DDGMS
ADVANCED HEADQUARTERS
AUSTRALIAN MILITARY FORCES
- INTRODUCTORY
This report is intended to supplement and to add to “NOTES ON JAPAN FOR HYGIENE OFFICERS” which should be read in conjunction with it, since matter previously included has, to avoid repetition, not been duplicated here. As no decision has yet been reached upon the parts of JAPAN likely to be occupied by Australian troops, it has not been possible, as was intended, to give precise and detailed information concerning billets and camp sites in specific areas. However, the information supplied should be found adequate to permit a reasonably comprehensive and accurate hygiene appreciation to be made even if troops move on short notice.
- LOCAL ADMINISTRATION
Subject to the direction and advice of the Supreme Commander, civil administration in JAPAN is effected by the National Government through the Prefectural Government, Local Authorities and the civil service.
Public Health administration is in the hands of the Ministry of Health functioning through the Prefectural Governments, the Local Authorities and the police force. The various phases of civilian medical service, epidemic control and sanitation remain wholly a Japanese responsibility and function, but the medical staff of the Supreme Commander may advise or assist in problems as they arise and will direct the Japanese Ministry of Health to adopt any measure necessary to be taken to prevent conditions obtaining in the civilian population menacing the health of the occupation troops.
Normally, communication with the civilian administration is through command channels, but for the appreciation of local epidemiological conditions, the Senior Medical Officer in an occupied area has direct access to the local Japanese health authority. Similarly, when advice or action is necessary locally to curb laxity in administration, or to meet an epidemiological situation fraught with danger to the occupation troops, the Senior Medical Officer of the area is empowered to communicate directly with the appropriate local authority.
- CLIMATE
The climate of JAPAN varies from sub-arctic in HOKKAIDO to temperate in Southern HONSHU, SHIKOKU and KYUSHU.
(a) Rainfall:
In SHIKOKU, KYUSHU and HONSHU south of the main mountain range, the summer is subject to a heavy rainfall, whilst the winters are relatively dry and sunny.
(b) Temperature:
In Southern JAPAN, the average maximum summer temperatures are moderately high, ranging from 80-90 degrees Fahrenheit. The winters in this area are generally mild, minimum temperatures averaging above the freezing level although extremes of low temperature of 10 to 20 degrees below freezing are not infrequent.
- ACCOMMODATION
The requisitioning of buildings is subject to restriction. In particular, factories producing civilian goods, schools, private houses and administration buildings are not available. Generally, however, it will be possible to billet troops in substantial buildings, usually of masonry. These may be:-
- Japanese barracks
- War production factories
- Commercial offices
- Hotels
Factories are usually heavily littered with rubbish, scrap and dust, requiring through cleansing. With the possible exception of hotels, heating, ablution, latrines and messing facilities in these buildings will be found inadequate or entirely lacking. They lend themselves, readily however, to artificial heating, are connected to the water reticulation systems and electric power mains and are usually sited in sewered areas, if not actually connected to the sewer.
In SAPPORO, NIIGATA and KYOTO and in similar areas which have escaped heavy bombardment, suitable billets are not lacking.
In devastated areas, on the other hand, more particularly in OSAKA, KOBE, YOKOHAMA and KURE, there remain very few buildings suitable for billets and the use of huts and tents may have to be considered. Whatever type of accommodation be ultimately determined the control of droplet infection and to some extent of typhus, requires that each man be allotted not less than 50 square feet of floor space and that the air of billets be completely changed not less than three times every hour by effective ventilation.
It may be remarked that the climate is, during the winter, entirely unsuitable for the accommodation of Australian troops in tents, having regard to:-
(a) the impossibility of ensuring safe and efficient artificial heating whilst maintaining a safe frequency of complete air change.
(b) the prolonged service of most Australian troops in the equatorial zone.
(c) the short period of transit in moving these troops from the equatorial summer to the Japanese winter
(d) the relatively heavy latent malarial rate in Australian troops.
Most existing buildings must be regarded as possibly infested with parasitic insects and all will require thorough cleansing and DDT treatment before occupation.
In order to facilitate personal cleanliness as a precaution against diseases borne by body parasites, adequate facilities must be provided for warm water ablution. Pending installation by Engineers these can be improvised from 44 gal drums to the design developed by 1 Aust Corps Mobile Hygiene Cadre. Fuel for these will not be locally available and the heating agent will require to be oil brought in for the purpose.
- WATER SUPPLY
In most built up areas including SAPPORO, NIIGATA, TOKYO, OSAKA, KOBE, KYOTO and KURE water is reticulated from efficient water treatment plants. The sources which raw water is obtained are usually, but not invariably, good – the OSAKA supply for instance is drawn from the NEW YODO river, 20 miles below the outfall of the KYOTO sewer. The water treatment plants are designed to operate with a maximum of efficiency by precipitation, filtration and chlorination and in normal times usually assured a safe supply.
Certain factors however, are temporarily or permanently operating to impair the efficiency of water treatment in all cities.
- Most premises, even city buildings, supplement the reticulated supply with water drawn from private wells. Ostensibly, this water is used only for the flushing of water closets but it has been found that there usually exists inter system connections which convey untreated water to all parts of the building.
- Cessation of chemical manufacture in JAPAN has been followed by an acute shortage of water treatment re-agents. Efforts to recommence and expand production of water sterilizing powder have been successful only to the extent that current requirements for TOKYO and OSAKA are assured to the end of December 1945, but new difficulties calculated to impede production attend the shortage of salt and coal in JAPAN.
As a palliative measure to protect troops from possibly infected water supplies, US Army provides in each building Lister Bags of chlorinated water for drinking purposes. The pitfalls of such a method are self-evident and have been consistently emphasised in the AMF throughout the Pacific campaigns. As a purely temporary expedient for the first few days only, Lister Bags may be necessary in Australian billets unequipped with special treatment facilities at the time of entry, but no system short of complete super-chlorination as required by GRO A.573 of 1943 can be accepted as satisfactory and adequate treatment of all water entering Australian billets must be objective. This point has been discussed with CRE 34 Bde who has expressed the view that no real practical difficulties attend the implementing of complete treatment.
Owing to the predominant use of incendiary bombs rather than high explosive in air raids, reticulation systems have for the most part escaped bombardment damage except:-
(a) In HIROSHIMA and NAGASAKI where the distribution systems have been destroyed by atomic bombs.
(b) In OSAKA where a dam was demolished reducing available water storage and necessitating water rationing.
(c) In fire devastated areas – particularly in TOKYO where the lead service pipes used for premises supply were sealed occasioning extensive leakage. It is estimated that even now only 60% of the TOKYO supply reticulation is under control.
(d) In damaged and devastated areas the passage of heavy MT and the bulldozing of wrecked buildings sites has contributed in some measure to the local disruption of the water reticulation system.
These sources of local flooding, coupled with the accumulation of summer rain in bombardment and fire debris will multiple the potential breeding place of mosquito vectors of disease.
- WASTE DISPOSAL
(a) Excretia
(i) Sewerage: In the built up areas of cities including SAPPORO, NIIGATA, TOKYO, OSAKA, KYOTO, KOBE and KURE, efficient water carriage systems exist. Sewage may be passed through treatment plants before discharge at TOKYO, KYOTO and OSAKA or discharged directly into the sea as at KOBE and YOKOHAMA.
Sewerage systems and the sewage treatment plants escaped bombardment damage except in HIROSHIMA and NAGASAKI. They may be regarded as functioning efficiently although the shortage of labour and other causes during the war years have led to some reduction in the standard of plant maintenance.
(ii) Conservancy: Even in sewered cities considerable sections of the inhabited area were in peacetime served by some form of conservancy system. Of these there were two principal types.
In one, the household excreta were passed into a pit which was periodically emptied by a contractor, the contents being ladled into a special wagon in which it was removed for disposal.
In the other, the household excreta were collected in a bucket set below the squatting platform. The contents of these buckets were removed by a cleansing squad employed by the municipality, using a covered tub mounted on a wheeled vehicle.
In neither conservancy system were the privies fly proof.
The night soil so removed was finally disposed by a variety of methods. In rural districts it was usually used as fertilizer and distributed to farmers but in the cities it was either taken in barges to sea, or where the city was sewered, dumped into the sewer at a special disposal point.
Reversion to the use of conservancy methods has been extensive in the devastated areas of sewered cities owing to the mushroom growth of shanties and improvised shelters. Simultaneously the work of collection has been rendered increasingly difficult by deficiencies in labour and transport and in many localities by the inaccessible siting of shelters in areas heavily littered with bombardment and fire wreckage.
Even conceding that the Japanese is much cleaner in his habits than his Chinese counterpart, the existence of promiscuous faecal fouling in extensive areas of bombardment debris must still be visualised. Such fouling will immeasurably increase the risk of epidemic bowel infections during the warmer months.
When troops move into billets entirely unequipped or inadequately equipped with water carriage systems alternative methods of disposal will be required.
It is improbably that recourse to shallow trench latrines will be necessary and in any case this method should be permitted only during the first 24 hours of occupancy.
Disposal by the pan conversancy system should not be entertained.
The deep trench latrine properly fitted with a fly proof seat and fly trap is the conversancy method of choice and should be adopted wherever the conservancy method is necessary and soil conditions permit. In certain areas, – at OSAKA for example – the subsoil water level is too high to permit the excavation of trenches to an adequate depth. US troops have overcome this difficulty by “building up”, the trench being sunk in a mould bulldozed up from the surrounding soil. This expedient has many very objectionable features and very little to recommend it and is not recommended for Australian troops. In such area, incinerator latrine should be used and these possess the additional advantage that the necessary equipment may be brought in prefabricated thereby obviating the necessity for the temporary use of shallow trench latrines. Fuel is in short supply in JAPAN and incineration will require to be effected by the oil water flash system using oil fuel brought in for the purpose.
All conservancy methods should be regarded as purely temporary. Water carriage systems connected either to existing sewers or to specially constructed IMHOFF tanks should be installed at the earliest opportunity.
(b) Garbage
Normally the householder is required by law to place all litter and refuse in approved receptacles for removal. The municipality is held responsible by the Prefecture for the regular emptying of these receptacles, the contents being removed to a disposal area.
In some cities, modern incinerator plants have been erected to destroy this refuse but in most, disposal is by dumping and burning in the face of the dump. Although incineration plants have not suffered bombardment damage to any extent, the current tendency in all cities owing to shortage of labour and fuel is to dump refuse and burn it on the ground. This method is notoriously inefficient and must be recognised as contributing to prolific fly and rat breeding the warm seasons.
In most cities except HIROSHIMA and NAGASAKI, the collection of garbage, subject to difficulties occasioned by labour and transport shortage is being satisfactorily effected. Even in TOKYO however, evidence of the failure of the system in certain respects is not lacking, notably in the silting of street water tables and in the accumulation of refuse in curb drains and on devastated allotments.
Palliating factors reducing the dangers of current deficiencies are:-
- Shortage of food which minimises the quantity of organic wastes.
- Shortage of fuel which minimises the amount of combustible material discarded.
Disposal of organic refuse by occupation troops should conform to the method hitherto used in operational areas – complete incineration in unit lines.
Owing to the difficulty of supervising disposal of wastes by Japanese who may seek garbage for food or for other purposes, removal by Japanese civilians should be strictly prohibited, in order to prevent the mass being picked over and unwanted portions dumped in secluded parts of the camp area or nearby,
Careful consideration must be given to the disposal of burned cans and incombustible litter. US Army practice is to dump this in approved “sanitary fills”, but there are several serious objections to this method:-
(i) To prevent abuse, the dumps require constant policing.
(ii) Notwithstanding efforts at control these dumps extensively increase the potential breeding ground of disease vector mosquitoes. In spite of organised policing, these tips invariably become polluted by the dumping of unburned garbage, breeding flies and attracting rats This is particularly likely to occur where such dumps are available to civilians unfamiliar with the restrictions applying to them.
(iii) When a load unsuitable for dumping is turned back by the piquet from the “sanitary fill” it is usually offloaded from the vehicle by the roadside on the way back to camp.
(iv) Where dumping outside unit lines is prohibited, the control of vehicles loaded with refuse can much more readily be effected by preventing their use of roads.
(c) Sullage
In sewered areas, the disposal of sullage offers no problems.
In unsewered areas, waste water from premises is run to the street water table and thence is carried with flood water and street washings to creeks or canals.
The preference of Culicine mosquitoes – vectors of B. encephalitis and Filariasis for pools and streams polluted by sullage water, underlines the importance of diverting fluid wastes or artificial collections of water in the vicinity of billets.
In unsewered areas, therefore, camp sullage, unless it can be run to a deep cut flowing canal, should be disposed underground and every effort made to ensure that the town drainage outfall itself does not create a danger to troops.
- FOOD
The climate of JAPAN, particularly through its winter months – December to March – demands certain changes in the AMF diet. Variations suggested are:-
- Increase of animal fat in the basic ration. This may be achieved by the substitution of butter for “spread” and by increasing the ration of eggs, bacon and fresh meat.
- Serving of hot meals.
- More extensive use of oatmeal and coca.
Inevitably there will arise the question of supplementing the ration with supplies acquired by local purchase but the local situation demand that as a matter of general policy the diet should be wholly of Australian origin in order to obviate
- Further reduction in the already inadequate supplies available for the civilian population.
- The risk of bowel and other infections attending the use of locally produced articles of food.
Where local purchase is at once desirable and practicable decision should be subject to the following considerations:-
(a) Dairy produce, in particular milk, cream and butter are unsafe. Pasteurization in JAPAN is inefficiently performed and apart from the serious risk of heavy infection by the organisms of the Enteric B. abortus, Diphtheria and Scarlet Fever, there is a real danger of infection with Tuberculosis.
(b) Eggs and live poultry may be considered safe.
(c) Fish, both fresh water and marine, are important agents in the transmission of certain warm parasites common in JAPAN. In addition, fish are especially likely to be contaminated with human excreta and to carry the infective agents of cholera, dysentery and typhoid.
Fish therefore must be thoroughly cooked before serving and preferably should not be obtained from areas in which clonorchis sinensis and the intestinal flukes are endemic.
Wherever obtained, the introduction of fish into the kitchen or food store provides a ready means of bringing bowel infection into contact with food ready for service and utensils used in the preparation and service of food. Special precautions must therefore be taken to circumvent the introduction of infection in this way if local fish be purchased.
Crabs: Certain crabs serve as the intermediate hosts of Lung Fluke paragonimus. Crab therefore is better avoided although safe if thoroughly cooked.
(a) Fresh vegetables: Human night soil is used extensively in the fertilization of vegetable gardens in JAPAN. Fresh vegetables play an important part in maintaining the high bowel infection and Helminth parasitisation rates obtaining there. No local vegetables therefore should be eaten unless thoroughly cooked and their introduction to food stores and kitchens must be subject to the strict precautionary controls to which reference has already been made in regard to fish.
(b) Fresh fruit: Tree fruit is safe only to the extent to which it has been protected from contamination by other cultivated produce.
Ground fruit is as dangerous as the cultivated vegetable.
No particular factor of safety attaches to the so-called “skin” fruit – unless previously washed carefully, infection on the skill will be conveyed to the feeder’s hands and to the inner flesh of the fruit in the process of peeling or slicing.
For these reasons the indiscriminate purchase of food by individuals and by units should be forbidden. Purchase of supplementary rations if authorised, should be only through DADST subject to the advice and concurrence of the Senior Medical Officer.
Similarly Japanese, cafes, inns and refreshment rooms should be placed out of bounds to troops until satisfactory supervision and hygienic service can be assured. In point of fact in devastated areas such as TOKYO, OSAKA, KOBE and KURE, the shortage of food and the destruction of premises renders such a prohibition one of comparatively easy enforcement. In SAPPORO, NIIGATA and KYOTO, on the other hand, premises remain intact and enforcement may be more difficult although food shortage will still operate as a more or less effectual deterrent.
Owing to the risk of their infecting food with organisms of bowel disease, Japanese should not be employed in or about kitchens or messes unless adequate precautions for the exclusion of infection have been taken. Actually, the Japanese being naturally clean and readily responsive to training, make excellent cooks and kitchen or mess orderlies . Before employment in these capacities however, they must be subjected to strict medical inspection and during the currency of their employment to continued supervision and frequent medical examination.
- FRATERNIZATION
Fraternization is officially forbidden by US Army but it appears to be favoured by the Japanese Government. Evidence of the friendly and even intimate association between US troops and Japanese women is not lacking and Venereal Disease figures in US Sixth Army reveal little inclination on the part of US troops to hold aloof from their recent adversaries. How soon Australian troops will overcome any surviving race prejudice sufficiently to conform to the American attitude is a matter of speculation. The Japanese population is conspicuously friendly and it is probably that amongst Australians, race segregation will be as short-lived as it has proved with US troops.
Apart from Venereal Disease, epidemic Typhus (louse borne) constitutes and important risk attending fraternization. P. corporis, the vector, is widespread throughout the Japanese islands. Typhus is already epidemic in HOKKAIDO and YAMAGUCHI Prefectures at the two extremes of the main group and it must be expected as in previous years to become epidemic elsewhere in HONSHU during the winter.
Whilst sexual intercourse provides optimal conditions for the interchange of body parasites, it must be realised that many less intimate degrees of association will permit the successful passage of infected lice between fraternizing individuals.
The risk of Typhus as of Tuberculosis and bowel infections renders it important that the Japanese should not have uncontrolled access to camp and billet areas at any time and that those employed by the Force in any capacity should be subject to strict supervision, frequent medical inspection and periodic delousing.
For the same reason clothing should not be removed from camp areas for laundering. If Japanese, who are expert launderers, are to be used as washermen, they should work in the camp area where they can be kept under close medical supervision.
- VENEREAL DISEASE
The Japanese approach to sexual promiscuity is in some respects dissimilar to that of the Anglo-Saxon, and the divergences complicate the problem of controlling Venereal Disease.
The accepted “one time, short time, 30 yen” indulgence usually sought by the Anglo-Saxon male, is alien to Japanese taste.
The professional Japanese prostitute is primarily an entertainer and sexual intercourse, although the ultimate objective of the relationship, is in point of time, purely incidental.
Prostitution in JAPAN therefore, is a recognised and registered entertainment trade and its practitioners are housed in definite areas set aside for their use.
There are three types of prostitute in JAPAN.
(a) The professional operating in one of the recognised brothels commonly as a unit of a commercially owned and managed prostitution enterprise.
It is estimated that 70% of this group are infected with Syphilis and not less than 50% with Gonorrhoea. The incidence of Chancroid, though heavy, is uncertain.
(b) Part time prostitutes – café and inn waitresses and the like who appear to correspond to the Australian “amateur” and the American “good time girl”. Though habitually promiscuous, they are unregistered and their services may be wholly or in part the property of the management.
(c) “Street girls”, part time prostitutes who actually correspond to the Australian “amateur” and American “good time girl”.
The incidence of Venereal Disease in the latter two groups cannot be ascertained.
No effective system of Venereal Disease control exists in JAPAN. Venereal Diseases have not been notifiable and reporting of the source of infection is repugnant to the Japanese concept of chivalry.
Venereal Disease clinics – private and government, existed for the periodic examination of professional prostitutes but the methods of examination employed were unsatisfactory and attendance irregular. Hospitals for the treatment of Venereal Disease existed but the methods of treatment were archaic and inefficient and the standard of cure uncertain.
During the war, girls of all three classes were diverted to war work, so that in effect all prostitutes became part time. With the cessation of war industry, synchronising with the arrival of large numbers of occupation troops commercial interests were quick to recruit girls for the purposes of organised prostitution in registered houses, so that there has been a sudden and violent reversion to pre-war practice and there has been a tendency for part time prostitutes to become professional.
Superficially, the tendency of the Japanese to organised prostitution on a commercial basis in strictly defined areas offers ready opportunity for the protection of troops by:-
(a) Placing brothel areas out of bounds, and preventing access of troops by MT patrols.
(b) Maintaining strict medical supervision of a number of girls in an “official” brothel to be exclusively patronised by troops.
It must be remembered, however, that the basic organisation of the brothel involves for a number of girls enforced surrender of personal liberty to a commercial enterprise exploiting their servitude for profit. Recognition and use of the official brothel therefore would present the Allies to the Japanese as tolerating for their own convenience and for the large scale indulgence of, to the Japanese, an unnatural, crude and humiliating sexual practice, a form of slavery inconsistent with the vaunted ideals of democracy so publicised during the war years. Such behaviour in the victor could only be interpreted by the vanquished as a revelation of hypocrisy. The affect would be to stultify the precepts and frustrate the educative purposes of the occupation and in consequence could not be entertained.
In point of fact, either of these measures must be expected to defeat its own object if unsupported by other strict controls for:-
(a) Girls in areas denied the lucrative patronage of troops will revert to the practice of street “pick up”.
(b) Exclusive patronage by troops would be impossible to guarantee even in an official brothel, unless the girls were subjected to a form of imprisonment inconsistent with the Allied profession of human rights.
Control of the part time prostitutes and the street “pick up” would be effectually controlled by full compliance with the order against fraternization. Such full compliance, however, can only be expected when it is the personal inclination of every individual to remain aloof from the Japanese population. Enforcement is impossible. At the risk of public disturbance, fraternizing couples in public places could be separated by the police, but complete elimination of fraternization could not be expected to be achieved in this way.
Probably the best results would attend a system embracing:-
(a) Education of troops in the risks of typhus and venereal disease involved in fraternization and sexual intercourse with Japanese women.
(b) Generous provision of amenities and attractive evening entertainments.
(c) Establishment of PACs in unit lines with free issue of prophylactic outfits.
(d) Enforcement of the non-fraternization order by police patrolling in pairs – 1 MP and 1 civilian.
(e) Placing brothels out of bounds.
(f) Establishing in the Japanese Ministry of Health an efficient organisation for the control of Venereal Disease in the civilian population and in particular for the
i. prompt notification of Venereal Disease
ii. weekly medical inspection of prostitutes with serological tests for Syphilis each month.
iii. efficient and modern treatment of Venereal Disease
Action to have Venereal Disease made legally notifiable in JAPAN has already been taken up by the Supreme Commander but it is not yet possible to determine the incidence of these diseases in the population at large.
Amongst American troops the incidence is:-
12 per 1000 per annum in Eight Army Area
170 per 1000 per annum in Sixty Army Area.
In view of the wide divergence in incidence between these two formation it is of interest to note that in Eighth Army area brothels are out of bounds and policed whilst in Sixty Army area no such precaution is taken.
- NOTIFICATION OF DISEASE
The following diseases are notifiable under Japanese law:-
Cerebro Spinal Meningitis
Cholera
Diphtheria
Dysentery
Para-typhoid fever
Plague
Scarlet Fever
Typhoid Fever
Small Pox
Typhus (epidemic)
The householder or the medical practitioner attending is required to notify to the local authority – in rural areas the Police Officer – within 24 hours, every suspected or known case of notifiable disease. In practice it may be expected that notifications come only from the medical practitioner in private or hospital practice.
Weekly returns are forwarded by the local authority to the Prefectural health authority within 7 days. The Prefectural authority in turn forwards within 7 days a consolidated return for the Prefecture to the Ministry of Health. At the Ministry of Health, the Prefectural returns are tabulated and summarised information forwarded to SCAP.
Notification of infectious diseases therefore, will ordinarily not be received by SCAP until some 3 weeks after the first notification.
In order to bridge this gap, the Senior Medical Officers in occupied areas are required to effect liaison with the local and Prefectural authorities so that they may be at all times fully informed of the prevailing epidemiological situation. Similarly Senior Medical Officers may direct Prefectural Health authorities to take such action as may seem desirable and necessary to initiate control. In accepting returns of notifiable disease as indications of the epidemiological position, it should be remembered that:-(a) they are probably incomplete
(a) they are probably incomplete
(b) they are usually out of date
- PREVALENT DISEASES
Civilian Population:
Of the notifiable diseases, those currently prevalent are:-
(a) Bowel Disease:
Incomplete returns for the week ending 3 Nov 45 notified 4330 cases of bowel disease including 2264 dysentery and 2066 typhoid and para-typhoid. Dysentery was most heavily prevalent and patently epidemic in HIROSHIMA and YAMGUCHI Prefectures on the SW tip of HONSHU; an epidemiological situation probably to be attributed to the destruction of sanitary facilities by the atomic bomb at HIROSHIM and to the heavy influx of refugees from that locality into YAMAGUCHI Prefecture adjoining.
Enteric disease was most prevalent in HOKKAIDO where the overcrowding of labour barracks consequent upon the Japanese coal miners’ strike and the delayed repatriation of the Korean labour force has created conditions favourable to transmission. At the same time it must be remembered that typhus is epidemic in HOKKAIDO and that mistaken diagnosis may play a major part in inflating the enteric figures for this Prefecture.
The weekly notifications reveal that even in winter when chiefly food-borne, bowel disease are by far the main cause of morbidity in JAPAN and that they constitute a major menace to the health of troops. In the warmer months when fly prevalence introduces a mode of transmission more difficult to eliminate from army billets the risk to troops will become of first importance.
(b) Typhus:
Tsutsugamushi fever (scrub typhus) is endemic in the Prefectures of AKITA, YAMAGATA, and NIIGATA. No cases have so far been reported amongst US troops in the endemic area.
Available information has been summarised in “NOTES ON JAPAN FOR HYGIENE OFFICERS” (q.v.)
Endemic typhus. The diagnosis and notification of typhus, being in JAPAN largely upon clinical rather than epidemiological grounds, some uncertainty surrounds the relative prevalence and distribution of endemic and epidemic typhus. The former however, is essentially a disease of spring and summer incidence, whilst the latter is one of winter prevalence. It is probably therefore that the outbreaks in TOKYO (1400 cases) and in KAGOSHIMA on KYUSHU during the spring of 1944 were in fact endemic typhus. The US Typhus Commission expects to determine this point finally by serological tests in the near future.
Endemic typhus is a disease of rats conveyed to human by the rat flea and its occurrence in JAPAN year after year reveals the persistence of epidemiological conditions favourable to the dissemination, not only of murine typhus but also of plague.
It is apparent that the heavy littering of the principal ports and cities with bombardment and fire wreckage must immeasurably increase the opportunities for rat and flea breeding and harbourage there. Gross prevalence of these vermin with its attendant grave potentialities in respect of typhus and plague epidemics might reasonably be expected therefore during the spring of 1946. On the other hand, mortality amongst rats and fleas during the conflagrations which produced this damage must have been enormous, and this, coupled with the scarcity of food, deriving from the present famine conditions may offset the risks visualised.
To control rat borne disease persistent measure of rat reduction by poisoning and trapping must be undertaken. Wastes serving rats as food must be completely incinerated and incombustible litter providing them with harbourage must be buried. Billets must as far as possible be rendered rat proof and stores so disposed as not to attract vermin in search of food or shelter.
Fleas can most effectively be destroyed by DDT treatment of billets and suspected rat runs.
The necessary measures for rat and flea reduction are embodied in “PROPOSED STANDING ORDERS FOR HYGIENE – JAPAN OCCUPATION FORCE – AMF” attached hereto.
Epidemic typhus: Louse borne typhus occurs annually in JAPAN during the colder months, October to May, and recently incidence has progressively increased each year.
Epidemics of some magnitude are present reported in HOKKAIDO and in the YAMAGUCHI Prefecture of KYUSHU, the mortality amongst Japanese being 30%.
Special conditions operating this year to foster the epidemics include the overcrowding of labour barracks consequent upon delay in repatriating imported Korean labourers and the double banking system of accommodating labour in HOKKAIDO under which the same living quarters are used by two shifts, the one working by day and the other by nights.
General conditions prevailing throughout JAPAN and calculated to extend epidemicity to new areas and to unprecedented intensity are:-
i. Overcrowding of certain areas by refuges living under the poorest of conditions.
ii. Shortage of fuel which at once reduces opportunities for cleanliness and fosters intimate association thereby increasing lousiness and facilitating the interchange of lice.
iii. Famine which reduces personal resistance.
iv. Absence of an effectual system of quarantine to process Japanese troops and displaced persons returning from endemic areas on the Asiatic mainland or moving through JAPAN from HOKKAIDO and KYUSHU.
Louse born typhus is, and for some months will continue to be the most important communicable disease to which troops will be exposed in JAPAN.
Control measures amongst troops must include:
(i) Immunization
(ii) Instruction in the dangers of fraternization, in the epidemiology of the disease and in the control of lice.
(iii) Enforcement of the order against fraternization
(iv) Prohibition of the removal of laundry outside billets.
(v) Mass or personal disinfection vide Appx 4
(vi) Regular and frequent inspection and delousing of Japanese employed in the camp area.
(vii) Disinfection of fomites – Rickettisiae are unaffected by DDT and must be destroyed by steam or by boiling.
(viii) Close liaison with the local health authorities to ensure timely recognition of first cases and prompt application of control measures to the civil population.
(c) Cerebro Spinal Meningtitis:
24 cases of meningitis were reported for the week ending 3 Nov 45; of these 11 were from the TOKYO Prefecture. The persistence of this droplet infection as a sporadic manifestation emphasises the necessity of providing adequate ventilation in winter quarters for troops.
(d) Scarlet Fever:
66 cases of Scarlatina were reported during the week referred to, 28 of these being from HOKKAIDO.
Other notifiable diseases not reported as occurring during the week were:
(a) Plague:
Plague is not an epidemiological feature of JAPAN, but synchronisation of its introduction from nearby epidemic areas on the Asiatic mainland with the development of a rat and rat flea plague during the spring may well occasion an epidemic of major proportions during 1946.
The broad epidemiology and the control of plague, involved as they are with the bionomies of the rat and of the rat flea, may be considered as analogous to those of endemic typhus which have already been discussed.
(b) Small Pox:
Variola occurs sporadically throughout JAPAN with increasing incidence each year owing to failure during the war period to maintain the artificial immunity of the civilian population. It must be expected to be encountered in small though possibly sharp epidemics anywhere on the Japanese islands, more particularly where there has been gross displacement of the population and where artificially induced resistance has been lowered by malnutrition.
The security of troops can only be assured by the early detection and recognition of civilian cases and by constant maintenance of artificial immunity at a fully effective level.
(c) Cholera:
The epidemiology of cholera may be considered closely linked with that of the other bowel infections already discussed. Although not recently reported in JAPAN the introduction of this highly fatal disease by repatriates from ASIA is an ever present risk under the imperfect quarantine methods currently operating. Furthermore the displacement of large sections of the population, the disruption of sanitary services, in both devastated and refugee areas and the prevailing famine conditions immeasurably increase the risk of wide dissemination and heavy epidemicity if infection be imported.
The control of cholera must be effected by constant and strict attention to unit sanitation and by the artificial immunization of troops.
Communicable diseases not notifiable in JAPAN
Information concerning the prevalence of these diseases can only be obtained from Japanese medical practitioners and medical institutions so that close liaison must be constantly maintained by the Senior Medical Officer with local medical practitioners.
Communicable diseases which although not notifiable are important in their relation to the health of occupation troops are:-
(a) B. Encephalitis:
This seasonal mosquito borne appears in late summer and early autumn casing suddenly with the onset of cold winter. 90% of cases occur in August and September. Cases average 1500 annually with a mortality of 60%.
The localities chiefly affected are the salt producing areas on the shores of the Inland Sea and epidemics are usually associated with seasons of high temperature and low rainfall.
Birds and animals may serve as reservoirs.
The principal vectors are believed to be:-
(i) Culicine: C.pipens palens and C. tritaeniorryhynchus are regarded as the principal vectors but several other species are suspected. The mosquitoes breed in casual water near habitation particularly polluted water. They feed at night or in the shade.
(ii) Aedes: A. togoi is regarded as the principal aedes vector but A. albopictus is suspected. These are domestic breeders favouring artificial collections of water and bite essentially by day although A. togoi also feeds at nightfall.
A planned campaign for the prevention of B. Encephalitis must include:
i. The control and treatment of natural mosquito breeding places in the vicinity of billets.
ii. The elimination of artificial mosquito breeding places.
iii. The elimination of mosquito harbourage in and about billets.
iv. Organised adult destruction by DDT spraying including residual spraying in billets.
v. Personal protection – maximum coverage by clothing and the use of repellent by day and night when mosquitoes are prevalent.
vi. The screening of occupied buildings and the use of nets by night.
vii. Segregation of troops from the infection population and the destruction of animal reservoirs in the vicinity of billets.
viii. Prophylactic vaccination of troops as soon as cases are reported – two doses of 2cc. at 3 days interval of a formolised mouse brain culture.
(b) Malaria:
The incidence of malaria in JAPAN is impossible to determine as the disease is not notifiable.
B.T. infections predominate amongst cases reported from hospitals and A. Hyrcanus sinensis, a swamp and rice field breeder is the principal vector.
Atebrin suppression in troops will not be necessary except during the first month of occupation and then only for the purposes of eliminating any M.T. infections contracted in the Southwest Pacific.
After that time Atebrin suppression may be discontinued.
Active anti-mosquito measures undertaken for the control of B. Encephalitis Filaria and Dengue including the eradication or treatment of breeding places, adult destruction in billets and personal protection, should be adequate to control malaria in JAPAN.
(c) Filaria
The principal vectors of this disease in JAPAN are:
C. fatiagans and A. Hyrcanus sinensis. Involvement of the first named which breeds for preference in polluted water emphasises the necessity of preventing the pollution of streams and pools by sullage water from billets. Otherwise control should conform to the general principles of mosquito control detailed in respect of B. Encephalitis.
The summary of available information upon other disease including Tuberculosis, Dengue, Leptospirosis, various forms of Helminthiasis, Brucellosis, Rabies, Trachoma and others, has already been given in “NOTES ON JAPAN FOR HYGIENE OFFICERS”. (q.v.)
Occupation Troops:
The weekly incidence of certain disease in Sith and Eight US Armies is shown in subjoining table
Eighth Army is stationed North and Sixth Army south of a line following the Southern boundaries of KAMAGAWA, YAMANASHI, and NAGAWA Prefectures and the Western boundary of NAGAWA Prefecture vide Chart 2.
Although the periods covered by the weekly returns in the table are not comparable and although the epidemiological experience of the two Armies is in some respects dissimilar, it is possible to make the following generalisations:-
(a) Respiratory Disease:
A sharp rise in respiratory disease is to be expected in troops after landing.
(b) Diarrhoeal Disease:
Probably owing to the winter scarcity of flies and the exclusive use of army food supplies diarrhoeal diseases have not so far been an important source of casualties.
(c) Malaria:
Both armies have discontinued malaria precautions including Atebrin suppression. Recurrences show a tendency to increase in number as the winter advances. No new infections have been reported.
(d) Hepatitis:
These cases originated outside JAPAN and have no local significance beyond the fact that under conditions of defective hygiene they may serve as a source of infection for troops moving into the area.
(e) Skin disease:
Skin diseases are not reported by Sixth US Army, but in Eight US Army they show a progressive decline in the weeks following disembarkation in JAPAN.
(f) Venereal Disease:
In the Sixth Army area where brothels are not out of bounds there has been a progressive rise in the Venereal Disease rate. In the Eighth Army area on the other hand, where access to brothels is restricted, the rate remained consistently low.
- IMMUNIZATION
US Army orders require that all personnel serving with US Army shall receive the following prophylactic innoculations:
(a) Variola:
An initial vaccination repeated every three years.
(b) Typhoid – para typhoid:
Three doses respectively of 0.5cc, lcc, 0.5 cc at weekly interval repeated annually and in the presence of disease.
(c) Tetanus Toxoid:
An initial course of three doses each of 1cc. A reinforcement dose of 1cc after the lapse of 1 year. A further dose of 1cc at the time of injury as directed by the Medical Officer.
(d) Typhus:
An initial two doses of 1cc each at one week’s interval. A stimulating dose of 1cc in the presence of disease or before commencing travel through an endemic area.
(e) Influenza:
A dose of 1cc in October or November of each year.
In addition, personnel serving North of the 20th degree Nth Latitude and West of 150∞ East Longitude are required to receive:-
(f) Typhus:
A reinforcement dose of 1cc seasonally in November and February.
(g) Cholera:
An initial course of 0.5cc and 1cc at one week’s interval. A reinforcement dose of 1cc in the presence of disease.
ADH, Advanced Headquarters, Australian Military Forces, has raised with the Chief Surgeon, GHQ SCAP, the questions whether:-
- an Australian Occupation Force would, for the purposes of this order be considered as serving with US Army,
- in the event of Australian troops being subject to this order, Australian practice in respect of vaccinations for Variola, TAB and Tetanus would be accepted as satisfactory notwithstanding its occasional deviations from the standards set down.
Chief Surgeon, SCAP, will in due course furnish Brigadier W.M. ANDERSON, Commander Australian Liaison Section GHQ SCAP, with his replies to these queries and meantime has intimated that the answer to the second will be in the affirmative.
Whether or not Australian troops are to be considered subject to this order, compliance with it in respect of typhus and cholera before embarkation from MOROTAI should be a matter of AMP policy. Immunisation in respect of influenza and plague should be favourably considered.
- AMENITIES
Control of fraternisation and of communicable disease, particularly Venereal Disease and Typhus will be facilitated by liberal provision of camp amenities. These should be suitable controlled arrangements to meet the demand of troops for souvenirs and sightseeing.
The purpose should be to ensure congenial occupation or adequate entertainment for troops outside training time, and particularly during the evenings, it being postulated that fraternisation will be forbidden and that centres of population will be out of bounds at night. It should be the objective to provide some such entertainment or occupation for every evening in every unit.
Suggested pastimes are-
(a) Organised and competitive sport.
(b) Frequent picture shows. Japanese cinemas are out of bounds to troops – a prohibition inspired by the necessity of reserving the inadequate space available for the use of the civilian population, but equally important as a measure of typhus control.
(c) Plays and concerts by local and unit players.
(d) Educational classes and study groups directed towards rehabilitation.
(e) Discussion groups on economic social and political problems.
(f) Illustrated talks upon the history, geography and culture of Japan.
Souvenirs: To obviate the necessity of troops seeking souvenirs in Japanese stores during the epidemic season, and to prevent them being charged exorbitant prices, AACS might purchase in the best market, supplies of local silk goods, ornaments etc. and resell them for troops in unit line.
Sightseeing: To the Occidental notwithstanding the bitterness and prejudices engendered by the war Japan will prove a country of scenic enchantment. Troops will with increasing avidity apply their leisure hours to exploring its scenic wonders and to enjoying its fascinating native charm.
In order that these reasonable aspirations may be gratified without the risk attending transit in overcrowded trains or close association with civilians under dubious environmental conditions ample provision should be made for sightseeing tours under controlled conditions to points of interest both near to and more remote from the occupied area. Similarly displays of Japanese culture and art may be brought to the troops or opened to them under controlled conditions.
- MOSQUITO CONTROL
In addition to Malaria, prominent amongst disease carried by mosquitoes are B. Encephalitis and Filariasis. The mosquito vectors of disease, known and suspected include an extensive range of species with a wide diversity of breeding and feeding habits. Control therefore must embrace the prevention of breeding in all varieties of surface water.
Medical and Hygiene officers must make a close study of the breeding and feeding habits of the several species of mosquitoes involved in the transmission of Malaria, Encephalitis, Filariasis and Dengue and conduct frequent and thorough surveys of the camp area and its neighbourhood, so that the work of anti mosquito squads may be effectively directed to the elimination of all breeding places.
With emphasis removed from Malaria there is serious risk that collective and individual consciousness of the importance of mosquito control will rapidly be lost. Any such tendency must be vigorously countered. Malaria remains a summer and autumn risk but more important are the highly fatal B. Encephalitis and the insidious Filariasis.
The former will strike suddenly and disappear before neglected measures of control can be efficiently implemented. In the absence of constantly effective control, the latter will, unrecognised, achieve an incidence which will only be realised with its rippling effects perhaps a decade after discharge from the Army.
In respect of both these condition the importance of controlling day biting and nocturnal pest mosquitoes is again emphasised. Particularly must attention be given to controlling the breeding of Culicines in polluted water and of Aedes in artificial collections of rain water. The utmost importance therefore attaches to the careful disposal of sullage underground, to the prevention of the dumping of garbage particularly near water, and to the effectual burial of incombustible litter.
In this connection the dangers associated with the widespread littering of devastated areas must be fully appreciated.
Unit mosquito squads must be thoroughly trained in the several methods of using DDT in mosquito control and in the preparation of the various mixtures entailed.
- SUPPLIES
It is the firm policy of SCAP that all formations entering the occupied area shall be logistically self supporting.
Preliminary examination of the situation suggests-
(a) Sprays Rega
Sprays Hand
Nets Mosquito
Spray Fly
Creosote
Kerosene
(On the existing scale).
(b) Aerosol Dispensers.
1 to 5 men per 14 days during the period of mosquito prevalence May to October.
(c) DDT.
Existing unit scale plus the entitlement of one ‘A’ type AMCU.
(d) Anti louse powder (10% DDT in Pyrophyllite)
80 lbs per 1000 men per month November – May.
(e) Dusters Hand for application of above.
1 per 100 lbs of anti louse powder.
(f) Malarial
Existing unit scale plus entitlement of one ‘A’ type ANCU.
(g) In lieu of Malarial in certain areas.
Equivalent amount of Larvicide Dusting Powder. (10% DDT in talc).
(h) Dusters for above.
Equivalent ‘A’ type ANCU Rega Spray scale.
(i) W.S.P.
Areas to be occupied not being W.S.P. should tentatively be supplied on existing scale.
(j) Extra fuel for Incinerator latrines and refuse incinerators.
Six x 44 gals per 1000 per week.
(k) Vaccines.
In addition to existing scale the following are indicated.
B. Encephalitis vaccine.
400 cc per 100 men per annum in July of each year.
Plague.
150 cc per 100 men on embarkation.
100 cc per 100 men per annum reinforcement does in the event of epidemic.
Typhus.
200 cc per 100 men per annum.
Influenza.
100 cc per 100 men per annum.
Cholera.
200 cc per 100 men before embarkation; 300 cc per 100 men per annum thereafter.
- CONCLUSION.
In order to remove any temptation to peruse conclusions without reference to the data on which they have been based the usual practice of closing with a summary will not be followed here.
This section is limited to adding emphasis to certain aspects of control to which reference previously has been indirect or incidental.
(a) Liaison. It is impossible, even were it desirable in this appreciation to do more than outline the broad principles underlying the control of epidemics involving the civilian population. The SMO of the Australian Occupation Force must from the earliest opportunity after landing maintain the closest liaison with the Chief Surgeon SCAP and the Chief of the Public Health and Welfare Section SCAP in order that they may always be fully informed upon current problems, new developments in technique, modifications of routine and changes in approach suggested by research or imposed by the supply position.
(b) Immunisation. The inoculation state of all troops and particularly of reinforcements must be constantly checked so that every solder may at all times be assured the maximum protection afforded by artificial immunity. In addition to the immunisations at present required all members of the Force should before embarkation at MOROTAI be immunised against Plague and Typhus and if possible also against Influenza.
Stocks of B. Encephalitis vaccine adequate to treat all men in epidemic areas should be held available not later than July of each year in case of need.
(c) Hygiene. The control of by far the greater number of the communicable diseases menacing the health of troops can be effected by constant maintenance of a high standard of unit and personal hygiene designed to counter danger at all points. In non epidemic times this will eliminate the danger of sporadic cases initiating epidemics amongst more susceptible troops. In times of pestilence it will be necessary to prevent disastrous epidemics. It must be remembered that in such emergencies the sudden application of restrictive control measures not previously enforced and the hasty imposition upon the individual of precautionary responsibilities hitherto neglected will inevitably lead to confusion and possibly to panic, whilst effective prophylaxis is delayed. The necessary measures of control must be inaugurated immediately and sedulously developed to a maximum of efficiency during non epidemic periods.
(d) Flea born Disease. Outbreaks of Endemic Typhus and of Plague must be anticipated during the spring and summer. Constant attention must be given to the control of rats and fleas by reduction and exclusion methods. Unit anti mosquito squads should be thoroughly trained in methods of flea control with DDT, and should conduct systematic disinfestation of billets, bedding etc. during the spring and summer.
(e) Epidemic Typhus. On present appearances Endemic (louse borne) Typhus will be disease risk par excellence during the winter months.
The Senior Medical Officer must by close liaison with the U.S. Typhus Commission make himself fully familiar with the epidemiological situation from time to time obtaining and with developments and control amongst both civilians and army personnel.
Medical Officers must be carefully trained in the diagnosis of this infection and maintain constant watchfulness for its appearance amongst troops.
Hygiene Officers and NCOs must be fully trained in the epidemiology and control of Epidemic Typhus both in its army and civilian aspects.
A comprehensive scheme of control, conforming to U.S. practice and embodying the principles detailed in para 11 (b) must be evolved. The training of personnel necessary to implement this should be completed before the endemic area is entered and must be maintained during non epidemic periods.
(f) Quarantine. The prevalence of Epidemic Typhus, and the possible occurrence of Plague and Cholera raise important questions of quarantine, vitally affecting Australia.
It must be fully appreciated that personnel leaving endemic or epidemic areas in aircraft may themselves carry disease to Australia whilst still apparently fit and well. Alternatively during local movement they may convey infected insects to Transit Camps, US or Australian, and there transfer parasites to personnel moving by air to Australia from non endemic areas.
To ensure adequate control –
i. all personnel leaving endemic areas of Typhus and Plague and
ii. all personnel leaving for Australia from Japan or the Asiatic mainland
should be DDT dusted before embarkation or emplaning, and ordered to wear the treated clothing unchanged not less than 48 hours and to defer its washing for at least 14 days unless it can be steam disinfected meantime.
The quarantine requirements of The Commonwealth Department of Health should be ascertained at the earliest opportunity and conscientiously implemented.
C E Cook
Lt-Col
AD of H, Dv HQ, AMF