Part VI
ASIA
CHAPTER XVII
China-Burma-India Theater
Kirk T. Mosley, M. D., and CaptainDarrell G. McPherson, MSC, AUS
ORGANIZATIONAL BACKGROUND
The CBI (China-Burma-India) Theater was created on 4 March1942 when the U. S. Forces Commander, Lt. Gen. (later Gen.) Joseph W. Stilwell,established his headquarters in Chungking, the wartime capital of China. As thetheater was being organized, it consisted of a Theater Headquarters, SOS(Services of Supply), the Army Air Forces, and the Air Transport Command. Majorresponsibility for civil public health activities fell to the Theater Surgeon,Col. (later Brig. Gen.)Robert P. Williams, MC, andthe Services of Supply Surgeon, Col. John M. Tamraz, MC.1
The Theater Surgeon's staff operated two headquarters, the"forward echelon" at Chungking and the "rear echelon" at NewDelhi, India, until August 1944. At that time, the SOS Surgeon was named DeputyTheater Surgeon as an additional duty and headed a combined staff of theater andSOS personnel, already located in New Delhi (map 21). Col. Alexander O. Haff, MC,was named to this Deputy position, having replaced Colonel Tamraz when thelatter rotated to the United States in the spring of 1944.
After General Stilwell's recall in October 1944, the CBIwas split into two theaters: the China Theater commanded by Lt. Gen. Albert C.Wedemeyer, and the India-Burma Theater headed by Lt. Gen. Daniel I. Sultan.Thereafter, Col. (later Surgeon General of the Army) George E. Armstrong, MC,directed medical activities in China. Colonel Williams continued as TheaterSurgeon in India-Burma until February 1945, when Brig. Gen. James E. Baylis, MC,was named Theater Surgeon and SOS Surgeon, replacing both Williams and Haff. GeneralBaylis returned to the United States in September 1945. Col. Karl R.Lundeberg, MC, who had headed Preventive Medicine activities in India-Burma,served as theater surgeon until December, when Lt. Col. Howard A. Van Auken, MC,succeeded him.
During the war, the primary concern of American militarypersonnel in China and northeastern India was the development of an effectiveChinese fighting force while, elsewhere in India, attention was focused on thedevelopment and use of U.S. service, air, and ground combat troops. Althoughmedical officers throughout the CBI, especially in India, became
1(1) History of the United States ArmyMedical Service in the War Against Japan, ch. X. [In preparation.] (2) MedicalDepartment, United States Army. Organization and Administration in World War II.Washington: U.S. Government Printing Office, 1963, ch. XII.
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MAP21.-China-Burma-India Theater.
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involved with specific civil public health activities, no specialorganization for directing civil public health functioned anywhere in the areauntil after October 1944. Then, a G-5 Section was organized as part of theGeneral Staff of the newly created China Theater, and within the section, aCivil Affairs Branch outlined provisions for health activities for civilpopulations in reoccupied areas. However, since the potential reoccupied areasin the theater were to be returned to China, an Allied power, the directresponsibility for restoring civil administration rested with the ChineseGovernment, and the Civil Affairs Branch acted in an advisory capacity only.2
After the Japanese surrender in September 1945, forces in both theaters werereduced rapidly, and civil public health activity ceased almost immediately inthe India-Burma area. Medical activities in the China Theater were moved toShanghai, where, for the first time in the whole area, civil public healthplanning and activity involved a considerable share of the effort devoted toPreventive Medicine. By that time, however, forces had been drastically reduced,and in April 1946, the China Theater was closed, which was followed 1 monthlater by the inactivation of the India-Burma Theater.
CIVIL PUBLIC HEALTH PROBLEMS
The overwhelming problems of disease and malnutrition among the millions inthe China-Burma-India area during World War II might lead one to believe thatthe U.S. Army could have fulfilled a civil public health function of lastinghistorical importance. Yet, for reasons which become obvious after a briefexamination of the factors involved, the Army's role in promoting the healthof civilians there was minimal.
Diseases.-In these three countries which encompassed about twice as muchland as the United States, and where transportation and communication wereextremely limited and out-of-date, the population totaled more than 790 million.Among these millions raged epidemics of diseases that most American physiciansin the theater had only heard about. Plague, cholera, epidemic typhus, scrubtyphus, and malaria were common in many parts of the theater, and the spread ofthese and other diseases was increased by the hardships of war and the erraticand uncontrolled movements of millions of refugees.3
Other endemic diseases included various types of worm infections, tetanus, rabies, leprosy, venereal diseases, yaws, encephalitis, poliomyelitis, meningitis, diarrhea, dysentery, typhoid and paratyphoid fevers, dengue, tuberculosis, diphtheria, measles, smallpox, and various types of animal diseases affecting humans. Many of these diseases became epidemic at frequent intervals. Their spread and the possible spread of some diseases not endemic in the three countries were made possible by the overabundance of peo-
2Mosley, Kirk T.: History of the G-5 Section, China Theater, 21 December 1945. [Official record.]
3Simmons, James Stevens, Whayne, Tom F., Anderson, Gaylord West, Horack, Harold MacLachlan, and collaborators: Global Epidemiology, A Geography of Disease and Sanitation. Volume I. Philadelphia: J. B. Lippincott Co., 1944, pp. 1-16, 34-76, 105-130.
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ple, filth, rats, fleas, mites, flies, lice, bedbugs, ticks, and scores ofvarieties of mosquitoes.
Civilian health services, clean water, and safe sewage disposal facilitieswere totally inadequate throughout the area.
Army responsibilities.-The number of American Army medical personnel assignedto the CBI (few of whom were Preventive Medicine specialists) reached a peak of20,025 in May 1945, having gradually built up from only 119 in March 1942.4These persons were kept busy trying to bring down the high rates of malaria, andvenereal and enteric diseases among U.S. troops, as well as to meet extensiveresponsibilities for the health of the Chinese armies in training and in combat.In these circumstances, and with the threat that epidemics of plague, cholera,typhus, or other diseases might engulf the military at any time, the Army'sprime responsibility was to make certain that areas where troops wereconcentrated were relatively free of health hazards. To do this, medicalpersonnel maintained liaison with civil and military authorities of Alliedpowers and, in confined areas, carried out civil public health procedures, suchas mosquito control, rodent control, and sanitation activities. Such publichealth procedures were carried out in areas in which the health of the troopswas actually endangered. Generally, they were reactions to health hazards asthey occurred rather than well-coordinated and carefully weighed programsplanned for the benefit of the civilian population.
Subjects which became of specific concern to the Army in its attempts to makeareas safe for troops included political and social complications, liaison,direct medical aid to civilians, sanitation problems, and some of the moreimportant diseases endemic and epidemic in the three countries.
Political and Social Complications
Not only was China divided between the Japanese and Chinese, but also thoseregions still held by the Chinese were split further by warring politicalfactions, of which the followers of Gen. Chiang Kai-shek and the Communists werethe strongest. That portion of Burma not occupied by the Japanese was tornbetween nationalist and pro-British natives, with some of the nationalistspreferring the Japanese to the British. Similarly, India was in the midst of anationalist struggle with Britain and this situation was complicated further byinternal struggles between Hindu and Muslim groups. Indian nationalists regardedthe arrival of Americans in the theater as reinforcement for the British and,therefore, were not disposed to be cooperative when cooperation was necessary tocarry out civil health measures.
India was divided into 12 British provinces and some 560 Indian states; the latter enjoyed local self-government but were bound by British treaties. A complicated hierarchy of British, national, district, municipal,
4Medical Department, United States Army. Personnel in World War II. Washington: U.S. Government Printing Office, 1963, pp. 347 and 360.
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and local officialdom made up the health administration. A similar situationexisted in China, where the central government, headed by General Chiang,maintained general political supremacy in some areas, but where provincialofficials had almost absolute power locally. Burma was a combat zone. Civilpublic health machinery in all three countries had been inadequate incontrolling diseases through the years and could offer only a limited amount ofeffective cooperation to the military.
All but a small percentage of the immense population of the theater werepoor, illiterate, and unorganized peasants. Disease and famine reaped fantasticmortality rates while the great majority of the living existed only a fewmouthfuls of food away from death. The size of the populations was almostequaled by their great diversity in cultural, racial, and linguisticcharacteristics.
Religious and cultural traditions combined with the other conditions toreduce further the effectiveness of attempts by U.S. Army personnel to improvehealth within the theater. For example, one religious sect in India so objectedto the taking of life that antimosquito measures were considered to be murder.Some of these people would cover their noses with cloth to avoid breathing inand killing any tiny form of life. Among the Hindus at that time, it wasimportant that food be prepared by a member of the same or a higher caste,while contamination by flies or vermin was considered relatively unimportant.The filthy waters from sacred rivers were considered pure and beneficial todrink. Attempts by outsiders over a period of months to change such conditions,even on a small scale, could not make any impression on the traditions andhabits of centuries.5
Liaison and Command Relations
China.-Most official contact with other governments was handled throughcommand channels. As part of the mission to increase the combat efficiency ofthe Chinese Army, the Theater Surgeon, Colonel Williams, held regularconferences with the Surgeon General of the Chinese Army Medical Administration,the Director General of the National Health Administration (China), and theDirector General of the National Red Cross Society of China.6 TheNational Health Administration was the chief official civilian agency concernedwith medicine. The U.S. Army coordinated plans with the agency when a plagueepidemic threatened the civilian population in 1944. The Theater Surgeon alsohelped to arrange for the postgraduate training in the United States of some 20members of the National Health Administration and subsequently arranged fortheir transportation to America.7 Red Cross supplies allotted to the NationalHealth Administra-
5(1) Stone, Lt. James H.: The Organization and Administration of theMedical Department in the China-Burma-India and India-Burma Theaters, 1942 to1946, pp. 20-21. [Official record.] (2) Ross, Lt. Col. Stuart T.: History ofthe U.S. Army Medical Department in Delhi, India, 1945. [Official record.]
6Annual Reports of Medical Department Activities,Surgeon, China-Burma-India Theater, 1943 and 1944.
7Annual Report, Surgeon, China Theater, 1944.
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tion were transported within China by Fourteenth Air Force planes on someoccasions though the general policy was that supplies for civilian agenciesshould be carried by Chinese planes, using the facilities at U.S. bases, but notAmerican planes.8
Personnel from the Theater Surgeon's office communicated regularly withrepresentatives of the United China Relief, British and Canadian Red Crossorganizations, and other agencies to advise them on financial assistance, topreclude duplication of effort, and to keep their aims pointed toward winningthe war. Civilian agencies in China, particularly the National EpidemicPrevention Bureau, provided laboratory services for the U.S. Army, and the Armyreciprocated by furnishing transportation when the agency was forced to evacuatebefore the advancing Japanese.9 Some sort of contact was made withscores of missionary and relief organizations operating in the theater; however,the efforts of many of these organizations were curtailed somewhat during thewar, and no extensive cooperation between them and the Army was reported.
India.-The SOS Surgeon, Colonel Tamraz, worked on a more informal levelwith British and Indian officials and made several inspections of civilianhospitals in India, in part for possible American military use should thatbecome necessary. The British and Americans freely exchanged hospitalization atthe local level when there was a need. Colonel Tamraz also worked directly withIndian officials in obtaining the admission of U.S. Medical Corps officers tothe School of Tropical Medicine at Calcutta,10 and also arrangedwith the Indian Medical Service for a course of instruction in tropical diseasesto be given to some American officers at Bombay.
Medical Corps officers maintained informal contact at the local level withcivilian hospitals and officials. Health institutes and medical schools in thearea were sometimes consulted on diseases of local importance, and statisticsconcerning the health of civilians were gathered from local governmental andmilitary officials. However, the U.S. Army Medical Department did not use localagencies extensively as advisers on an official and standing basis.11 Alimited number of cooperative measures on sanitation and antimalaria procedureswere worked out with local authorities (see pp. 642 and 647).
Direct Aid to Civilians
In Burma, Army medical personnel gave treatment and emergency aid to native tribesmen who visited the several aid stations set up to provide care for troops constructing the Ledo Road, for patrols, and for Chinese sol-
8Letter, Maj. Gen. T. G. Hearn, GSC, Chief of Staff, China Burma-India Theater, to H. Hughes Wagner, D.D., 1 Apr. 1944.
9Letter, Robert M. Drummond, Special Red Cross Representative, Kweiyang, to John D. Nichols, Director, China Unit, American Red Cross, 15 Dec. 1944, subject: Trip to Kweiyang and Report on the Kweiyang Situation, November 21st-December 5th.
10See pages 185-186 of footnote 5 (1), p. 637.
11See pages 185-186 of footnote 5 (1), p. 637.
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diers being trained nearby. Provision of such aid to civilians was certainlyunofficial, but sanctioned, and came about of necessity as a means of insuringthe natives' tolerance of Allied military activity. The aid proved to be anexcellent means of securing good will and helped make possible the acquisitionof guides, laborers, housing, and other necessities, as well as informationabout enemy movement and assistance in rescuing downed airmen.12 Unofficial aidto civilians was also offered by the many native nurses working with the Armyand by personnel of medical units accompanying combat forces in the area (fig.83).
In India and China also, American personnel sometimes offered unauthorizedemergency medical aid directly to civilians, or transported the injured or sickto a civilian hospital, thus involving the U.S. Government in someresponsibility for the hospitalization.13Problemsarose because civilian hospitals sometimes refused to admit patients injured byAmerican personnel or equipment unless the individual deposited funds in advance.Sometimes, bills were sent to the U.S. Government.
Employees.-Conditions varied so greatly that a general theater policy onthe treatment of civilians employed at U. S. military installations was notconsidered practicable until January 1944. At that time, the CBI Theater Surgeonpointed out that medical officers should not compete with local practitioners,but that, in accordance with Army Regulations No. 40-505, dated 1 September1942, the Army could provide medical aid for civilian employees at stationswhere other medical attendance was not available The failure of civiliancontractors, authorities, and relief agencies to provide medical facilities for locally procured civilian employees led Adm. LouisMountbatten, the SouthEast Asia Theater Commander, to announce in May that the Army would providemedical treatment for such employees at military works in Assam and Ceylon.14
Dependents.-The question of providing care for dependents of employees atRamgarh arose early in 1944. The Theater Surgeon, Colonel Williams, decidedthat, because the unskilled laborers, sweepers, constables, and other civilianemployees were necessary for the operation of the training post, because thefamilies of these employees were already living there, and because no othermedical facilities were available for their use in that part of India, theUnited States was obligated to care for them.15
In May 1945, the China Theater commander spelledout exactly how much and to which civilians medical care or expenses for medicaltreatment
12Stone, Lt. James H.: The Hospitalization andEvacuation of Sick and Wounded in the Communications Zone, China-Burma-Indiaand India-Burma Theaters, 1942-1946, p. 39. [Official record.]
13Essential Technical Medical Data Report, RearEchelon, Headquarters, United States Forces, China Theater, Office of the ChiefSurgeon, 30 May 1945, p. 3.
14(1) First endorsement, Theater Surgeon,China-Burma-India, 3 Feb. 1944, to letter, Col. Elias E. Cooley, MC, Rear Echelon, Headquarters,USAF, China-Burma-India, to Theater Surgeon, 17 Jan. 1944, subject: Policy of Medical Treatment for CivilianEmployees. (2)Memorandum, Supreme Allied Commander Advance Headquarters, South East Asia Theater, to GeneralHeadquarters, India, 26 May 1944.
15First endorsement to memorandum, Assistant Theater Surgeon, Rear Echelon,USAF in China-Burma-India, to Theater Surgeon, 9 Feb. 1944.
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FIGURE 83.-Maj. Seldon O. Baggett, MC, examines natives typical of those who flocked daily to the 46th Portable Hospital in Hsipaw, Burma, in April 1945.
could be offered.16 Any civilian injured bypersonnel or equipment of the U.S. forces, or any employee becoming ill as aresult of employment, was eligible for care. Civilians employed by contractors(who were obligated to provide their own medical care for employees) orindividuals picked up and taken to hospitals by Americans for humanitarianreasons were not considered eligible. Contracts to provide aid to authorizedpersons at U.S. Government expense were signed with specific civilian hospitals.
Contractors in the India-Burma Theater were also obligated to provide their own medical care for civil employees. However, in at least one instance, the Army stepped in to provide inoculations. In May 1945, General Baylis, India-Burma Theater Surgeon, pointed out to Brig. Gen. Joseph A. Cranston, Intermediate Section commander, that smallpox, cholera, and typhoid fever were common among the natives in his section. General Baylis suggested that the native drivers for several civilian motortruck units destined for duty along the railway in that section be vaccinated as a protective measure for American troops who would be in contact with them. General Cranston ordered the vaccinations immediately, but pointed out that the con-
16Circular No. 73, Rear Echelon Headquarters, U.S. Forces, China Theater, 22 May 1945.
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tractors again would be obligated to provide their ownvaccine and other medical services as soon as they received their own supplies.17
Refugees.-Efforts of the U.S. Army to help some of thecivilian population in closest contact with American troops involvedconsiderable expense and time. Little in supplies and personnel was allotted tothe CBI during most of the war in relation to the hundreds of millions ofcivilians living in the area and the huge numbers of civilian refugees on themove. These refugees always streamed in front of advancing forces in the combatzones. More than 200,000 came into Kweiyang during the first evacuation ofKweilin in July 1944. In the last 2 months of the year, millions of homelessrefugees trudged on foot out of Kweilin, Liuchow, Ishan, and Tushan, cloggingall roads. During one 10-hour jeep trip from Tushan to Kweiyang, Americansobserved 800 bodies, stripped of everything useful, along the shoulders of theroad.18 Ofcourse, disease was common among the millions ofhomeless. Chinese relief agencies did what they could. DDT was requisitioned to delouse civilians in close proximity to U.S. camps, but it was notavailable for such use in that area during the war. The Army did provide alimited amount of truck space, on already scheduled trips, to haul supplies forcivilian relief agencies.19
Sanitation and Veterinary Problems
Typical conditions in the CBI theater during the war arereflected in descriptions of some of the travel experiences of Colonel Tamraz.Despite all his precautions, Colonel Tamraz was undergoing a siege of diarrheacontracted while on a tour of inspection in India, when his train pulled into astation in August 1942. "The filth, dirt, and smell in most of the railroadstations is appalling," he recorded in his diary. "It is a frequentsight to see children being allowed to defecate right on the platforms. Vendorsof food are dirty and messy, and yet they are allowed to sell contaminated andfilthy food to passengers."
Later that year, Colonel Tamraz wrote, "One of the mostdisgusting sights while traveling is to see passengers rush out immediately onthe stopping of the train to urinate and defecate in plain view of all thepassengers. This may be done right near a brook or a river where otherpassengers are filling their canteens with water for washing their faces orscrubbing their teeth. It is no wonder that infection and contagious diseasesrun rampant in this country * * *"
The British, even in their newer hospitals, had not installedflush-type
17(1) Letter, Theater Surgeon, India-Burma Theater, toCommanding General, Intermediate Section, 16 May 1945. (2) Letter, CommandingGeneral, Headquarters, Intermediate Section, SOS, U.S. Forces in India-BurmaTheater, to Theater Surgeon, Headquarters, U.S. Forces,India-Burma Theater, 18 May 1945.
18Annual Report of Medical Activities,Headquarters, Services of Supply Area Command, U.S. Forces in China Theater,1944, p. 5.
19(1) See footnote 9, p. 638. (2)Letter, Robert M. Drummond, Kweiyang, to John D. Nichols, Director, China Unit,American Red Cross, 9 Oct. 1944, subject: Trip to Ishan.
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sewage disposal facilities but used the "sweeper"system in which feces were collected by low-caste Indians and disposed of inseptic tanks.20
The water supply throughout the theater was usually polluted;cities were fantastically overcrowded; the habits of the native populations werehighly insanitary; human excreta was used as fertilizer; refrigerationfacilities were meager and, where ice was available, it was often polluted. Evenin New Delhi, considered a favored area, the restaurants, markets, and foodtransportation facilities (bullock carts) were dangerously filthy. Samplings ofmilk from pasteurizing plants showed bacterial counts approximating those forraw sewage. Disease was everywhere.
If similar conditions were not complained of as often inChina as they were in India, it was only because there were fewer troops incontact with the local inhabitants.
U.S. Army personnel in both China and India were billeted attimes in local hostels, some food had to be procured locally, and the Americanstraveled and traded within the local economies and came regularly into closecontact with the native populace. The Army restricted and supervised the use ofnative labor in messhalls and assigned the few Veterinary and PreventiveMedicine personnel available for such duty to inspect civilian hotels, cafes,and food selling establishments. "In-bounds" and"out-of-bounds" procedures were the only control the Army had overlocal businesses. A Medical Department inspection mission in India in 1944reported that the in-bounds control policy was very limited in its successbecause all restaurants were so filthy that any attempt to bring them up tooccidental standards would simply result in "placing all restaurantsout-of-bounds and create a hopeless morale and police problem for militaryauthorities."21
Sanitation.-In some areas of India, responsibility forcontrol of sanitation was shared, from time to time, with the British, ordivided between the British and Americans, on either a formal or an informalbasis. In places like Karachi and Calcutta, Allied Sanitary Commissions orAllied Hygiene Committees were formally organized to give direction and order tocombined efforts. When the two forces disagreed, as they sometimes did, aboutsuch policies as putting a particular restaurant out-of-bounds, the overallsanitation program suffered.22
The Indian Government assumed a limited amount ofresponsibility for sanitation near Army installations, such as reducing flybreeding in designated villages. However, the problem of sanitation wasenormous, and the
20Tamraz, Col. John M.: History of the Medical DepartmentActivities in India, pp. 15, 59, and 86-87. [Official record.]
21Report, Brig. Gen. Raymond A.Kelser, Col. Robert H. Kennedy, and Col. Karl R. Lundeberg, to CommandingGeneral, U.S. Forces, India-Burma Theater, 9 Nov. 1944, subject: Report ofMedical Department Mission, p. 18.
22(1) Letter, Col. Karl R. Lundeberg, SOS Medical Inspector,to Surgeon, SOS, U.S. Forces, India-Burma Theater, 21 Dec. 1944, subject: FieldTrip-Sanitary Inspection of Bombay, Lake Beale, and Camp Kalyan. (2) VanAuken, Lt. Col. H. A., MC: A History of Preventive Medicine in the United StatesArmy Forces of the India-Burma Theater, 1942 to 1945, dated 8 Dec. 1945 (section, "History of Restaurant Sanitation in the Calcutta Area").[Official record.] (3) See page 51 of footnote 5 (2), p. 637.
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Indians did not have effective laws or procedures to enforcesanitation regulations. For example, a health officer was a licensing authority,but withholding a license for lack of proper sanitation did not close abusiness. A food processing organization, such as an ice cream plant, couldeasily absorb the small fine imposed daily for operating without a license,and continue in business, no matter how filthy the surroundings.23 Inaddition, the Indian governmental health organizations were so entangled inbureaucratic red tape and their limitations were so great that neitherattempts at cooperation nor attempts by the Indians to meet commitments forsanitation were satisfactory.24 No sanitation efforts were eversuccessful enough to protect troops from repeated attacks of diarrhea anddysentery.
Procurement of food-Early in the war, the Army hadto rely, for the most part, on locally procured food. Meat for the troops wasslaughtered in local abattoirs. However, the short supply of Veterinarians whocould be used to inspect local food sources; the questionable sources andquality of all food of animal origin; the lack of storage and refrigerationfacilities; the hot, muggy weather; and the filth in local markets and abattoirsquickly led to the condemnation of local procurement.25 In 1942, thebase section Veterinarian at Karachi inspected the local abattoir, iceplant, anddairy. He condemned them all and recommended that SOS build and operate its ownfood-processing plants, a step which later became standard at all large U.S.troop concentrations.26
Animals to be slaughtered were often so emaciated that it wasdoubtful that the flesh contained enough nutriments to be of benefit. Sometimeswhole herds were observed with rinderpest, foot-and-mouth disease, or anthrax.An Indian law protected working bullocks under 10 years of age as well aspregnant cows and cows in milk, further decreasing available beef.27 Generally,safe pork products were lacking. In some areas, Veterinary personnel could onlyselect the best from very poor quality food and determine whether or not it was safe for consumption. By 1945, however, the Army hadbuilt many of its own facilities, and a few more Veterinarians were available.Only about one-sixth of the meat used by the U. S. military in the Delhi area, forinstance, was slaughtered locally, and this under the direct supervision of aVeterinary officer; the remainder was imported.28
23See page 42 offootnote 5 (2), p. 637.
24(1) Letter, S.N. Russell, Deputy Secretary to the Government of India, to Commanding General, U.S. Forces, India-Burma Theater, 29 May 1945, subject:Anti-Infection Measures Around USAAF Installations. (2) Letter, D. G. Bhore, Under Secretaryto the Government of India, to Commanding General, U.S. Forces, India-Burma Theater, 7 July 1945,subject: Anti-Infection Measures Around USAF Installations.
25(1) Essential Technical Medical Data From Overseas Forces,Rear Echelon Headquarters, U.S. ArmyForces, China-Burma-India, 6 Sept. 1943, pp. 7-8. (2)Jennings, Lt. Col. William E.: Report of Medical Department Activities in China-Burma-India,dated 5 Feb. 1945.
26For a complete discussion ofveterinary responsibilities for food inspection and animal care in the CBI theater, see MedicalDepartment, United States Army. United States Army Veterinary Service in WorldWar II. Washington: U.S. Government Printing Office, 1961, pp. 340-379.
27Essential Technical MedicalData From Overseas Forces, Rear Echelon, Headquarters, USAF, CBI, 13 Dec. 1943.
28See page 56of footnote 5 (2), p. 637.
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In India, attempts to improve the food supply for theprotection of the military may have led to some small improvements in thecivilian food supply.
U.S. Army Veterinarians worked closely with civil andmilitary authorities in the three countries of the CBI theater concerning theprocurement and care of pack animals.29 In rare instances, U.S. aidmay have helped keep animal diseases from spreading to human populations,30but, on the whole, the health of the civil populace was not affected.
DISEASE PROBLEMS
Cholera
Sanitary deficiencies were the main cause for the frequentcholera outbreaks among civilians in the CBI theater during the war. The Army'saction against these conditions was limited, as described, but the incidence ofcholera among U.S. troops was kept to a minimum as a result of onpost sanitationprograms, educational campaigns, and immunization procedures, as well asfrequent inspections of those civilian eating establishments most frequented byAmericans.
Inoculation policies.-American troops going into thetheater were inoculated with cholera vaccine, and inoculations were repeated inlocal areas when an outbreak was reported. Within the civilian population ofIndia, outbreaks were reported by doctors in the cities or by village headmen tothe nearest civil medical officer who, in turn, sent out technicians toinoculate the residents of the affected area.31 The Army task instrictly civilian epidemic areas consisted mostly of keeping informed of theextent and direction of the epidemics.
Typical of problems connected with cholera were theinsanitary conditions at Chittagong, East Bengal, in 1943. The Fourth CombatCargo Group occupied quarters near an abandoned prison where some dilapidatedmud-walled buildings still stood. Some of the old buildings were occupied byIndian laborers working for the Army while other buildings served as latrines.Most were dirty and fly filled; all were honeycombed with ratholes. Incooperation with local Indian authorities, the laborers were removed and thebuildings demolished. Housing for the laborers was then provided in tents.32Similarly, when cholera reached epidemic proportions in native villagesnear American installations, Army engineers razed the villages with
29Pyle, Lt. Col. Norman J., VC: Reportof Mission to China, 29 June 1944.[Official record.]
30Letter, Col. George E. Armstrong,Surgeon, China Theater, to Maj. Gen. Norman T. Kirk, The Surgeon General, 31Aug. 1945.
31Report, Col. Elias E. Cooley toTheater Surgeon, U.S. Army Forces, China-Burma-India, 7 Dec. 1943, subject:Report on Cholera in Lakhimpur District, Assam, and Dacca District, Bengal.
32Essential Technical Medical Data, Headquarters, India-BurmaTheater, 1 June 1945. (Enclosure: Mosley, Maj. Kirk T.: Investigation of Three Cases ofSuspected Cholera Reported by the Fourth Combat Cargo Group.)
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the cooperation of the Indian Government. In other instances,the U.S. bases had to be moved to another area.33
Out-of-bounds procedures were the most common weapon of Armycholera fighters. During a 1945 epidemic of cholera in Calcutta, the AlliedHygiene Committee made more frequent and stricter restaurant inspections34and required during the epidemic that: all restaurant employees beimmunized, only hot cooked foods be served, water be sterilized, and no icebe used in drinks. Sometimes, whole cities had to be put out of bounds, as OldDelhi was in 1944.
Other procedures usually put into effect by the Army duringepidemics included inoculating all Indian servants and releasing those nativebearers and food handlers who came from epidemic villages. Also, the hiring ofnative personnel was suspended during epidemics.
Direct assistance.-On at least one occasion, medicalofficers from Army malaria groups were directed to lend assistance to localhealth officials, who conducted educational campaigns in affected villages.35These campaigns emphasized the boiling of water and the burning of deadbodies rather than their disposal in rivulets and tanks to become furthersources of disease.
In China, the Army sent officers to observe firsthand theefforts by the National Health Administration and other Chinese agencies to stopepidemics which might affect military operations. A thorough check was made onwhat was being done by the civilian agencies, and epidemic areas were inspected,but little more than encouragement could be offered.36Cities such asLiangshan were put out of bounds during epidemics while preventive measures onpost were tightened.37 Cholera was widespread among the thousands ofrefugees in China, and the U.S. Army's localized efforts may have had aslight effect on the problem of cholera among the millions throughout thetheater.38
Plague
Plague had been reported regularly from China, Burma, andIndia for more than 20 years before 1945. The disease became of increasingconcern to the military in 1944 and 1945 as more and more outbreaks werereported,
33Essential Technical Medical Data From Overseas Forces, RearEchelon, Headquarters, U.S. ArmyForces, China-Burma-India, 12 Aug. 1943.
34See footnote 22 (2), p. 642.
35Letter,Surgeon, 7th Bombardment Group, to Commanding Officer, 7th Bombardment Group(H), AAF, Panda, India, 16 June 1943, subject: CholeraEpidemic Among Natives in Panda.
36(1) Annual Report, MedicalDepartment, India-Burma Theater, 1944, pp. 44-45. (2) Memorandum, Lt. Col. Marcus D. Kogel for Theater Surgeon,China Theater, 7 July 1945, subject: Trip to Chungking and Environs to Estimate Cholera Situationand Recommend Protective Measures for Our Troops.
37Annual Report, Medical DepartmentActivities, Fourteenth Air Force, 1 Apr.-30 Nov. 1945, p.9.
38Foradditional information about cholera in the CBI, see Medical Department, United States Army. Preventive Medicine in World War II. Volume IV. CommunicableDiseases Transmitted Chiefly Through Respiratoryand Alimentary Tracts. Washington: U.S. Government PrintingOffice, 1958, pp. 455-460.
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especially in connection with the movement of refugees inChina.39 Medical personnel inoculated American and Chinese militarypersonnel as well as civilian laborers working for the Army. Colonel Armstrong,the China Theater Surgeon, kept in close contact with the Chinese NationalHealth Administration about the progress of the disease. He also detailed someAmerican military personnel, including a Sanitary Corps officer, to maintainliaison and to help civilians trying to stamp out the disease in localcommunities.40 Colonel Armstrong reported to The Surgeon General inAugust 1945 that "American military supervision in western Yunnan Provincehas squelched two plague epidemics in that area."41 Actionstaken by the governmental agencies, with which the military cooperated,consisted of the inoculation of civilians and the execution of a vigorous rodentextermination program (fig. 84). Civilian ambulance units attached to a Chinesedivision sometimes assisted the National Health Administration in its civilianinoculation program.
China Theater personnel carried out a rodent survey andcontrol program in 1945. The lack of trained personnel and the immensity of therodent problem in many areas limited the Army's activities to protecting themilitary. Thus, the program had but little effect in civilian communities.42
Malaria
Malaria was an especially difficult problem in refugee andcombat areas, and where great numbers of civilian laborers were used; it wasalways a threat to American troops billeted in, or passing through, the endemicand epidemic areas throughout the theater. An estimated 100 million to 200million of India's 388 million people had malaria in 1941. In Burma, the deathrate from malaria was 214 per 100,000 population in the towns alone.43 Malariawas a serious problem in China also, but statistics concerning its incidencethere are not available.
Only a few U.S. Public Health Service officers (assigned tothe Army) and a relative handful of supplies were available to fight the diseasein 1942; but by 1943, a malariologist and a number of antimalaria units wererequisitioned from the United States, and a control program, headed by Lt. Col.(later Col.) Earle M. Rice, MC, was underway. The personnel situation improvedsteadily thereafter and several officers were sent to be trained at the CalcuttaSchool of Tropical Medicine and the Malaria Institute in Delhi.
39Letter, Surgeon, China Theater, to The Surgeon General, 2Dec. 1944.
40(1) Letter, Surgeon, China Theater,to The Surgeon General, 27 Jan. 1945. (2) Pin Hui Teng: Report of Plague Control Work in the Tengchung Area andAlong the Burma Road, Yunnan Province, China, 16 January-20 April 1945.[Official record.]
41See footnote 30, p. 644.
42(1) Report, Surgeon, China Theater,to The Surgeon General, attention: Army Committee for Insect and Rodent Control, 31 Aug. 1945, subject: RodentSurvey and Control. (2) For additional information on rodent control in the CBI theater, seeMedical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene.Washington: U.S. Government Printing Office, 1955.
43(1) War Department TechnicalBulletin (TB MED) 174, July 1945, subject: Medical and Sanitary Data on India.(2) War Department Technical Bulletin (TB MED) 77, 2Aug. 1944, subject: Medical and Sanitary Data on Burma.
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FIGURE84.-Rats, caught alive in Nantien, China, for examination and experimentation,February 1945.
Before the end of the war, malaria rates among U.S. troops were down to an insignificant level. In addition to Malaria Survey and Control Units with theaterwide responsibilities, antimalaria details (fig. 85) were formed in all companies and other organizations throughout the CBI theater by direction of War Department Circular 223, dated 21 September 1943, and theater circulars.
Spraying.-After small quantities of DDT arrived in the theater in 1944 and first tests indicated that the insecticide was much more effective than any other agent then available,44 residual spraying became the top priority job of all vector control work. By agreement with local governments, all native dwellings within a control zone, usually a 1-mile radius of an installation, were also sprayed.45Many U. S. installations were surrounded by agricultural villages and paddy fields. Local economic conditions made it impossible to move the natives or to drain the fields, but by killing the mosquitoes, a gap was made in the chain of transmission of the disease
44Report, Col. J. W. Scharff, 17 July 1944, subject: FirstReport on Operational Air Spray Experiments with D.D.T. [at Charbatia, Sunakala,and Sananairi].
45Annual Report of MedicalActivities, Base Section No. 1, SOS, India-Burma, Office of the Surgeon, 1944.
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FIGURE85.-Natives in Calcuttasweep the water's surface clear of vegetation before spreading oil to kill larvae.
and other attempts to rid an area of malaria werestrengthened. At the same time, residual spraying killed other insects andhelped improve the health of people generally.
At the outset, it was believed that control measures couldnot always be carried out by American authorities because of such complicatingfactors as the unusual relationship between central and provincial governments,language and dialect problems, and certain religious and social difficulties.Religious customs among the Muslims, for example, prohibited the spraying ofMuslim homes by American soldiers. In 1943, Army representatives contactedofficials of provincial governments, some of whom agreed to institute sanitationcontrol around many of the larger U.S. installations. In actuality, however, theArmy assumed antimosquito and other sanitation responsibilities in some of theseareas.46 Those programs which the Indians did conduct, and which wereof great help to the Army within confined areas, were discontinued in late 1945,when evacuation of the India-Burma theater began.
Informing civilians.-Some Army antimalaria procedures, suchas per-
46See Part I of footnote 22 (2), p. 642.(2)Medical Department, United States Army. Preventive Medicinein World War II. Volume VI. Communicable Diseases: Malaria. Washington: U.S.Government Printing Office, 1963, pp. 347-398.
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sonal protective measures, had no effect on civilians. Othershad some effect, however; for instance, before movies at army camps, slides wereshown illustrating how malaria was acquired and how it could be avoided.Arrangements were made with the British in Delhi to show these slides atcivilian theaters. The Army also supplied antimalaria propaganda for broadcastby a local radio station and, during "special weeks" in at least onecivilian area, the Army displayed posters, airdropped leaflets, demonstratedairplane DDT spraying, and exhibited antimalaria devices in an attempt to better inform the civilians aboutmalaria.47
All work with civilians, including the malaria surveys inwhich mosquitoes were collected and blood smears were taken from civilians inselected areas, had the primary purpose of protecting the soldier and reducingnoneffective rates. Antimalaria work in areas near concentrations of U. S. troopsdid have an effect on civilians, as illustrated by a study of certain nativegroups in northern India. After an 18-month period of living in areas wherespraying and other antimalaria procedures were carried out, some of those testedshowed reductions in spleen rates of as much as 80 percent.48 Theseoccurrences were in confined areas, however; outside of these areas, malariaraged with its usual uncontrolled fury.49
Venereal Diseases
In India, a land of many contrasts, the venereal diseaseproblems were serious and difficult to combat. In one region of Assam, near anSOS rest camp, the attractive light-skinned women of a hill tribe were anxiousto introduce white blood into their families and further lighten their skins.Not only the women, but also their families, openly solicited among the whitesoldiers, meanwhile discouraging the use of prophylactics and increasing diseaserates. The native area was put out of bounds, and other measures to reduce rateswere tried, but unsuccessfully.50 At the same time, venereal diseaserates in India among Negro soldiers were much higher than among other soldiers,apparently because the Negroes did not find the racial barriers to sexualcontacts that others found with some Indians. According to a study on theproblem, venereal disease rates among Negro soldiers were higher not because theindividual Negro was less careful in the use of prophylactic procedures, butbecause the number of exposures among Negro soldiers was about four times as great.51
47See page 19 of footnote 5 (2), p. 637.
48Mantz, Maj. F.A., MC: A History of Malaria Control Activities in the CBI Theater From July 1942 Until July 1944, p. 28. [Official record.]
49For additionalinformation on malaria in the CBI, see footnote 46 (2), p. 648.
50(1) See footnote 22 (2), p. 642. (2)Letter, Headquarters, U.S. Army Rest Camp No. 5, to Venereal Disease Control Officer, CBI, 29 Apr. 1944. (3)Report, Headquarters, U.S. Forces, India-Burma Theater, to Surgeon, USFIBT, 21 May 1945,subject: Investigation of Venereal Disease Control Activities at Air Crew Rehabilitation Center, ArmyAir Forces, with enclosure, subject: Venereal Disease Survey of Shillong, India, conducted 10 to13 May 1945.
51Essential Technical Medical Datafor Overseas Forces, India-Burma Theater, 4 Dec. 1944. Enclosure, subject: AStudy of Attitudes, Actions, and Knowledge Related to Venereal Disease Among TwoGroups of Soldiers in CBI.
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Conditions in India-More U.S.troops were stationed in India than in China or Burma, and rest areas for allCBI soldiers were concentrated there. As a result, most theater venereal diseaseproblems, early in the war, originated in India.52 The loweducational and economic levels in India, the unique and diversified religiousand social customs, and widespread prostitution in filthy surroundings madepreventive measures among the civil populace almost impossible. Brothels withbetter sanitary conditions, housing women who were under some degree of medicalsupervision and which provided good prophylactic procedures, did exist, butprices for patronage were usually in the $10 to $20 range. Soldiers indicatedthat they would prefer to atronize such places, but economic factors and thebrain-clouding effect of alcohol all too often led the men to visit cheap,infected, easily available women in hovels, carts, or fields.53
At the civilian national level in India, the Public HealthCommission supervised measures for the protection of health, but very littleprogress had been made toward any effective program as a result of insufficientpersonnel and a lack of local cooperation. Civilian police would not cooperateto control prostitution and, although British military authorities did join theU.S. forces in providing some prophylactic stations, they usually went nofurther than that.54
In the absence of effective cooperation from localauthorities, the U.S. military venereal disease control program, in addition tothe usual educational program and appeals to morality, became one of placementof prophylactic stations and enforcement of off-limits regulations. Even theprovision of prophylactic stations was difficult because local property ownersdid not like to rent buildings for such use. The reasons for this were probablythe same moral and religious reasons which made the problem of venereal diseasegenerally more difficult.
Religious groups felt that attempts to inaugurate venerealdisease control programs insinuated promiscuity which the religions prohibited.Promiscuity did exist, however, but the moralists refused to let anything bedone about it. The same ideas would not permit surveys or the collection of dataregarding rates. Treatment facilities were available for the natives but werelittle used. Meanwhile, the caste system strengthened the practice ofprostitution. Prostitutes were so low in caste that religious sects would havenothing to do with them, and all female children of prostitutes were destinedfor the same means of livelihood.
Venereal disease control officers spent much time travelingthroughout their theaters, investigating trouble spots, and consulting withofficers of
52For an overall picture of theantivenereal disease campaign in the CBI theater and elsewhere, seeMedical Department, United States Army. Preventive Medicine inWorld War II. Volume V. Communicable Diseases TransmittedThrough Contact or by Unknown Means. Washington: U.S. Government Printing Office, 1960,ch. X.
53Report, 188th Engineer AviationBattalion, Office of the Surgeon, 13 Jan. 1945, subject: Special Report on Venereal Diseases.
54Letter, Capt. Malcolm A. Bouton,MC, CBI Venereal Disease Control Officer, to Theater Surgeon, CBI, 21 Feb. 1944.
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units having high rates. Venereal disease work was ofteninvolved more with treatment than with prevention. However, after the initialoutbreak, venereal disease rates in general were brought down in the CBItheater, and noneffective rates resulting from venereal diseases were notserious.
Conditions in China and Burma-Prostitution wasuncontrolled throughout China.55 Because there were no laws againstprostitution, civilian authorities had no means of suppressing it. Apart fromprophylactic means, military authorities had to rely on off-limits procedures,recreation facilities, and education in their efforts against the spread ofvenereal diseases. Although troops in China were few, rates among white soldierswere higher in China than in India, apparently because of the multiplicity ofcontacts and the attractiveness of the women.56
In Burma, venereal disease control, as well as civil publichealth in general, was considered to be of little importance throughout most ofthe war because many areas occupied by U.S. engineer and combat forces weresparsely populated by headhunting Naga tribesmen. Upon the opening of the BurmaRoad, a venereal disease problem developed along convoy routes because female"hitchhikers" would pay for a ride in a manner acceptable to bothparties.57 However, venereal disease was mainly contracted by menwhile they were in rest areas in India.
Other Diseases
Epidemic typhus-After Brig. Gen. Leon A. Fox, MC,Field Director of the United States of America Typhus Commission, visited Chinain September and October 1943, some 1.4 milliondoses of typhus vaccine were sent to China, of which 500,000 ml. were for use bycivil agencies in the immunization of medical and essential personnel.Arrangements for the Lend-Lease transfer of vaccine were renewed from time totime later in the war.58 Some vaccine was used to inoculatetransportation personnel at Chinese roadside stations, but how much thecivilians were finally benefited was not determined.
In India, several outbreaks of epidemic typhus occurred amongthe civil population and among Chinese troops training there during the war. TheTyphus Commission and the Theater Commander arranged for the distribution ofvaccine and louse powder to civilian groups as well as to British troops inaffected areas.
Scrub typhus.-The Typhus Commission set up a laboratory andmite-collecting stations to acquire data on scrub typhus in the theater, andthere
55(1) Essential Technical Medical Data Report, Rear Echelon,Headquarters, U.S. Forces, China Theater, Office of theChief Surgeon, 4 July 1945, p. 8. (2) Derr, Capt. Russell H., VC: History of Venereal Disease Control in China, p. 6. [Officialrecord.]
56Recorded interview, Deputy Chief, Operations Service, toHistorical Division, Office of the Surgeon General, 4 Apr. 1945, subject: Reportof Medical Department Activities in China and India-Burma Theaters by Capt.Malcolm A. Bouton, MC.
57See footnote 55 (2).
58For additional information onepidemic typhus in the CBI theater, see Medical Department, UnitedStates Army. Preventive Medicine in World War II. Volume VII.Communicable Diseases: Arthropodborne Disease Other Than Malaria. Washington:U.S.Government Printing Office, 1964, p. 196.
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was some contact with civilians in this work. However, theobject of all activity was the ultimate protection of American and Alliedsoldiers.59
Yellow fever and other diseases-Although yellow feverwas not to be found in India, the Aedes varieties of mosquitoes, vectorsof the disease, were abundant. Representatives of the civil government hadreason to fear the extremely serious situation which might have developed if thedisease had been introduced from Africa or elsewhere. Therefore, Indianimmunization and quarantine requirements for yellow fever were more stringentthan those prescribed by international convention. These requirements, in turn,caused serious delays in troop movement and supply shipments by Allied powersthrough India and became a serious handicap to the war effort. From 1941 through1943, the U.S. State Department made several attempts to get Indian regulationschanged, but no settlement was reached until February 1944, when negotiationsthrough military channels resulted in the reduction of Indian requirements.60
The Army did not become formally involved in civil publichealth programs for China, Burma, or India other than those described elsewherein this chapter. However, as a byproduct of such activities as malaria controland sanitation procedures, the risk of contracting certain diseases, such assandfly fever or typhoid fever, was reduced for the civilian population in someareas.
CLOSING OF THE THEATERS
India-Burma Theater
Before the end of 1945, the strength of the forces in theIndia-Burma Theater had been reduced to about one-third of their peak; in 1946,the reduction of forces continued at a fast pace until the theater wasinactivated on 31 May 1946. Malaria control units and food inspection units wereinactivated as soon as they were no longer needed by the Army. Remaining troopswere concentrated in large cities and the required disease-control personnelwere absorbed into headquarters units at such locations.
With the exception of personnel who contracted venerealdiseases, the percentage of personnel going on sick call rapidly declined assoon as the war ended. More free time and a general atmosphere of relaxationcombinded with increased sex contacts caused VD (venereal disease) rates toclimb abruptly. However, the usual procedures for VD control were maintained andno new civil public health measures were introduced.
The Army also took precautionary measures to protect theMilitary Establishment against epidemics of poliomyelitis and smallpox whichbroke out in the civil population during the closeout period.
59For a complete discussion of scrubtyphus in the CBI theater, see pages 292-301 of footnote 56, p. 651.
60For more complete information on yellow fever andquarantines, see pages 304-307 of footnote 42 (2), p. 646, and pages 357-370of footnote 58, p. 651.
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China Theater
After the Japanese surrender, the U.S. Army began phasing outactivities in China, the most significant exception being the Shanghaimetropolitan area, where theater headquarters and most theater personnel wererelocated. Fewer than 10,000 American soldiers remained in China by the end of1945.61 This number was reduced each month until 30 April 1946,when the theater was closed and a small overall headquarters calledHeadquarters, USAF, China, and an operating agency, the China Service Command,were created to conclude American business in the area.62
As the influx of American troops into Japanese-held Shanghaibegan in September 1945, the China Theater medical inspector, Col. Marcus D.Kogel, went there to conduct a sanitary survey and check on potential diseaseproblems. He found that the general health of the people in the city of morethan 4 million was fair, the sewage plant modern, and the municipal abattoir inmoderately good condition. Cholera was endemic in the city and malaria wascommon in the outskirts. An outbreak of virus encephalitis occurred duringthe summer, but it was dying out by the time Colonel Kogel began his inspection.He immediately detailed a Navy lieutenant to make a preliminary inspection ofdairies, iceplants, restaurants, hotels, and drinking water.63
During Colonel Kogel's inspection, 15 American prisoners ofwar were released, eight in good condition and seven hospitalized for pulmonarytuberculosis. Some 6,000 civilian internees, mostly British and American, werein good condition and anxious to leave camp to take over their businessinterests from the Japanese. About 15,000 "stateless" refugees,mostly Jews who had fled before the Nazis, had been badly treated, packedtogether in a ghetto during their internment. Their health was poor and theywere vermin infested. Typhus, typhoid, and other diseases were still takingtheir toll.
Office of Preventive Medicine.-As soon as medicalpersonnel arrived in early October 1945, the medical sections of the theater andof the local base command were combined under Colonel Armstrong. Army and Navymedical personnel immediately formed a consolidated preventive medicine section,known as the Office of Preventive Medicine,64 which consisted of thefollowing divisions: Epidemiology; Sanitary Engineering; Venereal DiseaseControl; Malaria, Rodent, and Insect Control; Laboratory; and SanitaryInspection.
Colonel Kogel directed the office and served asOfficer-in-Charge of the
61Medical History of the China Theater for Month of January 1946,Headquarters, U.S. Forces, China Theater, Office of the Surgeon, 1 Feb. 1946,pp. 1, 2, and 12.
62Medical History of the ChinaTheater for Month of April 1946, Headquarters, China Service Command, Office ofthe Surgeon, 1 May 1946, pp. 1-2.
63Memorandum, Col. Marcus D. Kogel,MC, to Theater Surgeon, Headquarters, SOS, U.S. Forces in China Theater, 14Sept. 1945, subject: Inspection Trip to Shanghai.
64(1) Essential Technical Medical DataReport, China Theater, 14 Nov. 1945, pp. 2-4. (2) Annual Report of MedicalActivities, China Theater, 1945.
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Epidemiology Division. He and the senior naval representative in the officemet frequently with the Commissioner of Health of Shanghai and arranged for suchactivity as the air spraying of the older sections of Shanghai, and ofairfields, internment camps, and dock areas.
Preventive Medicine personnel conducted a weeklong educational program forthe benefit of Municipal Health Department employees and gave talks at varioustimes on new methods of disease prevention before such groups as the ShanghaiMedical Society. They demonstrated the proper use of DDT while spraying thechief detention prison in Shanghai (fig. 86). Some Chinese generals, a Districtjudge, and a large number of medical and laboratory personnel from the localhealth department attended. Army medical personnel inspected and sprayed somecivilian hospitals and also deloused stateless refugees who, it was thought,might constitute a health hazard to U.S. forces.65
Sanitation.-Other activities coordinated with the city health departmentincluded sanitary inspections of restaurants and hotels and the establishment ofin-bounds and out-of-bounds procedures to protect the health of troops. Inaddition to military inspectors, the armed forces hired five civilianinspectors, former employees of the Shanghai Municipal Council, to help withthis work. Lists of out-of-bounds establishments were sent to the municipalcouncil, and frequent meetings were held with the council to work out a policyon sanitation inspections and areas of responsibility. Civilian representativesof the city government then began accompanying the armed forces inspectors, thusadding the stamp of civilian authority to the recommendations and actions of themilitary. These city representatives were even empowered to close businesses tocivilian patronage should that be considered necessary, but the Army did notinvolve itself in license procedures.
The close cooperation between the Army and the city also produced othermutual benefits. One example was the removal, at city expense, of a dump whichhad been too close to a dairy products processing plant having a contract withthe Army.66 Then, in the spring of 1946, a local labor strike causeda garbage disposal problem and the immediate threat of disease, and the mayor ofShanghai called on Colonel Armstrong for help. Colonel Armstrong, with theconcurrence of G-5, authorized the immediate air spraying of the city withDDT. Increased efforts on the ground also helped to eliminate flies andmosquitoes, and the problem was resolved.67
Venereal diseases.-The venereal disease problem in Shanghai proved to be asdifficult as anticipated. Many young white Russian girls, as well as Orientals,were actively engaged in prostitution, and procurers were everywhere. Inaddition to the usual measures, 11 prophylactic stations were
65Daily Reports, Preventive Medicine Section andVeterinary Section to Shanghai Base Command Surgeon, subject: Activities for 11,27, 29, and 30 October and for 6 and 7 November1945.
66Daily Reports, Preventive Medicine Section and Veterinary Section toShanghai Base Command Surgeon, subject: Activities, 22 October 1945.
67Govern, Col. Frank W.: Personal Experiences in theCBI. [Official record.]
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FIGURE86.-Capt. Lyle Smith supervised the delousing of a prisoner as part of a demonstration and lecture given on 6November 1945 at the Shanghai Detention Prison.
soon established in the city. Also, representatives of theOffice of Preventive Medicine, after consultations with the Municipal Council,worked out a plan to establish a special clinic to which infected women would bereferred for treatment. The Municipal Board of Health furnished facilities anddoctors and nurses for the clinic while the Army and Navy supplied drugs andlent nonexpendable equipment to help carry out the program. The project promisedto be such a tremendous undertaking that the armed forces officers contactedofficials of UNRRA (United Nations Relief and Rehabilitation Administration) tosee if it could furnish additional supplies. However, there was a problem inactually getting women to go to the clinic, and this project never succeeded aswell as had been hoped.68
Work with other agencies.-Army medical personnel alsomaintained close liaison with representatives of UNRRA and the USPHS (UnitedStates Public Health Service) on other matters. For example, UNRRA provided theArmy with information about the epidemiologic experience among civilians inShanghai and made special daily reports on the admission of cholera patients tothe local isolation hospital.69 The Army fur-
68(1) See footnote 61,p. 653. (2) Daily Reports, Preventive Medicine Section andVeterinary Section to Shanghai BaseCommand Surgeon, subject: Activities, 19-20 October and 5 November 1945.
69DailyReport, Preventive Medicine Section and Veterinary Sectionto Shanghai Base Command Surgeon, subject: Activities, 19 October 1945.
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nished medical supplies and equipment to UNRRA for civilianuse, turning over more than $500,000 worth in November 1945 alone. Many of thesesupplies were used to treat liberated military and civilian internees, and theremaining supplies were used to treat indigenous civilian employees of the Armyor other civilians who had been injured in connection with military activities.Contracts were also negotiated with local hospitals to provide care for thelatter groups.70
During the months after the end of the war, serious outbreaksof plague, cholera, typhus, and smallpox occurred among civilians andrepatriates in China. Some cities, such as Hankow and Canton, had to be put outof bounds during epidemics. Medical personnel went to various parts of thecountry to investigate these outbreaks and offer advice to civilian medicalauthorities, and the Army funneled some medical supplies to civilian areasthrough UNRRA in an attempt to control the diseases and prevent their spread toU.S. personnel.71
The theater medical organization provided supplies andpersonnel for Personnel Recovery Teams responsible for recovering liberatedprisoners of war and repatriation groups working with the Japanese, and alsogave extensive support to G-5 and Offices of Strategic Services' operationsinvolving prisoners and internees. Liaison was continued with the Chinese Army;medical services were provided for U.S. Army groups working with the Chinese,such as the Army Advisory Group and a team working as arbiters between theCommunists and Central Government troops. Such activities created a drain onmedical strength, which was already being steadily diminished by evacuation. Bythe time the theater was closed, almost all Army civil public health activitieshad been discontinued.
SUMMARY
The need during World War II for an effective civil publichealth program was evident in every corner of the expansive China-Burma-Indiaregion with its millions of people and its overwhelming disease problems. Thesmall number of U.S. Army Medical Department personnel stationed in the area,whose primary mission was to keep the troops in good health, could becomeinvolved in civil public health activities only to a very limited extent. Someactivity among local civilians was necessary, however, to protect the health ofthe troops. In mosquito control to combat malaria, for instance, spraying,ditching, and other procedures were carried out in communities near troopconcentrations, producing beneficial results for the civilians as well as forthe military and providing the knowledge of how to carry out mosquito controlwork for future generations. This work, the cooperative efforts to clean upcivilian food-dispensing establishments, the medical aid to tribesmen in Burma,the work against plague and cholera, and efforts to control disease amongrefugees, beneficial as they were, were
70See footnotes 61 and 62, p. 653.
71See footnotes 61, 62, and 64 (1), p. 653.
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necessarily limited in scope and were carried out only duringthe few years that American troops were stationed in the theater. No theaterwide, coordinated civil public health program was ever attempted, and theonly time the Army could devote the efforts of more than a handful of men to onecivil public health activity was in Shanghai after the war had ended. At thattime, preventive medicine specialists from the various armed forces stationed inthe city joined local health officials in a concentrated campaign against filthand disease in the final months before the theater was closed.
No measurement of the total effect on civilians of Army civilpublic health activities in the CBI theater was ever attempted, but therelatively low sick rates of U.S. troops stationed in the midst of unbelievablybad conditions indicate that the immediate objectives of the time were met.
