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ACCESS TO CARE
The North Atlantic Area
Captain William D. Church, MSC
As Adolf Hitler's plans for world conquest became increasingly clear in 1938, the United States realized that it must take immediate steps to prevent the establishment of enemy bases in the Western Hemisphere. Though many secondary aims were stated at various times, the entire prewar strategy was based on the need "to reduce to a minimum the likelihood of accepting war upon our own territory."2
The fall of France in June 1940 and the threat to Great Britain and its North Atlantic lifeline focused American military attention on the North Atlantic area. In late 1940 and in 1941, a series of agreements was worked out which sent U.S. forces into Canada, Newfoundland, Greenland, and Iceland. Canada and the United States agreed to work together in the Ogdensburg Declaration of 17 August 1940. Under terms of the Destroyer-Base Agreement with Great Britain of 2 September 1940, the United States was given the right to lease bases in Newfoundland, a British colony until 1947, when it became a province of Canada. Agreements with the Danish Government in exile in April 1941 sent U.S. troops to Greenland, and in July, the Icelandic Government agreed to United States relief of British forces on that island.
By 1942, the North Atlantic bases had become the supporters of overseas offensives by protecting the sea routes and serving as stepping stones in the air ferry operations by which American airplanes were rushed to the scene of battle under their own power. In both the defensive and offensive operations of the United States, the northern bases were vital.
The various bases in the North Atlantic and in northwest Canada were organized under independent commands. The necessary medical support for them had to be sent in, and this was directed by command surgeons.3
To protect the health of the troops, medical officers had to become involved with public health problems; therefore, the potential existed for disagreement between Army medical officers and local civilian health officials. It must be remembered that U.S. troops were not moving into war zones. Except to rout a German weather detachment off the Greenland icefields and fight off German seapower in the waters around Iceland, U.S. forces in the North Atlantic bases defended areas where the people carried on their normal lives. American troops were visitors through detailed diplomatic agreements, not through occupation; therefore, even though public health problems threatened the health of U.S. troops, Army medical officers could not impose their will unilaterally. The problems had to be worked out with the cooperation of local health officials. As this chapter will depict, the work of U.S. Army medical officers in diplomacy, as well as in medicine, was exceptional.
One writer on United States-Canadian relations4 calls the collaboration of the two countries during World War II, "a record of solid accomplishment with only minor notes of discord."5 The North American neighbors combined both to defend the continent and the North Atlantic and to aid in the offense against the Axis by making it easier to rush airpower into action against the enemy. This joint effort brought into being expensive and wide-ranging projects on Canadian soil, such as the Alaska Highway (commonly known as the Alcan Highway), the Canol Project in the Northwest, and the CRYSTAL and CRIMSON airbase network in central and eastern Canada.
Canada and the United States did not rush into an alliance. President Franklin D. Roosevelt first pledged defense assistance to Canada at Chautauqua, N.Y., on 14 August 1936, but the significance of the speech was missed by most Canadians. During the next several years, the President and Canadian Prime Minister William L. Mackenzie King talked several times about mutual defense problems. Then, on 18 August 1938, in a speech at Kingston, Ontario, President Roosevelt stated U.S. intentions in terms that could not be misunderstood. He vowed that "* * * the people of the United States will not stand idly by if domination of Canadian soil is threatened by any other empire."6
Finally, on 17 August 1940, Canadian-United States collaboration became a reality when the President and Prime Minister Mackenzie King met at Ogdensburg, N.Y. A brief press release the next day announced that the two leaders had decided to set up a Permanent Joint Board on Defense to study "sea, land and air problems including personnel and material." The board was to "consider in the broad sense the defense of the north half of the Western Hemisphere."7
The Ogdensburg Declaration was very popular on both sides of the border, but naturally, there were to be differences of opinion during the war years. Many United States citizens poured into Canada to work on defense projects, and U.S. forces built and operated bases and facilities as if they were on U.S. soil. Many Canadians felt that these troops operated much too independently of Canadian jurisdiction. In addition to these military arrangements, there were smaller irritants, such as occasional cases of soldier misbehavior, competition for scarce housing and rationed supplies, and some fear that U.S. commercial enterprises in Canada might have an advantage after the war. It must be remembered that Canada was remote from the combat areas, and U.S. troops were intruding on territory where Canadians were trying to live relatively normal lives.8
The problems proved to be minor, however, and the joint effort was highly successful. Perhaps the best proof of this is that, when the war ended, there was never any question that the alliance would continue even when other wartime partnerships were breaking up. Today, our agreements with Canada are more extensive than with any other country.
Liaison between medical personnel of Canada and the United States on common problems was very valuable to the armed forces of both countries. An officer of the Royal Canadian Army Medical Corps, Capt. (later Maj.) A. H. Neufeld, acted as liaison officer to the U.S. Army Surgeon General's Office. He provided medical information from Canada, including reports of the National Research Council of Canada. In addition, Major Neufeld was authorized in April 1945 to coordinate all medical administrative matters for both the Canadian Army and Air Force directly with the U.S. Army Surgeon General. This helped to reduce delays in action on these administrative matters.9
When the Army moved into Canada, it found a well-developed public health system already in operation. Canadian public health activities were divided between the health departments of the Dominion and of the individual provinces.
The Dominion Government was responsible for public health matters
which were clearly international, national, and interprovincial. During the first few years of World War II, health activities were administered by the Dominion Department of Pensions and National Health. In 1944, the Canadian Parliament replaced this with a new agency, the Dominion Department of National Health and Welfare. However, the functions of the two bodies in the field of public health were quite similar. Both were responsible for preventing the entrance of infectious disease, screening out immigrants who could become a "charge" on the country, overseeing the medical care of workers on public construction projects, controlling food and drugs, working with the provinces to improve public health, conserving the health of Government employees, and conducting research in public health problems.
Each body included a Division of Quarantine and Immigration Medical Service. This section was charged with preventing the introduction of contagious diseases, such as plague, cholera, yellow fever, smallpox, and typhus. However, to insure the quick completion of defense projects in Canada, the U.S. War Department assumed responsibility for all quarantine measures concerning Americans, in accordance with pertinent provisions of Army regulations dealing with control of communicable diseases.10
The Dominion Council of Health coordinated the activities of the various provincial health bodies. In general, the Provincial Governments administered local public health activities. Municipalities, societies, and individuals carried on charitable and humane programs under the supervision and control of the Provincial Governments. The Dominion Government made grants to the provinces and to private voluntary organizations engaged in public health work.
Local municipalities usually built and supported the public hospitals. Treatment was "free of charge to all deserving applicants" whose resources were "so limited as to prevent them from receiving proper medical attention otherwise."11
Before December 1941, the American military effort had been directed toward the protection of the North Atlantic area, but the Japanese attack on Pearl Harbor forced Canada and the United States to plan more actively for defense on the west coast.
The first task was the completion and maintenance of the Northwest Staging Route-a series of airfields built by Canada, spanning the northwest-to connect the United States and Alaska. They were thought to be in
good condition, and Canada agreed to use of the facilities by the United States.
In January 1942, the first effort to reinforce Alaska by air proved disastrous as 13 of 38 planes crashed on the way. The idea of a highway to Alaska was not new, but to improve and supply the air facilities, to provide a ground guide for pilots flying the route, and to create a ground link with Alaska, the highway plan was reconsidered and approved by both the United States and Canadian Governments in February and March 1942. The highway and the staging route were tremendous engineering achievements which fulfilled the major purposes for which they were constructed. It was an enormous task to cut through virgin lands while overcoming the handicaps of landslides, freezing temperatures, sudden thaws, and other weather problems. The successful completion of the task was a tribute to United States-Canadian cooperation.
The Alcan Highway, when completed, linked Big Delta in south central Alaska and Dawson Creek in eastern British Columbia, a distance of 1,428 miles. A pioneer road was hacked out by U.S. Army Engineers (fig. 16); in the latter half of 1942, they were joined by a civilian construction organiza-
tion working under the U.S. Public Roads Administration. The highway remained a U.S. military road throughout the war, and on 1 April 1946, it was turned over to Canada.
Canol, a contraction of Canadian oil, became one of the most controversial projects of the war. Without the Japanese threat in the north, the plan to get petroleum supplies from the Norman Wells oilfield in the Northwest Territory would have been economically unsound. But the need for oil on the staging route and the highway brought the idea to life, and in an exchange of notes in June 1942, Canada agreed to let the United States proceed with the project.
The original Canol Project, later known as Canol 1, linked Norman Wells, in the heart of the oilfields around the Mackenzie River in northern Northwest Territory, with a refinery in Whitehorse, southern Yukon Territory. Subsequently, other projects came into being: Canol 2 provided a pipeline between Whitehorse and Skagway, in southern Alaska; Canol 3 involved a gasoline pipeline between Carcross, south of Whitehorse, and Watson Lake, in southeastern Yukon Territory; and Canol 4 linked Whitehorse with Fairbanks, Alaska.
Most of the work was done by U.S. citizens because there was little local help available in this barren area, more than a thousand miles from any settlement.12 To build the needed facilities, U.S. citizens were sent into northwest Canada in large numbers, and by June 1943, more than 33,000, both military and civilian, were stationed in the Northwest.13
Planning medical support for this extensive area was a big task. During 1942, U.S. Army Medical personnel cared for both U.S. troops and civilian employees of the PRA (Public Roads Administration), private contractors, and Northwest Airlines, Inc. The PRA employees were entitled to medical care as beneficiaries of the U.S. Employees' Compensation Commission. By 1943, four different U.S. medical elements were operating in the area: (1) the medical branch of the Northwest Service Command cared for the military, (2) the U.S. Public Health Service attached to the Public Roads Administration and the U.S. Engineer Department Health Service cared for civilians, (3) civilians requiring extended hospitalization, many emergency cases, and dental cases were sent to Northwest Service Command Station Hospitals, and (4) the Alaskan Wing of the Army Air Force provided medical care for its personnel (map 4).
Close liaison was maintained among these agencies to avoid duplication of medical service and to care for both military and civilian personnel in the most efficient manner.14 Civilian doctors were sometimes employed when
no Army medical officers were available, but this was not a common practice.
The last elements of the Public Health Service left in January of 1944; and in March of that year, the personnel and facilities of the Engineer Department Health Service were absorbed by the Northwest Service Command Medical Branch. This consolidation was in accordance with Letter, Headquarters, Army Service Forces, dated 10 February 1944, subject: Curtailment of Operations and Reduction of Military Personnel and Equipment, NWSC. The directive ordered that civilians, both Canadian and American, should be hired to replace military personnel.15
The effect of this directive was to increase the number of civilians in the command and to make the medical branch of the Northwest Service Command the only agency left to treat them. The civilians were not in as good physical or mental condition as the soldiers had been. Because of severe manpower shortages, the disadvantages of age and some physical infirmities had been overlooked by those who had hired them. The result was an increased patient load and a greater diversity of cases to treat.16
The U.S. Army hospitals also treated patients from the Canadian armed services, under reciprocal agreements of 24 March 1943 and 22 March 1945. These agreements provided for the use by either country of the hospital facilities of the other.17
Public health.-The provinces of Alberta and British Columbia already had extensive public health services when U.S. troops arrived. In addition to the usual services, Alberta maintained a system of 16 Rural Health Districts to provide for country areas and 36 Provincial District Nurses to give a wide-ranging medical and public health service to the outlying areas.
British Columbia used different types of local health services, including large city health departments, health units, public health nursing services, and, in outlying areas, private-practice physicians who were appointed as part-time health officers and school medical inspectors. The Health Unit, made up of a full-time physician medical director, public health nurses, several trained sanitarians, and a statistical clerk, was the basic unit of organization. Each section of the province was served by a health unit.18
Public health matters were of little concern in Yukon Territory and the Northwest Territories because of the sparse population. The territories contained less than 1/700 of Canada's total population. Municipal governments handled some public health measures, but matters affecting the general public health were directed by the Dominion Government.19
Sanitation.-The large increase in war production brought many more Canadians to the cities, putting a heavy burden on water supplies, sewage disposal, housing, and entertainment facilities in the settled areas. But it had very little effect on American troops because the Army supplied all these facilities except in Edmonton, Alberta, where local water and sewage facilities were used with no adverse effects on either the local population or the U.S. troops.20
Because of the wide area under control of the Northwest Service Command, it was impossible to impose overall sanitary regulations. The various sections required individual attention because of their locations and differing
problems. Medical officers made occasional area and district inspections, and 12 Sanitary Corps officers worked full time in the Command area.
Although sanitary standards were generally high, some settled communities did not meet Army standards until they received assistance. In several areas, American assistance cut down intestinal disease rates that had been major problems for years.
Obtaining safe water was a varied problem since it involved providing for camps with as few as five men as well as for areas where up to 10,000 troops were stationed. In most instances, supplying water for the Army did not entail any work with local civil officials. Only in Edmonton and Grande Prairie, Alberta, did the Army use water from a municipal system. In the other camps along the highway, water was obtained from wells, lakes, and streams, and then treated by Army personnel.
The Veterinary Service did not begin inspection of local food resources until the summer of 1943. During the first months of operation, the troops had eaten mainly "C" and "K" rations. When the veterinarians started inspections of local food, the diet of the men improved considerably. With good local cooperation in most areas, food establishments were inspected by U.S. Army and Canadian inspectors, and the list of approved restaurants and food stores grew rapidly.
The Army Veterinary Service accepted the meat production standards already in force at Canadian meatpackers under the supervision of the Veterinary Division, Health of Animals Branch, Dominion Department of Agriculture. Army personnel did inspect the plants for quality of the products during production and accuracy of weights. The Army Veterinary Service also persuaded civilian contractors working on the Canol project to procure their meats through Army channels in Edmonton instead of from the extremely unsanitary plants in the Mackenzie River area.
During 1944-45, the Edmonton Quartermaster Market Center purchased 22,500,000 pounds of frozen poultry throughout Canada. Veterinary Service inspections were praised by Canadian Government and poultry industry officials, and resulted in improved production and better sanitation.21
At Edmonton, the biggest city in the Northwest Service Command area, the Army had most of its contacts with local officials. All health matters of mutual interest were studied by a special board, which included the Surgeon for the Edmonton District representing the Northwest Service Command, provincial and city health officials, and representatives of the U.S. Army Air Force and the Canadian armed services.
Edmonton was the major supplier of fresh milk for the Army. Three dairies with modern equipment were approved in May 1943 to supply about 150 gallons a day for the troops. In July 1943, the Veterinary Service dis-
covered that the milk was not being inspected properly by the city for milk-borne diseases and quality. Edmonton did not require testing of cows for Bang's disease (Brucella abortus) which can cause undulant fever in man. An estimated 25 percent of the cows were infected. The city's test for bacterial content was considered inadequate; more effective pasteurization could have overcome the danger. Because of the relatively lax public health control over dairy production in Edmonton, Army veterinary officers established quality control testing of both raw and pasteurized milk.22
In the Edmonton area, troops were supplied directly by the dealers. In addition, some milk was shipped by plane to hospitals and by train to several railheads where neither fresh milk nor powdered milk prepared in a "mechanical cow" was available. Not until late 1945 were Army veterinary and sanitary officers able to arrange for shipment of fresh frozen milk in quart fiber containers, the safest means of transport. Small, extremely unsanitary sources of milk were found at all the railheads. Troops were prohibited from using this milk, but some did so when they could not get approved milk from Edmonton.23
Edmonton was the only major post where the Army obtained water from a municipal source and used a municipal sewerage system. Cooperation with local water officials was excellent. Even though the city purification plant was operating at 50 percent over designed capacity, the quality of the water met Army specifications.24 The sewerage system was also modern and satisfactory.
The repeater station at Grande Prairie used unchlorinated water from wells which also supplied the town's population of 1,500. Raw water samples sent to the Edmonton Station Hospital laboratory repeatedly proved satisfactory.
The village of Whitehorse, Yukon Territory, presented the most serious problems of sanitation to the Army. The Whitehorse Station Hospital Commander, Maj. Mendel Silverman, MC, described sanitary facilities as "execrable" and called the town "one vast cesspool."25 Whitehorse was an unincorporated town in a territory administered by a three-man council which met just once a year. A modern hospital had been established and a health officer had been appointed in Whitehorse several years before the war; but the health officer, Frederick B. Roth, M.D., lacked assistance, and though he had tried to improve sanitary conditions, especially in restaurants, he had not received support.26
Whitehorse had a population of about 600 before the war, of which about half left for the winter. The town was not prepared for the flood of
military and civilian personnel into the area. Camps were set up all around the town. The station hospital was established in the only large building available in the town, the community hall. This building was rented for $25 a month, and the local authorities gave the Army permission to fix it up and make it into an adequate hospital.27
A survey of the restaurants was made by Dr. Roth, Army sanitary officers, and a representative of the Royal Canadian Mounted Police in September 1943. They found that only two of the 11 restaurants met acceptable standards. Only one had chlorinated water, dishes were not sterilized, and adequate refrigeration was lacking. Because Dr. Roth believed he lacked the legal powers to take any positive steps and the Mounted Police simply took their business from one of the unsatisfactory restaurants to an acceptable one, the Army was forced to act. In the absence of adequate local laws, sanitary officers drew up standards for sanitation, discussed them with Dr Roth, and distributed them to the restaurants. Then, deficiencies of each establishment were noted, and Dr. Roth notified the individuals concerned. All proprietors were instructed in proper sanitary methods and the local officials were urged to enforce the regulations. When reinspection showed little improvement, the Army threatened to place the restaurants off limits for military and civilian personnel of the command unless improvements were made. Most of the businesses complied; of three eventually placed off limits, only one failed to be reinstated.
The Army sanctions brought a great improvement in the conditions of the Whitehorse restaurants. Just 3 months after the initial surveys, all had water from approved sources, a cool place for food storage, and dishes were washed and disinfected.
Fresh foods for the messhalls were not bought locally; prices were too high and only a limited quantity was available. All food for the North was imported except for an occasional supply of fish caught by the local Indians.
During 1942 and most of 1943, the water supply at Whitehorse was tenuous and inadequate. It was obtained from the Lewes River and shallow wells, and then chlorinated.28 An epidemic of dysentery among the civilian population of Whitehorse early in the summer of 1942 was traced to the town's water supply by Army Medical officers in cooperation with civilian authorities.
In October 1943, a new system using water from McIntyre Creek was built by the Army and provided an adequate supply. Local inhabitants of Whitehorse, working through the Canadian Department of Transport, requested permission to cut into the McIntyre Creek system. The Army could not approve this request because the town's water and sewer lines were laid alongside each other in the same trench. Several times each year, the ground water rose above the lines, which were made of wood-stove pipe,
creating a health hazard since the water could be polluted by sewage. This condition was corrected by disconnecting the water line before it came together with the sewer line and digging a new ditch for the water line. The town was then allowed to use the Army water system, and Army sanitary officers inspected it regularly.
The townspeople had an old custom of dumping garbage and refuse just outside the center of town on the banks of the frozen Lewes River. When the ice broke up, the debris was carried downstream. The sanitary officer persuaded them to end this practice and a new site was selected 3 miles from occupied areas.
Sewage disposal in the town consisted of privies, cesspools, septic tanks, and tile fields. The post used privies, but by November 1943, the new sewerage system was in operation and was also extended to parts of the town.29
The village of Dawson Creek, British Columbia, also cut into an Army water system in 1944. No problems were encountered and the system was turned over to the town in 1945.30
Up in the far North at Camp Canol, a serious problem for a while concerned the messhall which was staffed entirely by civilian cooks with long experience in the North. Whenever the medical officer suggested improvements in sanitation, these cooks quit, causing a large turnover of personnel.
Diseases.-Among the native population in western Canada, several outbreaks of cerebrospinal meningitis, diphtheria, and measles occurred. Tuberculosis was a major killer among the civilians, especially in the Indian villages. An Army survey revealed a tuberculosis death rate of two to four a week in several Indian villages. Tuberculosis rates were so high among the Indians around Norman Wells that military and civilian personnel were restricted from associating with them.
The medical officer at Norman Wells helped curtail an epidemic of smallpox among Eskimo fishermen in 1944. His help was requested by a nearby Canadian Government medical station, and he was flown by a Royal Canadian Air Force skiplane to the scene of the epidemic.31
Although bacillary dysentery was endemic among the native populations in the settled area, especially during the spring and fall, the Army remained virtually unaffected. Lt. Col. Walter L. Tatum, MC, surgeon of the Whitehorse Sector in 1942, credited the Army's potable water supply with protecting his camp.32
These infections were not a serious problem to the Army even while epidemics raged among the natives. On the contrary, the natives picked up
several diseases they had never had before. Dr. John F. Marchand, investigating for the U.S. Public Health Service, attributed this to the influx of outside contacts, both military and civilian, who acted as carriers. One remote Indian village in particular, on Teslin Lake in Yukon Territory, experienced successive attacks of measles, dysentery, jaundice, whooping cough, German measles, mumps, tonsillitis, and meningococcic meningitis.33
Army medical personnel were quite willing to aid the natives in coping with any diseases, many of which had been introduced by U.S. personnel. The Northwest Service Command Medical Laboratory was set up in August 1943 with the major purpose of assisting in the control and prevention of epidemic and endemic diseases. By a memorandum dated 16 September 1943, the laboratory's commanding officer, Lt. Col. Harry E. Wright, MC, instructed all medical officers to contact him immediately whenever any disease in the military or civilian population reached epidemic proportions.34
All U.S. military and civilian personnel entering the command were required to have up-to-date immunization records and to be free from disease. All personnel with contagious diseases were quarantined according to Canadian regulations. Dependents and visitors were the only Americans in the theater not under Army control.35
During the summer of 1942, an outbreak of serum hepatitis struck large numbers of troops working on the Alaska Highway. This was part of an Armywide outbreak of homologous serum hepatitis following vaccination against yellow fever.36 Many of the troops affected in Canada had been vaccinated for yellow fever at Fort Ord, Calif., leading to the conclusion that the vaccine was the cause.
The 35th Engineer Regiment was the hardest hit of the units working on the highway. The first case occurred in May 1942, about 90 days after the men had been vaccinated at Fort Ord. The number of cases increased steadily until a peak was reached in mid-July. During July, the disease was obvious in an estimated 500 cases; and in numerous other cases, there was no jaundice but the patients suffered from weakness and nausea. In August, there were only a few new cases; and after that, only a few recurrent cases in the fall of 1942 and the spring of 1943.
The exact beginning of each case was impossible to determine because the personnel of the 35th Engineer Regiment were scattered over a wide area. They were completely isolated by land although they had access to an airfield. Approximately 100 of the first jaundice patients were air-evacuated to the Fort St. John Station Hospital, but after that, only gravely ill patients were evacuated. Although the seriously ill were kept in camp
under a doctor's care, many jaundice patients, though weak and nauseated, continued the hard labor of building the road so that they could finish and get out of the wilderness. The Whitehorse sector of the highway reported 38 cases in June and 77 in July, the most serious of which were sent to the Whitehorse Station Hospital. Several other engineer regiments in the sector were affected.
Despite general agreement that the outbreaks were caused by yellow fever vaccine, one U.S. medical officer, Capt. George C. Cash, MC, at the Sub Port of Embarkation, Prince Rupert, British Columbia, reported that his jaundice patients had been vaccinated from three different lots of vaccine. He also pointed out that there had been jaundice outbreaks among civilians and Canadian soldiers in his area who had not been inoculated against yellow fever. Captain Cash reported that work was being done in Vancouver to determine the cause of jaundice in the area, but no conclusion had been reached.37
Insects presented no disease problem. Mosquitoes were plentiful, but not disease-carrying. Flies and cockroaches were the most serious health hazard, as in the United States.
Venereal disease was high on the list of communicable diseases in the Northwest Service Command, but it was not a serious local problem because most cases were acquired outside the command. Before the granting of furloughs, the occurrence of venereal disease was almost negligible.38
Syphilis and gonorrhea were the major venereal diseases in Canada, but the rates for both were somewhat lower than those in the United States. Control measures were the responsibility of the provinces, with liaison being established with the Department of National Defence during the war. Generally, control measures were similar to those used in the United States, and reports from all posts indicated that excellent cooperation was given by local authorities in tracking down contacts.39
Edmonton, the only large city in the command, naturally had the highest venereal disease rate. Prophylaxis stations were set up at the station hospital, at the Army airbase, and in downtown Edmonton in cooperation with the Canadian Services. In addition, the military and civilian authorities, working together, started a registration system for all women at public dancehalls. This proved to be valuable in checking contacts. Although the civilian authorities were very helpful in tracing contacts, their treatment was not always satisfactory because of their lack of facilities for cultures and their short supply of penicillin.40
In Whitehorse, the Royal Canadian Mounted Police and the local health officer, Dr. Roth, took strong measures against prostitutes and diligently
checked suspected contacts, so that the probability of infection was kept small. To protect the local civilian population, all men returning from furlough were held at their organizational areas for medical examination before returning to their units.41
Venereal disease became a problem in the village of Dawson Creek, BC, for a short time in the spring of 1943. However, Canadian authorities acted quickly to close a local house of prostitution when it was reported to them by U.S. Army personnel, and all men coming back from furlough were checked for venereal disease.42 Outside the villages, venereal disease was almost unknown.
In summary, the relations of U.S. Army medical officers and civil public health officials in northwest Canada generally were smooth. They worked together to protect the health of troops and civilians, and local sanitation usually was improved by the work of U.S. personnel in establishing new facilities or adding to already existing ones.
Central and Eastern Canada
Large numbers of American military personnel came to eastern and central Canada during 1941 and 1942 to help build and operate facilities for the North Atlantic air ferry operations. American military strength in Canada increased quickly to a peak of 17,000 in August 1942, but by the spring of 1943, need for bases had diminished because of the much greater range of aircraft and an improved shipping situation, and the military strength decreased to an average of 1,350.43 The ferrying plans were designed to speed aircraft to Europe where they were critically needed. The quickest way to deliver them was under their own power.
Air ferry operations had begun in 1940 between Dorval Airport, near Montreal, through Newfoundland, and then 2,100 miles to Prestwick, Scotland. This route was for heavy and medium bombers. In 1941, after U.S. personnel had made several studies and conferred with Canadian and British officials, it was decided that more bases would be needed to ferry short-range aircraft and to relieve congestion at Newfoundland Airport. A route was established using Greenland and Iceland as intermediate stops, and in late 1941, the Canadians began construction of an additional base at Goose Bay, Labrador. In addition, the United States received Canadian approval in August 1941 to construct much-needed weather stations at Fort Chimo, Quebec (known as CRYSTAL I), at Frobisher Bay, on Baffin Island (CRYSTAL II), and at Padloping Island, east of Baffin Island, just above the Arctic Circle (CRYSTAL III).
In the fall of 1942, to provide medical care in central Canada, station hospitals were set up in The Pas (131st) and Churchill (4th), Manitoba, along with a dispensary on Southampton Island. The theater surgeon was based at the Winnipeg headquarters of the U.S. Army Forces in Central Canada. In eastern Canada, small station hospitals were set up at Fort Chimo (133d) and Frobisher Bay (134th), with a few medical personnel scattered around at the other small stations.44 At Goose Bay, Labrador, the 6th Station Hospital was activated in the spring of 1943. Until this time, American troops had used the RCAF (Royal Canadian Air Force) hospital there (map 5).
Public health in Manitoba and Quebec-Both Manitoba and Quebec Provinces had developed public health systems. Manitoba's Department of Health and Public Welfare provided the usual services in sanitation and preventive medicine. In addition, a new Division of Local Health and Welfare Services supervised local part-time health officers, set up local health units, and offered consultative services to the province's municipal and local health departments.
Quebec reorganized its public health program in 1941 and established a Department of Health and Social Welfare to provide public health services. The province used a system of "county health units" to supervise public health work on a local level. Consultations, lectures, school inspections, investigations, immunizations, and sanitary improvements were offered to the local communities. A total of 21 antituberculosis dispensaries and 70 baby clinics was added to local public health programs.45
Medical treatment of the natives.-The members of the armed forces in eastern and central Canada had relatively few health problems. They learned to adjust to the cold, adopting the Eskimo mukluks or heavy felt shoes of the Hudson Bay Company. Severe snowstorms frequently arose with little warning, and the troops simply did not venture out for fear of getting lost.46 Even respiratory infections were less frequent than expected, and when they did occur, the patients made uneventful recoveries.
In contrast, the natives and Eskimos in remote parts of central and eastern Canada had many health problems and few civilian doctors to help them. The Army medical personnel performed a great service in treating these people, many of whom previously had never received medical care. Moreover, Army medical officers also had a certain responsibility to the natives because the rates of some of the diseases, such as influenza, were greatly increased when U.S. military and civilian personnel moved into the northland. Col. Jack C. Hodgson, AC, the commander of U.S. Army Forces in Central Canada, encouraged this aid to the natives, and the medical department of the command expressed great pride in its achievements.
Finally, early in 1945, the Manitoba College of Physicians, Surgeons, and Dentists issued temporary licenses to practice to the Army medical officers to guarantee legal protection and to express appreciation for their services.47
The post surgeon at each of the major posts in central Canada also served as medical inspector. In this capacity, he not only inspected the sanitary conditions but also paid particular attention to any disease outbreaks among civilians which could threaten the command.48
Capt. Werner Lehmann, MC, Surgeon, U.S. Army Forces in Central Canada, was very active in this treatment of the natives, often traveling to the various posts, including Southampton Island, the most isolated base. His highly informative report told of the problems and rewards of treating the natives. The Eskimos were reluctant at first to seek medical aid, preferring to heal themselves and their families unless the illness or injury became very serious. In bad weather, it was sometimes impossible for the natives to reach Army medical personnel; consequently, treatment was delayed.
Successful treatment of the first Eskimos who sought Army aid led to a large increase in the number of native patients. Word spread quickly among the Hudson Bay villages. Native patients were required to obtain permission from the Royal Canadian Mounted Police before coming to the Army posts. Captain Lehmann had great praise for the work of the Mounties who made possible the good relations between the Army and the natives, and handled several difficult liaison situations with tact and diplomacy. The police would go out in any weather to remote villages to answer calls for medical help. Although their supplies and medical knowledge were limited, they did a fine job. In addition, they sometimes called by radio to the Army medical officers, describing the symptoms of a patient and asking for a possible diagnosis and suggested treatment. Captain Lehmann reported several instances where this method was highly successful.
The Eskimo patients possessed remarkable ability to endure pain, which made their treatment easier. A 20-year-old Eskimo walked 8 miles to the 4th Station Hospital at Churchill on a broken leg. The bone was penetrating soft tissue around the fracture. He withstood the reduction of the fracture and the application of a cast without the slightest show of pain. Capt. George Benstock, DC, the theater dental surgeon, traveled widely to treat natives, and marveled at their stoicism during painful tooth extractions.49
A tragic episode in the Army's program of helping the natives occurred in June 1944. A severe epidemic broke out among the natives of Eskimo Point, about 200 miles north of Churchill, and almost 50 percent of the natives of the area died. Colonel Hodgson authorized 1st Lt. Oliver Austin, MC, Churchill Post Surgeon, to fly to Eskimo Point. Lieutenant Austin, suspecting diphtheria gravis, administered sulfonamide drugs and diph-
theria antitoxin and hurried back for laboratory tests. When these proved that his fears were correct, he hurriedly loaded a plane with large amounts of diphtheria antitoxin, even leaving behind the radio equipment, and with the pilot, 2d Lt. Robert Hyde, AC, took off for Eskimo Point. The plane never arrived; it crashed along the shoreline, killing both officers. The native population's actions in this tragedy showed their true gratitude for the work of the Army medical officers. They came from a radius of hundreds of miles around to search for the plane and, when it was found, expressed extreme sorrow and sent condolences to Colonel Hodgson and to the families of the dead officers.50
An epidemic of measles in Churchill in August 1944 among whites and natives alike provided a threat, but quarantine of the post and prompt preventive measures by the medical officer curtailed the danger. Also, the 4th Station Hospital cared for civilian employees of the construction company working on the base.51
In April 1945, several Eskimo children on Southampton Island contracted tuberculosis. Medical officers made a survey of the island with the cooperation of the Mounted Police. The Canadian Government sent up plates and chest X-rays were taken; many showed signs of active tuberculosis. During an influenza epidemic, the military dispensary on the island treated many of the cases.52
Tuberculosis was a serious problem among the Eskimos in the desolate areas under the jurisdiction of U.S. Army Forces in Eastern Canada. Here again, medical aid was given, and the Eskimos came to depend on the medical personnel of the Army for help. Practically all the Eskimos suffered from upper respiratory diseases and seemed to have no natural immunity. The coming of U.S. personnel greatly increased the incidence of influenza among the natives. In one outbreak around Fort Chimo, 22 Eskimos died in a total population of 150 to 200.53
The work of the Army Medical Service among the natives of eastern and central Canada was a real achievement in civil affairs public health. Though U.S. troops added somewhat to the native disease problems, Army medical personnel helped bring a general improvement in the health of the natives. This work was carried on in spite of great distances, bad weather, and a language barrier, but the effort did much to cement good relations between the United States and Canada.
Liaison with Canadian officials.-Liaison with Canadian medical officials was usually cordial. Under the reciprocal agreements for use of hospital facilities (p. 166), U.S. Army medical officers used Canadian military hospitals in the Winnipeg area. The services of these facilities were always quickly and skillfully given. Hospitalization for U.S. troops of
the command and for transients was frequently provided as were medical treatment, general and special surgical procedures, radiological and laboratory service, and eye, ear, nose, and throat care.
Canadian medical officers also helped out in unusual circumstances, such as holding sick call when Captain Lehmann was out touring the other posts. The most outstanding case was the flight of Squadron Leader M. W. Nugent, an ophthalmologist in the Royal Canadian Air Force, to The Pas to save the eyesight of a U.S. enlisted man. The U.S. Army Surgeon General commended this officer for his help.
Canadian civilian officials in the Manitoba Ministry of Public Health were also extremely helpful in safeguarding the health of American troops in Manitoba. The Command Surgeon used the modern facilities of the Provincial Laboratory for bacterial examinations, complement fixations, and various chemical tests and analyses. Specimens were flown to Winnipeg from the outlying posts and immediately given to the Provincial Laboratory for analysis.54
In The Pas, the Army used the facilities of St. Antoine's Hospital and received the utmost cooperation from local professional personnel.55
Venereal disease.-In central Canada, venereal disease was a problem for a time, being localized in The Pas, where almost all contacts and cases occurred. Some transients to and from the isolated northern bases, in addition to some of the men stationed at the airbase just outside of town, contracted venereal disease in The Pas.56 Canadian military and civilian authorities, working with U.S. venereal disease control officers, traced contacts, set up prophylactic stations, and brought about a general improvement by 1945.
In Winnipeg, the problem was not so great, and an Armed Services-Civilian Liaison Committee kept the danger in check. This committee traced and treated local contacts, policed local dancehalls, hotels, and restaurants, and obtained venereal disease legislation and publicity. By 1945, almost all new cases occurred among transients or men just returning from leave in the United States.57
In eastern Canada, venereal disease was never a problem because of the absence of contacts. All cases were transients or returnees from furlough.58
Sanitation.-Extensive surveys showed that no disease-carrying insects were present in central and eastern Canada. During the warm months, mosquitoes and flies were a nuisance, and control measures were of the passive type. Headnets, gloves, and screened buildings reduced the irritation somewhat. The natives were often infested with body lice, but proper control measures kept the troops from being affected. In addition, a program was
instituted to disinsectize all planes coming from areas where insectborne diseases were found. No federal, provincial, or municipal programs for insect control existed in Canada.59
Water for U.S. troops in central and eastern Canada was obtained principally from lakes, rivers, springs, and, in the winter, from snow melting machinery. Canadian officials were not involved in this water supply. At Churchill and The Pas, U.S. troops were able to obtain water from existing municipal and privately owned water plants. The Army delivered the water from these plants, usually in heated trucks, because pipes were not feasible in the permanently frozen ground. Water was chlorinated on the posts. The system was acceptable at most of the posts; only northern Southampton Island and Frobisher Bay had serious problems. In winter, the men there cut ice on the lake with a saw and then melted it. No epidemics caused by unsafe water occurred in the command. Latrines were all chemical or pail-type, again because pipes could not be used. Laundry was done on most of the posts. In The Pas and Goose Bay, civilian laundries on contract were satisfactory. In Mingan, local families took in laundry, but their work was unsatisfactory.60
Food.-United States troops did not eat much food of local origin. In The Pas, troops sometimes used local restaurants, and a limited amount of food was obtained from local markets. Also, a dairy in The Pas supplied fresh milk. Insufficient transport facilities greatly limited the amount of milk which could be carried to the other posts until 1945, when a weekly plane supplied fresh milk to the major installations. All supply sources of food and milk in The Pas were inspected regularly by the post medical officer with the help of the Royal Canadian Mounted Police.61
The Canadian-United States partnership in World War II proved to be a very successful undertaking. The North American neighbors worked well together to protect the continent. This friendly cooperation was very evident in the field of civil affairs public health. U.S. Army medical officers found Canadian health officials, both civilian and military, very willing to help. Officers of the Army Medical Service performed a great service by treating Canadian civilians scattered over vast areas of the barren northland. Working together, Canadian and United States doctors and sanitary officials provided a high level of public health in Canada for both United States troops and Canadian civilians.
United States troops moved into Newfoundland in January 1941 under the provisions of the historic Anglo-American Destroyer-Base Agreement.
Acting under this agreement, the Newfoundland Commission of Government, on 14 June 1941, leased to the United States several parcels of land. One, at Quidi Vidi, on the east coast near the capital, St. John's, later became Fort Pepperrell, headquarters of the Newfoundland Base Command. Another, 75 miles west, near Argentia, later became Fort McAndrew. On the west coast near Stephenville, Harmon Field was built. A fourth U.S. installation was at the Newfoundland Air Base, near Gander in the northeastern part of the island. This airfield was already occupied by units of the Royal Canadian Air Force.62
These were the major U.S. posts in Newfoundland. Medical care was established at all four in 1941 and 1942, and, finally, on 1 April 1943, the four Army hospitals were designated the 308th-311th Station Hospitals (see map 2).63
Newfoundland is a rugged, bleak island about the size of Virginia. Most of its population of about 300,000 lived either on the Avalon Peninsula in the east or in the lower Humber River Valley in the west. The weather was just slightly colder and windier than in New England.
The oldest of England's colonies, the island had been a dominion after World War I, but severe financial problems forced the Newfoundlanders to relinquish their dominion status in 1933 and suspend their Parliament. When U.S. troops arrived in 1941, the island's legislative and executive power was still held by a governor appointed by Great Britain, acting with the advice of a six-man royal commission.
This governmental arrangement resulted in complete centralization; all services, including public health, were directed from St. John's by the Governor and Commission. St. John's, the capital and largest city, with a population of about 40,000, had a more or less autonomous local government with a mayor and municipal councilors, but it did not have a municipal health department.
The Newfoundland Department of Public Health and Welfare was established as an independent autonomous unit in 1933 after the government reorganization; it administered hospital, medical, and nursing services, relief to sick and able-bodied poor, allowances to widows, orphans, and the infirm, old age pensions, war pensions, and vital statistics.
Sir John C. Puddester, a layman, headed the department as Commissioner, but the top-ranking, full-time medical man was the Secretary, Dr. H. M. Mosdell. Other professional personnel included two medical health officers and a general health inspector. The headquarters staff numbered 59, including various specialists. In addition, 50 general practitioners in the city and country districts worked part time for a set fee, receiving extra
pay for antituberculosis activities, immunizations, and venereal disease treatments. Their normal duties in general public health included sanitation, medical attention to the poor and the war pensioners, and maritime and shore quarantine.
The Department of Public Health also maintained a public health laboratory in St. John's which provided laboratory service for doctors and hospitals throughout the island.64
In anticipation of the movement of large numbers of American troops to Newfoundland, several surveys of the health and sanitary situation on the island were made in November 1940. Lt. Col. (later Col.) William A. Hardenbergh, SnC, studied environmental sanitation and general health conditions. Assistant Surgeon General Raymond A. Vonderlehr and Past Assistant Surgeon Roger E. Heering, of the U.S. Public Health Service, investigated specific health problems and available health services as they would affect an armed force. Both concentrated on the St. John's and Argentia areas on the Avalon Peninsula where it was expected that most American troops would be located.
Both surveys revealed that problems could be expected in Newfoundland. The U.S. Public Health study pointed out that the provision for medical care at public expense was developed more administratively than in the United States, but because of the widely scattered population, poor transportation, lack of competent physicians, and insufficient funds, the Newfoundland Government was not able to cope with all the medical problems it faced.65 Colonel Hardenbergh suggested that, "because the level of environmental sanitation and of health conditions is lower than in the United States, it will be necessary to undertake a greater responsibility for health than is normally needed. * * * Since the administration of health in St. John's (and in Newfoundland generally) does not rank with United States standards, Medical Department personnel should include officers who (a) are familiar with health needs and conditions, and (b) are able to cooperate helpfully with local authorities."66
Most hospitals were provided by the state. Medical facilities were not sufficient for local needs in St. John's. The Public Health Service survey reported that the medical services in St. John's seemed to be good but were handicapped by outdated physical facilities. At Argentia, one young physician ran a 20-bed government cottage hospital. He worked hard and did good clinical work, but he did not have the background and experience to carry on "an effective general health program."67
All the surveys made before U.S. troops moved into Newfoundland pinpointed specific disease problems among the natives and rated their general health as poor. Throughout the war, most of these problems remained in the civilian population. American military personnel were not seriously affected, with one outstanding exception-venereal disease.
The initial surveys of the Public Health Service had warned that venereal disease would be the major problem, especially in St. John's. The public health officers, Drs. Vonderlehr and Heering, reported that the attitude of the people of St. John's toward venereal disease control was 10 years behind that found in United States cities of comparable size. Persons afflicted with venereal disease were burdened with a moral stigma rather than treated as carriers of a highly communicable disease. While all the health services of the island needed some improvement, venereal disease control was the poorest of all. Lack of funds and trained personnel, inertia, and public indifference seemed to keep the Department of Health and Welfare from attacking the problem even though syphilis and gonorrhea were the most prevalent of the communicable diseases. Dr. Mosdell, the Secretary of the Department of Health and Welfare, admitted this.
The only St. John's physician employed to control venereal disease was a part-time employee of the Sudbury clinic, described by Dr. Vonderlehr as the worst venereal disease clinic he had seen in 20 years from the standpoint of facilities. The physician held four afternoon sessions a week. None of the accepted methods for the treatment of syphilis was used nor were the sulfonamide compounds use to fight gonorrhea. In addition to this clinic, family doctors were given the necessary supplies and were paid $3 an injection to treat patients who elected this treatment.
Casefinding and case-holding were not done, and even though 25 public health nurses worked on the Avalon Peninsula, they devoted all their time to clinical, rather than public health, nursing. Actually, facilities at the Sudbury clinic were so bad that effective case-holding was impossible. Lack of privacy stopped many persons from seeking treatment, but attendance doubled in the winter when the sessions were held after dark.
Prostitution flourished in St. John's even though it did not seem to be an organized operation. The girls were mostly young, ignorant, and irresponsible streetwalkers. They were scattered throughout the city, there being no "red-light" district as such.68
As U.S. troops came to Newfoundland in large numbers during 1941-42, the feared increase expressed in the original surveys came to pass. By October 1942, the venereal disease rate among American soldiers had climbed to 35 per 1,000 per annum for the entire command.69 Fort Pepperrell, Fort McAndrew, and Harmon Field all had high rates. Pepperrell, of
course, was near St. John's. McAndrew and Harmon had somewhat of a local problem, but many of their cases were picked up in St. John's. Venereal disease was nonexistent at isolated Gander Field except for personnel coming back from leave in St. John's or in the United States.
The fast-rising venereal disease rate brought action in late 1942, with the formation of an Allied Venereal Control Board, through the efforts of Maj. (later Lt. Col.) Gunnar Linner, MC, base surgeon at Fort Pepperrell, and Capt. (later Lt. Col.) Morton H. Flaherty, MC. Medical representatives of all the United States and Canadian services having forces on the island met and recommended improvements of the situation. In a letter to all commanders of the Allied Forces in Newfoundland, the medical officers appealed to the Newfoundland Government for vigorous and immediate enforcement of the Newfoundland Health and Public Welfare Act of 1931.70 Provisions of this law, if enforced, could practically eradicate the menace, they said. The Board also recommended immediate establishment of facilities for the compulsory treatment and detention of infected civilians.
The commanding officers of the Allied Forces acted immediately, and Maj. Gen. G. C. Brant, Commanding General of the Newfoundland Base Command, wrote the appeal to the Newfoundland Government. Weekly meetings were set up with Dr. Mosdell and Sir John Puddester, the Commissioner of Health, who promised to remodel an old building and staff it for use as a treatment and detention center for venereal disease patients.71 In addition to these appeals to civil authorities, the armed forces started an extensive education program for their troops. Prophylactic stations were established and the recreation programs of the posts were expanded.
As in the past, the Newfoundland Government continued to move slowly. Until July 1943, Army medical personnel continued to report only "average" cooperation from local authorities. The venereal disease hospital, promised for January, finally opened in July. It was a 35-bed facility in St. John's.72 Finally, by late 1943, definite progress was made. The Government suddenly stepped up its efforts by establishing a venereal disease department with a full-time doctor in charge. The base surgeon at Fort Pepperrell, Lieutenant Colonel Linner, reported that "identification and location of suspected sources in the civilian community improved markedly."73 The Government's new detention hospital worked well. Furthermore, a new law, "An Act for the Prevention of Venereal Disease," was drawn up, giving the health department complete control of the situation.
Conditions also improved at the other posts in late 1943. At Fort McAndrew, local doctors were very cooperative in treating known local
contacts and examining vagrants.74 At Harmon Field, after the Army's venereal disease control officer was given a license to practice medicine by the Newfoundland Government, he was able to order suspected civilian contacts to report for examination and treatment. This helped greatly to reduce to a new low Harmon's rate for the last 6 months of 1943.75
The year 1944 saw continued good work by the Newfoundland health authorities. Contact histories were taken on all patients, and routine blood tests of food handlers, job applicants, and visa applicants turned up more venereal disease cases. In all instances, the civilian control officer worked diligently to locate suspected sources and bring them in for treatment. As a result of this smooth-working civilian-military cooperation, the rate at Fort Pepperrell was brought down to 13.11 per thousand for the year.76 The command as a whole reported that many of their patients contracted the disease while on leave in the United States. A small flareup of the venereal disease problem occurred again in Newfoundland in the summer of 1945, but by this time, the control program was so efficient that the menace was quickly overcome.
Generally poor economic conditions played a part in the spread of other diseases among the civilian population of Newfoundland. Of these, tuberculosis was the most serious. Drs. Vonderlehr and Heering in their original survey had deduced that the relatively poor state of nutrition had a bearing on the high tuberculosis rate. There were not sufficient hospital beds for the number of patients. Also, housing on much of the island was poor, making isolation of the tuberculosis patient at home difficult. Under these conditions, the mortality rate for tuberculosis had climbed to approximately 200 per 100,000 population by the time U.S. troops arrived. This rate compared with 40 per 100,000 in the population of the United States.
Here again, the Department of Health and Welfare was handicapped by lack of funds and facilities. In the entire colony, there was only one tuberculosis sanatorium of 250 beds, located near St. John's. Sanatoriums in the outlying districts were needed desperately, as were traveling clinics. There were no facilities for a comprehensive casefinding program based on X-ray studies and tuberculin tests.
Other diseases prevalent in the civilian population were diphtheria, scarlet fever, typhoid fever, smallpox, meningitis, and dysentery. The diphtheria menace was fought by immunizations in the areas where it was most common, and about 50 percent of the school children were also immunized. However, there was no program of immunization against typhoid fever, scarlet fever, or smallpox.77
With all these highly communicable diseases on the island, it is remarkable that the military was generally unaffected. Immunizations, excellent sanitary conditions on the posts, good diet, and trained personnel seemed to protect the troops even while tuberculosis, scarlet fever, and diphtheria raged in nearby communities, especially St. John's. The soldiers suffered mainly from upper respiratory troubles in the winter. From May to September 1942, an outbreak of postvaccinal hepatitis struck all the bases of the command. Fort Pepperrell was especially hard hit with 298 cases. However, only one person died, at Gander Field; the rest of the patients of the command made routine recoveries. The outbreak was traced to yellow fever inoculations, with no relation to the civilian population.78
Medical Treatment of Civilian Workers
The Army Medical Department was concerned by the relatively poor health of the Newfoundlanders because of the large number of natives employed on Army projects. Up to 82 percent of the construction workers, mostly common laborers, were Newfoundlanders who were not in the best physical condition and suffered especially from dietary deficiencies.
The contractors established high physical standards for Americans to be employed on the projects and, although these standards had to be lowered somewhat for natives, no one was hired who might become a burden on the contractor. Both Americans and natives were immunized against smallpox and typhoid, and some of the dependent children of native workers were immunized by injections of diphtheria toxoid.
Initially, civilians were cared for by medical personnel assigned to the U.S. Engineer Department, the first of whom had arrived at St. John's in February 1941.79 When construction work neared completion and the Engineer Department left the island, all civilians employed on the bases became the responsibility of the Army station hospitals. As late as June 1944, almost all Army service organizations still used more than 50 percent native workers instead of service troops.80
At Fort Pepperrell, Army medical care included physical examinations for Newfoundlanders who were recruited to work in the United States on dairy farms and in mica mines. During 1944, nearly 2,000 were examined.81
At Fort McAndrew's 309th Station Hospital, extensive care was given to civilian employees, and one dental officer was assigned to treat civilians only. Because tuberculosis was a big problem here as on the rest of the island, and was a threat to military personnel, a survey was conducted
among the civilian employees in 1944. Chest X-rays disclosed that nearly 4 percent had active pulmonary tuberculosis of the reinfective type. These were immediately sent to the tuberculosis sanatorium in St. John's. Since there were no dentists in the area, emergency dental service was also offered.82
At Harmon Field, all employees received complete medical care at the 311th Station Hospital. Local medical facilities and doctors were inadequate.83
Both McAndrew and Harmon Fields had trouble with the civilians' disregard for sanitation and personal hygiene. The post surgeon at McAndrew, Maj. Francis E. Utley, MC, closed the civilian messhall in 1944 until improvements were made. At Harmon, only constant diligence and close supervision of the civilians kept their messhall up to standards.
Local Food Procurement
The major task of Army veterinarians in Newfoundland was the inspection of food, and to them must go much of the credit for the good health of the American troops. Capt. Duane Cady, VC, Base Veterinarian, arrived with the first troops in early 1941 and was appointed food inspector. The Base Surgeon, Maj. (later Col.) Daniel J. Berry, MC, praised Captain Cady and his assistant, Capt. (later Maj.) Philip R. Carter, VC, for "making the unhygienic city of St. John's and its environs a fit place for American soldiers to visit." These two men inspected restaurants, bottling plants, bakeries, and similar enterprises and, with good cooperation from the Newfoundland Department of Health and Welfare, succeeded in bringing these businesses up to U.S. sanitary standards.84
During 1941, most food was imported from the United States. The only supplies secured locally were fresh milk and fresh fish. Dr. Alex Bishop, a veterinary surgeon, was in charge of milk and food inspection for the Department of Health. The health surveys made before the troops arrived showed that food and milk standards were not up to U.S. levels. The high tuberculosis rates, especially among the children of the island, were attributed by the U.S. Public Health Survey to tuberculous cattle.85
The two Army veterinarians worked for several months to bring the local dairy industry up to acceptable standards. They outlined sanitary requirements, helped examine cattle, inspected dairies and pasteurization plants, and ran laboratory tests. Finally, the Newfoundland Government adopted the Army standards, and seven dairy farms and two pasteurizing plants were approved. The first milk was issued to troops on 1 August 1941.86 Throughout the war, regular inspections of farms, plants, and the
final product continued. Repeated tuberculin tests were run on the cattle to be sure they remained acceptable.
In 1942, an agreement between the United States and Canada resulted in the purchase of a great amount of fresh meats, eggs, and dairy products from Canadian sources.87 These products underwent both grade and sanitary inspections by the veterinarians at the various posts.
An outbreak of diarrhea among the natives of St. John's in late 1942 affected an estimated 10,000 to 12,000 persons. The soldiers were ordered not to eat or drink in St. John's during this period and, as a result, very few were affected.88
During 1943 and 1944, more than 7 million pounds of food were inspected each year, of which 3 million pounds were from Canada and Newfoundland.89 The quality of the Canadian meats in 1943 was rated only "fair" by Capt. (later Maj.) W. C. Jackson, VC, base veterinarian of the command, but in 1944, he was well pleased with the Canadian meat. Some fresh fish had been bought previously in Newfoundland, but the men requested much larger amounts in 1944. Since fishing was Newfoundland's main industry, the supply was plentiful. None of the filleting plants could meet the Army's sanitary standards, however, so the fish were bought from the boats as they came in, and carried directly to the messes where they were cleaned and served.90
At the outlying posts, most food was received from the Base Command Headquarters at Fort Pepperrell and from the naval base at Argentia. At Fort McAndrew, fresh cod were bought from local fishermen, who handled the fish in a sanitary manner after instructions from the Army veterinarian. Lack of transportation kept the outlying posts from getting fresh milk from Fort Pepperrell. In late 1943, the post veterinarian at Harmon Field, Capt. Norbert A. Lasher, VC, arranged for a dairy in Corner Brook, the nearest large settlement, to supply milk. He obtained improvements in the plant and barns, and found the cows free of disease.91 Harmon Field also received some perishable meats and vegetables directly from Canada. Gander Field obtained all its food from the main depot at Fort Pepperrell and used reconstituted milk.
The Army tried to procure as much as possible from local sources, but, to insure against creating shortages in the civilian supply, the Newfoundland Government was always consulted before a purchase was made.92
Water and sewage.-The only U.S. post in Newfoundland which used water from a municipal system was Fort Pepperrell where the water was
purchased from the city of St. John's. The source was a patrolled lake near St. John's and the water was not treated by the city. After the water arrived at the post, it was chlorinated before being fed into the post distribution system. St. John's did not have a sewage treatment plant so the Army built its own at Fort Pepperrell and the sewage was discharged into nearby Quidi Vidi Harbor.93 Supplying water and sewage facilities at Gander Field was a function of the Royal Canadian Air Force; at the other bases, water and sewage were responsibilities of the Army, and Newfoundland authorities were not involved.
Insects.-Flies, mosquitoes, and sandflies were fairly prevalent on the island during the summer and early fall; however, they presented no disease problem to the troops. The biggest insect problem at Fort Pepperrell, Fort McAndrew, and Harmon Field involved heavy infestations of bedbugs and cockroaches, especially in 1944.
At Fort Pepperrell, two civilians were trained to spray and apply insect powder where necessary at prearranged intervals. In some instances, they had to remove molding and framework to get at the insects; and in one building, hydrogen cyanide gas was the only remedy which proved successful.94
The civilian barracks at Fort McAndrew and Harmon Field had problems with bedbugs. Clothing and bedding were disinfected and the workers were moved to clean barracks. But the buildings were constantly reinfested by new personnel and by those who went to their homes on the weekends and returned with the bedbugs on their clothing and luggage.95
Relations With Newfoundland and Canadian Physicians
Army Medical Service personnel had good relations with medical officers of the Canadian services and with local Newfoundland physicians. Already mentioned were the joint efforts to fight venereal disease. At Gander Field, one ward of the RCAF Hospital was allotted to American personnel until the 310th Station Hospital was opened in December 1942. U.S. medical officers treated these American patients and were allowed to use the laboratory and X-ray facilities of the hospital. Several U.S. medical officers were invited by the Royal Canadian Air Force to attend a medical refresher course in Halifax and were provided air transportation. An Allied Medical Society held meetings to discuss professional problems. At Fort McAndrew, medical, veterinary, and dental officers and nurses of the Army and the Navy met once each month with the two civilian doctors of the area, and formed the Argentia Medical Society. This resulted in excellent
cooperation in this area on such problems as venereal disease and tuberculosis.96
During the war, medical officers of the United States and Canadian armies and of the U.S. Public Health Service contributed to a general rise in the health level of the people of Newfoundland. In cooperation with the government, an effective venereal disease control program was initiated and sanitary conditions, especially in St. John's, were improved. Many Newfoundlanders who worked on Army projects received good medical care and immunizations against the common communicable diseases. The U.S. projects significantly raised the entire economic level of the island, thus indirectly contributing to the health of the people.
The health of the natives was still only fair by the time most of the U.S. troops left after the war. Even in 1946, the Base Command Surgeon, Capt. Robert B. Wallace, Jr., MC, reported that the native population needed a "marked amount of medical attention." He termed the medical care provided by the Newfoundland Government "less than negligible."97
United States troops in Greenland fought for the most part against nonhuman enemies. Except for a few skirmishes against German radio and weather stations, the enemies were the cold, the wind, and isolation. As Col. Bernt Balchen, a famous Arctic explorer, wrote: "The casualties were not very glamorous: frozen lungs, a couple of missing fingers or toes, an amputated leg."98 But these American troops performed a very important task in both the defense of North America and the offense against Germany.
The importance of Greenland was not recognized at first by the United States. In May 1939, when the U.S. Senate considered purchase of the island from Denmark, the War Department advised against it, saying that strategically it was of little value.
In the next 2 years, however, the United States changed its opinion, and Greenland became valuable for several reasons. First, its mines on the West Coast at Ivigtut were one of the most important natural sources of cryolite, which was essential for the production of aluminum. Second, Greenland began to figure prominently in the plans for ferrying airplanes across the Atlantic.99 Third, Greenland was the key location for forecasting Europe's weather because most North Atlantic storms originated in the winds and currents around it. Control of weather stations on Greenland could mean control of valuable information. All of these considerations were pointed out to the United States by Canada, Great Britain, and the
Greenlanders themselves, who feared a Nazi invasion. However, it took several years of diplomatic maneuvering before the United States agreed to undertake the defense of Greenland.100
On 9 April 1941, Secretary of State Cordell Hull and Mr. Henrik de Kauffmann, representing the Free Government of Denmark in Washington, signed an agreement granting the United States the right to construct, maintain, and operate defense facilities in Greenland. The United States was given wide powers, immediate use of the land, the right of exclusive jurisdiction over all persons within the leased areas except Danes and Greenlanders, and exemption from all customs duties on material and income taxes on American civilian workmen and military personnel. In anticipation of the agreement, the United States sent a survey team in March to look for possible base sites in Greenland, the President allocated $5 million to start construction of the bases, and the first contingent of troops, mostly Engineer construction men, arrived in Greenland on 8 July 1941.101
Arriving with this first party were two medical officers and 14 enlisted men of the Medical Department. From this beginning, medical facilities eventually grew into four station hospitals at the four major bases. Largest of the hospitals was the 188th Station, located at the main base, BLUIE WEST 1, in Narsarssuak on the southwest coast. The 189th Station Hospital was located at BLUIE WEST 7 at Ivigtut, not far from BLUIE WEST 1. BLUIE WEST 8, located at the head of Søndre Strømfjord about 15 miles inside the Arctic Circle, was served by the 190th Station Hospital. The 191st Station Hospital was at BLUIE EAST 2, at Angmagssalik on the east coast, about 40 miles below the Arctic Circle (see map 2). In addition, medical aidmen were stationed at each of the 12 weather and radio outposts, with medical officers at the five largest of these isolated installations.102
Greenland's unfriendly natural environment was a challenge to U.S. military and civilian personnel. It is the world's largest island, but more than four-fifths of the country is covered by an enormous sheet of ice, whose thickness exceeds 2 miles in some areas. The ice sheet is contained by a range of high mountains which extends along the coastline, leaving only a narrow coastal strip fit for habitation.
American troops in Greenland found the weather extremely unpredictable, sometimes changing suddenly from bright sunshine to dense fog or a heavy snowstorm. Conditions varied widely according to location and season of the year, but most of the bases experienced harsh cold, high winds, and long hours of darkness during the winter months. Greenland's tempestuous weather and rugged terrain combined with almost complete isolation to make life hard for the soldiers.
Relations With the Natives
Americans had little contact with the native population. About 16,000 persons lived on the island and, except for approximately 600 Danes and pure Eskimos, the remaining inhabitants were "Greenlanders"-Eskimos with some European blood.
The base at Ivigtut, BLUIE WEST 7, was the only American base near a settlement. Other bases were within a reasonable distance of native villages, but transportation and communications were lacking. There were no roads, no railroads, and no telegraph wires. The only transportation was by boat, and this was limited by the weather.103
The isolation imposed by the environment was made complete by official decree in October 1943. The Government of Greenland charged that the U.S. Armed Forces had "introduced" prostitution and smuggling to the island. Consequently, although the feeling was that the charges were not justified, the Greenland Base Commander placed all native settlements off limits to military personnel unless they were on official business.104 Aside from this one dispute with the Greenland Government, the Army's very limited relations with the natives were excellent. The natives were simple and friendly and the Danish officials were generally willing to help the Americans establish bases.105
In the original 1941 agreement, the United States promised to give "fullest consideration consistent with military necessity * * * to the welfare, health and economic needs of the native populations" and to give "sympathetic consideration to all representations by the local authorities respecting the welfare of the inhabitants."106
Although American military personnel stood ready whenever necessary to give aid in the form of expendable supplies or professional consultation, the demand for their services was much less than they expected.
Danish doctors in Greenland were always courteous and informative when contacted by medical officers. They informed the Americans that pulmonary tuberculosis was the greatest health problem among the natives and that approximately 16 percent of the population suffered from the disease. A study of old skeletons revealed that the Eskimos had always been afflicted with tuberculosis: it was not introduced to the island by the white man.107 Most of the patients in the small hospitals, located in the larger villages, were tuberculosis patients. One doctor told Lt. Col. Otho Hill, MC, Greenland Base Command Surgeon, that, from November 1943 to August 1944, all the native population had positive tuberculin tests by the time they were 15 years of age.108
This serious native problem had no effect on American personnel because of the extremely limited contact with the local population. Colonel Hill did give supplies and professional consultation to Dr. A. Laurent Christensen in Julianehaab, not far from Greenland Base Command headquarters at Narsarssuak. Dr. Christensen, almost singlehandedly, attained excellent results among the Eskimos by performing lobectomies under local anesthesia.109
Epidemics of several other diseases struck the native population during the late summer of 1944. The U.S. Coast Guard station at the southwestern village of Frederiksdal called in Colonel Hill to investigate a disease which had struck the natives, killing six; it was diagnosed as botulism, resulting from eating spoiled seal meat.
In Holsteinsborg, about 100 miles from the 190th Station Hospital above the Arctic Circle, 18 Eskimos died in an epidemic diagnosed later by Danish doctors as typhoid fever. The disease started like influenza, with headache and stiffness of the neck. There were no laboratory facilities in that area, and, just from observing two convalescent patients, Colonel Hill suspected meningitis although he could not make a diagnosis. Since the village was distant from the American base and was off limits, there was no danger to U.S. troops.
At least 20 Greenlanders died on the east coast, in the area around Angmagssalik and Íkáteq where the 191st Station Hospital was located (fig. 17). Two cases were cared for by the Army surgeon there who made a positive diagnosis of cerebrospinal meningitis. His diagnosis was confirmed by Danish doctors at the Angmagssalik Colony Hospital. Natives were banned from the camp except for medical treatment, and no Army medical personnel were infected. The Army supplied sulfadiazine to fight the epidemic.110
Several Eskimos were operated on in Army hospitals. In November 1943, a native hunter was shot in the arm. A doctor went out to the village from the 191st Station Hospital at Íkáteq, examined the man, and brought him back to amputate the arm. The man lived, winning friends for the Army medical personnel in the villages of the area. In March 1946, an aidman at the Walrus Bay dispensary amputated the finger of a Greenlander who had been shot. The aidman used instructions sent by wire from Capt. Charles G. Fullenwider, MC, Base Command Surgeon, and the wound healed successfully.111
Dentists at the Base Command headquarters saw more of the natives than did other Medical Department officers. The first Dental Surgeon, 1st Lt. (later Capt.) Benjamin Hoffman, DC, and his successors were fre-
quently lent to the Greenland Administration to provide dental care for the native villagers along the southwestern coast.112
Until the last of the civilian contractors left in February 1944, their employees were the responsibility of Army medical personnel. At one time, 3,200 civilians worked at the four bases. This group presented few special problems except a tendency toward arthritis because of their relatively older age and the changeability of the weather.113
For military personnel usually in good physical condition, Greenland presented no disease problems. Colds were less common than in the United States, and the occasional epidemics of respiratory ailments were directly traced to new arrivals on the island. Even these respiratory cases were usually mild, and pneumonia was rare. The worst outbreaks of upper respiratory diseases occurred in the winter of 1943-44 at the Arctic post where the 190th Station Hospital was located. There were 206 cases of upper respiratory disease at the main base over a 3-week period. Epidemics of follicular tonsillitis and influenza abated quickly, and both were traced to new arrivals from the United States by way of Newfoundland.114
Venereal disease was never a problem in Greenland because of the lack of contact between American troops and natives and because of an agreement between the United States and Greenland in 1941. Under this agreement, the United States promised that no syphilitic persons would be sent to Greenland. If cases were detected en route to Greenland or after they arrived, they would be shipped back immediately. The Danish doctors in Greenland reported there was no syphilis in the native population, and they wanted none introduced. All cases of syphilis diagnosed in Greenland were acquired elsewhere, mostly by U.S. Navy and Coast Guard personnel.115
One case of gonorrhea was traced back to a native woman. The medical aidman at an outpost on the east coast treated the soldier and then journeyed to the native village to treat the woman.116
Insects presented no disease problems. They were a nuisance only during the summer months. Routine protections-screens, headnets, and repellents-were used successfully.117
Surprisingly, cold injuries were kept to a minimum, thanks to excellent arctic clothing furnished by the Army and adequate instructions in cold survival.118 The worst cases of exposure resulted from airplane crashes and from the torpedoing in February 1943 of a transport about 100 miles off the coast from the main base. Aside from these special cases, most injuries were fractures and sprains resulting directly from the rough terrain and icy walks and pathways. Wound infections were practically nonexistent, and Lt. Col. (later Col.) Norman L. Heminway, MC, the Greenland Base Command Surgeon in 1943, reported that the Greenland soil was probably tetanus-free. 119
The Army had no dealings with Greenland concerning water supply or sewage and trash disposal. All posts obtained their water primarily from lakes that filled in the winter with ice and snow and from wells sunk in gravel flats near a glacial river. The water was extremely pure, and no treatment was needed at the four main bases. At several of the outposts, water was chlorinated in Lyster bags. Those few Army personnel who visited native villages had to be careful of stream pollution. Several villages had dysentery outbreaks because of self-pollution of the water supply.
A central sewage system was operated at two bases. At the other two bases, pit latrines and chemical toilets were used. In all instances, sewage and garbage were emptied into fjords and trash was burned. No problems were encountered with this system.
No food or fresh milk could be bought locally by the Army. In the spring of 1944, Colonel Hill investigated the possibility of buying mutton and lamb from the herds of several thousand sheep in southeastern Greenland. But a veterinary survey showed that refrigeration facilities for shipping were inadequate. Occasionally, Army and Navy personnel shot and ate ptarmigan, a northern grouse. None of the birds was found to be contaminated. In addition, the servicemen caught salmon, trout, and cod, but usually not enough to stock an entire messhall.120
Isolation continued to be a major problem for Army medical personnel in Greenland. Severe mental cases occurred at no greater rate than in the United States-these would have had trouble no matter where they were stationed-but almost every soldier in Greenland suffered from a general apathy and low morale. The monotony was overpowering; the normal tour of duty was for 18 months, during which the average soldier saw no women, no home or town, no change of scenery, and no military action. Mail call was a major occurrence and, in the winter, even this was severely curtailed with delivery sometimes delayed 4 to 8 weeks.121
Obviously then, the U.S. Army in Greenland had very few problems in the field of civil affairs and public health. Medical personnel did lend aid on several occasions to the native population. Usually the Army and the native Greenlanders saw each other so rarely that there was little chance for problems to develop.
Unlike Greenland, where U.S. troops were stationed after negotiations with the Free Danish Government, Iceland122 received U.S. troops with the consent of its own government. Although tied to Denmark for centuries, Iceland had declared its virtual independence on 10 April 1940 when Germany seized Denmark. The Althing, Iceland's Parliament, declared that the Danish King, who was also King of Iceland under a 1918 treaty, was no longer able to exercise his royal power. Also, Denmark could not handle Iceland's foreign affairs. Therefore, the Althing lodged the executive power, "for the time being," in the Prime Minister of Iceland and his cabinet. This was the first time since 1264 that Iceland had been free of European ties, but this situation lasted only 1 month.123
On 10 May 1940, the British landed a force in Iceland which grew to more than 25,000 British and Canadian troops within a year. The British feared German control of the island which would give the Nazis a base from
which to attack shipping to the British Isles. Iceland had no armed forces to prevent such a German invasion, and although the people protested foreign military intervention, they realized that British protection was preferable to a German occupation.124
The Governments of Iceland and the United States had established direct relations in April 1940, and in July, Iceland inquired if it fell within the Western Hemisphere for purposes of the Monroe Doctrine. The Icelanders apparently thought that a simple declaration from the United States would make actual stationing of troops on the island unnecessary, and if U.S. troops were needed, they would not draw German attacks since the United States was not a belligerent. The United States was noncommittal.
By the spring of 1941, the beleaguered British, suffering heavy losses in the Mediterranean area, badly needed the troops tied down in Iceland. In late March, Hitler declared Iceland to be in the war zone. These developments, together with Iceland's obvious advantages as a base for air and sea protection of the North Atlantic shipping routes and a link in the air ferry route to Europe, caused President Roosevelt to order a survey of the island in April.
In early June, the President decided to send troops to Iceland if that government requested them. The Icelandic Parliament refused to approve an explicit request, but a solution was worked out in an exchange of notes between President Roosevelt and Prime Minister Herman Jonasson of Iceland on 1 July. The Icelandic Government "admitted" the help of U.S. troops was "in the interest of Iceland," and that the government was "ready to entrust the protection of Iceland to the United States."125 On 7 July, 4,100 marines landed in Iceland. The first Army ground combat troops arrived on 15 September, and by the next spring, most of the British and all of the marines had been replaced by the Army. In April 1942, command passed from the British to Maj. Gen. Charles H. Bonesteel, U.S. Army.
The strength of the Iceland Base Command increased steadily to a peak of 40,712 ground, air, and service troops in May 1943. Then, as the threat of German invasion subsided, the number of troops declined until, by the end of 1945, only 1,800 remained. To provide medical care for the Iceland Base Command, Army hospitals were set up close to the coastline on all sides of the island. By late 1942, one general hospital and nine station hospitals were operating in Iceland (see map 2). As the number of troops declined, medical facilities were reduced to three station hospitals.126
Relations With the Icelanders
The first American troops arriving in Iceland found a windy, wet island, inhabited by people who were as cool toward them as the weather.
Though Iceland had reluctantly agreed to U.S. protection, rumors circulated about high-living Americans, and some even discussed the possibility of soldiers resembling Chicago gangsters invading their island.127
In fairness to the Icelanders, although they had lived apart from the rest of the world for more than 1,000 years, they were an intelligent, cultured, and hard-working people who had moved their country forward despite adverse natural conditions. They feared that the arrival of large numbers of foreign troops would alter their old traditions and institutions and also threaten their newly asserted independence. The original note of 1 July 1941 accepting American protection emphasized that the United States must recognize the "absolute independence and sovereignty of Iceland" and must withdraw all troops at the war's end. The note asked that only "picked troops" be sent because of the small population and the "consequent danger to the nation from the presence of a numerous army." Finally, the United States had to promise "to ensure the greatest possible safety for the inhabitants themselves," and that military activities should be "carried out in consultation with Iceland authorities as far as possible "128
President Roosevelt agreed to all these conditions, and American military personnel were warned to respect local institutions, to refrain from interfering with the rights of the civil government, and to handle all political questions through the American Consul. The American commander, General Bonesteel, a man of tact and diplomacy, eager to grasp and understand local problems, worked closely with the civil government and the American Legation to solve the problems satisfactorily.129 Social and cultural relations between the soldiers and the people improved considerably as the two groups came to know each other better, and by the war's end, the President of Iceland praised the cooperation of the visiting troops on the island.130
Cooperation in Medicine
The Army Medical Department played a major role in helping to win the good will of the people of Iceland. Medical and dental help was freely given to civilians in emergency situations. Natives injured near Army hospitals or involved in accidents with Army vehicles and personnel were taken into the Army hospitals for treatment. Army medical officers got along well with the Icelandic physicians. At the more remote camps, civilian doctors were called in emergencies until a medical officer could arrive from an Army hospital. On the other hand, Army physicians were sometimes called in by civilian doctors for consultations on civilian patients. On several occasions, urgently needed biologicals and drugs were supplied by the Army. Leading public health and other doctors were shown through the
Army hospitals and invited to Army medical meetings and, in return, medical officers visited civilian hospitals and the homes of Icelandic physicians. The policy of the Iceland Base Command Surgeon, Col. Charles H. Beasley, was to cooperate with Iceland's physicians and public health authorities at all times.131
The Army group that did more than any other to cement good relations with the Icelanders was the veterinary section of the Iceland Base Command, led by Maj. (later Lt. Col.) Frank A. Todd, VC (fig. 18). This group of men went beyond their assigned duties of food inspection to perform public health services which benefited not only U.S. troops, but also all the people of Iceland.132
The outstanding example of the Army veterinarians' work in public health was the improvement they made in the milk supply. This, of course, was not entirely an altruistic undertaking because a safe supply of fresh milk was essential for both patients and troops. Nevertheless, with excellent
cooperation from governmental and dairy officials and farmers, the work of the veterinarians enabled all Icelanders to obtain safe milk.
Army veterinarians began investigating the milk supply soon after their arrival in late 1941. All farmers who sold milk belonged to a cooperative which processed the milk in several dairy plants around the country. Icelandic laws prohibited the sale of unpasteurized milk, but the large pasteurizing plant in Reykjavik was found to be operating with old, worn-out equipment and producing a pasteurized milk supply which varied greatly in bacteria content from day to day. This plant supplied milk to the markets and eating establishments of the Reykjavik area, where many Army personnel shopped and ate.
The veterinarians visited Secretary of State Vigfus Einarsson, Minister of Agriculture Jonasson (who was also Prime Minister), members of the milk control board, the medical research board, and the Iceland Agriculture Society. These authorities enthusiastically endorsed their plans for a milk control program. A laboratory was soon made available at the University of Reykjavik to do the required testing. The university supplied some equipment while other necessary supplies and biologics were sent from the United States.
The Army veterinarians inspected farms with the help of the Icelandic milk technicians and native veterinarians. They found the farmers friendly and eager to learn. The local newspapers requested that the Army veterinarians write a weekly column on Iceland's public health problems, and the first group of these articles offered suggestions on improving the cattle, the barn facilities, and the handling of the milk.
Iceland's cattle had never been tested for tuberculosis or brucellosis. Eventually, all of the cattle on the island were tested under the direction of Veterinary Corps officers. No tuberculosis was found, but there were several reactors to the brucellosis tests.
Finally, in the spring of 1942, the Reykjavik pasteurizing plant was studied in detail to find the source of its problem. The trouble was attributed to an old milk cooler. When dairy officials rearranged the equipment on the advice of the Army veterinarians, the quality of the milk improved immediately. Regular tests on the milk from this plant, and all the other dairy plants on the island, continued to show that a safe supply of milk had been made available through the cooperation of the Army, the Icelandic Government, and the dairy industry.
The Army veterinarians also studied the local supplies of lamb and fish. Slaughterhouses and lambs were inspected, and handling and storage were constantly checked. Fishing was a major industry in Iceland. The local dealers cooperated fully with all suggestions to improve sanitary conditions.
At the request of the Icelandic Government, General Bonesteel authorized the Army Veterinary officers to aid in the fight against animal diseases on the island. Since agriculture was the major occupation, this work was a
large factor in winning friends for the United States. The testing of cattle has already been mentioned. In 1942, an epidemic of hog cholera spread rapidly. With serum flown in from the United States, the Army veterinarians quickly brought the epidemic under control and demonstrated methods for inoculating the pigs. This speedy victory made them famous on the island and prompted an Icelandic humor magazine to suggest the veterinarians should next attack the island's political problems and bring them under control.
Most important to the Icelanders was the joint research by Icelandic research scientists and Army veterinarians into the serious diseases of sheep. One condition of the lungs, known as jagziekte, caused large losses, and paratuberculosis also was a major threat. At an experimental farm near Reykjavik, these diseases were studied (fig. 19).
Throughout their stay on the island, the Army veterinarians taught local professional groups and farmers the most modern methods of laboratory testing and inoculation of animals. The regular column on this subject in the newspapers was widely read and appreciated. In addition, they
prepared an illustrated booklet, printed in Icelandic, which included detailed instructions on milk production, disease control, and modern animal husbandry. Far from resenting these suggestions from foreigners, the Icelanders were extremely grateful, and much valuable meat was saved.
In addition to these activities, Veterinary Corps officers acted as liaison with the local government on matters such as native claims against the U.S. Government for losses of livestock in accidents. At Iceland's request, all fresh vegetable wastes were burned to prevent the introduction of parasites unknown to Iceland
The work of the Army Veterinary Corps in Iceland was one of the most outstanding efforts of the war in civil public health. Icelandic officials conveyed their thanks in many ways, including letters from the Prime Minister to the American Legation which praised Major Todd and his associates "for the valuable services they are rendering to Icelandic economy and the rural life of Iceland."133 Major Todd, Capt. (later Lt. Col.) Harry J. Robertson, VC, and Maj. (later Lt Col) Robert B. Meeks, VC, received the Legion of Merit for their work (fig. 20).134
Water, sewage, and garbage.-The Army in Iceland had no trouble obtaining a potable water supply. An abundance of lakes, streams, and wells supplied water to most camps and posts Several camps, including those in the Reykjavik area, drew their water from civilian mains. The capital city's water supply did not require chlorination, and monthly checks showed that only a few stations had to chlorinate their water. No diseases were caused by the water.135
The sanitation program was carried out in cooperation with the civil government and supervised by the sanitary officer. Capt. Earle Gibson, SnC, was sanitary officer until 1942 when he was put in charge of the Army laboratory. The Veterinarian, Major Todd, then assumed the duties of sanitary officer in addition to his other activities. Because most camps were near the ocean, the disposal of wastes presented little problem. Most camps had either flush toilets or pail-type latrines. The sewerage systems emptied directly into the sea or into settling tanks. Pail-type latrines were emptied regularly by civilian laborers who dumped the waste into the ocean at designated points, where the tides could carry it out to sea.
Civilians also handled most of the garbage by either dumping it into the sea or feeding it to pigs. Iceland did not have many swine, and this practice was not extensive. The use of garbage for feed was strictly super-
vised by both civilian and military authorities. A policy was also enforced barring the use of human waste for fertilizer on farms and gardens.136
Rats and insects.-By dumping the garbage into the sea, city officials were able to clean up the city dumps, which were made into sanitary fills. Wiping out the places where rats lived and propagated was a major step in reducing the large rat population. The rats had been a nuisance on the island for many years although there was no evidence that they spread disease among either the civilian or the military population. The Icelandic health authorities were very eager to cooperate with the Army in a program of rat extermination. Over the course of several years, this was carried out by using traps and poison bait and by cleaning up rat breeding areas. The Army provided Red Squill and barium carbonate poisons imported from the United States. Iceland, in turn, provided facilities for preparing the bait,
civilian manpower, and supervision of the campaign in civilian areas. This program greatly reduced the rat population, with a corresponding saving of food and military supplies which formerly had been destroyed.
Iceland's cold climate, lack of trees, and complete absence of temperate or tropical vegetation kept insects to a minimum. There were no disease-bearing insects of any kind. Flies were found only in towns near fish-canning factories and dumps, and for only a short period each year.137
The high sanitary standards enforced by the Army and civilian health officials and the absence of disease-bearing insects and rodents combined to keep the disease rate of American troops in Iceland extremely low. The noneffective rate dropped steadily from 29.5 per 1,000 in 1942, to 25.37 in 1943, and to 16.28 in 1944.138 About half of all admissions were for the common respiratory diseases; these always increased when a new shipment of troops arrived.
An outbreak of hepatitis hit the command in the summer of 1942, at the same time a similar epidemic was occurring Armywide.139 As in the other commands, the cause was not determined definitely at that time, but yellow fever inoculations were suspected. In Iceland, all but seven of the affected patients had been inoculated from the same lot of yellow fever vaccine. There were no deaths.
Aside from this incident, there were no epidemics among the troops during the entire time they were in Iceland though several outbreaks occurred in the native population. An epidemic of mumps in Reykjavik in 1942 caused the soldiers to be prohibited from going to town except on business. There were no local public health restrictions on persons with the disease. Only 134 sporadic cases occurred among Army personnel.140
In the town of Borgarnes, near the 72d Station Hospital, an influenza epidemic in March 1943 and a measles outbreak in May affected two-thirds of the civilian population. Here again, strict isolation and supervision of the military kept the diseases from affecting Army personnel.141 An epidemic of infantile paralysis in Reykjavik in 1945 was met successfully by keeping the soldiers away from public places.142
Venereal disease was never a major problem in Iceland. The Icelandic health officials were extremely cooperative and efficient in tracking down girls who infected American soldiers. All persons suspected of having or transmitting a venereal disease were put in a hospital at Government expense for examination. If found to have the disease, they were treated until cured or believed to be noninfectious. The strict enforcement of this
law resulted in a low venereal disease rate. Also, there was very little prostitution on the island. Much of the disease in existence was brought in by merchant seamen or soldiers returning from England; very little came from the United States.143
Cooperation With Allies
U.S. Army hospitals in Iceland served many personnel of other U.S. services, U.S. civil service workers, American National Red Cross workers, and members of the armed forces of Great Britain, Canada, Norway, Sweden, Greece, and Russia. Cooperation with the British was especially smooth. At Camp Tripoli, in 1941, all United States soldiers with serious illnesses were hospitalized in British facilities.144 During 1942, both the 208th General Hospital and the 11th Station Hospital shared quarters with a British hospital at Camp Helgafell on the southeast coast.145 One of the most valuable services of Army hospitals was the treatment of shipwreck victims, both belligerent and nonbelligerent. Numerous attacks were made on vessels in Icelandic waters, other ships collided, and several ran aground. U.S. Army personnel took part in many mercy missions, and survivors often found haven in U.S. Army hospitals.146
From a beginning in which relations between U.S. Army personnel and the native population were not too friendly, the Iceland experience grew into an outstanding example of civil-military cooperation in all fields, especially in public health. By working together, military and civilian health officers kept communicable diseases to a minimum. Together, they maintained high sanitary standards in water supply, sewage and garbage disposal, and in the fight against rats. Together, they provided a high level of medical care for both civilians and military. And together, they fought disease in animals, thus providing a much needed source of safe food and milk during the war years. The American defense of Iceland proved to be a mutually beneficial endeavor for both the U.S. Army and the people of Iceland.
The history of the Army Medical Department's civil public health work in Canada, Newfoundland, Greenland, and Iceland is generally a story of achievement. The major task of the Army medical officers was, of course, to protect the health of American troops. This was the reason behind the efforts to raise sanitary standards and prevent the spread of disease. But this vital work could not have been carried out as effectively as it was without the active cooperation of local health officials and physicians in
each country. Although in several instances pressure had to be applied by Army medical officers to achieve their objectives, this was the exception to the usual exceptional relationship. In almost every instance where the help of local medical and health officials was needed, it was quickly and eagerly given.
This medical cooperation did not benefit the U.S. Army alone. Wherever Army medical personnel were stationed, the general health levels and sanitary standards of the civilian population were raised; in many instances, Army medical officers went far beyond their required duties to aid the local population. The work of medical officers in caring for natives in the wilderness of northern Canada far from any Army base and of the veterinarians in Iceland which brought significant advances to the Icelandic livestock industry are examples of deeds which won many friends for the United States. When Army medical officers returned from their posts, they left behind them a legacy of improved public health for the northern neighbors of the United States.