Communicable Disease Control
Total Army rates for common respiratory disease and influenza declined markedly in fiscal year 1961 when compared with those of the past 10 years. The common respiratory disease and influenza rate for CONUS for the period from July 1960 through April 1961 was 94.7. The rate for the similar period in fiscal year 1960 was 119.6. It is felt that the reduced rates represent, partially at least, a beneficial effect from the use of adenovirus vaccine containing types 4 and 7 killed organisms.
Since 1954, there has been an ever-increasing effort at Army installations to diagnose streptococcal disease early and apply adequate treatment. These measures have materially reduced the commoner complications of streptococcal disease?rheumatic fever and nephritis. In more recent years, on a few Army posts where past experience revealed that a high incidence of streptococcal disease could be expected during certain months, benzathine penicillin prophylaxis was given to all trainees who were not penicillin sensitive. Another preventive measure that has been employed occasionally is the use of mass benzathine penicillin prophylaxis to stop a streptococcal disease epidemic in larger units. The last two actions were effective in reducing both the incidence of streptococcal disease and its complications. Chart 1 reveals the apparent increase in streptococcal disease since 1954 while the incidence of rheumatic fever was continuously reduced. This represents the beneficial effects of early recognition and treatment of streptococcal disease.
The incidence of tuberculosis also continued to decrease within the Army, and as important, the length of hospital stay of those patients with tuberculosis also decreased. A correspondingly satisfactory increase in the returns to duty as opposed to medical retirement was reported throughout the hospital system.
Additionally, the Preventive Medicine Division, OTSG, was named the coordinating activity for all aspects of the endeavor to be undertaken to improve communicable disease control during any period when biological weapons might be used.
A number of changes occurred in the Army immunization program. Some of the most significant of these changes were the standardization of the jet injector apparatus, the distribution of freeze-dried lyophilized smallpox vaccine, and the establishment of a standard dosage of immune serum globulin at 0.05 milliliter per pound body weight for the prevention of infectious hepatitis.
The Army occupational health program remains a huge undertaking in that it is applicable to approximately 900,000 military personnel and 300,000 Army civilian employees.
In order to achieve the aims of the program, full utilization was made of the total resources of USAEHA (U.S. Army Environmental Hygiene Agency), Army Chemical Center, Md. The services of specialists were called upon to identify potential hazards to the health of the military and civilian personnel working in Army industry and in the field, and to make recommendations for the control of these
hazards. The major occupational health hazards continue to be those associated with exposure to chemicals, metal fumes, noise, extremes of temperature and humidity, vibration, and radiation.
During the past years, special attention was given to toxicology with the aim of developing more complete data required for the hazard evaluation of compounds and processes used in the Army.
As a followup to a study made during fiscal year 1960, at the request of DCSPER, to determine if it were feasible to provide ?executive type health examinations? to civilian employees, it was concluded that modified multiphasic screening procedures would in part meet the management?s need. To lend command impetus to this program, a statement was included in ?CONARC Preliminary Program and Budget Guidance FY 1963 (U),? issued in April 1961.
Occupational medicine.?Since additional resources could not be diverted for the expansion of the Army occupational health program, several actions were taken to improve the efficiency of the personnel engaged in the program. Courses in occupational medicine, radiological hygiene, and industrial hygiene, each of 1 week?s duration, were given consecutively at USAEHA in January. Secondly, a scenario for a 30-minute film entitled ?The Army Occupational Health Program? has been completed and is ready for production. It is designed to acquaint medical personnel at the post level with the responsibilities, scope, objectives, and methods of the program. Lastly, a manual, ?Occupational Health Examinations,? is being prepared at USAEHA to provide guidance to physicians who are not specialists in occupational medicine.
Industrial hygiene.?Within the area of industrial hygiene, the most frequently recurring deficiencies in work environment continue to be inadequate ventilation at paint-spraying operations, accumulation of exhaust fumes in areas used for repairing automotive equipment, and the nonuse or improper use of respirators in dusty areas. In addition to sound technical recommendations, it is quite clear that supervision and attention to details are the most important elements in the control of occupational health hazards.
In connection with the periodic industrial hygiene surveys of Army installations performed during the year, emphasis was placed on investigations of industrial and military operations producing excessive noise levels. It became apparent that additional information regarding impulse noise was needed. At the request of the Chief of Ordnance, several meetings were held at Aberdeen Proving Ground, Md., to discuss this problem as it pertained to several weapons systems. Personnel of the Occupational Health Branch, OTSG, attended these meetings.
Microwave radiation.?There continues to be some potential hazard to personnel from the electromagnetic radiation in the microwave band. The need for control measures around the larger radar systems became a major subject of consultation during the year. The Surgeon General constantly emphasizes to all users, and to DA agencies responsible for these systems, that the problem is to avoid absorption of
excessive quantities of energy by human beings, and not to control energy fields in free space. New regulations were drafted to assign command and technical service responsibilities, and provide for biological criteria for acceptable limits of exposure to this type of energy.
Ionizing radiation.?A major effort continued to be expended on control of hazards to health from ionizing radiation. Surveillance of Army activities in this field, which exposes some 15,000 persons each month to this subtle and potentially very dangerous environmental hazard, requires painstaking work, persistency, and a high degree of technical skill and administrative judgment.
The explosion of a nuclear power reactor at the National Reactor Testing Station, Idaho, in January, focused attention on the need for the Army to be fully prepared should it need to cope with such an emergency in the future. Advice and guidance were sought from a group of national experts on radiation protection. This group prepared a comprehensive report on emergency radiation exposure as a
reference document for the Office of The Surgeon General. This will be used as a basis for developing and implementing AMEDS policy on reactor emergencies and other incidents of a catastrophic nature involving massive sources of ionizing radiation.
Drafts of new Army regulations on the control of health hazards from ionizing radiation were prepared and sent out for preliminary review and coordination. These new regulations will be consistent with the
concepts of the National Committee on Radiation Protection, the Federal Radiation Council, and the regulations of the Atomic Energy Commission.
Individual consultations of an important nature were furnished the Commanding General, USARAL (U.S. Army, Alaska), and the Chief of Engineers. In Alaska, a careful review was made of the quantities and intensities of the off-site liquid and gaseous discharges from the nuclear power reactor being built at Fort Greely. Standards for discharge of radioactivity to the environment were recommended and briefings were furnished the Alaska State Health Department and Public Health Service on the Army program for controlling these discharges to an innocuous level.
The Engineer Waterways Experiment Station?s proposal to use radio?active gold in Galveston Harbor as a tracer of silt movement was studied. Because of the sensitivity of the people in this area to problems of radiation, all interested officials in the State of Texas and Federal agencies which could be affected were briefed on the proposal.
Major effects, in the broad category of environmental health, were centered upon the specialties of entomology, sanitary engineering, toxicology, and environmental physiology as they pertain to the military. Activities within these categories are reported in the following paragraphs:
Entomology.?Diethyltoluamide was given final toxicological clearance, and recommendations were made for type classification of this material for use in the Army as a skin application repellent for pro?tection against biting insects. The item has been procured by the Army Chemical Corps and is now available for troop use.
A large-scale field test of 1 percent malathion dust for use to control resistant body lice was conducted in Korea during the winter. This material was determined to be highly effective against body lice and safe to use on persons.
Qualitative materiel requirements for a group of items of new lightweight equipment and materials for vector control were staffed through USCONARC (U.S. Continental Army Command) and through the Office of Chief of Research and Development, DA, and have now been approved for inclusion in a research program to develop items much needed for this purpose.
The entomology consultant, along with other members of the Armed Forces Pest Control Board, accompanied the Medical Adviser to the Assistant Secretary of Defense (Manpower, Procurement, and Reserve) on a tour of the U.S. Department of Agriculture?s Orlando, Fla., laboratory, and the U.S. Department of Agriculture?s Stored Product Insects Laboratory, Market Quality Research Division, Savannah, Ga., to review the research being conducted on control of disease vectors and pests of stored products and property of direct interest to the armed services. Of particular interest among the projects reviewed is work being done by the Orlando group on chemosterilants as prospective control agents for insects of military importance. Several chemicals tested to date offer promising leads for a completely new approach to pest control.
Consultation was provided the Armed Forces Pest Control Board in the revision of TIM (Technical Information Memorandum) No. 2,
"Diazinon,? and publication of TIM No. 9, ?The Use of Insect Repellents on Clothing.? Copies have been distributed to AMEDS entomologists.
Environmental health engineering.?Intial actions were taken toward development of area environmental health engineering services in CONUS Army areas. Following a staff study in OTSG, the
Surgeon, Sixth U.S. Army, established the first such service in the Sixth U.S. Army Medical Laboratory with an initial authorization of one officer and one enlisted man. It is planned to use the experiences of this unit in determining manning levels, equipment, funding, and procedures in establishing similar services in the other Army laboratories.
Actions were completed regarding type classification and pending use of Water Testing Kit, Bacteriological, FSN 6665-682-4765. A publication is being processed announcing the availability and basis
of issue of the kit. It will also provide technical guidance. The kit contains the molecular membrane filter, and therefore, water samples can be analyzed in the field. This procedure should eliminate all
shipment of samples to central laboratories.
Technical guidance was furnished the Chief of Engineers in preparation of TM 5-700, ?Field Water Supplies,? which will replace TM 5-295, same subject. The AMEDS liaison officer worked closely
with the project officer of the Corps of Engineers with a resultant manual which will provide major changes in field water supply procedures and policy.
A census was made of Army fluoridation through the assistance of major command sanitary engineers. Fluorides were being added to water by 28 plants operated by the Army. In addition, water was procured by 30 installations from municipal or privately owned water systems which were fluoridated. Three other installations had approved projects but were not operational as yet.
Clearance was given to the Chief of Engineers on the use of two commercial polyphosphate compounds for threshold treatment for corrosion control, and guidance was provided the Chief Chemical
Officer on preparation of a military specification for the same type of compound.
Consultation assistance was continued to the Chief of Engineers and the Chief Chemical Officer on the evaluation and abatement of ground water contamination at Rocky Mountain Arsenal, Colo. A basic industrial wastes survey was made by a team from USAEHA, and consultation was provided on health aspects of the problem. A deep injection well was installed to dispose of waste waters, but studies continued on means of clarifying the contaminated aquifer. The Omaha
District Engineers were considering a 10-year corrective program which would include AMEDS? participation on health aspects. Guidance was also provided on the disposal of unsymmetrical dimethyihydrazine mixing wastes at the Arsenal.
Field studies were conducted during the summer of 1961 on waste-disposal practices on the Greenland Icecap. The studies were under the cognizance of the U.S. Army Medical Research Laboratory, Fort Knox, Ky., with sanitary engineering assistance by WRAIR and USAEHA. Considerable difficulty was encountered in obtaining suitable core samples from the icecap at a used waste sump; therefore, only presumptive findings were made. It was apparent that waste waters discharged directly to the icecap form well-defined boundaries and are of a planoconvex shape. In the sump studied, the sewage mass was from 160 to 240 feet in diameter and had a maximum thickness of 30 feet. Vertical penetration of the icecap was about 85-100 feet. Much operating experience was obtained, and a successful solution to the problem of waste disposal in icecapped areas is likely in 1962.
A report was furnished to the Surgeon, Eighth U.S. Army, regarding development and prosecution of an aggressive program aimed at improving the quality of water supplies in Korea. It was based on a consultant visit made to Korea in June 1960 by the Chief Sanitary Engineer, OTSG. The results have been development of firm command directives, assignment of two more sanitary engineers to the command, review of all construction plans by an AMEDS engineer, improvement of AMEDS surveillance of water supplies, and increasing awareness of command to the problem area.
Activity was increased toward development of international standards for drinking water. A review was made of a paper prepared by the United Kingdom member of the NATO (North Atlantic Treaty Organization) Medical Working Group regarding principles to be used in developing NATO standards for water potability. Comments were provided for the guidance of the U.S. member. A concept paper was also prepared and staffed for use by the medical member on ?Provision of Potable Water During Employment of Nuclear Weapons.? The Assistant for Environmental Health Engineering, OTSG, was also appointed as the U.S. member of a working group to develop an atomic, bacteriological, and chemical water standard for combat. Preliminary actions were taken leading to a meeting of the working group in August 1961.
Environmental physiology.?Information on man?s interaction with his total environment, adverse effects of the environment on man, and methods of prevention of these adverse effects was furnished to the
Army Medical Service during the year. Department of the Army circulars on the prevention of heat and cold injuries, advice and policy guidance on air-conditioning problems, participation in conferences on various problems of closed environments on man, and liaison with U.S. Army Medical Research Laboratory and the Quartermaster Research and Engineering Command, Natick, Mass., comprised the main lines of endeavor during the year.
Policy on the first aid treatment of snakebite was prepared and staffed within OTSG following guidelines provided by the National Academy of Science and the National Research Council Committee on Trauma.
Current information on applied research in various thermal environments was provided by participation in the British Medical Research Council?s study on heat stress and heat acclimatization in Aden, in the Middle East, and by attendance at a conference on ?Man in the Arctic? held in Natick.
Army Health Nursing
The health nursing programs have made satisfactory progress during the year. Visits to 12 Army installations in CONUS by the health nursing consultant indicated that policies in reference to the programs
were now more clearly defined, as opposed to the situation reported last year, but that considerable orientation to and interpretation of the program was necessary at local levels.
A draft on minimum standards for day care centers on military installations was prepared and is in the process of being staffed.
Production on the film, ?The Army Health Nurse,? was completed at Fort Dix, N.J., and was released in April 1961. The Chief Health Nurse was the technical adviser. The film will be used primarily for orientation purposes for AMEDS personnel and in counseling and procurement of ANC officers.
Newly released commercial health educational and professional films continue to be previewed for the purpose of evaluating their suitability for use in military health educational and inservice education programs. Numerous films pertaining to home accident prevention have been previewed as films on this subject are locally much in demand. A long-range requirement for health educational films was submitted to the Directorate of Personnel and Training, OTSG, as the supply of these films is still inadequate.
The health nursing consultant participated in The Surgeon General?s Hospital Consultants Conference in September 1960 and discussed the ?Role of the Army Health Nurse in Outpatient Services.? In November
1960, the health nursing consultant spoke on the subject of ?Coordination of Social Work and Army Health Nursing? at the Conference of Social Workers at WRAIR. At the course in ?Occupational Health Services? held at USAEHA in January 1961, a presentation on the ?Role and Functions of the Nurse in Occupational Health Programs? was given. ?Current Trends and Developments in Army Health Nursing? was discussed at the Biennial Conference of Preventive Medicine and Laboratory Officers in January 1961.
The health nursing consultant also attended the annual meeting of the American Public Health Association in November 1960 and the National League for Nursing convention in April 1961.
A new technical manual, TM-8-501, ?Nutrition,? was completed and subsequently published on 28 April 1961.
The Surgeon General was represented on the Master Menu Board of the Quartermaster General and also at the fourth Armed Forces Internation Nutrition Conference, sponsored by the Interdepartmental Committee on Nutrition for National Defense, which was held in Washington, Denver, and Chicago, respectively, over a 7-day period. This conference was significant in that it greatly broadened the scope of foreign contacts knowledgeable in military nutrition throughout the world.
Civil Public Health
The Civil Public Health Branch, Preventive Medicine Division, continued to maintain close liaison with the Office of the Chief of Civil Affairs, DA, on public health matters of mutual interest. The U.S. Army medical support of refugees in foreign areas in time of war was the subject of conferences during the year. Although all of the varied aspects of this complex problem have not been resolved, the Civil Public Health Branch will continue to meet with appropriate DA representatives so that plans and mutually agreeable solutions, consistent with basic missions, may be reached.
World Health Data
The Preventive Medicine Division gave support and guidance to the Department of Health Data, WRAIR, in the publication of data pertaining to environmental health practices and disease conditions in various parts of the world. Special attention was focused upon those areas of Asia which are potentially the most significant to this country in its attempt to achieve a free world society.
Publications in the Health Data series were prepared and distributed during the year on the Republic of Vietnam (South Vietnam), Kingdom of Thailand, Nepal, Iraq, Kingdom of Laos, and the Republic of El Salvador.
Preventive Medicine Personnel and Training
At the direction of DCSLOG (Deputy Chief of Staff for Logistics), Preventive Medicine Division initiated correspondence with USCONARC covering recommendations to insure the adequacy of individual and unit training in preventive medicine principles and practices. It was recommended that a review and evaluation be made of the amount of time devoted to this subject in service school curriculums and in unit training programs, especially STRAC units at installation and post level. USCONARC, after review, concluded that the amount of time given these subjects is considered adequate. It was stated that laxity in personal hygiene and field sanitation is not the result of inadequate training, but the lack of sufficient command emphasis.
The third Advanced Military Preventive Medicine Course at WRAIR was completed in October 1960. The enrollment consisted of seven U.S. Army officers?four Medical Corps, two Army Nurse Corps, and one Veterinary Corps?and two German officers. This 3-month course supplements civilian institution training of personnel with a master?s degree in public health and is given before these officers start military preventive medicine residency training. No classes will be held in fiscal year 1962 due to the unavailability of candidates; however, it is to be rescheduled in fiscal year 1963.
Preventive medicine and occupational medicine officers.?At the end of the fiscal year, there were 82 preventive medicine and occupational medicine officers assigned in the Army. Of these, 78 are
preventive medicine officers and 4 occupational medicine officers. In the MOS 3005 group, 32 are board certified and 2 are similarly qualified in the 3006 category. During the fiscal year, an MOS A-3005 was assigned to five senior preventive medicine officers, bringing the total number of A-3005?s in the U.S. Army to nine.
Liaison was maintained with the Directorate of Personnel and Training on the assignment and training of preventive medicine and occupational medicine officers (MOS 3005 and 3006, respectively). An active program to stimulate interest in preventive medicine and occupational medicine was carried on for purposes of recruitment. Ten students were assigned to the preventive medicine clinical clerkship training program during fiscal year 1961 and six are scheduled to participate in fiscal year 1962.
There were three officers in the military preventive medicine residency programs at Fort Dix and Fort Ord. Eight MC (Medical Corps) officers were enrolled in civilian schools of public health (seven for a master?s in public health training and one working toward a doctorate in occupational health). In addition, a resident was assigned to the occupational medicine residency program at USAEHA. Beginning in February, one officer began fellowship training in biologics production at WRAIR. Preliminary arrangements were made
with deans of schools of public health and directors of State health departments for the training of officers in the 3-year preventive medicine residency training program.
Selected AMEDS personnel continued to receive advanced training in communicable disease control. One preventive medicine officer participated in the fellowship in tropical medicine at the Calcutta (India) School of Tropical Medicine, and one participated in the Louisiana State University fellowship in tropical medicine and parasitology in Central America during the period September to November 1960.
Two courses in ?Global Medicine? were held at WRAIR during the fiscal year, with 15 MC officers attending each course.
Army health nurses.?At the end of the fiscal year, there were 37 health nursing programs in the United States, including Hawaii and Alaska, and 20 in oversea areas (Germany, France, Italy, Eritrea, Korea, Okinawa, and Japan). As a result of an installation?s closing in Alaska, one health nursing program was discontinued. The program at Fort Hamilton was discontinued as the requirement for such a service did not justify assigning a full-time health nurse. A total of 85 nurses were assigned to these AMEDS health nursing programs. Two additional spaces were authorized for health nursing this year, but not filled as qualified personnel were not available.
Two nurses completed the master?s degree at civilian universities, two completed the Advanced Military Preventive Medicine Course WRAIR, and two completed the Advanced Military Nursing Course at the Medical Field Service School. The application of one health nurse to enter a civilian university in the fall of 1961 for training in public health leading to a master?s degree was approved. Two nurses attended the Functional Officers Course, Phases I and II, at the Civil Affairs School at Fort Gordon, Ga. Three nurses attended the epidemiology course for nurses at the Communicable Disease Center, U.S.
Public Health Service, in Atlanta.
Six training spaces, to provide training for nurses qualified for beginning positions in Army health nursing, were authorized for fiscal year 1962. These spaces have been allotted at Fort Dix, Fort Knox, Fort Bragg, Fort Benning, Fort Ord, and Brooke Army Medical Center.
Procurement of experienced public health nurses reflected the same pattern as in previous years with two nurses so qualified receiving commissions during the year. A new ?Fact Sheet on Health Nursing? was published, and increased publicity is being given to health nursing programs by ANC counselors in the field.
Entomologists.?Three officers were lost from the ranks of the entomologists during the year, and three were gained through new commissions while two others were added through MOS changes. Four other applicants have been approved by an OTSG review board and will probably receive commissions in July 1961. These last additions will bring the on-duty entomologists to the full authorized strength of 45. Four officers received postgraduate training in civilian universities, and four others attended short courses in medical entomology. The professional status of the group currently in the service is reflected by the fact that 9 have the Ph. D. degree, 22 the M.S. or M.P.H. degree, and the remainder hold the B.S. or B.A. degree. Professional prefixes for the MOS 3315 are held by 29 entomologists as follows:
4 A?s, 6 B?s, 12 C?s, and 7 D?s.
A Medical Service Corps Officers? Career Pattern for the Entomology Career Field, Allied Sciences Section, was published and mailed to all AMEDS entomologists during the year.
Nutritionists.?The number and quality of Reserve nutrition officers serving as mobilization designees to OTSG and the U.S. Army Medical Research and Nutrition Laboratory were enhanced by the addition of one MC and three MSC officers. All of the additional officers have attained nutrition training to the doctorate level.
Sanitary engineers.?The program of developing and strengthening the Sanitary Engineer Section, MSC, began to show the results of the recruiting and program development undertaken during the past 3 years. The active-duty strength of sanitary engineers was 89 at the end of the fiscal year, as compared to 64, 54, and 74 at the end of the 3 preceding report periods. The career group has been increased significantly, with the Regular Army component increasing from 26 to 34 in the 3-year period and the career Reserves from 9 to 13. An additional four engineers have also been approved for Regular Army commissions. Current Regular Army authorization is 46. A status report on the rank, training, and proficiency prefixes of the officer personnel in the Sanitary Engineer Section, MSC, follows.
Number of officers
Category Reserve: Lieutenant
Civilian institution training:
Bachelor of science
Master of science or master of public health
Degrees of sanitary engineering
Bachelor of science
Master of science or master of public health
Bachelor of science
Master of science or master of public health
Command and General Staff College
1Includes constructive credit
Training was accelerated during this fiscal year with particular emphasis directed toward the career course and to postgraduate short courses. Four engineers attended the career course and 43 attended professional short courses. Four engineers were in long-term postgraduate training at civilian institutions. Planning was completed and approval obtained from the PETC (Professional Education and
Training Committee) to conduct a course for senior engineers in January 1962 on ?Environmental Health Engineering in the Mid Range Time Frame,? and for continuation of the excellent short course training
program. Active-duty training for Reserve sanitary engineers was again conducted at the Robert A. Taft Sanitary Engineering Center, Cincinnati, Ohio, 5-16 June 1961. Three concurrent courses were conducted on ?Basic Radiological Health,? ?Atmospheric and Source Sampling,? and ?Water Quality Management.? There was a total of 115 officers in training, including 30 from the Army. The Office of The Surgeon General and the U.S. Army Engineer and Research Laboratory gave a 1?-day presentation on military water supply procedures and equipment.
The following DA publications in the field of preventive medicine were issued during fiscal year 1961:
AR 40-25, U.S. Army Environmental Hygiene Agency, 23 September 1960.
AR 40-551, Army Health Nursing Program, 1 November 1960.
Changes 1 to AR 40-562, Immunization Requirements and Procedures, 26 September 1960.
DA Circular 40-11, Special Immunization Requirements in USAR?PAC, 1 July 1960.
DA Circular 40-13, Poliomyelitis Immunization, 4 August 1960.
DA Circular 40-14, Adenovirus Immunization, 8 August 1960.
DA Circular 40-16, Prevention of Cold Injury, 30 August 1960.
DA Circular 40-17, Applications for AEC Byproduct Material Licenses and License Amendments, 10 January 1961.
DA Circular 40-18, Food Service Sanitation, 9 February 1961.
DA Circular 40-19, Prevention of Heat Injury, 6 March 1961.
DA General Orders 26, Redesignation of U.S. Army Environmental Health Laboratory to U.S. Army Environmental Hygiene Agency, 26 July 1960.
Changes 1 to TM 8-272, Manual for Army Health Nurses, 22 March 1961.
TM 8-501, Nutrition, 28 April 1961.
TB MED 35, Health Hazards From Industrial Solvents, 6 January 1961.
Changes 1 to TB MED 114, Immunization, 23 September 1960.
TB MED 249, Protection Against Radiation From Sealed Gamma Sources (NBS Handbook No. 73), 27 July 1960.
TB Med 261, Tularemia, 8 September 1960.