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Chapter 5

Contents

CHAPTER V

The South Atlantic Area

Colonel George E. Leone, MC (Ret.)

ESTABLISHMENT OF THE THEATER

The fall of France in June 1940 and the establishment of the Vichy government brought the war closer to the continent of South America, and especially to Brazil, whose "bulge" juts far out into the Atlantic Ocean and is only 1,619 nautical miles from Dakar, French West Africa. Vichy control of Dakar gave the Axis Powers easy access to the South Atlantic sea and airlanes, of which they took full advantage and seriously menaced South American security.1

The U.S. Government, in July 1941, agreed to cooperate with Brazil in the protection of her vulnerable northeast coastline. A contract was made with a Pan American World Airways subsidiary, the Airport Development Program, to build and operate airbases at Natal, Bahia, and São Luís. Airbases had already been built in Africa under the Airport Development Program so that the South Atlantic air route from the United States to Africa, Great Britain, and the Far East was established through Brazil. In conjunction with the operation of these bases and equally important to the Allied cause was the permission granted by the Brazilian Government to use them for refueling and servicing American-built Lend-Lease aircraft, manned by civilian crews, bound for the British Royal Air Force. Shortly after the United States declared war, unrestricted ferrying of personnel and materiel by the U.S. Army through these bases was allowed.

The Lend-Lease Act, passed in March 1941, authorized the War Department to supply war materiel to Allied countries. Approximately $25 billion worth of supplies and equipment was forwarded under this program, the majority of which went to the British.2

In view of improvement of the air-ground defense of Brazil and its acknowledged assistance to the prosecution of the war, the United States-Brazilian Mutual Pact Agreement was approved on 27 May 1942. One of the important provisions of this pact was for the United States to come to the assistance of Brazil if the latter were attacked by the Axis Powers. On 22 August 1942, Brazil declared war on Germany and Italy, the first South American country to do so.

1Unless otherwise indicated, all material in this chapter is from "Medical History, World War II, U.S. Army Forces, South Atlantic, 24 Nov. 1942-31 Oct. 1945." [Official record.]
2Department of the Army ROTC Manual No. 145-20, American Military History, 1607-1958, 17 July 1959, p. 400.


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Military Organization

As soon as the Brazilian airbases were completed, the Army Air Forces Ferrying Command assumed refueling and servicing duties. The pace of operations increased. By June 1942, the Ferrying Command was reorganized as the South Atlantic Wing of the Air Transport Command; it operated from the U.S. Army Base in British Guiana and moved to Natal when Brazil joined the Allies as a cobelligerent. The South Atlantic Wing functioned as the operational agency of all U.S. Army activities in Brazil until the activation of U.S. Army Forces, South Atlantic, on 24 November 1942, at Recife.

The South Atlantic Command included Brazil, Uruguay, and Paraguay, and extended from Amapá (Brazil) on the north to Montevideo (Uruguay) on the south and from Asunción (Paraguay) on the west to Ascension Island (British territory) on the east. There were no U.S. facilities south of Rio de Janeiro. The South Atlantic Command had responsibility for military missions only. Its stations were located at Belém, Amapá, São Luís, Fortaleza, Natal, Bahia, and on Fernando de Noronha and Ascension Islands. Its principal ferrying route bases of operations were Natal, Belém, and Ascension Island (map 3). Command strength, excluding the Composite Force on Ascension Island, was less than 1,000.

Since this area clearly would be one of growing activity and importance, the first medical officers selected to proceed to Brazil in May 1942 were prepared to assist in selecting and establishing bases capable of expansion for larger forces than those needed by the Ferrying Command. First as Surgeon, South Atlantic Wing, Air Transport Command, and later as Surgeon, U.S. Army Forces, South Atlantic, Col. George E. Leone, MC (fig. 13), with his staff, developed plans for the theater medical support of the U.S. Army Air Forces in Brazil.3

Soon after activation of U.S. Army Forces, South Atlantic, on 24 November 1942, at Recife, Colonel Leone established liaison with the Health and Sanitation Division, Office of the Coordinator of Inter-American Affairs. The Institute of Inter-American Affairs, under the directorship of Brig. Gen. (later Maj. Gen.) George C. Dunham, MC, was established as a separate corporation on 31 March 1942 by the Office of the Coordinator of Inter-American Affairs to carry out that office's health and sanitation programs in Latin America. The Office of the Coordinator of Inter-American Affairs, originally created in August 1940 "to combat German, Italian, and Japanese commercial and propaganda efforts in Latin America," ultimately was given responsibility for "most aspects of Latin American relationships not directly under the control of the State, War, or Navy Departments."4

3Medical Department, United States Army. Preventive Medicine in World War II. Volume VI. Communicable Diseases: Malaria. Washington: U.S. Government Printing Office, 1963, pp. 139-142.
4Conn, 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, pp. 196-197.


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MAP 3.-South Atlantic air routes between Brazil and West Africa.

Colonel Leone conducted frequent liaison visits with Drs. George M. Saunders and B. McD. Krug of the Health and Sanitation Division. They assisted the theater surgeon by familiarizing him with the individuals and agencies of the Brazilian Government with whom he would have to cooperate in civil public health matters of mutual benefit to the health and safety of both the Brazilian population and U.S. troops stationed in Brazil. Conferences were held in Belém and Rio de Janeiro in August and September 1942.

The groundwork and liaison having been prepared, Colonel Leone and his staff began their series of conferences with representatives of the various health services of the Brazilian Government, particularly with the Serviço Nacional de Málaria, Serviço Nacional de Febre Amarela (yellow fever), and a multitude of public health officers of the local, State, and governmental agencies. Vital statistics were obtained from cities adjacent to U.S. Army airbases. Brazilian medical authorities were helpful and cooperative.

Medical Organization

The medical organization of the South Atlantic theater was based upon the principle of furnishing the best possible medical service with the least


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FIGURE 13.-Col. George E. Leone, MC.

personnel to conserve both Medical Department personnel and equipment. To this end, every effort was made to develop a single compact organization, avoiding overlapping, duplication, and overspecialization. Emphasis was placed upon establishing medical service at each base, station, airfield, or post which would be equally available to all Army personnel, permanent and transient, as well as to U.S. Navy personnel and authorized civilians. Most important, the division of responsibility was scrupulously avoided and the old established principle of making the senior medical officer responsible for all medical service and sanitation in a particular geographic location was maintained.

There was ample opportunity for confusion since authorization existed for separate medical organizations in several commands; namely, the South Atlantic Wing of the Air Transport Command, Army Air Forces units, Army Ground Forces, and Army Service Forces units.

Medical directives issued by War Department, Army Air Forces, and Air Transport Command headquarters in Washington were received at each base. Each service was anxious to implement its own policies with respect to health and sanitation. Confusion and misunderstanding were evident by medical officers of each service in rendering reports and compiling statistical data for medical purposes. Air Transport Command headquarters at Natal at first was exempt from theater control, but with one commanding general in dual command, several difficulties which might have resulted were avoided. To bring all medical activities under single supervision, the theater surgeon, Colonel Leone, having qualified as a


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flight surgeon, was appointed, in addition to his other duties, as Surgeon, South Atlantic Division, Air Transport Command, in Natal, and as Surgeon, U.S. Army Forces, South Atlantic, in Recife. As the theater surgeon, he acted in a dual capacity until 28 July 1945, when a separate division surgeon was appointed and assigned to Natal by the Air Transport Command, upon the urgent request of its headquarters in Washington.

Under this arrangement of dual capacity, the theater surgeon, with the consent of the theater commander, acted as chief surgeon for all activities, including the Army Service Forces and the Air Transport Command. Medical Department personnel, equipment, and buildings were used where possible, resulting in considerable economy and improved medical service. All military personnel within the theater were required to adhere to the administrative policies of the theater commander at Recife on all Medical Department matters. The office of the South Atlantic Division surgeon with minimal personnel was maintained at the division's headquarters at Natal. The office of the chief surgeon for U.S. Army Forces, South Atlantic, was at Recife.

The theater surgeon's staff consisted of the following positions: surgeon, medical inspector, venereal disease control officer, sanitary engineer, veterinarian, malariologist, dental surgeon, medical supply officer, laboratory officer, and nutrition officer. Because so few officers were assigned to the medical section, several duties were necessarily assigned to each. Military exigencies required that the various sections be staffed to the fullest extent.

Preventive Medicine Sub-Section.-In the office of the chief surgeon, the Preventive Medicine Sub-Section faced the most difficult and important health and medical problems. The chief of this section acted as theater medical inspector, theater venereal disease control officer, and deputy chief surgeon. Capt. (later Lt. Col.) Everett W. Ryan, MC, occupied this position from the time the theater was activated. At first, he was placed on detached service with Headquarters, U.S. Army Forces, South Atlantic, in Recife, to occupy the position of medical inspector for the theater, in addition to his duties as medical inspector for the South Atlantic Division, Air Transport Command. Later, on 8 May 1944, he was transferred to U.S. Army Forces, South Atlantic, but he continued to work in this dual capacity. This was done in the interest of a unified medical service and the arrangement was satisfactory.

Disinsectization of aircraft and quarantine unit. A special organization consisting of one officer and 11 enlisted men was activated at the Natal base to meet the new problems encountered in the disinsectization of aircraft returning from Africa to Brazil. The medical inspector of the theater surgeon's office was responsible for the supervision and function of this service. The function of the organization was to prevent the reimportation of the Anopheles gambiae mosquito as a result of air traffic between Africa and Brazil. This became a major problem which necessitated close cooperation


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by the U.S. Army in liaison with the International Health Division, Rockefeller Foundation, in Brazil, and the following civil public health agencies: the Brazilian National Malaria Service, the Office of the Coordinator of Inter-American Affairs, and the Brazilian Port Health Service.5

Malaria control unit. To bring widespread malaria control activities within the theater under single supervision, a special organization for malaria control was activated.6The 57th Malaria Control Unit (later designated detachment) which had arrived in Belém on 8 February 1944 was made responsible for all control and survey work in northern Brazil.

Venereal disease control unit. As an integral part of the Preventive Medicine Sub-Section, venereal disease control was supervised by a Medical Corps officer. Although the total theater strength did not exceed 10,000 men, the stations were scattered and the operation of an efficient and coordinated program required considerable effort. Difficulty was experienced with venereal disease at Natal, and intensive efforts were directed at that base. The important task of preventing disease among combat crews en route to active fronts required constant vigilance by all commanders. Liaison was maintained with Brazilian authorities concerned with control work, but results were discouraging.

Sanitary engineers unit. The sanitary engineer functioned under the Preventive Medicine Sub-Section insofar as his duties were related to preventive medicine. Specifically, he investigated and rendered technical advice concerning procurement and treatment of water, disposal of sewage and refuse, control of insects and rodents, and sanitation of barracks and mess facilities. A complete coverage of the problems in water purification, waste disposal, control of insects, and foreign quarantine confronting the sanitary engineers in the South Atlantic theater can be found in another volume of this historical series.7An additional duty of the sanitary engineer was that of assistant theater medical inspector.

Medical laboratory service. To meet the growing need for laboratory service within the command, a laboratory officer was requisitioned from the Air Transport Command before activation of the South Atlantic theater. This officer arrived on 6 January 1943 and immediately began setting up a laboratory service for the command; as an additional duty, he acted as theater laboratory officer and epidemiologist. The laboratory was established at Ibura Field, physically attached to the 200th Station Hospital but under the direct supervision of the theater surgeon's office. In April 1944, it was designated as the theater medical laboratory and also the histopathologic center for the theater (fig. 14).

Veterinary Sub-Section.-Maj. James R. Karr, VC, who previously had served with the Air Transport Command in Natal, was placed on detached

5Medical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955.
6See page 143 of footnote 3, p. 132.
7See footnote 5.


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FIGURE l4.-Laboratory technician at work, 200th Station Hospital, Recife, Brazil, 1944.

service with the theater surgeon's office upon its activation. In addition to serving as staff veterinarian, he functioned as a full-time veterinarian at Recife. Veterinary officers were assigned to the following stations: Ascension Island, Natal, Belém, Recife, Fortaleza, and Rio de Janeiro.

The theater veterinarian was available as an adviser to Brazilian governmental agencies, to the International Health Division of the Rockefeller Foundation, and to the U.S. Navy. Major Karr rendered invaluable service through his professional visits to the local Brazilian slaughterhouses, meatpacking facilities, pasteurization plants, and pig and chicken farms.

Supporting medical service units.-Four station hospitals and two malaria detachments assisted in the all-important preventive medicine program.

Station hospitals. Medical service for U.S. military and civilian personnel was furnished by four station hospitals-the 193d at Val de Caens Field near Belém, the 194th at Parnamirim Field near Natal, the 175th on Ascension Island, and the 200th at Recife. In addition to providing hospital service for the Armed Forces in their areas, these hospitals also accommodated air evacuation patients en route to the United States. The 175th received several victims of sea disasters during the period of submarine


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activity. The 200th Station Hospital served as the theater hospital, providing medical service for troops in the Recife area and for transient U.S. Army personnel, U.S. merchant marines, U.S. nationals, dependents of U.S. military personnel, U.S. Navy personnel, and for Brazilian civilians employed by the War Department. Patients were received from all other medical installations in the command when prolonged hospitalization or ultimate evacuation to the United States was recommended. They were evacuated by both air and sea. For practical purposes, the 200th Station Hospital furnished definitive treatment similar to that offered by any general hospital. Chiefs of sections and specialists on duty there were available through the theater surgeon's office for consultation throughout the theater, including Rio de Janeiro and Ascension Island. In addition, medical consultation service was rendered outside the theater in Montevideo and Asunción.

Malaria detachments. The 57th Malaria Control Detachment arrived at Belém in February 1944 and undertook malaria control work at that city as well as at Amapá and São Luís. Normally, two men were sufficient to handle routine antimalarial operations at Amapá; the remainder worked at Belém. Only occasionally was it necessary to send a malaria control specialist to São Luís because good control was effected there by the Brazilian Serviço Nacional de Málaria. The detachment received information daily from the Serviço Especial de Sáude Pública. The greater part of the work of this detachment was in temporary and semipermanent antimalarial measures, which occupied the efforts of 40 to 60 Brazilian workers who were employed by the post engineer and supervised by this detachment.

Soon after the 202d Malaria Survey Detachment arrived in Recife on 3 July 1944, it was assigned the mission of malarial survey work for the entire South Atlantic theater in addition to malarial control for the Recife Military Area. The laboratory staff conducted mosquito identification and blood surveys, routine larviciding, ditching, and ditch maintenance. The 202d Malaria Survey Detachment's primary theater function consisted of performing surveys at the Army airbases at Amapá and Fortaleza. Further, the personnel assisted in survey work at Natal and Belém and performed experimental work on DDT (dichlorodiphenyltrichloroethane) as a mosquito larvicide, using an Army A-24 aircraft equipped for spraying DDT. Another function of this detachment included fly survey and control work on Ascension Island.

CIVIL PUBLIC HEALTH

United States-Brazil Relations

The U.S. Army preventive medicine program in civil public health in Brazil, the host nation, differed vastly from the comprehensive civil affairs programs implemented in liberated or occupied countries during World War II by the U.S. Government through its military government branches.


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In Brazil, the theater surgeon, his staff, and medical personnel at the various airbases, station hospitals, and dispensaries developed a close liaison with the Brazilian health agencies as the result of various necessary services requested of the local Brazilian community; namely, their assistance in administrative and logistical support for the American troops assigned to nearby military installations. The civil public health activities and subsequent programs, therefore, were oriented more towards the particular needs of the U.S. Army than towards Brazilian civilian health problems.

Problems of clothing, housing, nutrition, personal hygiene, water, waste, and protection from insects and rodents, all of which affected the health and efficiency of military forces in Brazil, were challenging to the sanitary engineers and to the malaria control and laboratory officers. The efforts of the theater surgeon and his preventive medicine officer, Colonel Ryan, were aimed at protecting the troops against such specific concerns as intestinal infections, respiratory infections, venereal diseases, nutritional diseases, environmental hazards, and arthropodborne infections.

The U.S. Army Medical Department's greatest professional contribution was in the assistance given to Brazilian health agencies in their civil public health problems. Extensive liaison activities were carried on with the many local, State, and Federal public health agencies throughout northeastern Brazil.

The Army Medical Department and Brazilian health authorities, working together, received assistance from other public health agencies and from the civilian and regular commissioned staff of the U.S. Public Health Service, as well as the International Health Division of the Rockefeller Foundation in Rio de Janeiro, the American National Red Cross, and the U.S. Navy.

The Army Medical Department in the South Atlantic theater, in turn, contributed to the improvement of civil public health of the Brazilian population. It carried out the overall military preventive medicine program at each military facility of the South Atlantic Command, furnished hospitalization and medical care to other than U.S. military personnel, cooperated with Brazilian public health authorities on all matters of foreign quarantine (disinsectization of military aircraft), and adopted excellent extra-military sanitation measures.

To appreciate the Army Medical Department's efforts to assist the Brazilian public health authorities, it is helpful to examine the civil public health activities of a representative city of northeast Brazil, the coastal city of Recife, the site of South Atlantic theater headquarters.

Civil Public Health in Recife

Civil public health authorities in Brazil were concerned with tropical communicable diseases as well as those more familiar in temperate climates. Throughout northeast Brazil, civilian public health problems were fairly


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uniform except that, as one approached the south from the Amazon Valley region, the conditions became generally better, the disease incidence lower, medical care more readily available, and sanitation more modern.

In October 1943, the city of Recife, including its suburbs, had an estimated population of 372,641; by 1945, this figure had grown to approximately 500,000. The population varied considerably with regard to race and color, being made up of Caucasians, Indians, Negroes, and various combinations of these three races. The Caucasians were generally of Portuguese or Dutch ancestry.

Recife contained modern conveniences such as water service, sewerage facilities, telephone service, and electricity which are usually found in most progressive cities. However, these facilities were substandard when compared with those available in North American cities of corresponding size. The better homes were constructed of stone, stucco, and tile; the poorer dwellings, greatly overcrowded, were generally mud or straw-thatched huts, locally referred to as "mucambos." Sanitary facilities in the poorer quarters were virtually unknown.

Communicable diseases.-Among the more important diseases prevalent in Recife and throughout northeast Brazil were malaria, parasitic infestations, intestinal infections, venereal diseases, and tuberculosis. The common respiratory diseases were troublesome to the civilian population but were insignificant when compared with the much-dreaded tuberculosis. Epidemics of contagious diseases, such as typhoid fever and smallpox, occurred from time to time. The dysenteries usually showed a higher rate than would normally be expected. Leprosy, tropical ulcers, leishmaniasis, scabies, and fungus infections were relatively common.

The statistics of disease in Recife and in the State of Pernambuco were more reliable than those from areas to the north, but even here, they were irregular and many diseases were never reported. The following tabulation shows the incidence in a population of 372,000 of some of the more common diseases in Recife in 1942, based on the total number of cases which were diagnosed and reported. 

Disease

Number of cases

Tuberculosis

2,061

Gonorrhea

1,392

Malaria

476

Typhoid fever

177

Dysenteries

116

Syphilis

84

Diphtheria

76

Measles

16

 
Total

4,398



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Tuberculosis. As in most sections of Brazil, the incidence of tuberculosis in Recife and the State of Pernambuco was high. The disease seemed to flourish where standards of living and of education were low, where nutrition was inadequate, or where health facilities were poor. Individuals with "open cases" of tuberculosis frequently refused hospitalization, and little effort was made to urge them to accept it because hospital facilities for treatment of tuberculosis were inadequate. There was no followup service for active cases. BCG (bacille Calmette Guérin) vaccine was given to many newborn infants despite considerable controversy on the subject among leading local practitioners. Diagnosis frequently was not made in early cases because a minimum number of X-rays were taken and tuberculin tests were rarely done. Casefinding and nursing care were minimal. In 1945, 12.2 percent of all the deaths in Recife were caused by tuberculosis; as a cause of death to children under 2 years of age, it was second only to diarrhea. In 1944, from 26 to 51 new cases of tuberculosis were reported each week. Fortunately, troop contacts were comparatively casual and the influence of this disease on the health of troops was unimportant. There were 12 cases among U.S. military personnel during the entire history of the South Atlantic Command. The admission rate per 1,000 was 1.5 for 1943, 0 for 1944, and 1.0 for 1945.

Venereal disease. There were no accurate figures concerning the prevalence of venereal diseases8among the civilian population. The incidence was high and infected prostitutes abounded. In Recife as in the other principal cities of northeast Brazil, an attempt was made to segregate the prostitutes in certain sections of the city. However, opportunities for clandestine contacts were plentiful. All the venereal diseases were present. In 1940, 2.7 percent of all deaths in the State of Pernambuco were due to syphilis; it ranked ninth as a cause of death. The venereal disease service of city, State, and Federal health departments included attempts to examine prostitutes, but there was serious need for expansion in this program. A survey conducted in 1944 by the Theater Laboratory, 200th Station Hospital, among Brazilian civilian employees of the U.S. Army in Brazil, revealed 14 percent to have positive Kahn reactions. A survey made by the Recife Health Department showed 30 percent positive serological reactions in a general population group of more than 1,000.

Malaria. Malaria was rampant along the entire northeast coast of Brazil where there were many marshes and swamps. In 1940, it ranked third as a cause of death in Pernambuco, causing 4.5 percent of all deaths. The chief insect vector was Anopheles aquasalis. Malaria surveys made by the U.S. Army in areas surrounding the various military establishments revealed parasitemia indices of 0.26 to 8.4 percent. Both Plasmodium vivax and Plasmodium falciparum were found. Preventive measures were

8For additional information on venereal disease in the South Atlantic, see Medical Department, United States Army. Preventive Medicine in World War II. Volume V. Communicable Diseases Transmitted Through Contact or By Unknown Means. Washington: U.S. Government Printing Office, 1960, pp. 316-318.


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FIGURE 15.-Two Brazilian civilians spray mosquito-infested area as precaution against malaria, September 1944.

carried on by the Serviço Nacional de Málaria, the Serviço Nacional de Febre Amarela, and the sanitary services of the various city health and hygiene centers (fig. 15). Lack of funds hindered civilian efforts.

Other communicable diseases. Typhoid fever was endemic throughout this area and occasional flareups reached mild epidemic proportions. In Recife, during February 1944, 20 to 50 new cases occurred each week. The outbreak abated after about 6 weeks.

The incidence of bacillary dysentery among the civilian population was not definitely known but was estimated to be very high. Diarrhea of unspecified cause in infants under 2 years of age was usually the leading single cause of death and was responsible for 25.4 percent of all deaths in the State of Pernambuco in 1940. It was six times as common a cause of death as tuberculosis, which ranked second. In 1940, in the group over 2 years of age, it was responsible for 1.5 percent of all deaths, ranking it as 15th. In Recife, during 2 weeks in June 1944, 105 of the 411 deaths were reported to have been due to gastroenteritis, of undetermined cause. In a majority of instances, the disease was spread through food, milk, or water; but poor


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sanitation was a strong contributing factor. The prevalance of flies, combined with the absence of screening, aided in its transmission.

Grippe was a diagnosis which was given as a cause of illness and death. The illness generally resembled influenza in symptomatology, but a number of febrile illnesses of unknown cause were diagnosed as grippe. It was the reported cause of four to 11 deaths each week during 1944 in Recife. Usually, four to 20 new cases were reported each week. During the epidemic of typhoid fever in February 1944, the prevalence of grippe according to the reports rose to 40 new cases each week.

Measles, mumps, diphtheria, smallpox, chickenpox, meningitis, and whooping cough occurred, sometimes in epidemic form. Epidemics of any of these diseases could have serious potentialities. For example, in August 1944, an epidemic of smallpox among the civilian population in Fortaleza presented an urgent epidemiological control problem for the Medical Department because of the importance of keeping the base open for air traffic.9When seven civilians working on the base contracted smallpox, all military as well as civilian personnel using the base were vaccinated immediately. Because of the urgency of the situation, the U.S. Embassy in Rio de Janeiro, Brazilian national health authorities, commercial airlines using the base, and Fourth Fleet Headquarters, U.S. Navy, were notified. No smallpox cases occurred among military personnel as a result of this epidemic.

Poliomyelitis, yellow fever, typhus fever, and encephalitis appeared infrequently. Plague, rabies, scarlet fever, tetanus, and erysipelas were seen occasionally.

Intestinal infections. Intestinal parasites were prevalent and caused much illness. Infestation with Schistosoma mansoni was endemic throughout northeast Brazil, and hookworm was quite common. Because of soil pollution, vegetables frequently were contaminated with organisms causing enteric infections and infestations. In 1944, the U.S. Army conducted a survey of the prevalence of intestinal parasites on 1,578 Brazilian civilian employees at a number of its bases in Brazil. This study revealed that 71 percent were carriers of pathogenic organisms. Necator americanus was present in 47 percent of the individuals examined, Ascaris lumbricoides in 40 percent, and Trichuris trichiura in 26 percent. This survey was conducted among civilians who had been selected previously as being alert and physically capable for the job at hand. Another study, made with the cooperation of a Brazilian physician in Recife, revealed that, of 2,800 stool specimens examined, 26 percent contained S. mansoni and 11 percent Entamoeba histolytica.

Public health services.-The Central Government Agency for Health in Brazil became the Federal Public Health Service which was immediately

9(1) Essential Technical Medical Data, U.S. Army Forces, South Atlantic, for August 1944, dated 4 Sept. 1944. (2) Smallpox in Civilians at an Air Field. Bull. U.S. Army M. Dept. 83: 27, December 1944.


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subordinate to the Minister of Education and Public Health. This arrangement, in theory, avoided the unwise expenditure of limited funds and made available to the public health authorities of each State of Brazil the supervision and consultation of experts of the Federal Government. Federal Public Health Districts were composed of one or more States, each having its own public health organization under the supervision of a director of health.

Public health services in the State of Pernambuco were conducted by three groups; namely, the State Department of Health, the School Physical Education Service, and the Institute of Hospital Aid. These activities were the responsibility of the Secretary of Interior. Water and sewerage systems were under the Secretary of Transportation and Public Works. The State Health Department consisted of four health centers in Recife, 11 major hygiene posts (one itinerant) in the interior of the State, and 44 minor municipal hygiene posts.

For administrative purposes, the State Health Department controlled the supervision of civil public health in Recife. The Department was divided into four sections: the directorate, or executive section; the administrative section; the professional section, which included supervision of professional activities, sanitary propaganda and education, epidemiology, statistics, and sanitary engineering, to mention a few; and the field service, which included the health centers and hygiene posts.

The following unofficial organizations were working in the interest of public health: The League Against Infant Mortality, The League Against Tuberculosis, and The Society Against Leprosy.

A good hygiene service was included in each health center in Recife and in each hygiene post in the interior of the State. The services were responsible for the inspection of all food offered for sale, the cleanliness of food establishments, and the health of those connected with the sale of food. There was also an inspection service for abattoirs, the Serviço Nacional de Defesa Animal and the Diretoria da Produção Animal de Estado, under the Secretary of Agriculture, Industry, and Commerce. Although abattoirs were maintained in most cities, there were no storage facilities, and, consequently, meat products had to be sold for immediate consumption.

Medical services.-The medical services consisted of the following categories:

Professional personnel. Medical service in Recife and in larger cities and towns was satisfactory but in need of improvement. The number of physicians in the Recife area was estimated to be somewhat over 300. Conditions in the rural areas were unsatisfactory, and many sections were without the services of a physician. Usually four trained nurses were employed by the City Health Department in Recife; their number in the hospitals was negligible. In addition to a medical school in Recife were a dental school and a pharmacy school.


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Hospitals. Eleven large hospitals in Recife were supported by State, city, or private sources. They were used variously for general medical and surgical cases; for neuropsychiatric, obstetric, and pediatric patients; and for treatment of contagious diseases. One was used for free (charity) patients and as a teaching hospital; another, controlled by the City Health Department, was an emergency hospital and operated an ambulance service.

X-ray and laboratory facilities. X-ray facilities were available in only a few of these hospitals; however, some private physicians had them. The various hospital laboratories were poorly equipped and understaffed. There were a number of privately owned laboratories as well. The two largest laboratories were in the school of medicine and in the State Health Department. The former laboratory performed all of the various examinations, including microbiologic, parasitologic, and histopathologic. The central laboratory of the State Health Department in Recife had sufficient equipment to accommodate all public health laboratory work for the city. Antirabies and smallpox vaccines were prepared there.

Medical Care of Other Than U.S. Military Personnel

Persons other than U.S. military personnel were hospitalized or given medical treatment in Army medical facilities in the South Atlantic Command in accordance with the provisions of Change 6, Army Regulations No. 40-590, dated 4 March 1943, and other pertinent directives. The principal recipients of medical care were civilian employees of the War Department and military personnel of cobelligerent nations. The only major problem that arose was in the care of Brazilian civilian employees of the War Department who were injured in the performance of their official duties. As many as 9,500 Brazilians were employed by the Army at its bases in Brazil during peak operations.

To establish an orderly plan for the medical care of these employees, the theater surgeon, the staff judge advocate, the base surgeons at Recife and Natal, and representatives of the Office of the Coordinator of Inter-American Affairs conferred at South Atlantic Command headquarters in July 1943. They decided to provide hospitalization and medical care through local civilian facilities, and to process all claims for disability and payment of expenses for medical service or hospitalization through this headquarters rather than through the U.S. Employees' Compensation Commission. A plan was approved and, subsequently, a War Department circular was published in which Armed Forces commanders overseas were authorized to establish local procedures to settle claims of native employees without applying to the U.S. Employees' Compensation Commission. This plan was embodied in an unnumbered War Department circular, dated 4 September 1943, subject: Application of Workmen's Compensation Laws in Oversea Commands.


146

Pursuant to this authority, a letter published by theater command headquarters directed that any Brazilian civilian employee suffering traumatic injury in the course of his employment be referred to the nearest medical installation of the U.S. Army for first aid and examination. If further care was required, he would be referred to designated Brazilian physicians or hospitals in the vicinity, and all claims for injuries or disability and bills for medical services furnished by civilian physicians or hospitals would be processed through the Contract Claims Commission at Headquarters, U.S. Army Forces, South Atlantic.

Although payment of claims through the Contract Claims Commission proved satisfactory, considerable savings probably would have resulted had complete medical care, including hospitalization, been furnished in U.S. Army hospitals and dispensaries. Accordingly, in August 1944, the Army was directed to provide this medical service through the use of its own facilities insofar as they were available. Medical officers were directed to maintain an outpatient index of all Brazilian employees treated in the dispensary and to complete hospital records for patients admitted to the hospital. The employee's immediate superior was required to prepare a request for treatment which was to be delivered to the medical installation before any treatment was instituted. Monthly reports showing total number of hospital patients, number of patient days, and total outpatient treatments were to be forwarded to the theater surgeon. Also, for those patients whose injuries might result in permanent disability, or where circumstances indicated that a claim against the U.S. Government might arise, the medical officer was required to furnish a report to the local claims officer and an information copy to the theater surgeon.

In conformance with an opinion of the Fiscal Director, U.S. Army Forces, South Atlantic, after 1 June 1945, bills for services rendered by Brazilian civilian physicians and hospitals in the care and treatment of injured employees were paid from Maintenance and Hospital Funds rather than through the Contract Claims Commission. However, all claims for injuries and disability resulting therefrom continued to be processed by the commission. On 1 June 1945, civilian personnel regulations were published by theater headquarters. Earlier directives concerning medical service for injuries and claims of Brazilian employees were incorporated in these same regulations. From September 1944 (when complete hospitalization was first provided for Brazilian civilian employees) to July 1945, a total of 384 patients were admitted to U.S. Army hospitals, as shown in table 2.

The decision to furnish complete medical care to Brazilians injured in the performance of official duties and to process all such claims locally, without applying to the U.S. Employees' Compensation Commission, was believed to have benefited the operation of medical service in this command. Claims of injured persons and bills for medical service were settled promptly, in lump sums. No claims were paid by protracted monthly pay-


147

TABLE 2.-Brazilian civilians employed by the U.S. Government and hospitalized in U.S. Army hospitals, September 1944-July 1945 

Period

Number of
 hospital patients

Number of
 patient days

Number of 
outpatients

1944

 

 

 

September

19

64

1,347

October

38

330

1,166

November

33

327

1,191

December

22

292

1,724

1945

 

 

 

January

27

344

1,509

February

22

172

1,318

March

22

283

1,535

April

47

482

2,009

May

63

587

2,383

June

42

344

2,690

July

49

452

2,853

 
Total

384

3,677

19,725


Source: Medical History, World War II, U.S. Army Forces, South Atlantic, 24 Nov. 1942-31 Oct. 1945, pp. 126-127.

ments over an indefinite period. The benefits given to the employees were in accordance with local laws and customs. The prompt settlement of claims by persons on the scene familiar with local conditions resulted in a great saving to the U.S. Government. Furthermore, harmonious relations with the Brazilians had been strengthened.

It was rarely necessary to employ civilian physicians and dentists or to obtain hospital facilities for the care of persons entitled to medical care at U.S. Government expense. The South Atlantic Command policy was to furnish complete medical and dental care to those persons entitled to it in U.S. Army medical facilities. This policy was plainly stated in Memorandum No. 106, prepared by the Surgeon's office and published by Headquarters, U.S. Army Forces, South Atlantic, on 4 July 1945.

Extra-Military Sanitation and Liaison Activities

In the South Atlantic Command, certain civilian health problems were so potentially dangerous to U.S. military personnel that considerable effort was expended on extra-military sanitation and liaison activities. The more important of these were venereal disease control (in neighboring native establishments), malaria control, elimination of fly-breeding areas, and other sanitary problems. These activities involved numerous civilian health organizations as well as the armies and navies of both countries.

Interservice activities.-An excellent spirit of cooperation in matters pertaining to health and sanitation always existed between the U.S. Army


148

Medical Corps and the U.S. Navy Medical Corps. Cooperative efforts were most important in control of venereal disease. Prophylactic stations were operated jointly in the cities. Where possible, the service which required the greater use of the installation furnished the medical personnel and equipment for all U.S. Armed Forces personnel present. Assistance in venereal disease control was rendered by Brazilian Federal, State and city health agencies, principally at Belém, Natal, and Recife. The Brazilian Army adopted some modifications of the method of treatment of venereal disease as prescribed by The Surgeon General, U.S. Army.

The Army Medical Department from the very onset furnished medical service to survivors of sea disasters, particularly at Ascension Island. Medical service was provided from time to time to U.S. Navy and merchant marine personnel and to Royal Air Force and other Allied services personnel. In 1943, a group of German prisoners of war under U.S. Navy jurisdiction were quartered at the U.S. Army dispensary at Ibura Field before transfer to the United States. Also, medical service occasionally was furnished to personnel of contract carriers-namely, Pan American World Airways, American Airlines, TransWorld Airlines, and American Export Lines-and to members of the U.S. Rubber Development Corp. at Belém.

Active cooperation was maintained with the Health and Sanitation Division and the Food and Nutrition Division of the Office of the Coordinator of Inter-American Affairs. The U.S. Army was given considerable aid in extra-cantonment sanitation, particularly in malaria control.

Liaison was maintained with the Brazilian Port Sanitary Service concerning importation and exportation of rodent pests. Fortunately, no serious problems were encountered.

Malaria control activities.-In 1945, in response to an invitation from the Serviço Especial de Sáude Pública the theater sanitary engineer inspected their facilities in the Amazon Valley.

The Brazilian Serviço Nacional de Málaria assisted the U.S. Army in those areas where the Office of the Coordinator of Inter-American Affairs did not operate. At São Luís, Fortaleza, Natal, Recife, and Bahia, data collected by that agency were made available to base surgeons and malaria control officers. Control work in these areas was coordinated with the Brazilian agencies concerned. At Recife, the 202d Malaria Survey Detachment with the able assistance of Dr. Durval T. Lucena of the Serviço Nacional de Málaria carried out experimental work on DDT as a mosquito larvicide. In addition, the 202d Malaria Survey Detachment performed blood survey work in the Recife area, with the aid of a "guarda" on loan from Dr. Lucena's agency to collect epidemiological data. On the basis of data furnished by the 202d Malaria Survey Detachment, infected natives were treated by the Serviço Nacional de Málaria. This detachment also gave invaluable laboratory assistance to the Brazilians in planning malaria control experiments based on the use of DDT as a residual spray against adult mosquitoes.


149

The SESP (Serviço Especial de Sáude Pública) at Belém contributed considerably to malaria control in and around Val de Caens Field and the Amapá Air Station. Before the arrival of the 57th Malaria Control Detachment, the SESP set up a program of permanent and temporary control measures to be applied around Belém and to barracks spraying at Amapá. After the arrival of the 57th Malaria Control Detachment, SESP continued to furnish important mosquito survey information in the malaria control work carried on by this detachment. In addition, SESP malaria control officials visited Recife in October 1942 to make a malaria survey of Ibura Field. Cooperative malaria control measures were decided upon by these officials and the Office of the Surgeon, South Atlantic Ferrying Wing, Air Transport Command. However, malaria control work around the Ibura base and the environs of Natal was taken over later by the Brazilian National Malaria Service and the SESP which confined its activities to Belém and Amapá. An SESP officer cooperated in a later malaria survey of Ibura by assisting the theater malaria control officer in establishing an Army malaria control program.

The Brazilian Government was vitally concerned with the possible entrance of A. gambiae mosquitoes into Brazil on aircraft flying from Africa. In January 1944, following coordination with Brazilian national health authorities, Brazilian port sanitary personnel, the International Health Division of the Rockefeller Foundation in Rio de Janeiro, and the U.S. Army, an efficient system for disinsectization of aircraft was placed in operation. This disinsectization system is discussed in volumes II and VI in this historical series10 and in a subsequent section (p. 153).

Medical laboratories activities.-Liaison with Brazilian medical authorities occupied an important place in the activities of the various medical laboratories. This was especially true at the principal theater laboratory at the 200th Station Hospital in Recife. Cooperation between this laboratory and the Faculdade de Medicina de Recife, the City Health Department, and other hospital laboratories was mutually beneficial. Contact was also maintained with the Instituto Oswaldo Cruz, the Hospital for Tropical Diseases, and the laboratories of the International Health Division of the Rockefeller Foundation in Rio de Janeiro. The laboratory at the 193d Station Hospital at Belém was active in liaison with the SESP laboratory in Belém; the latter was part of the medical activity of the Office of the Coordinator of Inter-American Affairs.

The city, State, and Federal health authorities of Brazil aided the epidemiological work of the Army Medical Department by supplying statistical data on current diseases in Brazil and other similar information. Cooperation in this regard was limited only by the availability of data. The Medical Department in return performed special laboratory procedures for the city health departments when requested and informed local health au-

10See pages 137-165 of footnote 3, p. 132, and pages 220-223 of footnote 5, p. 136.


150

thorities of important contagious diseases among American military personnel. It was necessary to notify Brazilian health authorities of the expected increase in the movement of aircraft from Africa to Brazil when provision was made to redeploy men and planes from Europe to the United States via the South Atlantic route. "The original purpose was to fly home for rest leave troops whose services would shortly be required in the war against Japan."11 This notification enabled Brazilian health authorities to provide additional disinsectization personnel at the airfields.

Brazilian Expeditionary Force.-Training of the Brazilian Expeditionary Force in medical matters was coordinated through the Office of the Surgeon, U.S. Army Forces, South Atlantic, and supervised by the Joint Military Commission in Rio de Janeiro. Maj. (later Lt. Col.) Raleigh H. Lackay, MC, was in charge of the medical training of the Expeditionary Force in southern Brazil, and the Office of the Surgeon was contacted directly for medical aid in northern Brazil.

At times, medical officers were assigned temporarily to assist in physical examinations of Brazilian Expeditionary Force personnel. The most important instance occurred during September 1944 when seven U.S. Army Medical Corps officers and one Dental Corps officer were sent to Rio de Janeiro. The largest contingent of the Brazilian Expeditionary Force was examined by the Medical Department of the Brazilian Army, with these officers acting in an advisory capacity. Eight examining teams, with one U.S. Army Medical Department officer on the reviewing board of each team, examined approximately 14,000 troops of the Brazilian Expeditionary Force in less than a week. The appreciation of the Brazilian Army's Surgeon General was conveyed in a letter from the Joint Brazil-U.S. Military Commission in Rio de Janeiro to the theater surgeon in which the professional efforts of these officers were highly commended.

Liaison with the Brazilian Expeditionary Force continued throughout the active period of the South Atlantic Command. Participation included activities in connection with air and water evacuation of Brazilian military personnel from Italy to Brazil. In February 1945, the Surgeon, U.S. Army Forces, South Atlantic, inspected the Brazilian Expeditionary Force in Italy.

Ascension Island.-Ascension Island is a dependency of the British crown colony of Saint Helena. An airfield built there by U.S. Army engineers in 1942 was used as a refueling base for transatlantic flights. A heavy fly population on the island plagued the U.S. Army cantonment despite determined efforts to control fly breeding in pit latrines. Not only were flies annoying and contributing to poor morale, but they were also incriminated on several occasions as vectors of gastrointestinal disease.

In January 1945, a Sanitary Corps officer of Headquarters, U.S. Army Forces, South Atlantic, performed an extensive survey of fly breeding on

11Craven, Wesley Frank, and Cate, James Lea: The Army Air Forces in World War II. Volume VII. Services Around the World. Chicago: The University of Chicago Press, 1958, pp. 216-227.


151

Ascension Island. The problem was determined to be one of extra-military sanitation. Fly breeding in huge manure heaps on the British Farm on Green Mountain was found to be responsible for the plague of pests in the lower areas of the island, to which they were easily carried by downdrafts off the crest of the mountain. The farm manager had to be convinced that he was losing the value of the manure as fertilizer by letting the rains leach it. An agreement was made to spread the manure on the fields, and the U.S. Army furnished a detail of men and trucks to haul it. On further recommendations, the post engineer built manure bins outside the barns and stables for storing the manure until it could be spread. The farm manager cooperated by setting up a composting heap for that portion of the manure which had to rot before use. The U.S. Army also furnished a detail of men, supplies, and equipment to spray the barns, stables, and pigpens with DDT residual spray and to treat the compost heap with borax and DDT. As a result, flies ceased to be pests, and little diarrheal disease was attributed to transmission by flies after these control procedures were established.

Uruguay and Paraguay.-U.S. liaison activities were extended to Uruguay and Paraguay in training and assisting in the reorganization of their military forces. Generally, the service to these countries was advisory; specifically, it was a matter of tailoring the medical services to correlate them with a proposed reorganization of their armed forces. Technical assistance consisted of providing them with training manuals, tables of organization and equipment for medical units, and technical manuals on sanitation and preventive medicine.

The theater surgeon and his representatives made numerous visits to these countries. The theater surgeon accompanied the commanding general to Uruguay in March 1945 on a liaison visit in which questions of future hemispheric defense were discussed.

The account just described covers only the more important liaison activities and problems. During the history of the theater, in many other instances smooth liaison was essential to the accomplishment not only of extra-military sanitation but also of the theater mission itself.

FOREIGN QUARANTINE

Early in the history of the South Atlantic Command, nearly all military traffic en route from the United States to Africa and Europe was accomplished with little consideration for quarantine12requirements because of the exigencies of war. Before August 1942, the War Department made little or no organized effort to require the Medical Department in the South Atlantic Command to impose any stringent foreign quarantine measures regarding military aircraft entering and leaving Brazil. Again, the objec-

12See footnote 5, p. 136.


152

tive of getting the military aircraft to North Africa and critical supplies to certain war zones was paramount in the minds of all commanders when the first contingent of U.S. military personnel arrived in Brazil in July 1942. Actually, there was no organized medical service until that time.

Clearance of personnel.-In August 1943, Air Transport Command authorities in Africa requested the South Atlantic Command to inoculate eastbound personnel against bubonic plague, especially those destined to pass through Dakar, French West Africa, and Marrakech, Morocco. These immunizations were discontinued in September 1943 on instructions from Air Transport Command headquarters which stated that such immunization of personnel would be accomplished upon their arrival in the endemic area.

In response to a War Department radiogram and to War Department Circular No. 254, 15 October 1943, a command directive was published affecting the requirements of troop movements through endemic yellow fever zones. On 19 October 1943, the War Department published the first directive on processing military personnel returning to the United States.13

Brazilian influenza control measures.-In December 1943, upon the recommendation of its port health authorities, the Brazilian Government requested the South Atlantic Command to check all individuals arriving in Brazil by plane to prevent the possible spread of influenza from the United States and Great Britain. The Brazilian authorities appeared on the Natal field one day prepared to take the temperatures of all personnel arriving at that station. This obviously would have impeded Air Transport Command activities. With the assistance of the U.S. Embassy in Rio de Janeiro, a compromise was reached whereby only those individuals destined to remain in Brazil would be examined. The Army Medical Department assumed the responsibility of examining those individuals upon their arrival at U.S. Army bases in Brazil.

Implementation of foreign quarantine directives.-When rotation of personnel to the United States began, the problem of foreign quarantine added further responsibilities. In March 1943, all base surgeons were instructed to fulfill these responsibilities by complying with existing directives on foreign quarantine requirements. Upon receipt of a letter from the Surgeon General's Office in March 1945, including directives, policies, and amendments, the base surgeons again were furnished additional information.

South Atlantic Command policies and procedures with references to foreign quarantine gradually were put into operation. During May 1945, the quarantine liaison officer, Lt. Col. Phillip T. Knies, MC, visited the South Atlantic Command to study the problems and practices of foreign quarantine. He became particularly concerned with the plans for increased traffic in the redeployment of troops from the European and Mediterranean theaters. The Brazilian Government, through Dr. Fabio Carneiro de

13War Department Memorandum No. W600-83-43, Assignment of Military Personnel Returned From Overseas, 19 Oct. 1943.


153

Mendonça, director of the Port Health Service and the Quarantine Service, indicated that it was satisfied with the quarantine precautions carried out by the U.S. Army and would impose no further restrictions if personnel had not been immunized against yellow fever. This policy would apply even though the passengers came from recognized yellow fever endemic areas.

Immunization for non-U.S. military personnel.-A South Atlantic Command directive was issued on 14 July 1945 regarding the writing of invitational travel orders for Brazilian, Uruguayan, and Paraguayan nationals. This directive provided that such orders would contain special instructions outlining the requirements for smallpox and yellow fever immunizations before departure for the United States.

In addition to non-U.S. nationals, the arrival of dependents of military personnel in the theater presented a similar problem. Hence, all such personnel, including American civilian personnel and Brazilian dependents of U.S. military personnel, were required to comply with South Atlantic Command headquarters Memorandum No. 97, dated 14 June 1945, regarding immunization, freedom from vermin, and freedom from communicable disease or from recent exposure.

Disinsectization of U.S. military aircraft.-In 1943, the Brazilian Government, through the persistent efforts of the director of the Port Health Service in Rio de Janeiro, vigorously protested the importation by U.S. military aircraft of the dreaded malaria vector, A. gambiae. Dr. Mendonça also claimed that by failing to disinsectize their aircraft properly U.S. Air Force crews were not cooperating fully. In 1938, Brazil had suffered very seriously from a malaria epidemic in which it was estimated that, of nearly 100,000 people who became infected with malaria, about 20,000 died. This epidemic had been eradicated through the assistance of the International Health Division of the Rockefeller Foundation, Rio de Janeiro, at a cost of $2 million.14

The Brazilian Government maintained constant surveillance over the airports at Belém, Fortaleza, Natal (both land and seaplane bases), and Recife. Brazilian crews were available for aircraft disinsectization at each airport.

The U.S. Army quarantine program was based on the principles of a generally accepted philosophy of quarantine. Within the limitations of military expedience, the program adhered generally to the quarantine regulations of the director of the Brazilian Port Health Service. However, the Army quarantine procedure differed from the civilian international quarantine program in subscribing to the policy of disinsectization at the point of departure of military traffic rather than at the point of entry.

Despite the publication of an Army quarantine directive (Army Air Forces Regulations No. 61-3, 14 October 1941, subject: Flying, Foreign Quarantine: Quarantine Inspection and Treatment of Aircraft), the in-

14Soper, Fred L., and Wilson, D. Bruce: Anopheles gambiae in Brazil, 1930 to 1940. New York: The Rockefeller Foundation, 1943.


154

herent problems of military expediency, and the resolution of disinsectization policy with the Brazilian National Malaria Service, the American air-crews did fail to cooperate satisfactorily with Brazilian health authorities. This failure illustrated the timeworn problem that faces large organizations, the breaking down of communications; in this instance, between the War Department and the medical or operational personnel in the field. Although implementation of the new military quarantine program was available to higher headquarters, including the Transportation Corps, Army Service Forces, and Air Transport Command, the military directive pertaining to quarantine was not distributed to the officers responsible for carrying out the program.

As a result of a sequence of events between October 1941 and the revision of Army Air Forces Regulations No. 61-3 on 11 February 1942, the Brazilian National Malaria Service, representatives of the International Health Division of the Rockefeller Foundation, the U.S. Embassy in Brazil, the Secretary of War, and the Army Surgeon General considered how aircraft could be disinsectized rapidly. Under the provisions of the revised Army Air Forces regulations, all base commanders and base surgeons in the South Atlantic Command were directed to cooperate in every way possible with accredited Brazilian health representatives who, with their own spraying crews, supervised the Port Health Service. The need for understanding the problems involved active cooperation between the U.S. Army and Brazilian health authorities. This joint cooperation was necessary for effective accomplishment of the War Department accelerated disinsectization program. The main difficulty was that the U.S. Army was striving for autonomy in a workable program for the sake of military security, and the Brazilian authorities were not in accord with this point of view.

The director of the Brazilian Port Health Service continued to be dissatisfied with the degree of cooperation received from the Army Air Forces crews in disinsectizing their planes, even after the regulation was revised on 30 November 1942.

Brazil's disinsectization law.-On 11 January 1943, Brazil published Decree Law 5181, which placed total responsibility for disinsectization of aircraft with the Brazilian authorities. In addition to the procedures outlined for this program, punishment for disregarding it would be meted out in the form of fines ranging from $500 for the first offense to a minimum of $3,000 for the second offense. Thus, in February 1943, during the height of the U.S. Army's drive to airlift men and materiel to Africa, the Brazilian health representatives took complete responsibility for the "disinfestization of aircraft from Africa."

Interdepartmental Quarantine Commission study.-The Brazilian representatives at Natal continued to submit reports on the failure of American crews to comply with Decree Law 5181 and on the finding of A. gambiae


155

mosquitoes on U.S. military aircraft arriving from Africa. Following a meeting of the commanding general of the South Atlantic Command, the U.S. Ambassador, and the Brazilian Foreign Minister, the commanding general requested the War Department to send representatives to his headquarters to advise, coordinate, and consult with the Brazilian representative in an effort to reach a satisfactory solution of the problem. The War Department promptly instructed the newly formed Interdepartmental Quarantine Commission to investigate the matter. Two members of the commission flew to Brazil. As a result of conferences held in Recife and Rio de Janeiro in November 1943, the following agreements were reached: (1) The Brazilian Port Health Service would participate in the disinsectization in Africa of aircraft controlled by the U.S. Army and destined for Brazil, (2) Brazilian public health representatives assigned in Africa would have responsibilities similar to those of the U.S. Army officers participating in disinsectization of U.S. Army planes arriving at Natal and Fortaleza from Africa, and (3) the ultimate objective was to render African ports of aerial embarkation for Brazil free of A. gambiae and the U.S. Army would continue its efforts to this end.

U.S. airbases in Brazil and West Africa were inspected by Maj. Elliston Farrell, MC, a member of the Interdepartmental Quarantine Commission, and Col. William A. Hardenbergh, SnC, and Lt. Col. (later Col.) Karl R. Lundeberg, MC, of the Surgeon General's Office. They investigated all the procedures, and Major Farrell studied the potential for the introduction of disease-bearing insects from Africa. He concluded that adequate measures were in force to prevent the importation of A. gambiae. Major Farrell indicated that the identification of arthropods recovered from incoming aircraft was not adequately confirmed, that there were discrepancies between reports by Brazilian and American officers stationed at Natal, and that a standard method of reporting by both parties was desirable.

As an outcome of these meetings and studies, a disinsectization and quarantine section was established in the office of the theater surgeon, and the theater malariologist, Capt. Jacob M. Benson, MC, was placed in charge. Disinsectization and quarantine squads were activated at Natal and Fortaleza. By January 1944, Captain Benson reported that, after conferences with Dr. Mendonça and others on the highly controversial reporting system and identification of insects, a method of capture and identification acceptable to everyone concerned had been adopted. Undoubtedly, the most significant change in the control and reporting of suspected A. gambiae was the final identification of all captured insects. This responsibility would now be undertaken by the laboratories of the International Health Division of the Rockefeller Foundation in Rio de Janeiro.

Even under these new systems, insects were still occasionally found, but on the whole, the arrangements worked satisfactorily. By December


156

1944, the Brazilian representatives were withdrawn from the airfields in Africa.

Redeployment of troops.-Plans for the anticipated increase of air traffic from Africa via Brazil to the United States (p. 150) were discussed by Colonel Knies, the Army quarantine liaison officer; Lt. Col. Oliver R. McCoy, MC, Surgeon General's Office; the U.S. Ambassador to Brazil; the U.S. medical military attaché, Brig. Gen. Hayes A. Kroner; and Dr. Mendonça. Dr. Mendonça's letter to General Kroner, dated 9 June 1945 (translated), shows his satisfaction with the planned arrangements and with the United States-Brazil relationship:

Dear General:

The object of this is to reaffirm to you the agreement made with Lt. Col. Phillip Knies about the position of the Health Service of the Ports, in relation to the troops that will pass in transit through the Bases of the North, proceeding from Europe, via Africa, and who, at the bases referred to, will not have contact with the civilian population of the cities:

1. Such service desires the most rigorous spraying of the airplanes, when they leave the African continent.

2. New and rigorous spraying will be done by our Service upon arrival in Brazil.

3. It would be highly desirable that airplanes landing at Ascension Island be rigorously sprayed, at this island, while they are being refueled.

4. No sanitary requirements will be demanded with respect to the American troops, since this Service has knowledge of the hygienic and prophylactic steps to which the same are submitted.

5. I take advantage to thank you for all the cooperation that we have received on the part of the American authorities.

SUMMARY

During the period 1943 through 1945, more than 8,200 aircraft entering Brazil from Africa were disinsectized at major airbases in Brazil under U.S. Army jurisdiction. Of this number, 118 harbored A. gambiae. In all, 320 of these arthropods were found, of which nine were alive. Table 3 shows the number of planes disinsectized, the number of planes on which these vectors were found, and the total numbers of living and dead A. gambiae that were recovered during each year. The one living A. gambiae recovered in 1944 was from a British hydroplane which had landed at the Natal seaplane base, which was not under U.S. Army jurisdiction. Seventeen of the 29 dead A. gambiae shown as recovered in 1944 were taken from one aircraft on 17 May 1944.

Before the disinsectization squad at Recife was organized, an occasional plane arrived directly from Africa. These planes were sprayed by the aircraft pilots with additional help from base operations personnel. Many of these planes transported very important individuals. Too often, the classification of their mission was such that it was not militarily expedient to notify the Brazilian Port Health Service authorities so that they could meet the aircraft upon their arrival at the airbases.


157

TABLE 3.-Number of aircraft disinsectized and number of Anopheles gambiae recovered at major U.S. airbases upon arrival in Brazil from Africa, by year, 1943-45

 


Year

 


Aircraft

Aircraft
from which
A. gambiae
were
recovered

 


A. gambiae

Natal

Fortaleza

Recife

Total

Living

Dead

Total

1943

746

73

0

819

100

8

273

281

1944

2,419

133

0

2,552

9

1

29

30

1945

4,453

375

13

4,841

9

0

9

9

 
Total

 


7,618

 


581

 


13


8,212

 


118

 


9

 


311


320


Source: Medical History, World War II, U.S. Army Forces, South Atlantic, 24 Nov. 1942-31 Oct. 1945, pp. 523-524.

All U.S. aircraft transporting troops via Africa and landing at U.S. airbases in Brazil en route to the United States during redeployment of men and planes were met upon arrival, and each aircraft was thoroughly disinsectized by the Brazilian disinsectization squads at the airfields (p. 150).

Daily reports of spraying of aircraft at each U.S. airbase were received in the Office of the Surgeon, U.S. Army Forces, South Atlantic. Similar reports were furnished to the Rockefeller Foundation laboratories in Rio de Janeiro.

The officers and men of the U.S. Army teams who worked with Brazilian representatives in accomplishing their mission of disinsectizing U.S. planes acted as consultants and advisers to that government. At the operating level, the U.S. medical teams and the Brazilian health officers worked in close harmony. The Brazilian Foreign Office through the U.S. Embassy in Rio de Janeiro made a considerable issue of each incident in which A. gambiae were found on incoming planes from Africa. It is a fact, however, that there was close coordination between the U.S. and Brazilian public health authorities at the airport level.

Every effort was made by the U.S. Army to cooperate fully and actively with Brazilian health officers operating on U.S. airbases in Brazil. This assistance was later extended to Brazilian representatives in Africa. Militarization of the Brazilian agency responsible for enforcing disinsectization and foreign quarantine measures would have brought these matters under better control and supervision as far as the U.S. Army was concerned. The Joint American-Brazilian Conference in Recife in 1943 did much to improve the disinsectization and identification procedures and led to better understanding between representatives of both countries. It became evident that the best method to protect Brazil against A. gambiae was to eradicate this species from the airdromes in Africa.

Both American and Brazilian authorities shared the anxiety aroused by the threat of malaria. Both fully realized that not only tragic loss of life but also their good relationship and the successful outcome of the war


158

were intimately involved in protecting the great country of Brazil from invasion by this small enemy. That their combined precautionary measures were successful and that A. gambiae did not regain a foothold in Brazil were matters of deep satisfaction to both nations.

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