of Staff for Civil Affairs was made fully responsible for the formulation of policies, plans, and directives pertaining to control and exclusion of civilians. These new functions of the Assistant Chief of Staff were in addition to any other duties and responsibilities which might be assigned to him and would be performed within the directives and general policies of the commanding general.

Next day, 11 March 1942, General DeWitt issued General Order No. 35, establishing the Wartime Civil Control Administration as the operating agency of the Civil Affairs Division. This also was placed under the direc-

35Who's Who in America. Chicago: The A. N. Marquis Co., vol. 23, 1944-45; vol. 26, 1950-51.
36Conn, Stetson: The Decision to Evacuate the Japanese From the Pacific Coast. In Command Decisions. New York: Harcourt, Brace and Co., 1959, p. 88.


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tion of the Assistant Chief of Staff for Civil Affairs. Thus the Assistant Chief of Staff for Civil Affairs performed a dual function. As a general staff officer and agent of the commanding general, he was empowered to issue appropriate directives pertaining to the control and exclusion of civilians in the name of the commanding general. As director of the Wartime Civil Control Administration, he was authorized to carry such directives into execution.

The Assistant Chief of Staff for Civil Affairs, who held these multiple offices simultaneously, formulated policies, and issued directives for their implementation was Colonel Bendetsen, recently transferred from the Office of the Assistant Chief of Staff, G-1, War Department General Staff, in Washington, to Headquarters, Western Defense Command and Fourth U.S. Army, at the Presidio of San Francisco. Later, in 1943-44 in London, Colonel Bendetsen played an influential role in shaping some of the policies and organization of the G-5 Section of Headquarters, European Theater of Operations, U.S. Army, and Supreme Headquarters, Allied Expeditionary Force.

The designated exclusion areas were those in which aircraft manufacturing plants and other war industries, ports, depots, and military installations were located; namely, Seattle, Portland, San Francisco, Los Angeles, Sacramento, and the vicinity of each. Obviously, practically the whole West Coast constituted the "vicinity" of those great cities.

As an initial step to facilitate voluntary migration of the Japanese, numerous Wartime Civil Control Administration offices were established, one in each important Japanese population center in the affected area. Later, when forced evacuation was put into effect, some of these and other offices became known as Wartime Civil Control Administration service centers, where the processing, examination, and medical care of evacuees were handled.

In the course of the next several months after March 1942, as mass evacuation of the Japanese proceeded, assembly centers were established in California at Fresno, Manzanar, Marysville, Merced, Pomona, Sacramento, Salinas, Santa Anita, Stockton, Tanforan, Tulare, and Turlock; in Arizona, at Mayer and Pinedale; in Oregon, at Portland; and in Washington, at Puyallup. At the assembly centers, various health procedures were carried out, including vaccination against smallpox and typhoid.

After varying periods of detention at assembly centers, the Japanese were evacuated to relocation centers in the intermountain States following difficult negotiations with governors and local officials who had agreed reluctantly to receive them. These relocation centers were to be their home for the duration of their internment.

On 18 March 1942, President Roosevelt, by his Executive Order No. 9102, established the War Relocation Authority in the Office of Emergency Management and, at about the same time, appointed Mr. Milton S. Eisen-


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hower as director. The director was given broad powers to relocate evacuees in appropriate places, to provide for their needs, and to supervise their activities. Although there were separate jurisdictions over evacuation and relocation, by agreement dated 17 April 1942, the War Department and the War Relocation Authority worked together in administrative, operational, medical, and public health affairs.

Mr. Eisenhower became director of the War Relocation Authority at a time when consideration was being given to the possibility that similar plans for the removal of persons of Japanese ancestry might have to be instituted on the East Coast. This was not done. Therefore, the problems falling to Mr. Eisenhower were those of taking over from the Western Defense Command the Japanese evacuated from the West Coast, moving them to relocation centers, providing for their care, and later returning them to their homes. The work involved many medical care, public health, and preventive medicine activities to be carried out in rather primitive but, on the whole, salubrious environments. These relocation centers were situated mostly in remote and thinly populated areas in California (Tule Lake and Manzanar), Colorado (Amache), Arizona (Poston and Gila

FIGURE 8.-Brig. Gen. Condon C. McCornack, USA.


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River, both on Indian Reservations), Arkansas (Rohwer and Jerome), Idaho (Minidoka), Wyoming (Heart Mountain), and Utah (Topaz).37

On matters pertaining to medical and sanitary aspects of the evacuation, Col. (later Brig. Gen.) Condon C. McCornack, MC (fig. 8), surgeon of the Western Defense Command and Fourth U.S. Army, and his successors, Lt. Col. (later Col.) Harold V. Raycroft, MC, and Lt. Col. Melvin Mark, Jr., MC, acted throughout in the capacity of general advisers to the commanding general and his Assistant Chief of Staff for Civil Affairs, who was also director of the Civil Affairs Division and of its operating agency, the Wartime Civil Control Administration. Actual direction and operation of medical service, sanitation, and preventive medicine activities at assembly centers were conducted by the U.S. Public Health Service, using its own officers, State and county health officers, and civilian volunteer physicians. Daily health reports and reports of inspections were made to the Wartime Civil Control Administration which imposed a multitude of rigid requirements, in accordance with U.S. Army regulations and practices. The medical and sanitary results were excellent. Morbidity was low, and no serious outbreaks of communicable disease occurred at either the assembly centers or the relocation centers. The death rates from all causes were as low as those in the civilian population outside the centers.

Section II. Alaska

Stanhope Bayne-Jones, M.D.

HISTORICAL NOTE

The purchase of Alaska by the United States was sealed by treaty with Russia on 30 March 1867, and the United States assumed formal jurisdiction over Alaska on 18 October 1867. For the next 45 years, this vast northern region, one-fifth the size of the continental United States, was governed by an ill-defined combination of local and Federal authority. On 18 March 1868, 5 months after the beginning of the American regime, the Military District of Alaska was created by the U.S. Army and the War Department became one of the chief Federal agencies to be concerned with both civilian and military government in the area. Even after Alaska became an organized territory and with the establishment of a limited Territorial government in 1912, the War Department, together with the Office of Indian Affairs of the Department of the Interior and the U.S. Public Health Service, continued to have influential practical connections. From 1868 to the outbreak of the war in Europe in 1939, many episodes occurred which in retrospect may be classified as civil affairs and military government activities arising under a system of limited military control exercised by

37Girdner, Audrie, and Loftis, Anne: The Great Betrayal: The Evacuation of the Japanese-Americans During World War II. New York: The Macmillan Co., 1969, pp. 216ff.


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agreement or convention.38 For example, the influx of miners during the gold rush in the late 1890's necessitated an extension of military control, preservation of law and order among civilians, and some concern for the protection of their health.

During the 71 years from 1868 to 1939, both the military forces and the civilian population of Alaska remained small and the military implications were considered to be minimal. As expressed by recent reviewers of the situation:39

* * * in prewar years the likelihood of military action in or near Alaska had appeared so remote that the Army had taken little more than an academic interest in America's huge northern continental territory and its island appendages extending far out into the Pacific. In fact, the only Army tactical force in Alaska in September 1939, when the German attack on Poland precipitated a new world war, was a garrison of 400 men-two rifle companies-at Chilcoot Barracks near Skagway, a relic of the Gold Rush days.

This academic interest was changed to urgent concern by the need in 1939 to strengthen the Alaskan outpost and to prepare its coasts, harbors, islands, and interior for defense against possible attacks from the Pacific. The process was greatly accelerated by the Japanese attack on Pearl Harbor and by the subsequent advance of the Japanese in the Pacific which culminated with the alarming occupation in June 1942 of Attu and Kiska in the Aleutian Islands. Driving the Japanese out of the Aleutians made Alaska the only area in the Western Hemisphere in which U.S. Army ground and air forces were battle-tested in World War II.

THE ARMY BUILDUP AND ITS RESPONSIBILITIES FOR PUBLIC HEALTH

The story is one of strenuous work in the construction of new bases and improvement of old bases and posts, of increase in the garrison by tens of thousands of troops, and of the importation of many thousands of civilian laborers, assistants, and technicians, greatly increasing the population and aggravating the problems of public health.40

An army, whether stationary or mobile, generates its own problems of public health and preventive medicine, wherever it may be. At the same time, it both intensifies existing health problems and initiates new ones, which easily spread to any neighboring civilian communities. Consequently, the Army has a responsibility, in its own interest and in the interests of local communities, to improve sanitation and to control all communicable diseases and other disabling conditions through appropriate measures. The desired result can be achieved only by collaboration between military and civil elements, and by some degree of military control over civil affairs.

38War Department Field Manual 27-5 (Navy Department OpNav 50E-3), United States Army and Navy Manual of Military Government and Civil Affairs, 22 Dec. 1943, p. 2.
39See pages 223-300 of footnote 33 (1), p. 86.
40According to the 1940 census, the total population of sparsely settled Alaska was 75,524, scattered over an area of approximately 584,000 square miles. Only eight towns had a population of more than 1,000; Juneau, the capital and largest, had 5,748.


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Frontier characteristics-The frontier characteristics of Alaska made the solution of health problems more difficult in some respects, easier in others. There was relatively slight development of urban life, and the small population of the country was widely dispersed. Natives were inducted into the Army in fairly large numbers, and many of the Army posts were situated adjacent to native communities and communities to which natives had migrated recently. Thus, opportunities for contacts were provided. For many years, the health of the native Eskimos, Indians, and Aleuts was a matter of concern to Government officials. Although there was no malaria, typhus, cholera, or plague-diseases largely of temperate and tropical zones-sanitary conditions among the natives were poor, tuberculosis and venereal disease rates were high, and the natives were extremely susceptible to the common communicable diseases of the white people. The Office of Indian Affairs, concerned with the medical care of the natives, had provided eight hospitals and a number of field physicians and nurses. The Army Medical Department, in addition to providing medical service for native inductees, was called upon frequently for emergency assistance in handling disease outbreaks, and to care for many sick and injured persons because civilian authorities lacked personnel or transportation. Furthermore, the Medical Department had to consider the possibility of nutritional deficiencies among civilians as well as among the military, and periodically furnished supplies of vitamins. Fortunately, no serious cases of deficiency diseases or malnutrition were reported to the Alaskan Defense Command.

The American National Red Cross-The program of the American National Red Cross in Alaska was determined by both War Department and Red Cross directives. Its activities, like some of the activities of military units, were limited by the cold wet climate, weather, fogs, williwaws, isolation, and the small and transient populations in the station hospitals. After 1942, the Red Cross activities became an important part of the programs of the larger hospitals in the Alaskan theater.

Civilian employees.-The large number of civilian employees brought into the area by the Army and by civilian contractors placed an additional burden on the Army Medical Department which had to compensate for the lack of civilian medical facilities at the worksites. For example, the total number of employed civilians rose to more than 17,000 during 1944. Frequently, they represented a third of the population of an isolated post and, occasionally, greatly exceeded the military, as at Shemya in December 1944. Hospital personnel had to be diverted for their care because an increase of personnel was not provided to meet the increased demands.

Army medical reports-The surgeons of military units in Alaska from 1941 to 1945 have provided valuable reports and histories.41 These docu-

41(1) McNeil, Gordon H.: History of the Medical Department in Alaska in World War II, 1946. [Official record.] (2) Report, Lt. Col. Luther R. Moore, MC, Surgeon, Headquarters, Alaska Defense Command, subject: Medical Problems to be Considered for All Areas, 1 January 1943. (3) Annual Report, Surgeon, Headquarters, Seventh Infantry Division, 1943.


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ments contain medical and technical data concerning the routine professional, sanitary, and administrative experiences of large and small organizations, but they have little to say about the public health activities associated with civil affairs and limited military government. Inevitably, however, unit surgeons participated in such activities through their collaboration with the semiterritorial, semitactical Alaskan authorities; and at times, they were actually local health officers of civilian settlements or villages.

The Territorial Department of Health-The chief civilian contribution to the joint work in public health was made by the Territorial Department of Health, under the Commissioner of Health, Walter W. Council, M.D. In a series of reports,42 Dr. Council described the organization of the department, summarized the activities of its six divisions, and stressed the fact that the work of these divisions increased greatly during the war as the result of the innumerable, varied, and widespread activities of the large military forces in the Territory of Alaska. Military authorities collaborated particularly with the Division of Public Health Engineering and Sanitation, the Division of Public Health Laboratories, and the Division of Communicable Disease Control. The other three divisions were Central Administration, Office of the Commissioner; the Division of Maternal and Child Health and Crippled Children's Services; and the Division of Public Health Nursing.

WAR-PERIOD ACTIVITIES AND DISASTER RELIEF PLANS
AND PREPARATIONS

The possible disruption of ordinary civilian activities in Alaska by enemy action was a prominent factor in planning the public health program. The "probable" destruction of cities and towns and their sanitary facilities, together with the threat of epidemics under such conditions and circumstances, made it necessary to anticipate problems and to prepare to meet them on a territory-wide basis. Almost all civilians living in accessible places in Alaska were immunized against smallpox and typhoid, and, to some extent, recommended immunizations against whooping cough and diphtheria were carried out. Shortages of personnel interfered with the immunization program as they did with other public health activities. In addition, the problems of communicable disease control were made more difficult by overcrowding, shifting population, and inadequate sanitation. With respect to this phase of the work of the Health Department, the commissioner reemphasized, in 1943: "Ever-increasing problems of sanitation due to the influx and relocation of civilian population were evident. Addi-

42(1) Annual Report, Territorial Department of Health, to the Governor of Alaska, 1 July 1941 to 30 June 1942. (2) Annual Report, Territorial Department of Health, to Governor of Alaska, 1 July 1942 to 30 June 1943.


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tional soldier personnel in nearby camps, as well as new camps, threw an extra load on the already crowded sanitary facilities."43

Laboratory facilities and services were made available on a wider scale than ever before. The commissioner noted: "Laboratories continued to provide an excellent service to the private physicians and the military services. In a few instances they were particularly valuable to the armed forces, due to the fact that they did essential laboratory work for the various camps while they were in the process of setting up their own laboratories."44 A new branch laboratory was opened in Ketchikan Health Center, and the Health Centers at Juneau and Fairbanks were enlarged and improved.

Public health nursing programs were expanded to provide new and increased services for the families of civilian defense workers as well as for the families of members of the Armed Forces.

A blood typing program was put into effect to provide at least the first step in the procedure of blood transfusion should civilian casualties occur.

Furthermore, the Territorial Department of Health together with other agencies was actively engaged in planning a territory-wide program for emergency first aid and medical services. First aid supplies, surgical equipment and supplies, and drugs were collected, to be made available to the principal towns in the event of an emergency or enemy attack. The other agencies were chiefly the American National Red Cross, the National Resources Planning Board, and the Office of Civilian Defense. Naturally, Army units in Alaska were prepared to aid civilians who might be harmed in an enemy raid or larger attack, and to assist in repairing sanitary facilities and in maintaining law and order.

Communicable Diseases

Respiratory infections, including tuberculosis, venereal diseases, and the diarrheas and dysenteries, were endemic in Alaska. Overcrowding accompanied the preparations for defense, and sanitary facilities became more inadequate than ever. The military forces usually improved the location in which they were stationed, but not always. To build airfields, bases, and camps, forests were cut down, trees and stumps were uprooted, tundra was bulldozed and churned into mud, and some sources of fresh water were contaminated. Waste disposal was difficult. Viewing this aspect of the situation in March 1944, the surgeon at Adak wrote that this island "had regressed from virgin nature to the pollution of modern civilization."

In dealing with communicable disease control in its environment, the military force in Alaska participated in broadly conceived extra-military area sanitation.

43See footnote 42 (2), p. 94.
44See footnote 42 (1), p. 94.


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Respiratory infections.-For the period 1942-45, the average rate of respiratory diseases (203 per 1,000 average strength) was higher in the Alaskan Department than in any other major region. In the first 2 weeks of April 1943 and, again, beginning on 2 December 1943, there were explosive outbreaks of sickness regarded as influenza. The most serious threat among the respiratory diseases was pulmonary tuberculosis. Although this was prevalent among the native Eskimos, Indians, and Aleuts, it did not spread among U.S. military personnel.

Venereal diseases.-Venereal diseases, although prevalent among native women and white prostitutes, were a much smaller health hazard to troops in Alaska and on the Aleutian Islands than in any other area of comparative size in which U.S. troops were stationed. Explanations given for this were: (1) reduction of contacts by the geographic isolation of many military posts; (2) good working collaboration between the military organizations and the Territorial Department of Health which, among other helpful actions, forced the deportation of infected prostitutes; (3) the ease and thoroughness with which houses of prostitution and the "line" (red-light district) in the main cities and towns could be kept "off limits"; (4) thorough application of rules of chemical prophylaxis; and (5) sanitary and health disciplines enforced by all commanding officers on orders from the commanding general.

Diarrheas and dysenteries-With low endemicity and variable severity among the aboriginal natives, intestinal infections in these categories were less of a problem than expected. The lowest rates for diarrheas and dysenteries, lower than for troops in the continental United States, were attained by troops stationed in the Alaskan Department. Factors contributing to law incidence were (1) climate and cold environment; (2) good control over water supplies for all bases in Alaska; (3) low endemicity among the natives, with only occasional epidemics; (4) adequate screening against flies and low prevalence of Musca domestica; (5) rapid installation of water-carriage sewage disposal units; (6) decrease of average troop strength after 1943; (7) use of military foodhandlers; (8) frequent sanitary inspections with emphasis on mess sanitation; (9) isolation and lack of contact with natives in many areas; and (10) practical public health educational programs especially with regard to sanitation.

Other serious communicable diseases among troops and natives included mumps, measles, and infectious hepatitis. Diseases of minor prevalence, however, raised few problems.45

Veterinary Activities

As described in detail by Lt. Col. Everett B. Miller, VC, in another

45(1) 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. 65, 405-409. (2) See pages 319-324 of footnote 4, p. 61.


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volume of the World War II Medical Department historical series,46 veterinary activities brought the military and civilian agencies concerned with food and feeding into numerous contacts involving close collaboration. These activities included procurement and inspection of fish, reindeer meat, eggs, dairy products, and vegetables.

Evacuation of Japanese From Alaska

Concurrently with the evacuation of the Japanese from the West Coast, the Army in Alaska engaged in the same kind of "protective" activities as those of its controlling authority, the Western Defense Command. After the attack on Pearl Harbor when the Alaskan Defense Command was made responsible for controlling enemy aliens in its area, it interned those it regarded as potentially dangerous. "On 6 March 1942," as recorded by Conn and his associates,47 "the Secretary of War extended his authority under Executive Order No. 9066 to the Army commander in Alaska. By the end of May, he had evacuated not only his alien internees but also the whole Japanese population of Alaska-230, of whom more than half were United States citizens."

Antibiological Warfare

During the last year of the war, the Surgeon, Alaskan Department,48 announced on 18 April 1944 that he had been appointed antibiological warfare officer in addition to his duties as surgeon, and that his activities as antibiological warfare officer were "limited to the preparation of precautionary measures and procedures." These measures and procedures might have involved civil affairs and military government public health activities. "Balloons of Japanese origin * * * carrying various types of explosive charges" had been found "and the possibility was considered that these balloons might be used as a means of biological warfare." The surgeon organized and instructed the balloon recovery teams which included medical or laboratory technicians "to inspect balloon landing sites and recover all possible bacteriological warfare specimens." These teams were not put to practical trial as there were no serious alarms over possible sabotage of health resources and facilities.

Section III. Hawaii

Ira V. Hiscock, M.P.H., M.D., and Stanhope Bayne-Jones, M.D.

Annexed by the United States on 12 August 1898, the Hawaiian Islands became an organized territory by act of Congress on 14 June 1900, in the

46Medical Department, United States Army. United States Army Veterinary Service in World War II. Washington: U.S. Government Printing Office, 1961.
47See pages 115-149 of footnote 33 (1), p. 86.
48See footnote 41 (1), p. 93.


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opening years of American expansion into regions of the Pacific Ocean. These years saw the beginning of the territory's contact with Federal military forces which exerted varying degrees of influence upon its civil affairs. These years also contained the seeds of the fated conflict between the United States as a new world power and Japan's moving, in 1940-41, into its so-called Greater East Asia Co-Prosperity Sphere. The military influences upon many civilian affairs, including public health activities, began to be especially notable in February 1913, when the Hawaiian Department, including Pearl Harbor on the island of Oahu, was established by the War Department to garrison and defend the territory and to serve as the main base in the line of support of U.S. forces in the Philippines, Guam, and other Pacific islands.

The strategic significance of the Hawaiian Islands as the most important Pacific outpost of U.S. defense was recognized from the first days of their possession. From 1900 onward, under the rule of the United States, Oahu and several adjacent islands were fortified increasingly. Organizations of the Army and Navy stationed there increased in number, strength, and local influence. The territory's civilian economic, political, and cultural growth took place under a paternalistic, friendly, military "occupation." Eventually, from 1941 to 1945, the strategic estimates became realities when Hawaii served as the main base for the hemiglobal counteroffensive against the Japanese Empire.49

DEFENSE PREPARATIONS AND PUBLIC HEALTH

The outbreak of war in 1941, and the emergency defense preparations which had preceded it, imposed new and additional duties and responsibilities upon the Board of Health of the Territory of Hawaii and necessitated considerable extension and expansion of the "normal" public health program. Fortunately, the territory, including the city of Honolulu, had one of the better programs of services in public health. It was superior in some respects to the programs of several States on the mainland, partly as a result of local initiative in periodic appraisal of needs and resources following a comprehensive health survey made in 1929. A resurvey was undertaken in 1935, which resulted in further constructive action. There was a firm basic structure for public health, with many members of the professional staff technically prepared, and a growing public interest in health affairs. The health department recognized not only the need for expanding its regular functions but also the necessity for preparing for any type of emergency.

From 1940 to the end of the war, increased demands were made upon the Department of Health, especially on Oahu, as a result of the national defense program. There was a rapid and continuous increase in population

49(1) Allen, Gwenfread: Hawaii's War Years, 1941-1945. Honolulu: University of Hawaii Press, 1950. (2) Anthony, J. Garner: Hawaii Under Army Rule. Stanford, Calif.: Stanford University Press, 1955. (3) See pages 150-222 of footnote 33 (1), p. 86.


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from 368,336 on 1 April 1930 to 423,333 on 1 April 1940, and an estimated 502,122 on 1 July 1945, when 261,023 military personnel also were stationed on the islands. As a result of the increased population alone, additional public health services, medical and sanitary supplies, and personnel were required in environmental sanitation, communicable disease control, food sanitation, public health nursing, supervision of water supplies and waste disposal, and problems related to housing.50

In providing these services, the Board of Health was joined by a number of other governmental and civilian agencies, including the Department of Institutions and its Bureaus of Hospitals and of Mental Hygiene, the local medical associations, the Junior Chamber of Commerce and the Chamber of Commerce of Honolulu, the American National Red Cross, and many others. Constant working liaison was maintained with the military medical establishment of the Hawaiian Department for joint undertakings and formulation of policies, especially in relation to sanitation, control of communicable disease, and disaster relief.

The lowest crude mortality and lowest infant mortality in the history of the territory were reported during the years immediately preceding the war, with a decline in the mortality from tuberculosis. The 1941 Annual Report recorded that "a receptive and public health minded community was a great assistance to the department [of Health] in helping to produce such results," while "military defense has precipitated many health problems."

President Roosevelt's proclamations of a limited and an unlimited national emergency, issued on 8 September 1939 and 27 May 1940, respectively, were followed by increasingly thorough planning and heightened efforts to prepare the public health services for meeting the needs that would arise in the event of an enemy attack from without, or sabotage from within, the territory. Anxiety about possible sabotage, an old obsession, was keener, at that time, than the fear of a possible overt enemy attack by air or sea. This long-held dread of sabotage was responsible, after the attack on Pearl Harbor, for repressive actions against the resident Japanese, aliens and citizens, and for stringent military antisabotage and antibiological warfare measures, both of which had an impact upon civil affairs.

When the Disaster Relief Council was organized after its establishment by an ordinance passed in April 1941, the Territorial Commissioner of Public Health was named chairman of the Health and Sanitation Committee composed of representatives of various related health, medical, and welfare agencies. The committee pointed out that its function would be almost identical with the normal functions of the Board of Health except for the expansion of specific activities to meet needs as they developed. All of this was carried on with an air of confidence in the impregnability of Oahu.

50(1) Annual Reports of the Board of Health, Territory of Hawaii, Honolulu, Fiscal Years 1940-1946. (2) Health Department Service in War Emergency. The Hawaii Health Messenger, vol. 1, No. 6, December 1941.


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FIGURE 9.-Brig. Gen. Edgar King, USA.

ATTACK ON PEARL HARBOR

The material damage inflicted by the Japanese attack on Pearl Harbor upon the military targets was enormous and casualties among military personnel were heavy. Honolulu was not deliberately bombed, but certain sections were strafed with machineguns. Several fires were started by Navy antiaircraft shells which had failed to explode in the air. The city suffered some damage and a number of civilians were killed or injured.51

The medical establishment of the Hawaiian Department, of which Col. (later Brig. Gen.) Edgar King, MC (fig. 9), was surgeon, treated casualties at aid stations and at various Army hospitals, particularly Tripler General Hospital. Civilian hospitals also were used by the military in cooperation with physicians and surgeons of Honolulu.52 Many relief measures, including the restoration of sanitary facilities and procedures, were undertaken at once.

51See footnote 33 (1), p. 86.
52Mason, Verne R.: Central Pacific Area. In Medical Department, United States Army. Internal Medicine in World War II. Volume I. Activities of Medical Consultants. Washington: U.S. Government Printing Office, 1961, pp. 625-693.


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Military control of civil affairs in Hawaii began on the day of the Pearl Harbor attack when Gov. Joseph B. Poindexter invoked the Hawaii Defense Act and proclaimed martial law at the request of Lt. Gen. Walter C. Short, commanding general of the Hawaiian Department. General Short then proclaimed himself "Military Governor of Hawaii." (The invocation of martial law and the suspension of the writ of habeas corpus were approved by President Roosevelt on 9 December.) The Military Governor asked that all departments of the Territorial government continue their special functions until otherwise ordered.

Within an hour after the first bombs fell, the executive heads of the civilian Department of Health were in conference, the well-laid plans were reviewed, and arrangements were made for carrying out the services which seemed to be required at the moment. An inventory was taken of the biologicals on hand at the health department and at the pharmaceutical supply houses in the city. All members of the health department in Oahu were placed immediately on 24-hour call. Day and night service was established at the Office of the Board of Health and was maintained for 2 weeks following the attack.

Close liaison was established and maintained with the medical departments of the Army and the Navy, the medical director of the first aid stations, the medical officer in charge of the Emergency Hospital, and municipal authorities, particularly those in charge of the water supplies, the sewerage systems, and garbage collection. All were urged to use the facilities of the Department of Health to the greatest possible extent.

On 8 December 1941, the United States declared war on Japan and formally entered World War II in alliance with Great Britain. This meant that the military representatives of the nation at war would, in the name of security and military necessity, exercise increasing authority over civil affairs, especially in a territory under martial law. However, medicine and public health in Hawaii were preempted less by martial law than were the judiciary functions and individual civil rights.

Further Public Health Activities After Pearl Harbor

Although the Hawaiian Islands were not attacked again, the war affected intimately the life of each individual there and was a constant factor in the responsibilities, plans, and everyday work of the Department of Health. So that appropriate measures for the prevention and control of communicable diseases might be instituted at the earliest possible moment, the Department of Health requested all physicians to report communicable diseases by telephone. An order from the Office of the Military Governor followed, directing physicians to comply with the request.

New public health problems were created by the forced evacuation of large numbers of civilians from residential districts close to military


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establishments to sections of Oahu distant from likely targets of possible renewed attack by the Japanese.

In Honolulu, a previously organized community health council proved useful. Routine sanitary, food, water, milk, and other inspection services were intensified. The outer-islands health department representatives took similar steps to meet local conditions.

The passage during the war period of various social security laws resulted in a flood of requests for copies of birth, death, and marriage certificates for such purposes as proof of citizenship, age, insurance, expatriation, passports, employment, school enrollment, social security, and welfare benefits. The demands upon the Bureau of Vital Statistics exceeded the capacity of the limited personnel, and the regular staff was increased with assistance from the Governor's contingent fund and other sources. The health education program was amplified, with special emphasis on nutrition.

Early orders of the Military Governor dealt with the economic use, control, and distribution of available medical supplies to meet the needs of both the military forces and the public during the emergency.

During the war period, while the territory was in a "theater of operations," the Board of Health continued to cooperate closely with the military authorities and other agencies for the mutual protection of civilian and military health. It collaborated with the surgeon of the Hawaiian Department in preparing a number of military orders relating to these matters. Two of those orders were especially noteworthy. The first order required the immunization against typhoid fever and smallpox of the civilian population of the territory who had not been vaccinated since 1 January 1941. The second order made venereal disease control measures more stringent.

Immunization program.-The immunization program of the territory's population against typhoid and smallpox was organized and administered by the Department of Health with the cooperation and assistance of the Army Medical Department, the Office of Civilian Defense, and voluntary organizations. Immunization against diphtheria, with toxoid, was not required but was recommended. Diphtheria toxoid was furnished by the Board of Health; typhoid and smallpox vaccines and incidental supplies were provided by the Army. As of 30 July 1942, records on file at the Department of Health covered 301,567 persons vaccinated against typhoid fever, 308,406 against smallpox, and 11,634 children injected with diphtheria toxoid. These numbers were exclusive of those on the large island of Hawaii, where the program was still in progress at the end of the fiscal year.

Venereal disease control-The venereal disease control order strengthened and supplemented existing communicable disease control regulations. It required that all cases of venereal diseases be reported to the Department of Health within 24 hours after diagnosis by medical officers of the Army and the Navy, as well as by civilian physicians. It provided for the naming of


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contacts and the reporting of delinquent cases. It made the Department of Health responsible for immediate examination of all suspected sources of infection and for the quarantine of infected individuals.

Many aspects of the situation in Hawaii were unique. A system of organized prostitution existed in the Territory. Houses of prostitution had attending physicians who examined the operators at regular intervals. * * * the practice was lucrative. * * * There were strong forces in the civilian community favoring the presence of organized prostitution. These forces included both a large group who obtained handsome financial support from a reportedly 10-million-dollar business and others who felt that the prostitution system had contributed to the low venereal disease incidence in the islands and was a protection to respectable women and girls of the community.

Efforts were made by the military authorities to close the houses of prostitution in Honolulu.

In September 1944, after many conferences with local authorities, the houses of prostitution in Honolulu were closed. Similar houses in other places in Hawaii had been closed previously. After this action, there was no increase in sex crimes or other criminal practices and there was an additional decrease in the already low venereal disease rate among Army personnel.

From this experience, it may be concluded that the proponents of organized prostitution were mistaken as to its benefits.53

Dengue.-After an absence of more than 30 years, dengue appeared in epidemic form in Honolulu in July 1943; apparently it was introduced by commercial airline pilots flying in from the Fiji Islands, where an epidemic had been reported. After several cases appeared in civilians and in military personnel about 3 to 4 weeks following the arrival of the pilots, vigorous measures were taken by the Territorial Board of Health in collaboration with the Army Medical Department and the U.S. Public Health Service. Although 1,498 civilian cases were reported through June 1944, only 56 occurred in military personnel. The disease reached its peak in October and did not spread from Oahu to the other islands.

Of the two proved vectors of dengue, Aedes albopictus and Aedes aegypti, A. albopictus was the more important-a persistent biter only during daytime. Protective measures consisted of (1) citywide inspections at 10-day intervals to eliminate mosquito breeding places, (2) selective spraying to kill adult mosquitoes, (3) mandatory screening for patients in hospitals and in homes, (4) placing large areas of Honolulu "off limits" to troops, and (5) educating the residents in how to prevent mosquito breeding on their premises.

Assistance in dengue control was given freely by the Army to civilian agencies because effective control in military establishments was not possible without adequate control in civilian areas. A medical officer was attached to the Territorial Board of Health to make an epidemiological study of all new cases. Fifty enlisted men were assigned to spray the buildings and eliminate mosquito breeding places in houses in which there

53See pages 139-331 of footnote 4, p. 61.


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were cases of dengue. Trucks, ladders, and spraying equipment were made available to civilian agencies.

As an aftermath, in 1944-45, Lt. Col. Albert B. Sabin, MC, of the Commission on Neurotropic Virus Diseases of the Army Epidemiological Board, recovered seven strains of dengue virus (which became known as the Hawaiian strain) from serum specimens drawn from Americans stationed in Hawaii.54

Plague.-After an absence of 3 years, human plague was again reported from the Hamakua District on the Island of Hawaii: seven cases, all fatal, in 1943; and seven cases, five fatal, in 1944. From May 1943 to April 1944, the flea index of rats rose from 0.17 to 0.61, and infected dead rats were found increasingly. The Territorial Board of Health attacked the problem of control vigorously. Some 5,000 persons were vaccinated with the Army plague vaccine. Air Force personnel and employees entering the Hamakua District also were injected with plague vaccine. Rat-free zones in and around infected areas were established by poisoning and gassing operations and by community sanitation. The rodent population was held at a low level in the epizootic area. Trapping was used primarily to determine whether or not the infection was spreading. This limited outbreak affected only civilians. The Army treated it "expectantly," cooperating with the Territorial Board of Health as indicated.55

Martial Law

The administration of martial law, particularly on Oahu from 1941 to 1944, and the activities that took place in this clearest of all instances of military government of civil affairs, included certain public health activities, in an internal domestic situation in a territory of the United States. During its enforcement, there was a period, beginning on 8 February 1943, in which partial restoration of civil authority prevailed. On that day, mitigating proclamations were issued by Gov. Ingram M. Stainback and by Lt. Gen. Delos C. Emmons who had succeeded General Short as commanding general of the Hawaiian Department and as Military Governor of the Territory. From June 1943 to August 1944, Lt. Gen. Robert C. Richardson, Jr., held the title of Military Governor. These three Military Governors administered martial law according to the pertinent field manual and army regulations.56 They applied the authorizations strictly in matters having a direct bearing on the prosecution of the war, particularly with regard to curfew, blackout, food control, and controls over a multitude of individual civil liberties. Their

54(1) Medical Department, United States Army. Preventive Medicine in World War II. Volume VII. Communicable Diseases: Arthropodborne Diseases Other Than Malaria. Washington: U.S. Government Printing Office, 1964, pp. 29-62. (2) Gilbertson, W. E.: Sanitary Aspects of the Control of the 1943-1944 Epidemic of Dengue Fever in Honolulu. Am. J. Pub. Health 35: 261-270, March 1945.
55See pages 79-100 of footnote 54 (1).
56(1) War Department Basic Field Manual 27-15, Military Law: Domestic Disturbances, 6 Feb. 1941. (2) Army Regulations No. 500-50, Employment of Troops: Aid of Civil Authorities, 5 Apr. 1937.


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orders bore heavily upon judicial proceedings. For example, military courts replaced civil courts, which were suspended. All schools were closed for a period. Practitioners of medicine and public health were subjected to severe controls in some matters, but were largely left to conduct their own affairs. The Office of the Military Governor included a controller of civilian medical supplies, and orders were issued regulating some phases of medical practice, the handling of drugs and poisons (including insecticides), garbage disposal, public health hospitals, insane asylums, water supply control, and so forth.

President Roosevelt arrived in Honolulu for a military conference on 21 July 1944, and the overbearing title, "Office of Military Governor," was changed to "Office of Internal Security." On 24 October 1944, the President ended martial law and restored the writ of habeas corpus by Proclamation No. 2627.

Throughout this long period, the public health activities of civil affairs and military government were aided considerably by the existence of martial law, through orders issued by the Military Governors and through collaboration between the Territorial Department of Health and the military establishments, both of which were endowed with wider powers.

Nevertheless, opinions differed as to the values of martial rule and its prolonged tenure in Hawaii. Criticisms have been expressed by Anthony57 and Biddle.58 However, more moderate statements summarize the case well, as an anonymous historian wrote:59

When the Japanese attacked Pearl Harbor on 7 December 1941, a situation unprecedented in American History came into being. Martial law was proclaimed in the Territory of Hawaii, subjecting the community to strict control by the Commanding General of the Army forces in Hawaii in his capacity as the Military Governor. This rule was destined to last for nearly three years. Previously, martial law had been used on numerous occasions in the United States to subdue riots, labor disorders, and other internal violence, but never before had it attained such proportions, so completely pervaded the community life, or remained in effect so long. * * * The daily life of each individual in the Territory was vastly and often rather suddenly changed by the emergency measures which followed the attack.

Finally, Conn, Engelman, and Fairchild60 assessed the situation as follows:

* * * By and large, at the outset [of martial law], civilians accepted these and other measures with understanding and good spirit. Later, both Hawaiians and agencies of the federal government other than the War and Navy Departments registered a good many complaints about the continuation of martial law; but the Army kept a tight control of civilians and civilian affairs until after the Battle of Midway in June 1942 erased any threat of invasion.

57See footnote 49 (2), p. 98.
58Biddle, Francis: In Brief Authority. Garden City, N.Y.: Doubleday & Company, Inc., 1962.
59History of U.S. Army Forces, Middle Pacific and Predecessor Commands, During World War II, 7 December 1941-2 September 1945. [Official record, Office of the Chief of Military History.]
60See footnote 33 (1), p. 86.


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Evacuation of Japanese.-From the beginning of the emergency in 1939, the authorities of the Territory of Hawaii and many important citizens had been fearful of injury to persons, installations, public utilities, offices, and property by acts of sabotage that might be committed by resident aliens, particularly by the Japanese. Many precautions were taken, notably a suspicious watchfulness over their activities. After the attack on Pearl Harbor, strict control of Japanese, both aliens and citizens, was increased, stimulated by the proclamations and actions of the central government concerning control of aliens living in the West Coast States.

Although there was much suspicion of the Japanese, there was no evidence that they committed sabotage of any kind at any time. During the first few days after the attack on Pearl Harbor, rumors were current that the water supply of Honolulu had been contaminated or poisoned. Upon investigation and examination, this rumor was shown to be without foundation; other similar rumors also were found to be false.

Of 160,000 Japanese in the territory, 1,450 were taken into custody during the war and, of these, 1,000 were evacuated to the mainland. They were interned for the duration in the relocation centers at Jerome, Ark., and Poston, Ariz.61

Antisabotage and antibiological warfare.-To further protect the health and safety of civilians, military personnel, and installations in the Territory of Hawaii, an extensive effort was directed against possible sabotage and biological warfare that might be carried on by Japanese or other residents of Hawaii.62 This effort was centered in the Office of the Surgeon, Hawaiian Department, as Colonel King was designated antibiological warfare officer early in 1942. From 1942 until the end of the war, his special staff consisted of a number of departmental antibiological warfare assistants. They conducted many surveys of water supplies, food processing and serving establishments, drugstores, chemical supply houses, and bacteriologic laboratories. They supervised hundreds of chemical and bacteriologic examinations of all kinds, and Colonel King's detailed scientific and practical reports contributed much to the effectiveness of precautionary measures. No instance of sabotage or biological warfare occurred.

SUMMARY

The public health program existing in Hawaii before the outbreak of war in 1941 made it possible to carry out unusually effective and well-administered military and civil public health operations in World War II. In concluding this section, it is appropriate to quote from an article by Richard K. C. Lee, M.D., Director of Public Health, Territory of Hawaii, published in the January 1944 issue of The Hawaii Health Messenger. Dr.

61See footnote 49 (1), p. 98.
62(1) See footnote 59, p. 105. (2) Personal information of the authors.


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Lee's summary and opinion of the health program in Hawaii during the early war years follow:

From December 7, 1941, until March 11, 1943, the Territory of Hawaii experienced health administration under civilian and military control. During this period, the Military Governor's office exercised general supervision over all health problems relating to the civilian and military population. The civilian health department continued to carry out health laws and regulations, while the military superimposed or added new regulations to meet the changed conditions of the community, and in several respects strengthened existing regulations.

Public health under military rule in wartime Hawaii demonstrated the value of a well organized health program and the possibilities of its expansion wherever it was needed. Instead of organizing and developing wartime health department services for the maintenance of public health, military authorities were able to utilize the Territorial health department personnel, supplementing their activities, where necessary, with additional personnel. The close cooperation between the military and the civilian authorities responsible for the maintenance of health in Hawaii has been very gratifying. The results of such a relationship have been adequately demonstrated in the low morbidity and mortality figures in the Territory during the past two years. And among the gains which have been made in public health can be prominently listed wider public acceptance of certain progressive community health measures, such as mass immunization and more stringent venereal disease control, which were initially imposed by military order and later promulgated and continued under civilian authority. 

Section IV. U.S. Possessions and Bases in the Caribbean Area

Major General Morrison C. Stayer, MC, USA (Ret.)

HISTORICAL NOTE

The concern of the United States with the security and defense of the Caribbean area was a part of the Nation's instinctive sense of the need to defend the entire Western Hemisphere. This precautionary attitude, assumed at the beginning of the country's independence, was first formally asserted in President James Monroe's annual message to the Congress on 2 December 1823. The Monroe Doctrine, modified and expanded from time to time, as one of the basic foreign policies of the United States, admonished against European political or military intrusion into the affairs and territories (including coasts, islands, seas, and adjacent ocean areas) of North America and South America. During the succeeding 80 years, the doctrine stood as a warning to foreign powers, and it was invoked several times with deterrent effect. However, no permanent defenses were created by the United States in the Caribbean area until after the Panama Canal Zone was acquired in 1903.

After the acquisition of the Panama Canal Zone, some defensive preparations were made to protect the canal and its approaches. Little was done, however, to plan and create the military means for the United States to engage in a defense of the Americas. A philosophy of isolation and a disinclination to maintain sufficient military strength to sustain defense on


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a hemispheric scale persisted from the end of World War I into the 1930's. In addition, by about 1936, new international agreements, and the displeasure of a number of Latin American countries, had forced the virtual obsolescence of the Monroe Doctrine. Toward the end of the 1930's, startling events immediately preceding World War II caused a radical change in outlook and a quickening of military and political activities to safeguard the Western Hemisphere.

These events have been summarized by Conn and Fairchild63 as follows:

Immediately after the Munich crisis of September 1938, the United States moved toward a new national policy of hemisphere defense. * * * The rise of aggressive dictatorships in Europe during the pre-World War II decade found the United States Army in condition to do no more than defend the continental United States, Oahu, and the Panama Canal Zone. The Navy, relatively much stronger than the Army, was tied down in the Pacific by Japan's naval expansion and aggressive action in China. Therefore, when President Franklin D. Roosevelt declared, six weeks after the Munich settlement, that "the United States must be prepared to resist attack on the western hemisphere from the North Pole to the South Pole, including all of North America and South America," the Army and Navy were presented with a much bigger mission than they were then prepared to execute.

Less than a year after President Roosevelt's pronouncement that the United States must be prepared to defend the entire Western Hemisphere, World War II began in Europe with the German invasion of Poland on 1 September 1939. The United States began at once to strengthen its continental perimeter on land and in the bordering seas and oceans. Great arcs of defensive installations were projected from Alaska through Hawaii to the Panama Canal Zone and, from there, eastward along the northern shores of Colombia, Venezuela, and the Guianas, and northward through the Antilles to Newfoundland, Greenland, and later Iceland.

One of the measures taken by the United States to strengthen its defense position was the acquisition of base sites on British territory in the Caribbean. The Destroyer-Base Agreement with Great Britain of 2 September 1940 secured additional base facilities, and "although the Army played a comparatively minor role in the actual negotiation" of the exchange of destroyers for bases, its Medical Department inherited major additional civil affairs and military government public health activities in a large portion of the Caribbean area.64

GENERAL CHARACTERISTICS OF CIVIL AFFAIRS AND  
MILITARY GOVERNMENT PUBLIC HEALTH ACTIVITIES

Although the 1940 leased-base agreement did not confer upon the United States sovereignty over British territory on Caribbean islands and

63Conn, Stetson, and Fairchild, Byron: The Western Hemisphere. The Framework of Hemisphere Defense. United States Army in World War II. Washington: U.S. Government Printing Office, 1960, p. 3.
64See page 45 of footnote 63.


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on the mainland of British Guiana, it did endow U.S. Army and Navy forces and certain agencies with some degree of authority over the inhabitants. Many problems that arose under this agreement, as well as under those with the Latin American countries which were not partners to the destroyer-base deal, called for serious and intricate negotiations between representatives of civil governments and U.S. military authorities to arrange for necessary sanitation and public health control over civilians living near military facilities. The development of programs of sanitation, preventive medicine, and public health was necessary in conformance with the limiting provisions, agreements, and conventions. This type of relationship between civilians and military forces under a form of mixed civilian and military rule was not new to the Caribbean area. It had been experienced in the Panama Canal Zone since 1904 and, to a lesser extent, in Puerto Rico since 1898.

This section deals with the joint civil and military aspects of public health activities in that portion of the Caribbean Defense Command that included U.S. possessions; namely, Puerto Rico, especially the islands of Saint Thomas and Saint Croix in the Virgin Islands, and the Panama Canal Zone. The Panama Canal Zone was not a possession of the United States, but was a portion of the Republic of Panama wherein the United States has perpetuity control.

THE CARIBBEAN DEFENSE COMMAND

According to war plans adopted in 1940 (Rainbow 4),65 a Caribbean theater was contemplated, with territorial limits consisting of "the islands in or bordering on the Caribbean Sea, the Guianas, Venezuela, Colombia, Ecuador, and the countries of Central America (except Mexico)." Although the theater concept persisted throughout the next several years, the actual designation of the area and its military organization was Caribbean Defense Command.66

The Caribbean Defense Command67 was authorized by the War Department on 9 January, officially activated on 10 February, and its organization was completed on 29 May 1941, under the command of Lt. Gen. Daniel Van Voorhis who was also commanding general of the Panama Canal Department. Its primary mission was "to meet any threat by air or water by European powers, coming directly from the East into this area or from an established base in the northeastern part of Brazil, and further,

65(1) A History of Medical Department Activities in the Caribbean Defense Command in World War II, vol. I, May 1946. (2) See footnote 63, p. 108.
66General Orders No. 8, Headquarters, Caribbean Defense Command, Quarry Heights, Canal Zone, 29 May 1941.
67(1) See footnote 63, p. 108. (2) Francis, Marion D.: History of the Antilles Department. Sec. II, Ch. I. War Plans and Defense Measures Prior to Organization of the Caribbean Defense Command (1 July 1939-29 May 1941), passim. [Official record, Office of the Chief of Military History.] (3) See pages 301-441 of footnote 33 (1), p. 86.


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to provide a more readily available force for augmenting the defense of Panama Canal from the above directions or from the Pacific."68

The area of the Caribbean Defense Command was more than a fourth the size of the United States. It extended eastward as far as planes could fly, fight, and return, without refueling; westward 800 miles into the Pacific to the Galápagos Islands; southward to Peru; and northward to encompass Cuba and Puerto Rico in the Greater Antilles, and thence eastward and southward through the Lesser Antilles to the northern coast of South America through French Guiana. The Caribbean Defense Command included British Honduras, Guatemala, Honduras, El Salvador, Nicaragua, Costa Rica, Panama, Ecuador, Colombia, Venezuela, and a portion of Peru, Cuba, Haiti, and the Dominican Republic (map 2).

Command Organization

The military medical organization in the Caribbean area began with the establishment of the Panama Canal Department, with headquarters at Quarry Heights, C.Z., on 1 July 1917. The Caribbean Defense Command was activated in the Panama Canal Department on 8 May 1941. However, in the course of prewar defense preparations, the Puerto Rican Department, which included the U.S. possessions in the Virgin Islands, was activated on 1 July 1939, with headquarters at San Juan, P.R.

On 29 May 1941, the Caribbean Defense Command was organized into three major sectors with lesser commands, as follows:

1. The Puerto Rican Sector (included the Virgin Islands in the Puerto Rican Department) and the Bahama, Jamaica, and Antigua Base Commands.

2. The Panama Sector absorbed the Panama Canal Department.

3. The Trinidad Sector was divided into the Trinidad, Saint Lucia, and British Guiana Base Commands.

When the Antilles Department was established as the northeast segment of the Caribbean Defense Command on 1 June 1943, the Puerto Rican Sector, which had absorbed the Puerto Rican Department in 1941, was transferred to the Antilles Department, with headquarters still at San Juan, P.R.

The purpose of outlining the organization of the Caribbean Defense Command is not to immerse the reader into the pool of jurisdictional complexities of 1941 but rather to indicate the intricacy, variety of territorial arrangements, and the many different peoples and national interests that were involved in the civilian and military administration of the Caribbean Defense Command. Diverse as were the elements, there were many common interests in problems of sanitation, preventive medicine, and public health. These peoples and their economic standards were united

68The Army Almanac. Washington: U.S. Government Printing Office, 1950, pp. 305-306.


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MAP 2.-Location of departments and major U. S. Army bases, Caribbean Defense Command.


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by two common afflictions, malarial fevers69 and venereal diseases. Civil affairs and military government public health activities were intimately intermingled in efforts to control and prevent these afflictions.

Medical Department Organization

In May 1941, the three separate health and medical organizations in the Caribbean area were Health Department, Panama Canal; Office of the Surgeon, Panama Canal Department; and Office of the Surgeon, Puerto Rican Department. These, with the addition of sector medical establishments, were continued after the Caribbean Defense Command was activated. Their chief surgeons, according to different arrangements, reported directly to The Surgeon General; to the Office of the Chief of Staff, War Department; or to First U.S. Army through Headquarters, Second Service Command. In planning for the Caribbean Defense Command, provision had been made for an overall medical staff. For various reasons-strategic, tactical, and conceptual-the establishment of the Office of the Surgeon, Caribbean Defense Command, was postponed until 13 October 1943. This delay of more than 2 years took place despite the strong recommendation of a War Department inspection team under the command of Col. (later Brig. Gen.) Frederick A. Blessé, MC, Surgeon, General Headquarters, U.S. Army. On 11 February 1942, this team reported that the headquarters of the Caribbean Defense Command was only partially organized and had no medical section, and that such a section should be established without delay.70

In the meantime, from 29 May 1941 to 13 October 1943, requests for expert professional advice and information on medical and health problems by Headquarters, Caribbean Defense Command, were dealt with chiefly by the informal assistance of Brig. Gen. (later Maj. Gen.) Morrison C. Stayer, MC, chief health officer of the Panama Canal since 1939 and acting chief surgeon of the Caribbean Defense Command since 1941 (fig. 10). In responding to these requests, General Stayer exercised unofficially some of the functions he was later to perform officially; General Stayer was not designated surgeon of the Caribbean Defense Command until 13 October 1943, when the Office of the Surgeon was established.71

Assignment of venereal disease control officer.-With the influx of troops into the Caribbean area in 1942, the incidence of venereal diseases rose rapidly. In September 1942, the Anglo-American Caribbean Commission requested the assignment of a U.S. Public Health Service officer to assist in directing a control program. At the same time, The Surgeon General was deeply concerned with this problem. The matter was taken up

69West, Luther S.: The South Atlantic and Caribbean Areas. In Medical Department, United States Army. Preventive Medicine in World War II. Volume VI. Communicable Diseases: Malaria. Washington: U.S. Government Printing Office, 1963, pp. 113-247.
70(1) See page 155 of footnote 65 (1), p. 109. (2) Medical Department, United States Army. Organization and Administration in World War II. Washington: U.S. Government Printing Office, 1963.
71(1) See page 167 of footnote 10 (3), p. 64. (2) See page 159 of footnote 65 (1), p. 109.


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FIGURE 10.-Maj. Gen. Morrison C. Stayer, MC, USA.

also by the Interdepartmental Committee on Venereal Disease Control, especially at its meeting on 17 November 1942. As a result of the discussions, the chief of the Venereal Disease Control Division, Surgeon General's Office, strengthened the Army venereal disease control program in the Caribbean area, assigning Maj. (later Col.) Daniel Bergsma, MC, an officer specially trained for this work, to headquarters of the Caribbean Defense Command, to initiate and promote the necessary control measures.72

Assignment of surgeon-There was no official surgeon of the Caribbean Defense Command when Major Bergsma began his duties as venereal disease control officer on 14 June 1943. This created an anomalous situation in the Command's Special Staff structure as Major Bergsma was the first medical officer to be assigned to the staff. Nevertheless, the Assistant Chief of Staff, G-1, held that the assignment of both a chief surgeon and a venereal disease control officer to Command headquarters was unnecessary. On 13 October 1943, 28 months after the Command had been organized, General Stayer was appointed Surgeon, Caribbean Defense Command, in addition to his regular assignment as Chief Health Officer, Panama Canal.

After the establishment of the Office of the Surgeon, Caribbean Defense

72See page 169 of footnote 4, p. 61.


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Command, most of the medical reports from both the Panama Canal and Antilles Departments were routed through headquarters for review and consolidation before being sent to Washington. This procedure was advantageous to the Caribbean Defense Command as many decisions involving policy could be rendered by the surgeon and necessary action could be taken without waiting for directives from Washington, where practical field conditions were not always completely understood.

General Stayer held his dual positions until 1 November 1943, when he was succeeded as Chief Health Officer, Panama Canal, by Col. (later Brig. Gen.) Henry C. Dooling, MC. General Stayer was then able to devote his time entirely to the duties of surgeon, and held that position until March 1944.

Assignment of assistant surgeon.-On 1 January 1944, Colonel Bergsma, the venereal disease control officer, was designated assistant surgeon and held that position until 22 October 1945. As assistant surgeon, Colonel Bergsma was responsible for the administration of all subordinate medical and health units in the Caribbean Defense Command. He also supervised research activities as a part of the preventive medicine program. In conjunction with the surgeon, he was active in coordinating all civilian and War Department agencies engaged in public health work in the area. During 1944, Colonel Bergsma also served as antibiological warfare officer for the Command, an activity which involved reviewing departmental plans and reports and transmitting directives from Washington.

Coordination of Military Government and Civil Public Health Activities

Although there was no specifically designated division of civil affairs and military government in the Caribbean Defense Command, the surgeon, as coordinator for all American military, civilian, and foreign health agencies within the Command, worked closely with civil health experts to establish overall health policies. The surgeon was called upon to advise, to make special investigations, and to consolidate selected medical reports on the health of troops and on the status of civil health on each of the islands that he visited.

The surgeon and his staff assumed a major responsibility for the supervision of the health, sanitation, and foreign quarantine problems of the many islands and land bases of the Caribbean area. For the benefit of both troops and civilians, the surgeon developed excellent liaison with leaders of the British, French, and Dutch Governments which controlled most of these islands and territories.

THE PANAMA CANAL DEPARTMENT AND THE 
HEALTH DEPARTMENT OF THE PANAMA
CANAL

For obvious reasons, the concern of the United States in the Caribbean area was centered upon the Panama Canal. It was "a focal point of national


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defense, a base of operations for the protection of the Hemisphere, [and] an instrument of national influence."73 Within the Canal Zone-the 5-mile strip on each side of the waterway-were located numerous military and civilian agencies. Among these were the headquarters and chief operational units of the two health and medical organizations.

The two health and medical organizations-The first health and medical organization was the Health Department of the Panama Canal. It was established in 1914, and replaced the Department of Sanitation, which Col. (later Maj. Gen.) William Crawford Gorgas, MC, created in 1904 when he began his epochal sanitation and disease control work as Chief Sanitary Officer of the Panama Canal Zone-work which made possible the building of the Panama Canal by the U.S. Army Corps of Engineers. The second organization was the Panama Canal Department, established by the War Department, on 1 July 1917, as the overall local operational military agency. The former was essentially a civil health department; the latter predominantly a military medical organization. The structure and functions of the two were different as may be seen from a comparison of their organizational charts (charts 3 and 4).

These two health and medical organizations had much in common and worked together whenever their independent interests merged. From their annual reports,74 however, it is difficult to identify their acts of mutual collaboration. One rarely mentions the other because, apparently, collaboration was taken for granted and because the respective commanding medical officers had similar viewpoints, traditions, and standards.

U.S. jurisdiction over public health in Colón and Panama City.-Under the terms of treaties and conventions between the United States and the Republic of Panama, the former's jurisdiction covered the Canal Zone and extended into adjacent towns and cities. A Sanitary Code, prepared by the zone's chief health officer and promulgated officially by decree of the President of the Republic, constituted the authorization for the application of public health measures in the terminal cities of Colón and Panama, and in certain other areas of the Republic. This code dealt with all the important phases of sanitation, quarantine, and disease control. It involved many relationships between military and civilian authorities. In the cities of Panama and Colón, the chief health officer was represented by two members of his staff who functioned as municipal health officers. At first, the two deputies were civilian physicians; after the United States entered the war, they were commissioned as lieutenant colonels in the Medical Corps. Their reports emphasized indigenous diseases-namely, enteric infections, malaria and a variety of parasitic infections, and venereal diseases-and included sanitary measures appropriate

73Padelford, Norman J.: The Panama Canal in Peace and War. New York: The Macmillan Co., 1942, p. v.
74(1) Reports, Chief Health Officer, Health Department of Panama Canal, 1939-44. (2) Annual Reports, Surgeon, Panama Canal Department, 1940-44.


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CHART 3.-Organization of the Health Department, Panama Canal, 1940

Source: Report, Chief Health Officer, Health Department, of the Panama Canal, 1940.


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CHART 4.-Organization of the Office of the Surgeon, Panama Canal Department, 1944

1Activated as the Panama Canal Air Force on 20 November 1940. Redesignated the Caribbean Air Force on 5 August 1941, and redesignated the Sixth Air Force on 5 February 1942.

Sources: (1) Annual Report, Surgeon, Panama Canal Department, 1944, enclosure 4. (2) The Army Air Forces in World War II. Volume I. Plans and Early Operations, January 1939 to August 1942. Chicago: The University of Chicago Press, 1948, pp. 160-166. (3) Annex No. 2 to Field Order No. 2, Headquarters, Sixth Air Force, Albrook Field, 1 Dec. 1944, subject: Missions of Commands, Air Bases, Airdromes, and Installations Under Sixth Air Force Jurisdiction.


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to a tropical environment. An effective public health program was developed and maintained which benefited Army personnel, zone employees, and others living in sanitated areas, and the Panamanian people within its reach.75

Disease control through negotiation.-Even in the presence of statutory authority based upon the Isthmian Canal Convention of 26 February 1904, The Judge Advocate General advised that careful negotiations should precede the prescription of sanitary ordinances that would place restrictions upon the people of Panama. This matter came up for consideration in January 1942, when an opinion was requested by the Assistant Chief of Staff, G-1, concerning the authority of the chief health officer of the Panama Canal to control venereal diseases in the cities of Panama and Colón. After reviewing the language of the Convention, and after citing precedents, The Judge Advocate General issued the following opinion accompanied by a wise suggestion on the procedure for carrying on public health activities under a permissive arrangement for civil affairs and military government in a friendly country.76

I believe * * * that the United States may prescribe ordinances with reference to the control of venereal diseases in the cities of Panama and Colon, and I suggest that the representatives of the United States take that position in negotiations on the subject with the authorities of the Republic of Panama. It seems preferable in any event for the matter to be handled by such negotiations rather than for the health authorities to prescribe ordinances without previous notice to the government of Panama of an intention to do so. It should also be noted that, according to paragraph 2 of Article VII, * * * when such ordinances shall have been prescribed by the United States, enforcement of them will in the first place be the responsibility of the government of Panama; and it is only if that government is unable or fails in its duty to enforce them that the officers of the United States may themselves do so.

Increased U.S. military authority over civilian affairs.-An increase in military authority over civilians in the Canal Zone was imposed by President Roosevelt under Executive Order No. 8232, dated 5 September 1939. Under authority derived from the Canal Zone Code, and in accordance with the precedent set during World War I, the President placed the Canal Zone and all its appurtenances, including its Government, under the exclusive jurisdiction of the Panama Canal Department. Normally, the Commanding General, Panama Canal Department, and the Governor of the Panama Canal shared the responsibility for the security of the Canal. In wartime, however, or whenever the President believed that war was imminent, the Governor was to be subordinate to the military commander. The Executive order did not bring about the invocation of martial law, nor was it intended to do so. Its chief effect was to further unify Army command.

75Francis, Marion D.: Medical Department, United States Army. Preventive Medicine in World War II. Draft manuscript. Volume I, Organization and Administration. Chapter XVIII, The Off-Continent Defense Commands and Base Commands, 1941-45, pp. 2793-2864. [Official record.]
76Memorandum, Maj. Gen. Myron O. Cramer, The Judge Advocate General, for Assistant Chief of Staff, G-1, 27 Jan. 1942, subject: Authority of the Chief Health Officer of the Canal Zone to Control Venereal Disease in the Cities of Panama and Colón.


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Apparently, the two chief medical organizations under this enlarged military jurisdiction carried on as usual, as did the Panama Canal authorities.

Enlargement of the Panama Canal Department.-Before the President's declaration of a "Limited National Emergency" on 8 September 1939, the Panama Canal Department was limited territorially to the Panama Canal Zone and to certain areas in the Republic of Panama occupied, with the consent of that Republic, for reasons of mutual defense. During World War II, from 1 January 1940 to 1 October 1945, the Panama Canal Department was expanded enormously. Extending south from the eastern tip of Cuba, it encompassed nearly all of Central America, Panama, and portions of the coastal territories of Colombia, Ecuador, and Peru, and the Galápagos Islands. (See map 2, p. 111, and charts 3 and 4, pp. 116, 117.)

Sanitation and public health-In all of these areas, the Office of the Surgeon, Panama Canal Department, was engaged in improving the sanitary conditions among the inhabitants of cities, towns, and plantations, and other areas. The primary purposes were to protect the health of troops and to support the general military effort.77 This activity involved the application of public health measures by military medical and sanitary officers in collaboration with civilian officials, as exemplified by extra-military area sanitation and disease control, and by malaria control in war areas (fig. 11). Purification of water supplies, drainage, insect and rodent control, housing, and foreign quarantine were familiar parts of the program.78 In addition, military veterinary activities improved and safeguarded food supplies and built up local sources of meats and other foodstuffs, thus aiding the civilian economy and reducing shipping.79

Control of communicable diseases-The three chief categories of diseases common to both civilians and troops in all segments of the Panama Canal Department were the enteric infections, venereal diseases, and malaria. The methods employed for the control and prevention of these diseases have been recorded in three earlier volumes in this historical series.80 While the locales and episodes were characteristic of the Panama Canal Department, the principles of the practices in these public health activities were the same as those in other tropical and temperate areas.

The outcome of all of these activities was highly beneficial for both civilians and troops. Of particular value were the personal and official contacts that fostered understanding and encouraged collaboration.81

77(1) The Prevention of Disease in the United States Army During World War II. The Panama Canal Department, 1 January 1940 to 1 October 1945. [Official record.] (2) See pages 193-201 of footnote 65 (1), p. 109.
78See pages 299 and 304 of footnote 2, p. 60.
79See pages 220-224 of footnote 46, p. 97.
80(1) 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. (2) See footnote 4, p. 61. (3) See footnote 10 (3), p. 64.
81See footnote 77 (1).


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FIGURE 11.-Medical personnel dip specimen jars in a drainage ditch along Madden Road, Canal Zone, December 1942, as part of the malaria control effort.

THE PUERTO RICAN DEPARTMENT

Puerto Rico

During World War II, Puerto Rico was a possession of the United States. Ceded by Spain by the treaty signed in Paris on 10 December 1898, this island, one of the larger land masses in the Greater Antilles group, was held under military government until 1900 and thereafter under civil government. Through the Organic Act of 2 March 1917 (the Jones Act), it became a territory of the United States, organized but not incorporated. Puerto Rico remained in this status until 25 July 1952 when, in accordance with the provisions of a resolution of the Congress signed by President Harry S Truman, it was proclaimed a Commonwealth and no longer was considered a colonial territory by the United States. On 1 July 1939, the War Department established within this territory the Puerto Rican Department, with headquarters at San Juan. By this action, the island of Puerto Rico and the adjacent U.S. possessions in the Virgin Islands (chiefly


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FIGURE 12.-Military hospital, Borinquen Field, P.R., where U.S. military personnel and some civilians were treated.

Saint Thomas and Saint Croix) were grouped under a single War Department administrative organization. The Puerto Rican Department continued as an administrative and operational unit of the War Department until 1 July 1943 when it was absorbed by the Antilles Department, created on that day.

Characteristics of civil and military public health activities-From 1939 to 1945, Puerto Rico was in the same general territorial status as Alaska and Hawaii. At the same time, it had a representative system of civil government which resembled State governments in the continental United States. An Insular Health Department and a commissioner of health functioned side by side with a military post and departmental surgeon and a departmental medical establishment (fig. 12). In addition, the U.S. Public Health Service, several U.S. governmental agencies, and certain voluntary organizations such as the Rockefeller Foundation carried out public health work among the civilians which helped to protect the health of troops. Consequently, many aspects of the joint military and civilian public health activities were similar to activities carried out under civil affairs and military government although they were not so named.

Puerto Rico was in a chronic state of economic depression. Most of the poverty-stricken people in overpopulated areas were undernourished. Housing was indescribably bad. Sanitation of water supplies, food preparation and eating places, waste disposal, and sewerage were woefully deficient.


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Incidence of tuberculosis, hookworm infestation, schistosomiasis, malaria, and enteric infections was high. There was some murine typhus fever, but no epidemic typhus although louse infestation was common. Venereal disease was widespread in the population and caused an enormous amount of sickness and mortality. The Army collaborated with civilian agencies to improve all of these conditions by methods which involved education, regulation, and support of civilian inhabitants as well as military personnel.82

An additional element of self-protection was essential because the U.S. Army drew many of its troops from the Puerto Rican reservoir, thus bringing infections as well as manpower into its units and installations. The Puerto Rican components of the U.S. forces on the island were the Regular Army's 65th Infantry Regiment and the National Guard's 295th and 296th Infantry Regiments, many of whose recruits were infected by various micro-organisms.

Reorganization of the Puerto Rican Department of Public Health-To coordinate activities better and to emphasize the representative character of the administrative units, the Puerto Rican Government reorganized its Department of Public Health in July 1942. Three main divisions were established, each with a director who was responsible to the commissioner of health. The reorganized Department of Public Health consisted of a central office, the Office of the Director, and several bureaus, each with a bureau chief. The scope and interests of some of the bureaus are exemplified by their names: Nursing; Sanitary Engineering; Epidemiology, with a section for the control of venereal disease; Tuberculosis; Malaria Control; Education and Research; and General Inspection and Sanitation.

U.S. Government assistance in local public health matters-At the onset of the national emergency, the U.S. Government assisted the Puerto Rican Government through several agencies, notably the Works Project Administration and the Federal Works Agency. This assistance encouraged many of the 76 municipalities, with a population of some 2 million people, to submit projects for the expansion and improvement of their water and sewage systems, and for the construction and improvement of their treatment plants.83

In 1943, when the civilian program was hampered by a shortage of sulfonamide drugs, the U.S. Army sold 100,000 sulfathiazole tablets to insular health authorities.

Sanitation of public establishments serving food and beverages-A helpful act of sanitary diplomacy in Puerto Rico in 1943 was described by Col. Clyde C. Johnston, MC, Surgeon, Antilles Department, as follows:84

Post surgeons have undertaken the inspection of the public eating and drinking establishments most likely to be frequented by soldiers, in an attempt to insure that

82(1) See pages 17-25 and 105-106 of footnote 65 (1), p. 109. (2) Annual Reports, Department Surgeon, Puerto Rican Department, 1941-43.
83Annual Report, Commissioner of Health, Puerto Rico, 1942-43, San Juan, Puerto Rico.
84Annual Report, Surgeon, Antilles Department, 1943, p. 89.


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minimum sanitary standards are fulfilled. The percentage of such establishments meeting these standards is small in Puerto Rico, and smaller elsewhere in the Sector. This necessitated the monthly publication of confusingly long lists of "Off Limits" places. In Puerto Rico, this question has been approached recently from a positive, rather than negative, point of view, a system of "On Limits" being adopted instead of "Off Limits" with respect to eating and drinking establishments. Establishments which are found, upon inspection, to meet those minimum sanitary standards to which the Army subscribes, are marked with a sign reading:

"On Limits for members of the Armed Services."

(The Army and the Navy work jointly in these matters.) This is a help to the soldier seeking a bar or a restaurant, and he can enter, with confidence, an establishment displaying the "On Limits" sign, whereas under the old system he could never be quite sure whether a place was or was not on the "Off Limits" list. * * *

The "On Limits" signs are a sort of free advertisement, highly prized by restaurant proprietors and more and more of them are requesting inspection. This adds to the work of the Medical Department, but is worthwhile.

Malaria control measures.-The Department of Public Health and the Bureau of Malaria Control of the Puerto Rican Government worked closely with the U.S. Army Medical Department in and around Army camps to protect the health of troops. The malaria control work consisted of treatment of all persons having a positive blood smear living within a 2-mile radius of Army installations. Larviciding of all mosquito breeding places within a 2-mile radius of posts and camps was carried out by dusting foliage with paris green or spraying small water areas with oil. Open ditches were constructed and old ones were cleaned and reconditioned to facilitate drainage of stagnant water. Low areas were filled with earth. The subsoil was drained with concrete pipes, which invariably resulted in reducing to a minimum the potential mosquito breeding areas. During 1941-42, under the supervision of the U.S. Public Health Service, the U.S. Army and the Insular Health Department sponsored joint Works Project Administration projects for the permanent eradication of mosquito breeding areas.

Russell-Boyd survey and recommendations-In September 1942, Lt. Col. (later Col.) Paul F. Russell, MC, chief of the Tropical Disease Control Subdivision, Epidemiology Division, Preventive Medicine Service, Surgeon General's Office, and Dr. Mark F. Boyd, of the International Health Division, Rockefeller Foundation, both experienced malariologists, surveyed the malaria situation in troops in Puerto Rico. The malaria attack rate there had reached 114 per 1,000 average strength by the end of July. They found many deficiencies in the activities required for effective malaria control and made a number of important technical and administrative recommendations. The most significant administrative recommendation was that a full-time malaria control officer, with suitable assistants, be appointed to the Puerto Rican Department and that he be placed on the staff of the surgeon. A malaria control officer was appointed to the surgeon's staff on 4 December 1942.85

85(1) See page 86 of footnote 70 (2), p. 112. (2) See pages 216-218 of footnote 10 (3), p. 64.


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Malaria control in war areas.-In February 1942, following the Army's request for information concerning future plans of the U.S. Public Health Service regarding extra-military mosquito control activities, the Office of Malaria Control in War Areas (generally referred to as "MCWA") was created by the U.S. Public Health Service "to direct and coordinate the efforts of Federal, State, and local health agencies near military establishments and to help integrate on an area basis the malaria mosquito control activities of military and civilian workers."86 This newly created special organization was organized by Dr. Williams, specialist in malaria control research and investigations for the U.S. Public Health Service. When MCWA began operations in Puerto Rico, it was agreed with the Insular Health Department that all mosquito control projects around posts, camps, and stations would be carried out directly by the U.S. Public Health Service. Local funds were then applied chiefly to malaria control in rural areas and civilian population centers, with special emphasis on the provision of antimalarial drugs. The work of MCWA contributed greatly to the remarkable reduction of malaria, which became evident among the troops in 1943. The incidence of this disease progressively decreased through 1944 and 1945.

Venereal disease control measures.-The control of venereal disease was a major health problem for the military forces in Puerto Rico. Prostitution was firmly established and accepted on the island, and infection was widespread. Frequently, prostitution was the only means of livelihood for individuals and families. The Puerto Rican Department of Health, the U.S. Army, and the U.S. Public Health Service attempted many times to cope with the situation.

After his arrival in Puerto Rico in early 1942, Dr. Oliver C. Wenger, of the Venereal Disease Control Section of the U.S. Public Health Service, instituted a vigorous effort known as "the Wenger Plan for Venereal Disease Control." Dr. Wenger embarked on a program to educate prostitutes in antivenereal-infection methods. He conducted conferences with large groups of prostitutes throughout the island, and acquainted them with approved methods of personal hygiene and with preventive measures to be applied by their patrons. His plan met with enthusiastic response and appeared to be producing good results. At that time, however, the cardinal tenet of the venereal disease control policy emanating from Washington was the suppression of prostitution. As a result of the implementation of the new policy designed to suppress prostitution, the prostitutes who were recognized as such were arrested and detained by the police. Soon the promising work accomplished by the Wenger plan was lost. The prostitutes on the island continued their activities but quickly abandoned the use of personal hygiene and individual protection for their patrons and themselves.

86See page 74 of footnote 10 (3), p. 64.


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During 1943, venereal disease control was made a command function. The U.S. Army developed a stepped-up educational sex hygiene program concerning the nature of venereal disease, the mode of its spread, the dangers attendant upon sexual promiscuity and excessive indulgence in alcohol, and the value of venereal disease prophylaxis. It must be emphasized that, in the top management activities for venereal disease control among troops, hundreds of difficult and important military and civilian relationships were involved.87

The Virgin Islands

The U.S. possessions in the Virgin Islands are the islands of Saint Croix, Saint Thomas, and Saint John. Of these, Saint Croix and Saint Thomas were of major military significance during World War II because of their geographic location in the northeast segment of the Caribbean defense perimeter.

The public health standards of these islands were below those of the States in the continental United States but, in general, were higher than those of other Caribbean areas. The Department of Health was operated by the local government. A limited number of physicians were furnished directly by the Federal Government. Hospital facilities were available and satisfactorily organized.

Venereal disease was prevalent, but the rates among civilians were lower than they were in other Caribbean populations. Nevertheless, the chief medicomilitary problem encountered in the Virgin Islands was the control of venereal disease among troops. The U.S. Public Health Service, with the aid of the U.S. Army, attempted to eradicate venereal disease by searching for every contact and treating every case.

There was little endemic malaria. The dryness of the climate and the land reduced mosquito breeding.

The most important environmental sanitation problem was met by the development of an adequate water supply.

THE ANTILLES DEPARTMENT

The Caribbean Defense Command was divided into two large departments in mid-1943 by the establishment of the Antilles Department in its northeastern half. The Panama Canal Department remained unchanged. The Antilles Department absorbed the Puerto Rican and Trinidad Sectors, and consisted of some two dozen U.S. Army installations in Puerto Rico, the Virgin Islands, the British and Netherlands West Indies, Cuba, Trinidad, and Saint Lucia, and the coastal regions of Venezuela and the British, Dutch, and French Guianas on the South American mainland.

87History of Medical Department Activities, Antilles Department, Preventive Medicine (Venereal Disease and Malaria), pp. 13-22. [Official record.]


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The Antilles Department contained all the naval and airbase sites for military operations in the Caribbean area which the United States had acquired the right to lease from Great Britain in the history-making destroyer-base agreement of 2 September 1940. Additional base sites were acquired, by an exercise of protective custody or negotiation, from other governments as military necessity arose.88

Because the leased-base agreement did not confer sovereignty over the base sites acquired through it, occasionally difficult and intricate negotiations were required to secure permission and concurrence from the local governments (1) for the installation of U.S. Army, Navy, and Air Force units upon the islands, and (2) for the occupation and use of land and properties for cantonments, airfields, and docks, as well as territory for maneuvers. The same type of negotiations were required with Dutch, French, and Venezuelan authorities regarding stations on the South American mainland. Consequently, civil affairs arrangements had to be adjusted by agreement and convention, rather than by command, to the degree of U.S. military authority regarded as essential to carry out the mission of the Antilles Department-one of the main divisions of the Caribbean Defense Command.

Except for the civil public health activities of the Army Medical Department on the island of Trinidad, there was generally a minimum of contact between U.S. military and civil groups on the leased bases. The general policy of the base command surgeons and of the commanding officers of hospitals and dispensaries on the various islands and other sites was to comply with any reasonable requests for supplies and professional consultations. For their part, the local British, Dutch, and French doctors were uniformly courteous, informative, and cooperative.

It can be said emphatically that the period of construction at these bases was as notable for effective sanitation as it was for the building of military facilities. As medical adviser and later as Surgeon, Caribbean Defense Command, from 1941 to 1944, General Stayer visited all of these bases and collected and consolidated an immense amount of information about their medical and sanitary condition. During these years, General Stayer, acting upon the basis of this accumulated information, directed public health activities that were as beneficial for civilians as for troops.

COMMUNICABLE DISEASES AND THEIR CONTROL

Malaria

Malaria89 was the leading cause of death, the most debilitating illness, and the chief deterrent to economic development among the native population in the Antilles islands. The highest incidence of malaria was concen-

88(1) See pages 51-62 of footnote 63, p. 108. (2) See pages 354-408 of footnote 33 (1), p. 86.
89See footnote 69, p. 112.


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trated chiefly in the coastal plains where the most important mosquito vectors (Anopheles albimanus and the Anopheles aquasalis-Anopheles tarsimaculatus complex) breed in a wide range of habitat, including temporary accumulations and saline waters.

Malaria Control

It was not possible to impose upon the civilian populations living outside military posts the same extensive and rigorous malaria control measures that were enforced within the cantonments. Nevertheless, the exercise of a certain amount of military authority over civilians living in areas adjacent to Army installations was required for necessary ditching, drainage, and larviciding. In the operation of extra-cantonment malaria control projects, the U.S. Public Health Service rendered valuable assistance, particularly through the supervision provided by its MCWA in Puerto Rico and Jamaica. A Malaria Control Board was formed in the Office of the Surgeon, Antilles Department; it consisted of the Antilles Department Malaria Control Officer, a representative of the U.S. Army Corps of Engineers, and the Chief of Operations, MCWA. This board instituted and supervised extra-cantonment malaria control on several islands and on the South American mainland. Services important to civil public health undertakings in malaria control were rendered by the Antilles Department medical research laboratory at San Juan, P.R., and by the Malaria Control Detachment at Fort Read, Trinidad.

Because some native communities appeared to be potential reservoirs of human infection, at times it was thought desirable to relocate a native village for more effective malaria control if U.S. forces were not given complete jurisdiction over its sanitation. The most notable example of this was the recommendation made by Lt. Col. (later Brig. Gen.) Leon A. Fox, MC, when he surveyed the U.S. Army base area on Parham Harbor, Antigua, in 1941. A village containing some 300 Negroes jutted into the center of the base. General Fox recommended that the village be relocated about 2 miles away. Careful investigation by a representative of the MCWA failed to confirm General Fox's suspicions. "The daily tidal character of the great mangrove swamp nearby apparently rendered its water unsuitable for any significant breeding of A. albimanus."90

Venereal Disease

Venereal disease was widespread among the natives of the Caribbean area as few had inhibitions regarding sexual promiscuity. For many years, these people had been living under regimes which made little or no effort to prevent or control venereal infections. Syphilis and gonorrhea were the

90(1) See page 203 of footnote 10 (3), p. 64. (2) Report, Lt. Col. Leon A. Fox, MC, U.S. Army, subject: Sanitary Survey of Antigua, British West Indies, 17-21 February 1941.


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most prevalent and serious forms. During the early years of World War II military operations in the Caribbean, venereal disease was the major cause of sickness and disability among both troops and construction workers. The civilian public health authorities of the colonial governments were not especially concerned with the situation and, except for some members of the health department staffs in Jamaica and Trinidad, they were of little assistance to the venereal disease control officers of the Army units in their areas. In spite of these difficulties, a vigorous venereal disease control program was carried on, and, by 1944, the venereal disease rates had been greatly reduced.

Sanitation and Public Health

The supervision of local establishments serving food and beverages was another activity which brought military preventive medicine into authoritative contact with native civil affairs. In the Antilles Department, medical, sanitary, and veterinary officers inspected foodstuffs and their handling and serving. They exercised some degree of control over the cleanliness and sanitary standards of eating places and restaurants. As in Puerto Rico, the salutary device of labeling satisfactory eating places "On Limits for Members of the Armed Services" was more effective than listing the unsatisfactory places as "Off Limits."

The control of water supplies sometimes carried military personnel further into civilian public health affairs. As Colonel Johnston reported:91

In most cases the water supplies at the posts were developed and operated by the U.S. Army. However, in some cases it was more economical to obtain water from sources already developed by local municipal or governmental agencies, whenever these agencies could provide sufficient quantities of water of the required quality. These local plants are inspected by Army personnel in order to insure the safe quality of the water supplied to the posts.

COOPERATING ORGANIZATIONS

In the Caribbean Defense Command-including its two main divisions, the Panama Canal Department and the Antilles Department-influential medical, sanitary, and political organizations carried on activities in which civilian and military personnel and interests were mingled. These were not a part of any formal civil affairs and military government division, but they served some of the ends that such a division would have sought had it existed there.

The Anglo-American Caribbean Commission was created on 9 March 1942 to encourage and strengthen social and economic cooperation between the United States, Great Britain, and the Caribbean possessions of the two countries. The Caribbean Research Council carried out research activities

91Annual Report, Surgeon, Antilles Department, 1945.


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for the commission, which also took an important part in public health affairs in the Caribbean area. Commission headquarters were located at Port of Spain, Trinidad. Its advisory group consisted of three members from each of the two countries.

The Institute of Inter-American Affairs, incorporated on 31 March 1942, was set up by the Coordinator of Inter-American Affairs to aid in improving the health and general welfare of the people of the Western Hemisphere. It was an important force affecting indirectly the health of both troops and civilian laborers in the American Tropics. Key defense areas and those producing critical war materials received particular attention.92

SUMMARY

The U.S. Army and the Caribbean Defense Command did not pursue a planned public health program at the various Allied bases where troops were assigned during World War II. There was no special organization concerned with civil affairs in the Caribbean area; the joint civil and military affairs were conducted through agreements and conventions. This was especially true in public health activities.

The extent of U.S. Army Medical Department assistance to the host government of each island base in matters of sanitation, malaria control, venereal disease control, and the prevention of communicable disease generally was directly equated with its importance to the safeguarding of the health of U.S. troops assigned to these bases.

Because of the poverty, illiteracy, overpopulation, economic under-development, local customs, and lack of material and monetary resources, much of the civil public health activities undertaken by the local governments stressed curative rather than preventive measures.

The Army medical organizations and installations committed to the Caribbean area were chiefly (1) offices of surgeons at headquarters of departments and base commands; (2) sanitary units such as those used for malaria control; (3) station hospitals and dispensaries; and (4) laboratories with broad capabilities. During World War II, medical activities expanded and contracted in accordance with the varying missions and status of the Caribbean Defense Command. Regardless of the limited medical capabilities at some Army bases, the surgeons and their staffs, together with the Army Medical Research Laboratory (Malaria) at San Juan and the Malaria Control Laboratory at Fort Read, maintained continuous liaison and cooperation with the local British, French, Dutch, and Venezuelan public health authorities in efforts to safeguard the health of local civilian populations.

92Dunham, G. C.: Malaria Control Activities of the Institute of Inter-American Affairs. J. Nat. Malaria Soc. (No. 1) 3: 31-38, March 1944.

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