Part V
THE PACIFIC
CHAPTER XV
Australia and New Zealand
Lieutenant Colonel Eugene T. Lyons, MSC
Section I. Australia
INTRODUCTION
The first U.S. troops to arrive inAustralia landed in Brisbane on 22 December 1941 from ships of the Pensacola convoy,which had been en route from Hawaii to the Philippines when Pearl Harbor wasattacked on 7 December 1941. Aboard the ships of the convoy were 4,600 troops,airplanes, ammunition, and other materiel dispatched to strengthen Gen. DouglasMacArthur's force. Following the Japanese attack, the Joint Army and NavyBoard first voted to order the convoy's return to Hawaii to prevent possibleloss of its now doubly valuable cargo. Fearing the implications of this seemingabandonment of the Philippines, President Franklin D. Roosevelt, however,ordered the board to reconsider its recommendation, and the convoy wassubsequently diverted to Australia. It was hoped that the reinforcements andsupplies could safely be sent north from there.1
Upon debarkation, the troops were billeted in existing campsof the Australian Army. These contained all facilities necessary including fivefully equipped dispensaries. Arrangements had also been made to hospitalize U.S.troops in Australian military and civilian hospitals.2
Until 7 December 1941, Australia had been considered only asa possible point on an air ferry route to the Philippines. Consequently, nocarefully considered and fully coordinated plans had been made to use anAustralian base and it was necessary for a plan to be hastily improvised. Thisenvisaged the establishment of a supply base in Australia and the operation of aline of communications northward to the Philippines, along which supplies andreinforcements could be sent, beginning with those carried aboard the Pensacolaconvoy. Personnel from the convoy were to man this line of communication.Maj. Gen. (later Lt. Gen.) George H. Brett was named to undertake this task. Hiscommand, USAFIA (U.S. Army Forces in Australia), was organized on 22 December1941, at Lennon's Hotel, Brisbane, the same date the convoy arrived at thatport.3
1Morton, Louis: United States Army in World War II. The War in the Pacific: The Fall of the Philippines. Washington: U.S. Government Printing Office, 1953, p. 146.
2Medical Diary, 10 December 1941-30 June 1942, of Col. P. J. Carroll, MC, Chief Surgeon, Headquarters, U.S. Army Service of Supply, SWPA, p. 3.
3Barnes, Brig. Gen. Julian F., Report of Organization and Activities of United States Forces in Australia, Dec. 7, 1941-June 30, 1942, dated 6 Nov. 1942.
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Many agreements were necessary to establish and operateAmerican medical activities in Australia and these were arrived at throughnegotiation with Australian civilian authorities. Since no CivilAffairs/Military Government Division existed in General MacArthur'sheadquarters to handle such negotiations until preparations were being made toretake the Philippines in 1944, each staff surgeon found himself conducting hisown negotiations with his Australian civilian counterpart.
THE LAND AND THE PEOPLE
The Australians warmly welcomed American troops not onlybecause they were traditionally hospitable but also because their country wasrelatively undefended except by some small naval and air forces. Since almostall of the Australian Army was fighting in North Africa, in the Middle East, andin Malaya, few troops were left to defend the continent. Hence, although theAmericans viewed Australia, initially at least, as a base from which to supportGeneral MacArthur's troops in the Philippines, the Australians saw theAmericans as the force to defend their continent from the Japanese invasion.4
Australia, which many American soldiers came to know duringthe next 4 years, is a land of extreme contrasts, not the least of which are thereversed seasons. Men who had left the States, with winter fast approaching,found the summer just beginning. The continent is roughly rectangular in shape;its population is concentrated along the eastern and southern coasts, leaving arather barren and relatively undeveloped interior. The northern coast, facingtowards the route of Japanese attack, is highly humid tropical jungle. Largestamong the few settlements was Port Darwin. The eastern coast, facing theAmericas across 7,000 miles of almost empty ocean, ranges from tropical in thenorth to temperate in the more heavily populated south. Sydney is situated onthis coast, as are Brisbane, Townsville, and Cairns. Melbourne and Adelaide aresouthwest of Sydney, but on the southern coast.
Transportation over great distances was quite difficultbecause of the lack of roads in the interior and because the railroad system,generally confined to the coastal area from Cairns in the north to Perth in theSouthwest, has five changes in gage of track over that distance. Additionally,Darwin, only a small undeveloped port at the war's beginning but the closestport to the Japanese line of advance, had no railroad connection with thepopulous and highly industrialized southeast. The extreme danger of Japanese airattack, combined with the general shortage of port facilities in the north,necessitated that American bases be widely scattered along the coast from Darwinto Adelaide, a distance of approximately 6,000 miles by water. This dispersionhad the practical result of confronting the U.S. Army Medical Department withthe complete spectrum of diseases endemic to Aus-
4Brereton, Lewis H.: The Brereton Diaries. The War in theAir, in the Pacific, Middle East, and Europe; 3 October 1941-8 May 1945. NewYork: William Morrow and Co., 1946, p. 81.
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tralia. For civil affairs, it multiplied the number ofcivilian communities and governments to be dealt with.
From the public health standpoint, Australian morbidity ratescompared favorably with those of the United States in most respects. Diseasesconsidered of special importance included malaria, typhoid, amebic dysentery,hookworm, scrub typhus, endemic typhus fever, Q fever, dengue fever, diphtheria,filariasis, yaws, leptospirosis, and undulant fever.5
Sanitary practices, except in the largest cities, werecomparable to those found in rural areas of the southwestern United States atthat time. For the most part, public health measures were behind the moderntrend, only a few cities and towns having sewage disposal plants or watertreatment facilities. There were not many septic tanks in the small towns. Thepan system of night soil collection was most frequently used, with subsequentdisposal either in the sea or in trenches. As in the United States, pit latrineswere used in most rural areas. In those regions occupied by aborigines, it wascommon to find the ground widely contaminated by human excrement.
The Commonwealth of Australia is composed of six states andtwo territories. Paralleling the structure of the Commonwealth Government, eachstate has an executive, a parliament, and a judiciary. Relationship of the stateto the federal government is quite similar to that in the United States; theCommonwealth holds jurisdiction over interstate and international affairs, andall residual powers not delegated to the states. In public health, theCommonwealth usually confined its activities to national organizations such asthe Quarantine Service, while the active, protective, investigative, andeducational aspects of health work are carried on by the individual state healthdepartments. The significance of this is that the laws concerning control ofvarious diseases differ in each state, sometimes to a considerable extent.
Political subdivisions below the state government are cities,towns, and boroughs. The borough or shire, as it is sometimes called, is quitesimilar in function and form of government to the American county. All three ofthese political subdivisions are governed by elected councils.
This, then, was Australia as the first American soldiersfound it in late 1941.
U.S. ARMY COMMAND STRUCTURE
On 5 January 1942, General Brett assumedcommand of the U.S.Army Forces in Australia and immediately activated a number of base sections,each assigned the responsibility of overseeing U.S. Army activities within aspecified area of Australia. By mid-April, seven base sections covered all thecontinent and an ADSEC (advance section) in New Guinea.6
5(1) Army Medical Bulletin No. 63,July 1942, Medical and Sanitary Data on Australia, pp. 28-32. (2) For furtherdetails concerning these diseases, see volumeson communicable diseases in this series.
6General Orders Nos. 1, of 5 Jan. 1942, and 38, of 15 Apr.1942, Headquarters, USAFIA.
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This number changed several times and boundaries wererealined; however, base section functions did not change nor did that of theoverall command, even under the reorganizations which took place (map 16).7
Medical Organization
The initial medical staff for Headquarters, USAFIA, and foreach of the base sections was selected from among the nine medical officers andfour dental officers traveling as casuals in the Pensacola convoy.Additional personnel were assigned to the organic medical detachments of unitswith the convoy; however, most of these individuals remained with their units.Until the arrival of Col. (later Brig. Gen.) Percy J. Carroll, MC, from thePhilippines and his designation as Surgeon, USAFIA, on 7 February 1942, a rapidsuccession of officers was assigned to this position. Among these were Lt. Col.(later Brig. Gen.) George W. Rice, MC, Maj. (later Lt. Col.) George S. Littell,MC, and Maj. Jesse T. Harper, MC.
For the first few weeks, medical personnel were concernedwith establishing base section dispensaries, removing supplies carried aboardthe ships of the convoy, setting up medical supply depots, and establishingcontact with Australian medical authorities, both civilian and military. Theimmediate goals, of course, were to forward as quickly as possible the suppliesnow vitally needed by General MacAuthur and to prepare hospital beds forcasualties imminently expected from the battle area.
More formality in coordinating and planning medical supportfor USAFIA was achieved on 15 January 1942, when the Chief of Staff and theSurgeon took part in a meeting of the Hospitals Subcommittee of the AustralianPlanning Committee. At this meeting, the Australians agreed to provide medicalsupplies for an estimated 25,000 American troops and to furnish hospitalizationfor them in Australian Army and civilian hospitals. These arrangements wereexpected to continue for about 3 or 4 months until hospitals and medicalsupplies could arrive from the United States.8 A Joint Hospitals Subcommittee was formed "* ** to examine requirements and existing resources inrespect of both hospital and medical equipment in relation to the requirementsof U.S.A. Forces now in Australia and prospective U.S. casualties from thetheatre of war operations."9
Meanwhile, the establishment of the surgeons' offices inthe various base sections continued. The "pick and shovel work" of allaspects of medicine was to be done by these base surgeons who, with a fewenlisted assistants, had to open dispensaries, find medical supplies, accomplishmedical surveys in areas which were equivalent in size to several western statescombined, and establish contact with local hospitals and public health
7For a detailed discussion of the organizational changes inAustralia, see MedicalDepartment, U.S. Army. Organization and Administration in World War II.Washington: U.S. Government Printing Office, 1963, pp. 410-429.
8See footnote 2, p. 533.
9Memorandum, Headquarters, USAFIA, for Heads of General andSpecial Staff Sections, 20 Feb. 1942, subject: Planning for Australian-AmericanCooperation.
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MAP16.-Routes of communications inAustralia.
officials. Their establishments seemed to spring upovernight; problems bewildered Americans and Australians alike. In Base Section4, for example, Maj. John R. Finkle, MC, accompanied the commander to thebuilding chosen for base section headquarters, the "Mission toSeamen," in Melbourne, a large modern building with clubrooms, a chapel,and a parsonage. Major Finkle reported that several seamen who came in duringthe inspection were disappointed not to be permitted to play billiards on thestill remaining tables. The medical section eventually used the parsonage foroffice and dispensary space, where, for several weeks, the parson remained inresidence after the building was taken over, and his wife served tea in the Eng-
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lish manner to the delighted Americans who "found thisnot inconvenient." Major Finkle's mention of success in locating severalmicroscopes, bottles of pills, a package of tongue depressors, and some officefurniture only served to illustrate the overall supply problems.10
The primitive, sparsely populated area comprising BaseSection 1 offered limited choice in surroundings orfacilities. Headquarters, Base Section 1, was first located in Darwin, but afterJapanese bombings began in February 1942, it moved out into the nearby bush andsubsequently to Birdum, the southern terminus of the railroad from Darwin to theinterior. Offices of the Base Section Surgeon, still in a tent in mid-1943, had,at one time, been on the open porch of the Birdum hotel.11
Medical activities to support the rapidly growing contingentof U.S. Army troops became more fully organized in April 1942, following thearrival of a group of medical, dental, and veterinary officers, sufficient innumber to staff USAFIA and the various Base Section Headquarters.12
Coordination With Civil Authorities
Preventive medicine problems in Australia were concentratedin three general categories: (1) control of communicable diseases such as dengueand malaria, which were endemic in some areas; (2) improvement and maintenanceof hygienic standards in water supply, waste disposal, and processing offoodstuffs; and (3) suppression of venerealdisease. Medical staff officers soon discovered that little or no progress wasto be made in any of these areas without the active cooperation of civilofficials at all levels of government. They found that problems such as controlof malaria was national in scope and that coordinated action was required atthat level. VD (venereal disease) control and tuberculin testing of cattle wereproblems of the state and ultimately required coordination with each state andterritorial government; others, such as water supply and human waste disposal,were within the jurisdiction of the local town council.
For various reasons, but chiefly for lack of direction fromhigher headquarters, civil affairs, particularly in the realm of preventivemedicine, usually were undertaken at the base section and station level. Thelack of direction was caused by the unorthodox command structure established inthe SWPA theater which, for a time, left U.S. Army forces with no singlecommander below Allied GHQ headed by General MacArthur.13
Since no Preventive Medicine Division was directing effort atthe theater level, coordination in preventive medicine planning was not achieveduntil March 1943, when General MacArthur established the Combined AdvisoryCommittee on Tropical Medicine, Hygiene, and Sanitation, composed
10Letter, Headquarters Base SectionNo. 4, USASOS SWPA, to The Surgeon General, U.S. Army, 13 Jan. 1943, subject:Report for the History of Medical Activities, Base Section 4.
11Letter, Headquarters, Base Section 1, to The SurgeonGeneral, U.S. Army, 5 Apr. 1943, subject: Report for History of MedicalActivities, SWPA.
12See footnote 7, p. 536.
13See footnote 7, p. 536.
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of American and Australian specialists. The three Americanmembers were Colonels Howard F. Smith, USPHS, SWPA malariologist,14 BeaconC. Wilson, MC, and Maurice C. Pincoffs, MC, also committee secretary. Thiscommittee was given broad authority to develop plans, measures, and policies tobe followed by Allied Forces. Their recommendations to General MacArthur usuallywere implemented in the form of a directive from his headquarters to thesubordinate commanders. Through its Australian members, the committeecoordinated preventive medicine matters with civil public health officials whowere particularly watchful of the malaria menace from the military source andvigorously protested to Headquarters, SWPA, whenever a malarial soldier wasallowed to enter potentially malarious districts. Largely through the efforts ofthis committee, steps were taken by all agencies towards control of malaria andother tropical diseases. This resulted in both civilian health protection andreduction of the military malaria rate to the point where it no longer endangered combat operations.15
The absence of early command guidance, the difficulty incommunicating over long distances, the diversity of problems, and the urgency ofthe situation forced each surgeon to work out his own problems with civilauthorities. To do this, he often joined forces with his Australian militarycounterpart whose command health hazards were usually identical to his own. Thus,committees, such as the Allied Services Health Council in Perth and theCooperative Allied Sanitation Committee in Townsville, were formed to takemeasures necessary to protect the Allied serviceman from local health hazards.Each military service having troops in the area was represented on the committeeby a medical officer and sometimes by a veterinary and a military policeofficer. They worked closely with civilian officials to improve restaurantsanitation, control prostitution, improve waste disposal, and develop approvedfood sources. Many projects required U.S. contributions in labor, materials, andfunds, especially extensive drainage improvement to eliminate mosquito breedingplaces. In Cairns, for example, a project was undertaken jointly withCommonwealth, Queensland, Cairns, and Australian Army health officials toprovide permanent drainage improvements designed to completely eliminate malariain the vicinity (fig. 71). The U.S. Army Engineers agreed to cut drains throughthe town and to furnish equipment for other digging and drain construction.16
14Dr. Howard F. Smith was one of sixU.S. Public Health Officers serving in the Philippine Islands when war began. Hewas appointed aide-de-camp to General MacArthur on 12 December 1941 andaccompanied him to Australia in March 1942. He was subsequently named SWPAMalariologist, in which capacity he worked to lower the incidence of malariaamong Allied troops in Australia, Borneo, and New Guinea. SeeWilliam, Ralph Chester, M.D.: The United StatesPublic Health Service, 1798-1950. Washington: Commissioned Officers Association of the United States PublicHealth Service, 1951, p. 712.
15Medical Department, U.S. Army.Preventive Medicine in World War II. Volume VI. Communicable Diseases: Malaria.Washington: U.S. Government Printing Office, 1963, pp. 536-542.
16(1) Letter, Brigadier N. H. Fairley,Allied Land Forces Headquarters, to Col. Howard Smith, 25 Feb. 1944, subject: Mosquitoes in Cairns. (2) Report, AMFHeadquarters 17L of C Sub-area, 21 Sept. 1943, subject: Brief Notes of Conference Held on 16Sept. 43 to Discuss Drainage Scheme. (3) Sanitary Report of Medical Inspector, USAFIA, on Cairns area,July 1942, subject: Malaria at Cairns and Proposed Methods of Control.
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FIGURE71.-Military personnel conduct tests andspray for mosquitoes, Queensland, Australia, August 1942.
In most instances, local officials were willing to correctany conditions dangerous to health that were pointed out to them. Naturally,there were also instances of individuals' refusing to cooperate, such as theoperator of a hotel in Mount Isa who refused to drain a large pool into whicheffluent from the hotel was discharging. The town authorities had tried for 2years to force this hotel to comply with local sanitary laws. The fact that thehusband of the hotel operator was a representative on the Cloncurry ShireCouncil perhaps had something to do with its lack of success. This filthy, flybreeding ground was not eliminated until waterborne sewage facilities for theentire town were completed.17
At other times, although the local authorities recognized theexistence of health hazards, they had insufficient resources to make necessaryimprovements or they were reluctant to correct, at their own expense, a situationnot considered dangerous during normal times when fewer people were living inthe community. When confronted by these situations, medical officers had thechoice of offering help within their resources, which was often done
17Informal Sanitary Report,Headquarters, Motor Transport Command No. 1, USASOS, SWPA, 31 Oct. 1942.
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and accepted, or they had to appeal to higher authority.These appeals usually were directed to the Base Section Surgeon or, less often,to the state DGMS (Director General of Health and Medical Services). The BaseSection Surgeon worked closely with the state DGMS, who was his counterpart inthe civilian government. Any problem that could not be solved by the militaryalone was taken up with the DGMS, and many agreements were made at this levelfor joint action to alleviate bad conditions.
The state DGMS had legal authority to order compliance oflocal communities with state sanitation laws. When compliance was notforthcoming, he was empowered to make necessary improvements and charge the costto the local government. This drastic step was seldom required since theseconditions were usually corrected upon the DGMS' recommendation. The role ofthe DGMS, however, was not just that of enforcement. His knowledge of localconditions and his professional advice were invaluable to both the civilpopulace and U.S. medical personnel. Further, he had funds and resources at hisdisposal to help the community pay for improvement projects and could gainadditional support through the Commonwealth DGMS.
Sir Raphael Cilento, DGMS in Queensland, was particularlyhelpful to the U.S. forces in their relations with civilian communities in thisstate. His assistance and cooperation were important since Queensland, the stateclosest to the fighting, contained most of the American bases. The extent of hiscontribution can best be judged by his actions while on an inspection tour ofNorth Queensland during the dengue fever epidemic in April 1942. On this tour,he visited Townsville, Rockhampton, and Charters Towers, all sites of Americaninstallations in the process of being established. In Townsville, he conferredwith Lt. Col. (later Col.) Carl R. Mitchell, MC, surgeon of Base Section 2 and,then, commander of the 12th Station Hospital. He discussed medical and hygienicproblems of North Queensland with Colonel Mitchell and later addressed thehospital staff.
Since Aedes aegypti was the primary vector of denguein that country, Sir Raphael vigorously attacked the problem of mosquitodestruction in each locality where the fever was epidemic. He toured the townsin company with local officials, pointing out mosquito breeding places, andinstructed them in methods of eliminating such places by either drainage oroiling. He also directed health officers in the larger town to report denguefever rates regularly. Reporting of dengue previously had not been required, butin recognition of its military importance, the Commonwealth had appropriatedmoney for this purpose. Finding Rockhampton more heavily infested withmosquitoes than it had been in previous years, Sir Raphael called a meeting ofthe city council to intensify a program of extermination. He warned the councilthat failure to institute an effective program would result in his department'staking the work over directly and carrying it out at the expense of the city. Hetook this approach because a considerable body of nonimmune American troops wasto arrive soon at Rockhampton.18
18Report, Sir Raphael Cilento, April1942, subject: Visit to North Queensland.
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COMMUNICABLE DISEASES
Malaria
Malaria was the most significant communicable diseaseencountered by American forces in SWPA. Until effective control measureswere taken, it threatened to make combat operations a practicalimpossibility. In January 1943, the malaria attack rate per 1,000 troops per annum was3,308 for U.S. troops at Milne Bay, New Guinea.
Before the war, malaria was practically nonexistent inAustralia, being endemic only around Cairns, with a few indigenous casesoccurring over a wide area. Anophelines, however, could be found along the northand northeast coast in the vicinity of Darwin, Townsville, and Cairns.Therefore, the potential for spread of malaria existed, only awaiting thearrival of the human host, which now appeared in the form of evacuees from themalarious combat regions of the Philippines and Dutch East Indies.
There was little serious official concern, even on the partof the Commonwealth Government, until May 1942 when three original cases ofmalaria occurred in American troops at Townsville. At about the same time, 52cases were reported among the civilian population at Cairns. Beginning on 7 May1942, a series of meetings were called by Australian officials, at which theproblems of mosquitoborne diseases were discussed, plans were made to insureproper communicable disease reporting, and measures were proposed to control thespread of these diseases. Presiding at these conferences was Col. N. HamiltonFairley, Australian Army Medical Corps, an eminent specialist in tropicalmedicine, who was later appointed chairman of the Combined Advisory Committee onTropical Medicine, Hygiene, and Sanitation. Malariologists, parasitologists,entomologists from the Australian Army, and health officers from the states ofQueensland and New South Wales attended the meetings. The U.S. Army MedicalDepartment was represented by Col. Howard F. Smith, malariologist, and Maj.James W. Bass, MC, Chief, Sanitation and Vital Statistics Division, USAFIA.Persons attending these meetings functioned as an informal committee whichinvestigated reports of epidemics, determined their causes, developed plans forcurtailing and avoiding epidemics, and implemented control measures through theagencies of its various members (fig. 72).19
During the ensuing months, Australian concern mounted overthe spread of malaria. The Cairns area was overrun by mosquitoes, their numbersswollen by an unusually wet season, and the number of malaria cases there roseto more than 600. The cases discovered at Townsville were confirmed asoriginating there, thus indicating the presence of malaria-bearing
19(1) Report, Maj. J. W. Bass, MC, 7 May 1942, subject: Meeting Held at Royal College of Surgeons Building. (2) Letter, Maj. James W. Bass, MC, Headquarters, USAFIA, Office of the Surgeon, to Colonel Carroll, 8 June 1942, subject: Report of Inspection Trip and Conferences With Australian Medical Officers, May 26 to June 6, 1942. (3) Letter, Maj. James W. Bass, MC, Headquarters, USAFIA, Office of the Surgeon, to Colonel Carroll, 13 June 1942, subject: Inspection, Base Sections 2 and 3. (4) See page 578 of footnote 15, p. 539.
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FIGURE 72.-Army preventivemedicine personnel spray a stagnant pond with kerosene guns to destroy mosquito larvae, part of the malaria controlprogram.
mosquitoes. Further, beginning in July 1942, heavily seededAustralian troops began returning in large numbers from the fighting in NewGuinea. The concern spread to Parliament, which prescribed that nostrum of alldemocratic governments, a Parliamentary investigation, to be carried out by SirEarle Page, MP. Among other recommendations, such as the quarantine ofmalaria-seeded troops, Sir Earle proposed that the Federal Government implementa complete drainage scheme of all swamps in Cairns capable of breeding Anophelesmosquitoes. His report was reviewed by the Combined Advisory Committee onTropical Medicine, Hygiene, and Sanitation and, upon their recommendation,General MacArthur directed that U. S. Army projects underway or planned at Cairnsbe coordinated with measures undertaken by Australian civil or militaryauthorities.20 By the timethis investigation was completed in mid-1943, however, most of hisrecommendations had already been adopted
In the interim, Australian and American military medicalstaff officers worked together, eliminating mosquito breeding grounds,resettling and segregating the infected native population, treating andevacuating recurrent cases to nonmalarious areas, quarantining and sending southnew arrivals from the north, and implementing personnel protective measures,
20(1) Letter, Capt. Frank K.Powers, MC, to Division Surgeon, 41st Infantry Division, 27 Aug. 1942, subject:Final Report of Mosquito and Sanitary Survey. (2) See footnotes 16 (2) and (3),p. 539. (3) Letter, Brig. Gen. L. S. Ostrander, USA, to Commanding General,USASOS, 12 July 1943, subject: Malaria Control in Cairns Area.
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such as the use of netting and suppressive drugs. To preventan influx of infected hosts into potentially malarious areas, the AustralianArmy Director of Hygiene proposed, in November 1942, that troops returning fromNew Guinea or Guadalcanal be barred from that part of the continent north of19? S. latitude. The bases for determining an area to be potentially malariouswere the presence of anopheline mosquitoes (fig. 73), a warm, humid climate, andlow-lying land containing swamps and stagnant water. Only after 6 months hadelapsed, during which all recurrent malaria cases were removed, were units to bepermitted to return to potentially malarious areas. Deviations from this policynecessitated by military emergency were to be reported immediately to theAustralian Army, and the personnel involved were to be given suppressive drugs.
This policy was adopted in December 1942 by General MacArthur'sheadquarters.21 It was made applicable to troops in the Allied Forcesthroughout SWPA and continued without significant change until the war ended.
The record seems to indicate that the dividing line wasestablished by the Australian Army without consultation with the CommonwealthGovernment. On 11 January 1943, the Commonwealth Director-General of Health, Dr.J. H. L. Cumpston, in reply to an inquiry from Colonel Carroll, suggestedkeeping malaria-infected troops south of 25? S. latitude, a move that wouldhave denied them almost the whole northern half of the continent. The tone ofhis letter suggested that he was unaware of the previously made decision toestablish the line at 19? S. latitude. The demarcation line was never changed,however, so apparently Doctor Cumpston accepted the decision of the military.The point to be made here is that the further south these troops were kept, themore difficult it became to stage them for further invasions of Japanese-heldareas.22
In February 1943, the first malaria survey and control teamarrived from the United States. These teams were given the task of eliminatinganopheline mosquitoes in areas occupied or visited by American troops. Theyworked closely with local authorities to conduct malaria surveys in the civiliancommunities. Their purpose was to identify mosquito vectors and breeding places,and to treat with larvicide stagnant waters which could not be drained. Thearrival of these teams, the growing effectiveness of the Combined AdvisoryCommittee on Tropical Medicine, Hygiene, and Sanitation, the establishment of anefficient malaria control organization, and enforcement of a strict malariacontrol program all contributed towards overcoming the crippling effect ofmalaria on military operations. By the end of 1943, this problem had beensubstantially solved.23
21Letter, Col. B. M. Fitch, AGD, to Commanders, Allied Navaland Air Forces, and Commanding Generals, I Corps and USASOS, 6 Dec. 1942,subject: Malaria Control in Australia.
22Letter, J. H. L. Cumpston,Department of Health, Commonwealth of Australia, to Col. P. G. Carroll, MC, 11 Jan. 1943, subject: Malaria.
23See footnote 15, p. 539.
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FIGURE73.-Identifying breeds of mosquitoes,Brisbane, Australia, January 1943.
Dengue Fever
Dengue fever was the first disease of military consequence tobe encountered by American forces.24 Maj. Henry C. Johnson, MC,Surgeon, Base Section 1, reported an epidemic of a mild form of dengue inFebruary 1942 in the vicinity of Darwin, where it was endemic. On 27 March 1942,the American Consul in Brisbane advised Capt. N. J. Serlin, MC, then Chief ofSanitation, USAFIA, that there were several thousand cases of dengue fever inthe Townsville area and that it wasspreading into Brisbane and Cloncurry.
This outbreak was a serious danger to American forces sincethey were situated mostly within the area covered by the epidemic and had notacquired immunity against the causative organism. Dengue fever was extremelydebilitating, having the potential of hospitalizing whole units at the sametime. Just before the Battle of the Coral Sea, the outcome of which caused theJapanese to abandon their plan for a seaborne invasion of Port Moresby, morethan 80 Army Air Force pilots and crewmembers in one unit were afflicted at thesame time with this illness which grounded flying personnel for an averageperiod of 3 weeks.Fortunately, with the arrival of
24For a more detailed discussion ofthe occurrence of dengue, scrub typhus, and other communicable diseases amongthe U.S. forces in Australia, seeMedicalDepartment, U.S. Army. Preventive Medicine in World War II. Volume VII.Communicable Diseases: Arthropodborne Diseases Other Than Malaria. Washington:U.S. Government Printing Office, 1964, pp. 29-32, 124, 275-286.
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cooler weather by late April, the incidence had begun todecline and the Air Forces had sufficient aircrews able to fly the numerousreconnaissance missions dispatched to locate the Japanese invasion fleet.25
Until the onset of the dengue epidemic, discussions andcoordination between American and Australian medical authorities had beenconcerned mostly with allocation of supplies, equipment, and facilities. Theynow realized that coordination and cooperation would have to go much farther.From this time on, both worked together to reduce mosquito breeding places,improve water supplies, and raise sanitary standards. Efforts to coordinatehealth activities on the local level were made in every community havingAmerican troops located nearby.
Venereal Diseases
In May 1942, venereal disease among U.S. military personnelin Australia reached its highest point: 45.8 per 1,000 troops per annum. ByNovember 1944, the rate had fallen to 4.2. This remarkable 90-percent reductionwas achieved only through the vigorous combined efforts of military and civilianagencies.26
Although venereal disease rates among the civilian populationhad been low for some years, the beginning of war in 1939 precipitated a gradualrise in the rate until it became evident, in 1942, that more effective controlmeasures were necessary. The Commonwealth then passed a law authorizing chiefpublic health officers in each state to order the apprehension and testing ofany person suspected of having a venereal disease (fig. 74). If diseased, theperson was to be detained until cured. Later, in 1943, this authority wasextended to any medical practitioner, including Allied medical officers who, ofcourse, exercised this authority through the civil courts. This last changeprovided a speedier and more effective system for detention of female venerealdisease carriers identified by soldiers reporting for VD treatment.27
A coordinated command program to control venereal diseasesbegan in July 1942, when the VD Control Section was organized in the Office ofthe Chief Surgeon, USAFIA. Lt. Col. Ivy A. Pelzman, MC, was designated SWPA VDControl Officer, and officers were appointed to similar positions in each basesection. This is not to imply that there were no such programs before that, butestablishment of this formal structure allowed development of programs whichwere more closely coordinated with the community or the state. Because thesource of infection was usually within the civilian
25(1) Johnson, Maj. Henry C., MC, Office of the Surgeon,Base Section No. 1, to Commanding Officer, Base Section No. 1, 28 Feb. 1942, subject: SanitaryReport for the Month of February 1942. (2) Letter, J. P. Ragland, American Consul, Brisbane, to Capt. N. J. Serlin, USA, Chief of Sanitation, Office of the Surgeon, Headquarters, USAF1A, 27Mar. 1942, with enclosed copies of Consular Sanitary Reports. (3) Kennard, Lt. Col. William J., MC,Report on Philippine and Australian Activities, p. 21.
26Medical Department, U.S. Army. Preventive Medicine in WorldWar II. Volume V. Communicable Diseases Transmitted Through Contact or byUnknown Means. Washington: U.S. Government Printing Office, 1960, p. 290.
27Headquarters, Base Section No. 2,Sanitary Report for July 1943, dated 5 Aug. 1943.
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FIGURE74.-Laboratory techniciansat the 3d Medical Laboratory, Brisbane, Australia, determine the results of a Kahn test.
community, the support of local health and law enforcementofficials was essential to the success of the program. Concern over venerealdisease was not confined to the military, of course. In July 1942, Sir RaphaelCilento, reflecting civilian concern, held a conference to consider the risingincidence of venereal disease in Queensland. At this meeting which was attendedby Col. George W. Rice, representing the Surgeon, USAFIA,28 a three-waydrive to suppress venereal disease was launched. Other programs organized laterusually followed the same pattern. First was the matter of education. Bothsoldiers and civilians had to be told what venereal diseases were, how they weretransmitted, and how to recognize them. The main emphasis here was placed oncontinence. Widespread publicity among civilians was difficult at first becauseof extreme delicacy which forbade even mention of the subject in public print.However, with American assistance, information campaigns marked by good tasteeventually were conducted by various state and local governments. Often theposters and bulletins used were copied from those developed previously in theUnited States.
28Minutes, Conference on the PublicHealth Aspects of Venereal Disease in Queensland, 30 July 1942, Brisbane, Australia.
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Second, prophylactic stations were to be established incities and towns frequented by Allied troops and they were to remain openconstantly. Soldiers on leave or pass were to be thoroughly familiarized withthe location of prophylactic stations in the area. An agreement was also reachedwhereby U.S. troops could patronize stations operated by Australian defenseforces and vice versa.
The third, and perhaps most important effort in the program'sdevelopment, was the system of obtaining identification of contacts frominfected soldiers. For this to be effective, such soldiers were requiredimmediately to provide all information known about the contact; such as, name,address, and where met. At most bases, a Provost Marshal investigator workedclosely with VD clinics. He interviewed infected soldiers, then turned over tothe civil authorities the information gained concerning the contact togetherwith the physician's certificate to the effect that there was reasonableassumption that the contact had venereal disease. On the basis of thiscertificate, the stipendiary magistrate issued an apprehension order to thecivil police.29 Apprehension, testing, and detention usually followedwhen sufficient identifying information was given to the police. Of course, thiswas done with varying degrees of efficiency, but by 1945, over 50 percent ofcontacts reported were traced by the civil police. In Townsville, which had anoutstanding record in this regard, over 95 percent of contacts were located.30
The effectiveness of these measures is illustrated by the lowincidence rate achieved by the war's end. This rate was among the lowest forU.S. troops stationed anywhere in the world.
SANITATION
Sanitation and the maintenance of high sanitary standardssufficient to protect United States troops were major problems in relativelyunpopulated northeastern Australia where most bases were established. Part ofthis area was desert where almost no water could be found, and part was tropicaljungle with stagnant, polluted water. Waste disposal in the few towns wasexceedingly primitive, and the local supply of fresh food was completelyinadequate for the large numbers of troops stationed there.
Each U.S. Army base had problems peculiar to it alone;however, a brief look at the sanitation difficulties faced at Cloncurry,Queensland, will serve to illustrate those encountered at almost all bases nearsmall Australian towns. In early 1942, when it was decided to establish anAmerican airbase nearby, Cloncurry was a typical farm town of about 1,600people. A U.S. Army engineer survey made on 28 March reported that the townwater supply was inadequate. This water had a high coliform count, and typhoidoccurred at the rate of about two cases each year. The pan system of
29Headquarters, Base Section No. 6,USASOS, SWPA, Medical History to September 30, 1942, dated 30 Oct. 1942.
30Base Section No. 2, QuarterlyHistory of Medical Activities, 1 July-30 Sept. 1943, pp. 66-68.
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human waste disposal was most common except for the fewseptic tanks, all of which discharged their effluence into the ground. Usedwater was run out onto the ground. The inspector immediately arranged with theDistrict Health Officer for chlorination of the town water supply by the U.S.Army. He also judged that water from the well being dug at the airbase wouldhave to be completely sterilized as it was in an area receiving drainage fromthe town.31
On 30 March, Colonel Rice sent the following message to theCommanding General, USAFIA: "Urgently recommend no further troop movementto Cloncurry Air Field, camp facilities inadequate, city water supply untreated,sanitation in city and camp poor, mosquitoes and flys [sic] numerous anddangerous to health of command, recommend sending at once an Army engineer andsenior medical officer."32 Apparently as a result of thismessage, a sanitary survey was made on 4 Aprilby 1st Lt. Donald D. Davis, MC, Flight Surgeon, 30th Bombardment Squadron, inwhich he made many recommendations for improvement. Chief among these were:
1. Immediate installation of water purification system,together with periodic testing and bacteriologic control by the U.S. ArmyMedical Department. At the same time, he condemned water from an airbase well,then being dug, as unfit for drinking since it was located in the town drainagearea.
2. Screening and flyproofing buildings of Cloncurry DistrictHospital where 10 beds had been allocated for U.S. Army patients. Replacement ofopen pail latrines in the hospital by a closed sewer system with a septic tank,and draining of stagnant pools of waste water in which mosquitoes were breeding.He deemed conditions so poor here that he requested a clearing station unit beprovided to care for and feed Army patients.
3. Improvement of sanitary conditions within the camp. Hefound these appalling due to stagnant water, the presence of animal excreta allover the ground, and a superabundance of flies and mosquitoes. Conditions wereso serious here that he also recommended that "enlisted men" beordered to use face nets constantly.
4. The immediate institution of a townwide campaign foreradication of fly and mosquito breeding places. He judged town conditions thus:"No attempt whatsoever is being made by the general public of Cloncurry tocontrol the breeding of mosquitoes * * *.Open water pails and water tanks exist everywhere and arenot protected by oil film. * * * U.S.Army troops * * * subjectedto the dangers of diseases endemic and epidemic in this area ** *. At present time Dengue Fever is epidemic. Malariais endemic, as is typhoid fever."33
His progress report 2 weeks later revealed how much it wasnecessary
31Letter, A. E. Kelso to Commanding General, USAFIA, 31Mar. 1942, subject: Report of Inspection, Cloncurry Water Supply, 28-29 March1942.
32Radiogram, Col. George W. Rice, MC, to CommandingGeneral, USAFIA, 30 Mar. 1942.
33Letter, 1st Lt Donald D. Davis, MC, Flight Surgeon,30th Bombardment Squadron, to Senior Flight Surgeon, USAFIA, 4 Apr. 1942,subject: Sanitary Survey of Cloncurry Camp.
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for the Americans to do. Actions were taken with at least thetacit consent of the civilian authorities who had little manpower, funds, andmaterial at their disposal, and seemed quite willing for the Americans to stepin and take charge, as long as the United States paid the bill.
Lieutenant Davis reported that both civilians and soldiershad been forbidden to swim in the Cloncurry River because of the pollution foundthere. He had also enlisted the help of Australian VAD (Volunteer AidDetachment) nurses to impress upon the local residents the need for eliminatingmosquito breeding places. Concurrently, to conserve water, the VAD nurses werecanvassing all homes to locate any leaking tanks, pipes, or faucets which theythen reported to Lieutenant Davis. Not all improvements recommended for thehospital were yet being made, but construction of a closed sewer system for thehospital had started, with the work being done by a detail of men from the 394thQuartermaster Battalion (Port). Advertising and publicity were begun throughoutCloncurry to enlist support in fighting flies and mosquitoes. Handbills weredropped from airplanes and were given to schoolchildren to take home,advertisements were placed in the newspaper, and notices were flashed nightly onthe local theater's screen. These actions were only hasty beginnings in theeffort to establish a safe environment for American troops. As time passed, morepermanent and lasting improvements were made through joint Australian-Americancooperation.34
Experiences similar to those in Cloncurry took place in manyother communities, some with even more extensive American participation, such asthe use, in Rockhampton, of U.S. Army troops as agents of the town council inmaking a house-to-house search to locate and eliminate mosquito breeding places.Cairns was the scene of many cooperative projects, all designed to end epidemicmalaria in this region.35
FOOD INSPECTION
Since Australia was a food-exporting nation and food shippedfrom the United States took up valuable hold space in the too few cargo ships,it was soon decided that Australia would supply meat, dairy products, and otherfoods to the American Army in a reverse Lend-Lease program. While this decisionwas logistically sound, it posed extremely grave problems in preventive medicinesince food-handling sanitary standards were appallingly low when compared withthose in the United States. This was particularly true of the small marginalproducers who were suddenly required to increase production manyfold and couldnot hire trained personnel, expand their plants, or buy modern equipment.Sanitary reports repeatedly described the lack of cleanliness and inspectionstandards in slaughterhouses, dairies, and food-processing plants. Lt. Col. C.W. Cowherd, VC, appointed
34Letter, 1st Lt. Donald D.Davis, MC, Flight Surgeon, 30th Bombardment Squadron, to Senior Flight Surgeon,USAFIA, 21 Apr. 1942, subject: Progress Report on Sanitary Survey, Cloncurry.
35See footnote 20, p. 543.
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chief of the USAFIA Veterinary Section in April 1942,estimated that 5 to 10 percent of the cattle had tuberculosis and found littleevidence of a tuberculin-testing program.36
Initially, because U.S. Army troops were grateful for anyfood furnished, medical and veterinary officers confined their inspections todelivered food products. This food was the regular ration used by the AustralianArmy with some adjustment to accommodate the difference in diet between the twoarmies. Because it was procured and issued to American units by Australian Armyquartermasters, there was some doubt among American inspectors of theirauthority to condemn or reject rations issued by the Australian Army. However,in early 1943, this system ended, and food was purchased directly from theproducer. Subsequently, as procurement became better organized and wasformalized by contract with suppliers, preventive medicine and veterinaryofficers were able to expand their inspections to food sources, rejectingproducts from all suppliers who failed to maintain adequate sanitary standards.Through this method, satisfactory standards were achieved.
At no time, of course, did the American forces have anylawful basis to force maintenance of good sanitary conditions among suppliersexcept through contractual penalty clauses which included the right to inspectfood at any point in its processing. Contract cancellations, of course, producedno food; therefore, American inspectors much preferred to advise and help theproducers rather than to threaten or penalize them.
Some meat and dairy products already met U.S. standards.Foods of animal origin destined for export were processed under supervision ofthe Department of Commerce, Commonwealth of Australia. The standards of thisagency were such that food prepared under its supervision was acceptable to theU.S. Army without further inspection except upon receipt. Unfortunately, theDepartment of Commerce was not sufficiently well staffed, nor in a legalposition, to inspect food for domestic consumption. This was the states'domain, and their laws were not so stringent nor their inspections so carefulas those of the Commonwealth.
This is not meant to imply that local health officials wereindifferent to adequate public health measures. They were fully aware ofdeficiencies but were hampered by shortages of personnel, equipment, and funds,not to mention the indifference of local officials and politicians.37
American officers assisted the producers in many ways, suchas obtaining priority in delivery of pasteurization equipment and securingrefrigerated railroad cars for shipping milk. Realizing that public health inall Australia would be enhanced by the adoption of sanitary measures, suppliersusually were willing to accept American Standards when given the guidance andthe wherewithal. Particular impetus toward improved milk han-
36Stauffer, Alvin P.: U.S. Army in World War II. TheTechnical Services. The Quartermaster Corps: Operations in the War Against Japan. Washington: U.S.Government Printing Office, 1956, pp. 99-120.
37Memorandum, O. St. J. Kent, Senior Dairy Technologist,to Director of Dairying, Department of Agriculture and Stock, 16 Aug. 1942,subject: Townsville Milk Supply.
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dling was generated in March 1943 when a cholera epidemicoccurred among the civilian population of Melbourne, and cost 28 lives in 500cases. This epidemic, traced to the consumption of contaminated raw milk,resulted in establishment of more sanitary milk-handling programs.38 Althoughno U.S. military personnel contracted cholera, its appearance in epidemic formillustrated the absolute necessity for the U.S. inspectors' insistence uponhigh sanitary standards and made their task somewhat easier. Undoubtedly, thisinsistence had a permanent effect on Australian public health. At the least, itgained, through voluntary cooperation of the suppliers, safe and ediblefoodstuffs for the U.S. soldier. In milk, particularly, the improvement wasremarkable. While Army standards required a bacteria count of less than 50,000per cc., samples of milk taken at the point of consumption by preventivemedicine personnel sometimes contained up to 196 million bacteria per cc., allwith colon aerogenes present.39 Nevertheless, by 1943, with Americanassistance, the dairy industry was able to produce sufficient milk meeting Armystandards to supply all American troops except for a few in remote areas. Thiswas a remarkable achievement, even considering the advice and assistance givenby U.S. inspectors.
There was also the problem of protecting the health ofsoldiers eating in civilian milk bars and cafes, many of which were unsanitaryor whose food did not come from U.S.-approved sources. In some instances, Alliedsanitary committees or similar groups were formed which outlined sanitaryrequirements to restaurant owners, gave them a period of time to meet thestandards, and then inspected the premises. Submission to this program wascompletely voluntary on the part of owners; however, desiring the soldiers'patronage, they were usually eager to cooperate.40
Approved establishments were given signs to display in theirwindows, which indicated that U.S. troops were permitted to trade there. Thesoldiers were instructed to consider as "off limits" all places notdisplaying such a sign.41
MISCELLANEOUS CIVIL AFFAIRS
Quarantine
Commonwealth quarantine regulations governing the importationof American foodstuffs for the Army were initially waived but were partiallyreimposed in January 1943, when importation of uncooked meat products wasbanned. This order, to which General MacArthur strongly objected, was issuedfollowing an outbreak of hog cholera, which had not occurred in
38(1) Miller, Everett B.: MedicalDepartment, U.S. Army. Veterinary Service in World War II. Washington: U.S. Government Printing Office, 1961, pp. 303-331. (2) Headquarters, 22d PORT (TC) and Base Section No. 4, USASOS, SWPA, to The AdjutantGeneral, 8 Apr. 1943, subject: Sanitary Report for Month of March 1943.
39Headquarters, Base Section No. 2, USASOS, SWPA, to TheAdjutant General, 3 Mar. 1943, subject: Sanitary Report for the Month ofFebruary 1943.
40See footnote 29, p. 548.
41See footnote 39.
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Australia since 1928. The Commonwealth investigator named asthe source a cold storage shipment of spareribs brought aboard the Pensacola convoywhich was not consumed until August or September 1942.42
Animals accompanying the U.S. forces were never permitted toenter Australia, but, inevitably, some troops hid pets and brought them ashoresurreptitiously. Even such animals as war dogs and pack artillery mules,destined for important use in tactical operations, were barred so as to preventthe entry of equine encephalomyelitis and infectious anemia, both epizootic inthe United States. Despite a direct appeal from General MacArthur to the PrimeMinister, this ban was never relaxed.43
Commonwealth quarantine officials permitted U.S. medicalofficers to inspect personnel debarking from either ships or aircraft. Ineffect, they were expected to act as agents of the Chief Quarantine Officer toprevent the unauthorized entry of persons with smallpox, plague, cholera, yellowfever, typhus fever, or leprosy. Any person discovered with symptoms of thesediseases was required to be placed in one of the quarantine stations operatedby the Commonwealth.44
Public Health Laboratories
Until U.S. Army hospitals and laboratories began arrivingfrom the United States in mid-1942, medical officers had no facilities undertheir control for bacteriologic examination of water and food specimens or toaccomplish serological tests for tropical diseases. To remedy this, Dr.Cumpston, the Director-General of Health, permitted American medical officersnot only to submit specimens for examination but also to use personally thelaboratory facilities to conduct necessary research. Twenty public health anduniversity laboratories were designated to provide the assistance desired. Thefact that working space was offered in these important installations ischaracteristic of the harmony and general spirit of cooperation existing betweenthe Australian and American medical officers and physicians.45
Professional Relationships
In reviewing the various reports submitted by medical unitsand individuals, one is impressed by the many references to the cordialrelations enjoyed with Australian members of the medical, dental, and alliedprofessions. There was a substantial friendly exchange of information, supplies,and support. This cross-fertilization of medical knowledge, techniques, and
42Medical Department, U.S. Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955, p. 323.
43Letter, GHQ, SWPA, Office of the CinC, to The Right Honourable John Curtin, Prime Minister, 23 Jan. 1943, subject: Quarantine Restrictions.
44Letter, Paul Mitchell, Chief Quarantine Officer (General), to Colonel Rice, Base Section No. 3, USASOS, SWPA, 30 May 1942, subject: Quarantine and Air Navigation.
45(1) Memo, J. H. L. Cumpston, Director-General of Health, to Secretary, Department of Defense Co-ordination, 20 Apr. 1942, subject: Permission to Use Laboratory. (2) Letter, J. P. Abbott, Chairman, Administrative Planning Committee, to Capt. Nathan J. Serlin, MC, 9 Apr. 1942, subject: Use of Laboratories.
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schools of thought proved of permanent value to both nations.It took tangible form in such matters as the passage of the Commonwealth Act forbetter control of venereal disease carriers, which was earnestly supported bymedical personnel of both nations, and in the training given American physiciansthrough courses of instruction at such schools as the Sydney University Schoolof Tropical Medicine and Hygiene. Even more important but less tangible was theexchange of information gained at professional meetings, where each attended theother's functions as welcome, distinguished guests and lecturers.
SUMMARY
Wartime conditions dictated the concentration of U.S. troopsin the steamy, unhealthy jungles of northern Australia, not in the pleasantcities nor fertile farm lands further south. Hence, disease problems weremultiplied. Small towns, near which the troops were concentrated, were healthfulenough for the small number of inhabitants but simply did not have the purewater supply nor waste disposal facilities to cope with a large influx ofsoldiers; nor was there time, equipment, money, or manpower to build them.Unsanitary conditions in food processing were the inevitable results of hastilyexpanded wartime production. Small rural slaughterhouses had to produce hugequantities of meats without the equipment or facilities to do so under sanitaryconditions, nor did the people operating them have the requisite training orexperience. The public health agencies were simply too undermanned because ofincreased wartime demands to solve these difficulties quickly.
At the same time, however, one should not overlook theremarkable accomplishments of U.S. Army medical personnel. Their task wasdifficult. Australia presented unfamiliar disease problems. There was, to beginwith, no agency to maintain liaison with local civilian authorities, and U.S.Army facilities, such as hospitals, medical depots, and laboratories, were atfirst nonexistent.
The remarkable fact is that so much was done. The health ofour troops was protected, adequate quantities of wholesome food were produced tofeed the fighting forces, and many other vexing problems were solved. Thesepositive achievements are permanent monuments to the cooperation betweenAustralians and Americans.
Section II. New Zealand
INTRODUCTION
New Zealand had been at war with Germany and Italy sinceSeptember 1939 when its government declared war on Japan on 9 December 1941. NewZealand forces, fighting as part of the British Commonwealth, had
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been driven out of western Europe, Greece, and Crete andwere, even then, fighting a seesaw battle in North Africa to save Cairo and theSuez Canal. The Japanese blow at PearlHarbor and the swift advance through southeast Asia brought a new opponent, andthis one much closer. New Zealand, with fewer than 2 million people and most ofits armed forces serving many thousands of miles away, felt vulnerable indeed atthis time. However, its location only 1,200 miles east of the AustralianContinent, was of extreme strategic importance to the Allies because it securedAustralia's flank against further Japanese incursion, and was also on the lineof communications from the United States (map 17). Quickly, therefore, the U.S.Navy was given the mission of securing this line of communications, thusbecoming responsible for New Zealand's sea defenses but not its land defense,which remained under the control of New Zealand. Later, although both Australiaand New Zealand preferred to be included in the same theater of operations, NewZealand fell within Adm. Chester W. Nimitz' Pacific Ocean Areas, a Navycommand, while Australia became part of General MacArthur's Southwest PacificArea, an Army command. Consequently, all U.S. Army activities in New Zealandwere under Navy control.46
Strictly speaking, there were no formally designated U.S.Army Civil Affairs/Military Government activities in New Zealand because theregular government remained in authority. Thus, all public health activities andproblems which arose as a result of U.S. troops' being in that country werearranged and solved through negotiation and agreements between the twogovernments. These activities, of course, were Civil Affairs, regardless oftheir name.
THE NATION
New Zealand is composed principally of two large islands,North Island and South Island, which together form the bulk of the landmass. Onthem are located most of the inhabitants, industries, and farms. Auckland andWellington, both on North Island, are the largest cities and the major ports.The country is spectacularly beautiful, with many mountains and much vegetation.Abundant streams provide an ample supply of hydroelectric power; however, theabsence of large mineral deposits made New Zealand primarily an agriculturalrather than an industrial society. Blessed with a temperate climate and richgrazing land, it had become one of the world's leading exporters of mutton,lamb, wool, butter, and cheese.
Dominion status was not granted to New Zealand until 1904although it had been self-governing since 1852. The Labour Party, which firstcame to power in 1935, had sponsored a program of liberal economic and socialmeasures which culminated in the socialization of medicine in 1941. It wascarrying forward a tradition of social welfare legislation that began as ear-
46Morton, Louis: United StatesArmy in World War II. The War in the Pacific. Strategy and Command: The First Two Years. Washington: U.S. GovernmentPrinting Office, 1962, pp. 203-204 and 244-252.
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MAP17.-Allied shipping and airlines from the United States to Australia and New Zealand.
ly as 1898 when the dominion was the first to adoptnoncontributory old-age pensions. In 1907, a national infant welfare system wasestablished and, in 1938, the Social Security Act provided greater old-agebenefits, widows' pensions, family benefit payments, care of orphans, minimumwage levels, a 40-hour week, and unemployment and health insurance.
Generally, health conditions in New Zealand were excellent,the recorded death rate being among the lowest in the world, and there was awell-organized public health service. The Department of Health of New Zealandwas headed by a Director-General; and the nation was divided into healthdistricts, each under the direction of a physician qualified in public healthwork.
U.S. ARMY COMMAND STRUCTURE
Although the U.S. Navy began using New Zealand ports almostimmediately, the threat of an early Japanese invasion was remote; hence, no im-
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mediate effort was made to dispatch U.S. Army troops there.But early in March 1942, Winston Churchill, hopeful that he could retain in theMiddle East the experienced troops these countries wanted brought home for theirprotection, asked President Roosevelt to send a division each to Australia andto New Zealand. This Roosevelt agreed to do, and ordered the 37th InfantryDivision to New Zealand.47 On 30 May 1942, the advance party ofthis Division landed at Auckland, together with Headquarters, and HeadquartersCompany, 1st Port of Embarkation, which was sent to establish port facilitiesfor the main body of the 37th Division. Shortly thereafter, the 1st MarineDivision, destined for early combat, also began to arrive. By early August,however, both divisions had departed, the Marines to prepare for theirGuadalcanal invasion and the 37th Division to the Fiji Islands to relieve theNew Zealand troops there. Allied planners, by this time, had realized that NewZealand was too remote from anticipated combat areas in the South Pacific foruse as an advanced base for American military forces. Subsequently, large UnitedStates combat units were stationed there only for reorganization andrehabilitation following combat.
U.S. Army troops, which were soon stationed on many of theislands in the South Pacific area, did not come under a single Army commanderuntil 14 July 1942 when Maj. Gen. Millard F. Harmon was named to commandUSAFISPA (United States Army Forces in the South Pacific Area). The USAFISPASurgeon was Col. (later Brig. Gen.) Earl Maxwell, MC.
Headquarters, USAFISPA, was first located in Auckland butmoved to Noum?a, New Caledonia, in November 1942. The Army command remainingbecame Headquarters, Service Command, and USAFINZ (United States Army Forces inNew Zealand).
Several officers served as Surgeon, USAFINZ. Lt. Col. (laterCol.) Amos R. Koontz was in this position for 2 years, succeeding Lt. Col.(later Col.) Wallace S. Douglas, who moved on to New Caledonia in March 1943.
U.S. Army Hospitals
The first U.S. Army hospital to arrive in New Zealand, the18th General Hospital with 1,000 beds, landed at Auckland on 12 June 1942,together with the main body of the 1st Port of Embarkation which had an organicmedical section sufficiently large to staff a port dispensary and a Surgeon'soffice. An infirmary had already been established on an Auckland pier by membersof the advance cadre of the 1st Port, and hospitalization had also beenarranged at various military and civilian hospitals in and about Auckland.
Auckland was only a temporary stop for the 18th GeneralHospital, which soon went to the Fiji Islands. But while in New Zealand, thisunit established a 30-bed casualty clearing hospital at Camp Papakura where the
47See page 220 of footnote 46, p. 555.
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male personnel lived in New Zealand Army barracks. Nofacilities were available, however, for nurses who were housed in private homes.48
In July 1942 upon the establishment of U.S. Naval MobileHospital No. 4 at Hobson Park, Auckland, and, later, Hospital No. 6 atWellington, hospitalization of U.S. service personnel was fully assumed. In theinterim, hospitalized troops primarily were under the care of New Zealandphysicians although U.S. Army medical officers did make daily ward rounds. Herethese medical officers first learned "that all nurses were 'sisters'and that even medical activities wait on morning and afternoon tea."49
On 28 October 1942, construction was begun on a 1,000-bedhospital plant which was subsequently to be staffed by the 39th General Hospital(fig. 75) upon its arrival in November 1942. Until their building was ready,personnel of that hospital were loaned to the U.S. Navy hospitals to help carefor the casualties then beginning to arrive from Guadalcanal, and some evenwent on duty at the Auckland City Hospital to help relieve the shortage ofcivilian physicians.50
The U.S. Army Medical Department finally started "takingcare of its own" on 7 February 1943, when the first Army patients were transferred from theNavy hospital to the 39th General Hospital. The new hospital had been built bythe New Zealand Government and lent to the Army in a reverse Lend-Leasetransaction. Located just outside Auckland, it was intended for use as aveterans' hospital after the war and was substantially constructed. Throughoutthe war, the 39th General Hospital was the only U.S. Army hospital to functionas such in New Zealand although a center consisting of two 1,000-bed generalhospitals had initially been planned. Two other hospitals, the 18th General andthe 37th Station, were in New Zealand for short periods but were never fullyoperational. Despite the failure to establish the center and another hospital,the number of beds planned was reached and exceeded by the 39th General Hospitalalone, which maintained 2,536 beds at one time. In addition, the 39th operated aconvalescent hospital.51 Hospitalization for U.S. personnel ended asit had begun, with the transfer, on 20 November 1944, of 12 patients to anAuckland civilian
48(1) Douglas, W. S., M.D., Summary ofMy Military Experiences (With Special Remarks Concerning New Zealand), December 1964. (2) Tilgham, R. Carmichael,M.D.: L.O.D-Yes: An Odyssey of the Army's 18th General Hospital. The Johns Hopkins Alumni MagazineXXXVI, Nos. 1, 2, and 3, November 1947, January and March 1948.
49See footnote 48 (1).
50(1) Army Medical Bulletin No.63, July 1942, pp. 41-70. It was estimated that almost one-third of the NewZealand physicians were serving overseas with their armed forces. (2) Letter,Capt. John H. Robbins, Commanding Officer, U.S. Naval Mobile Hospital No. 4, toRear Adm. Luther Sheldon, BUMEDS, Navy Dept. 9 Jan. 43. The following quotationfrom this informal report reveals that help from the 39th General Hospital wasboth significant and appreciated by the Navy: "You probably did not knowthat we had made some use of the personnel of the U.S. Army General Hospital No.39, * * * theywere a God-send as at that time we had only 290 corpsmen and the patients werewell over the thousand mark. Today we have 414 corpsmen on duty and 28 nurses (Navy) plus 143 Army corpsmen, 45 Army nurses and 14 Armyofficers." (3) History, 39th General Hospital July 15th, 1942-June 30,1943. This report states also that 25 nurses were lent to USNMH No. 6 atWellington.
51(1) Memorandum, Maj. Gen. Thomas T.Handy to Commanding Generals, AGF and SOS, 19 July 1942, subject: Army Hospital Center for Auckland, NewZealand. (2) Annual Report of Medical Department Activities, South Pacific Area1943, 12 Feb. 1944. (3) Annual Report and Medical History, 39th GeneralHospital, 1943.
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FIGURE 75.-Aerial view of the 39th General Hospital, near Auckland, New Zealand.
hospital from the 39th General Hospital preparatory to its closing. During its 21 months in operation, the hospital admitted 23,411 patients, most of them sick and wounded from the Solomons Campaign.52
Preventive Medicine Activities
Unlike Australia where it was necessary to create bases in unsettled or rural areas, the U.S. Army in New Zealand went into more or less established military installations near large, modern cities. Thus, a potable water supply was available and adequate waste disposal systems usually existed without augmentation. Further, when new construction became necessary, such as the hospital plant for the 39th General Hospital, the New Zealand Government developed the plans and supervised the construction although modifications or alterations suggested by U.S. staff officers often were accepted.53
No venereal disease problems of consequence were encountered. The usual educational campaigns were conducted among U.S. forces and a number of prophylactic stations were operated in or near the metropolitan
52Annual Report and Medical History, 39th General Hospital 1944.
53Interview, Lt. Col. Eugene T. Lyons, MSC, with Col. Frederick Freese, Jr., MC, USAF, 11 Dec. 1964.
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areas on a 24-hour basis. When the name and address of asuspected venereal disease contact were given to the local health authorities,they cooperated in apprehending and hospitalizing her until treatment hadrendered her noncontagious. Another aspect of cooperation began in 1944 whenpenicillin was administered to infected female contacts by U.S. Army medicalpersonnel. At that time, penicillin was not available to civil public healthofficers for their use.54
COMMUNICABLE DISEASES AND SANITATION
New Zealand had none of the tropical diseases found on thoseSouth Pacific islands located closer to the Equator nor were the importanttropical diseases found, such as cholera, plague, smallpox, epidemic typhusfever, and yellow fever, which are subject to quarantine laws. However, it didhave all the diseases that commonly occur in temperate climates, and these inabout the same proportion as on the North American Continent.
The venereal disease rate was not high because of awell-organized venereal disease control service. Enteric diseases, includingtyphoid and paratyphoid fevers, amebic dysentery, and bacillary dysentery,occurred sporadically and in small epidemics. It was estimated that 44 percentof the sheep and cattle were infested with Echinococcus, minute tapewormswhich are transmissible to man and cause hydatid cysts. Other transmissiblediseases included dengue fever, infantile paralysis, leptospirosis, undulantfever, anthrax, tetanus, tuberculosis, helminthiasis, and acute infectiousrespiratory diseases. Principal insect disease vectors were houseflies andmosquitoes of genus Aedes.
Screening of morbidity reports from U.S. Army units in NewZealand did not reveal the occurrence of Echinococcus amongst Armypersonnel, nor any cases of undulant fever, at least in 1942 and 1943 whenNew Zealand was included in the South Pacific Island Command. In 1944, the SouthPacific Island Command was combined with the Central Pacific Island Command toform the Pacific Ocean Areas Command, after which separate records for NewZealand could not be traced. Tuberculosis incidence is available for 1942 and 1943;however, there are no separate figures on theincidence of bovine tuberculosis amongst Army personnel.
Before the war, only a few cases of malaria were reportedeach year, perhaps from among travelers abroad, and there were no reports of thepresence of anopheline mosquitoes in New Zealand. Regardless, precautionsagainst importation of anophelines were adopted. Besides routine spraying orfumigating of aircraft and vessels to kill adultmosquitoes, their potential breeding places in uncovered water reservoirs, suchas lifeboats, were washed down with seawater or treated with insecticide, andstagnant water around airfields was either drained or treated.
Servicemen returning from islands where malaria existed were permit-
54Thompson, Capt. Arthur I., Surgeon, Section SPBC: History of Venereal Disease-South Pacific Area, 24 Jan. 1946. [Official record.]
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ted to go anywhere in New Zealand without fear of introducingthe disease. This differed from the situation obtaining in Australia wherethey were barred from potentially malarious areas on the continent. The problemexisting in New Zealand was not to control the spread of malaria but only totreat the malaria existing among troops returning there for hospitalization,rest, or rehabilitation (see p. 564). Ordinarily, this would not have concernedcivilian hospitals and medical practitioners because there were sufficientmilitary hospitals to care for military patients. But civilian physicians oftenwere called upon to treat the many U.S. servicemen who suffered malaria attackswhile on leave. When the 1st Marine Division returned from Guadalcanal inDecember 1942, leaves and passes were given liberally to the combat-weary men,who promptly spread throughout the Islands. Suppressive quinine or Atabrinedoses were immediately discontinued for some of these men while others weregiven up to 30 grains of quinine sulfate to be taken over a 3-day period.Shortly, wherever they were and at more or less the same time, many of themcollapsed with severe malaria attacks. Surprisingly, a large number ofphysicians treating the stricken soldiers were no more familiar with malariathan their American colleagues. While Colonel Douglas was USAFINZ Surgeon, heoften was called by physicians who were reporting that a U.S. soldier was sickwith pneumonia. Almost invariably, when blood examinations were completed, itproved to be malaria. Occurrences like this ceased when the necessity forcontinuing suppressive drugs was recognized.55
Except for a few regions where irrigated farming waspracticed, water was plentiful. That for human consumption was generally fromrivers, deep wells, and impounded surface water. Only a few of the larger citiesfiltered and chlorinated their water. Where flush toilets were in use, theiruntreated effluent emptied directly into streams or the ocean.
Despite the exportation of dairy products in large amounts,dairy facilities in New Zealand were not modern and epidemics frequently werecaused by milkborne diseases. Undulant fever and tuberculosis were widespreadamong dairy herds, but there was only limited veterinary inspection of meats anddairy products.56
FOOD PROCUREMENT AND INSPECTION
Food Procurement
More than 500 million pounds of foods of animal origin wereprocured in New Zealand by the JPB (Joint Purchasing Board), an agency havingU.S. Army representation but under U.S. naval control. This amounted to almosthalf the food consumed by American forces in the South Pacific Area during thewar. This board was not permitted to buy products directly from the source but,instead, had to order from the Dominion Government,
65See footnotes 48 (1) and 50 (1),p. 558.
66See footnote 50 (1), p. 558.
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which then placed its own contracts with the producers fordelivery to JPB warehouses. This procedure hopefully would avoid competition forthe available food, unwarranted price increases, and unequal distribution.Praiseworthy though its goal may have been, the procedure, throughout the war,clouded the right of U.S. procurement officers to inspect food during itsprocessing and to reject any not meeting U.S. standards. Not until 1944 wereVeterinary Corps officers permitted to begin large-scale inspection of plantsand food products although development of adequate inspection services had beenadvocated as early as 1942 by unit officers who inspected food upon issue to theusing unit.
According to medical and veterinary personnel, the need forinspection was acute despite the high reputation New Zealand food exports hadenjoyed before the war. Most food destined for export was produced by large foodand meat processors in modern, efficient plants whose output was inspected by anational agricultural agency recognized by the U.S. Department of Agriculture.Wartime demands for food production brought unprecedented expansion of existingplants and the establishment of additional slaughterhouses, dairies, andcanneries. Many of the new producers were basically unfamiliar with requiredsanitary practices. Further, their plants and machinery were either antiquatedor makeshift. Dominion veterinary inspectors were both few in number and rarelywell qualified, which was not surprising since New Zealand had no school ofveterinary medicine and the ratio of veterinarians to domestic farm animals wasless than one-tenth that of the United States.
Even when the necessity for inspection was fully recognizedby the Joint Purchasing Board, there were never enough personnel to perform acontinuous inspection during foodstuff processing nor did those present haveauthority to threaten contract cancellation for noncooperating producers, as wasdone so effectively in Australia. By persuasion and instruction, however,inspectors did succeed in improving food quality and raising sanitary standardsin most plants supplying products to the Board. This was usually done by showingthe producer that better sanitation and more modern processing methods meantfewer losses by contamination or spoilage.57
Inspection of Eating Establishments
The many civilian restaurants and dairy bars offered awelcome diversion from Army messes for the large numbers of soldiers sent to NewZealand for rest, rehabilitation, and convalescence. On the whole, these eatingplaces were reasonably sanitary; the few maintaining less than acceptablestandards were placed "off limits" to our troops after inspection byU.S. personnel who, at least in Auckland, were able to inspect cafes andrestaurants through the cooperation of the Public Health Officer. Dairy bars
57(1) Moore, Col. H. K., MC:History of the Army Veterinary Service With the United States Joint Purchasing Board, New Zealand, 29 Oct. 1945, ch.II. (2) See footnote 38 (1) p. 552. (3) Medical Department, United States Army. Organization and Administration in World War II. Washington: U.S. Government Printing Office, 1963, pp. 391-392.
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proved the most troublesome from the preventive medicinestandpoint because pasteurization was rarely accomplished and raw milk was oftenmixed with pasteurized milk. Only one of the three large Auckland dairiesproduced milk which met U.S. standards, and the small amount of milk purchasedfor troop messes was bought from that dairy. Not until quite late in the war didthe other two dairies qualify. Milk was not the same desirable beverage to thetypical New Zealander that it was to the American. The New Zealander muchpreferred tea, and fresh milk's reputation for periodically causing typhoidepidemics caused many to shun it in favor of evaporated milk. Home-deliveredmilk was carried on carts in large, often uncovered containers, and poured, ordipped, into vessels the purchasers brought themselves. The entire transactiontook place on streets both paved and unpaved. Containers were seldom sterilized,and the average person working with milk was unschooled in the need forcleanliness. One U.S. medical officer recalls that "the milk bars did notseem clean, were odorous and sour smelling." He also reported that at leastone New Zealand public health officer, in despair over the unsanitary milkhandling conditions, "thought that milk should not be permitted as abeverage."58 Under these conditions, it was decided that milkbars would be placed "off limits" to U.S. troops. Despite manydiscussions between American and New Zealand public health officials, progressin improving the product was slow and never accomplished to the fullsatisfaction of U.S. officials.
MISCELLANEOUS CIVIL AFFAIRS
Quarantine
Responsibility for enforcement of New Zealand quarantineregulations rested with the Port Health Officer at each port of entry until 13September 1943 when U.S. authorities were permitted to inspect vessels andairplanes. Discussions to this end had begun between public health officials andmilitary officers as early as November 1942. The long interval between thebeginning of discussion and the final enactment of enabling legislation wouldindicate some reluctance to delegate the inspection function. This is borne outfurther when one considers that even the New Zealand armed forces were notpermitted to conduct their own inspections until this time.
The new regulation permitted the military medical officers ofeither nation to inspect and disinsectize their own ships and aircraft. Theywere also required to report any suspicious illness or disease among passengersto the civil public health officer. In the same regulation, civilianharbormasters were directed to keep down the rat and mosquito populations atports, and military airbase commanders were told to establish mosquito controlmeasures for a distance of 1 mile outside their bases.
58(1) See footnote 48 (1), p. 558,and pages 164-167 of footnote 57 (1), p. 562. (2) Koontz, Amos R., M.D.,unpublished manuscript, 1964, subject: Civil Affairs-Military Government PublicHealth Activities, New Zealand.
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Enforcement of disinsectizing regulations in actual practicewas somewhat less than perfect as is evidenced by the adoption in August 1944 ofan amendment to the quarantine regulations, providing that a fine of LNZ 50($160.30) be assessed against any person leaving an aircraft or taking anythingfrom it less than 5 minutes after fumigating or spraying. Although thisregulation specifically applied to military personnel and aircraft, there is norecord of an actual levying of the fine against any U.S. military personnel.59
Professional Relationships
Rapport between U.S. medical personnel and their New Zealandcounterparts, both civilian and military, was excellent. On numerous occasions,American servicemen were admitted to civilian hospitals and placed under thecare of staff physicians. Conversely, to the great appreciation of the AucklandHospital Board, seven medical officers served the staff of Auckland CityHospital for about 3 months to help alleviate the shortage of civilianphysicians while the 39th General Hospital was awaiting construction of itsbuildings. Civilian physicians and personnel of allied professions wereextremely anxious to help their American counterparts. They eagerly shared theirknowledge of South Pacific tropical diseases, their resources and equipment,assisting in every way possible. This was reciprocated whenever practicable,such as in the administration of penicillin to civilians. Illustrative of themutual respect existing were the monthly meetings of Auckland members of theBritish Medical Association with the combined staffs of the 39th GeneralHospital and the U.S. naval hospitals. Case studies and papers were presented atthese meetings and joint clinics were held at both military and civilianhospitals.60
59(1) Notes of conference held on2 September 1943 at the Department of Health, Wellington. These notes refer to aprevious meeting on the subject of quarantine, at which a resolution was passedrecommending certain changes in quarantine procedures. (2) Memorandum, Office ofMinister of Health, Wellington, to Minister of Defense, 16 Dec. 1942, subject:Quarantine Responsibilities of Military Forces (NZ and US). (3) The Quarantine(Armed Forces) Emergency Regulations 1943 and Quarantine Regulations 1921,Amendment No. 3, effective on 21 August 1944.
60(1) See footnotes 50 (3) p. 558,and 58 (2) p. 563. (2) History of the 39th General Hospital, quarterly period 1April-1 July 1944.
