1. INTRODUCTION

The information in this section was prepared under the direction of the Surgeon General of the U.S. Army, in a War Department pamphlet titled "Health Precautions for the Far East." Extracts from the pamphlet are reproduced below in order to insure a wide dissemination of this information among enlisted men and junior officers.

In connection with this section, reference should be made to a similar article, "Some Health Rules for North Africa and the Middle East," which appeared in Intelligence Bulletin, Vol. I, No. 9, pages 65 to 78. That article dealt mainly with the health aspects of water supply, foods, clothing, and housing in the North African and Middle East areas. Since this information is also applicable to the Far East areas, it will not be repeated here.

2. INSECT CARRIERS OF DISEASES

The most important insect carriers of disease are listed below, together with brief discussions of the diseases that they may carry and applicable precautionary measures.

a. Mosquitoes

(1) Malaria

Malaria, which is spread only by the bite of the female anopheles mosquito, is a serious disease, and its danger cannot be overestimated. Anopheles mosquitoes feed during dusk or night periods, and possibly during the day when the light is greatly reduced, as in deep, shaded jungles or inside of dwellings. With the exception of a few of the mountainous areas, great numbers of mosquitoes, many of which may act as carriers of malaria, are found throughout the Far East.

Man is the reservoir of malaria. Eighty to 90 percent or more of the native inhabitants of some regions are infected with this disease. Anopheles mosquitoes become infected when they feed on (bite) a human being who has malaria. After an incubation period of from 14 to 40 days, these mosquitoes are capable of transmitting the disease. While most anopheles mosquitoes breed in slow-moving streams, lagoons, and swamps, several varieties of malaria-carrying mosquitoes breed in small collections of water about houses. Unless care is taken, they may enter buildings through carelessly opened screen doors, torn screens, cracks at the junction of tiled or corrugated roofs with walls, and so forth. During the day these mosquitoes hide in corners and other parts of the house where there is little light but come out to feed after dark.

Preventive measures include the following:

(a) Sleep in screened rooms or under mosquito nets. Inspect screens, doors, and mosquito nets at regular intervals, and search for live mosquitoes in those parts of the house where there is little light.

(b) After dark, stay indoors in properly screened buildings as much as possible.

(c) When it is necessary to be out of doors after dark, move about continually.

(d) If possible, select camp sites on wind-swept ground away from areas infested with mosquitoes and far removed (at least 1 1/2 miles) from native villages (the inhabitants of which are usually infected and act as a reservoir of malaria).

Additional measures that may be applicable include:

(a) The use of head nets, gloves, and mosquito boots, along with other mosquito-proof clothing covering the entire body. Mosquitoes are able to bite through the material ordinarily used in shirts and other lightweight clothing.

(b) Mosquito repellents applied to all exposed parts of the body at regular intervals.

(c) Insecticide sprays used inside airplanes and in living quarters in the early morning and late afternoon, and at other times when necessary.

(d) Quinine and atabrine do not prevent malaria. However, these drugs are of definite military value in that they do prevent clinical symptoms of malaria as long as they are taken, and thus afford a means of keeping troops fit during periods of emergency in the field. Such drugs should be used only under special conditions and when advised by medical officers, flight surgeons, or local health authorities. The present War Department policy advocates 0.1 gram of atabrine (1 1/2 grains or one tablet) once daily at the evening meal for six days each week (total, 0.6 gram or six tablets per week). An alternative method of administration which has been found satisfactory in some areas is to give 0.05 grain of atabrine (one-half tablet) once daily at the evening meal for six days each week, and a dose of 0.1 gram (one tablet) at the evening meal on the seventh day (total, 0.4 grain or 4 tablets per week). If atabrine is not available, take quinine sulfate 0.6 gram (10 grains or two tablets) after the evening meal each day. (Circular Letter No. 153, Surgeon General's Office, dated 19 August 1943.)

(e) The estive-autumnal type of malaria may give rise to strange symptoms, entirely different from the usual chills and fever. It is therefore advisable, when residing in or traveling from malarial areas, to suspect malaria when the cause of an illness is unknown, regardless of whether or not there is fever. A medical officer should be consulted and advised of the recent possibility of exposure.

(2) Dengue Fever

Dengue fever, or breakbone fever, is apt to occur in any part of southern Asia and is common in eastern India, the Netherlands East Indies, and along the coast and on the islands of the China Sea and the Sea of Japan. The "yellow fever mosquito," Aedes aegypti, is the carrier in southern Asia, whereas Aedes albopictus most commonly carries dengue fever in China and Japan. These mosquitoes feed (bite) during the day but usually not in bright sunlight. Although this disease is rarely fatal, it may be the cause of much disability among troops. The precautionary measures outlined in (1) (a) and (d) and (a), (b), and (c) above, under preventive measures for malaria, are also applicable for protection against dengue fever.

(3) Filariasis (elephantiasis)

This disease, often called elephantiasis, is caused by several different types of small worms that can be injected into man by the bite of mosquitoes. These worms travel through the lymphatic channels, frequently blocking them. While the disease ordinarily does not cause any serious incapacity, chronic swelling of the legs and scrotum may develop, and it seems certain that sooner or later all individuals affected will suffer some ill effects.

Since the disease is prevalent throughout the Par East and chances for exposure are great, it is likely that considerable numbers of soldiers will be affected by it. Methods for protection against malaria as outlined in (1) (a), (b), (c), and (d), (a), (b), and (c) above, also will prove valuable in preventing filariasis.

(4) Yellow Fever

Yellow fever has never been reported from Asia. However, the Aedes aegypti mosquito (the carrier of yellow fever) is found throughout the East, The transportation of infected individuals or of infected mosquitoes by airplane or ship from an area where yellow fever is present is a serious hazard, for by either of these means the disease could be introduced into the Far East. If it were introduced, its spread undoubtedly would be rapid.

b. Lice

Body lice are small, gray, flat, six-legged, wingless insects. In the Far East they are the carriers of the epidemic form of typhus fever (not to be confused with typhoid fever) and louse-borne relapsing fever. Typhus fever is prevalent in the hill country of India and throughout all of China. It occurs sporadically in other parts of the Far East.

To keep from getting lice, the following measures are advised:

(1) Frequent bathing (when a satisfactory water supply is available);

(2) Frequent changes into freshly laundered and pressed clothing;

(3) Careful selection of sleeping quarters so that clean bed clothing is used;

(4) Avoidance of native habitations and close contact with louse-infested individuals (sleep and eat only in the best accommodations available);

(5) Use of Army-issue insecticide powder on the seams of clothing and on bedding as indicated; and

(6) In the presence of mass louse infestation, group delousing methods as outlined in paragraphs 57 to 66, inclusive, FM 21-10, and additional instructions on delousing that are issued from time to time, may be employed.

c. Fleas

Fleas are small, wingless, brown or black insects with a flat body, small head, and large legs. In addition to being annoying, rat fleas are the carriers of bubonic plague and endemic or flea-borne typhus fever. Rats and other wild rodents suffering from these diseases infect the fleas. At death the fleas leave the rat in search of a new host and infect man. The finding of dead rats or other dead rodents may indicate that these diseases, especially plague, are prevalent.

Plague in man (human plague or bubonic plague) was reported throughout most of 1942 from the Dutch East Indies, Java, Madura, West Java, New Caledonia, parts of China, India, French Indo-China, and Burma. Although not reported recently, the disease is known to be present in many of the towns and villages of central China and the seaports of Japan.

Plague in wild rodents is known to be present constantly in several large areas in central Asia, in northeastern China, and in Manchuria.

Endemic or flea-borne typhus fever is found in the Malay Peninsula, the Dutch East Indies (where it is called shop typhus), the lowlands of India, and ports of the China Sea.

Neither the plague nor the endemic form of typhus fever is likely to be of importance to individuals if the precautionary measures outlined under "Lice" (b above) are followed, and rats and rat-infested buildings are avoided.

d. Ticks

Ticks can be identified by their flat, oval body, small head, and comparatively large abdomen. In the Far East ticks are carriers of tick-borne relapsing fever, a disease which is found in Western and Central Asia and in China. In Northern India they transmit Indian tick typhus.

Precautionary measures include:

(1) Measures outlined under "Lice" (b above).

(2) Avoid native homes, especially at night, when the ticks come out of the walls.

(3) Avoid sleeping on the ground, particularly in long grass, or resting near the trunks of trees (ticks hide in grass and under the bark of trees during the day).

(4) Always examine your bed for ticks before turning in.

(5) Examine skin and clothing for ticks at least twice daily. Remove all ticks and kill them. Never squash a tick on the skin or attempt to pull it out. Cover the tick with a good coating of oil, vaseline, gasoline, paraffin, or even spit. After a few moments the tick will let go and be easy to remove. The tick should then be killed by burning or by crushing between two stones.

(6) The site of the tick bite should be cleaned and treated with an antiseptic such as iodine or alcohol.

e. Mites

Mites are small insects resembling fleas. In different parts of the Orient they are the carriers of various forms of mite typhus. These diseases are common in Java, New Guinea, Malaya, Japan, India, and Burma. In Southern China their bite causes a skin disease known as "coolie's itch."

Mites are usually found in association with rodents (particularly rats), with birds, and possibly in the flowers of certain palm trees. They are most commonly found in areas that are subject to flood and in recently cut-over jungle lands; they are most numerous in the late spring and early summer.

Precautions include:

(1) When possible, avoid mite-infested areas.

(2) Wear clothing that protects the skin, such as long trousers tucked into boots, long sleeves, and so forth.

(3) Use Army-issue insecticide powder and insect repellents on skin and clothing.

f. Flies

Certain fly-borne diseases are of importance in Asia.

(1) Common House Fly

By mechanical means, flies are capable of carrying intestinal disease germs from filth and fecal matter to the food of man. Infectious material from the ulcers of yaws and Oriental sore may be carried by flies in the same manner, and eye diseases may be transmitted mechanically by these insects.

General precautionary measures (see par. 35, FM 21-10; also AR 40-205):

(a) Destruction of flies by swatting, trapping, poisoning, and so forth;

(b) Elimination of fly breeding places by careful and complete disposal of wastes and refuse (human excreta, manure, garbage, rotten fallen fruit, and other organic matter);

(c) Use of insect repellents (sprays);

(d) Use of nettings and/or screens; and

(e) Protection of foods.

(2) Myiasis (fly boils)

The bites of certain types of flies (especially botflies and gadflies) may cause deep-seated abscesses or boils that heal with difficulty in the absence of medical attention. In the process of biting or alighting, the flies deposit their eggs or larvae (maggots, grubs) in or on the skin, open wounds, nostrils, or ear canals. The eggs of some of these flies may be carried by other insects, mosquitoes, for example. The development of the maggots in these locations is accompanied by bacterial infection and subsequent boil formation. Surgical removal of the growing fly larvae is necessary for cure.

(3) Sandflies

Sandflies transmit a virus disease known as pappataci fever or sandfly fever. This disease is of a mild nature but is prevalent over practically all the Far East, where it may cause considerable disability. Evidence indicates that sandflies also are capable of transmitting the organisms causing Oriental sore, and may be responsible for the spread of kala-azar or Dumdum fever, a serious disease affecting many people in the Orient.

3. ANIMALS; DISEASES ACQUIRED FROM THEM

Animals are not only the hosts of insect carriers of disease (par. 2: rat fleas, lice, dog ticks, and so forth), but also may be directly responsible for the spread to man of diseases which these animals themselves contract. The following animal-borne diseases are likely to be encountered in this part of the world:

a. Rabies (mad-dog bite, hydrophobia)

This can be acquired from both wild and domestic animals. This disease is of great importance throughout southern Asia, especially in India, and also in parts of the Dutch East Indies, where great packs of dogs are kept as food. In the case of a bite by an animal thought to be rabid, the wound should be cleansed as thoroughly as possible, any available antiseptic applied, and a physician consulted as soon as possible. If practicable, save the animal for observation and examination.

b. Snake Bite

Poisonous snakes are found throughout tropical and temperate Asia. The majority of them do not attack man unless disturbed. Cobra venom contains a powerful poison which affects the nervous system, while the venom of the vipers affects the red blood cells. In case of snake bite, identification of the offending snake is less important in the Far East than in other areas, since the antivenom usually available is effective against both types (polyvalent). The presence of an undigested or partially digested "ball" of food in the snake's stomach may indicate the amount of venom injected into the victim. When a venomous snake kills, a part of its venom is used up; thus the presence of a visible food ball in its stomach may mean that its poison sacs were relatively empty and therefore that probably only a small amount of venom was injected at the time of biting the person.

Take the following precautions:

(1) Wear boots when required to walk in snake-infested areas.

(2) Avoid the careless touching of shrubs, brush, trees, tree branches, and so forth, or walking near ledges where snakes may be hiding.

(3) Examine clothing and shoes before getting dressed, and always look in cupboards, drawers, and other dark places before reaching into them.

(4) Have a flashlight or other source of light available at the bedside so that the floor may be examined before getting out of bed in the night.

(5) If bitten by a snake, the following procedures are recommended:

(a) Immediately apply pressure or a tourniquet (rubber tubing, belt, piece of shirt, string, vine, or weed) above the bite, no tighter than a snug garter. This will stop the venous-blood return toward the heart and keep the poison from getting into the general circulation. The tourniquet should be released for a few seconds every 10 or 15 minutes to permit some circulation.

(b) Under field conditions, and in the absence of medical care, do not make an incision, but instead place a 3- or 4-inch square sheet of thin rubber (rubber from a condom or similar material) over the site of the fang punctures, and, by vigorously sucking and kneading with the teeth, remove as much venom as possible during a period of 5 minutes. The rubber sheeting will prevent sucking the venom into the mouth. Wash the wound and the rubber sheeting and repeat the sucking and kneading at frequent intervals while removing the patient to the nearest medical officer or other physician. If no rubber sheet is available, blood from the fang-punctures may be sucked into the mouth directly. In this case, the person sucking should rinse out his mouth with water at frequent intervals to lessen any danger of his becoming poisoned from the venom.

(c) If practicable, kill the snake and take it to the physician for inspection.

(d) Whisky or other alcoholic drinks must not be given.

(e) Keep the patient from exerting himself, for this will increase blood flow and thus cause more venom to be absorbed.

c. Leeches

Leeches look like thick, short worms. They are troublesome in India, the Malay Peninsula, and the Dutch East Indies. They are of two types, the large "horse" leech found in fresh water, and a small jungle leech found on shrubs and in tall grass in the vicinity of streams and rivers. They attach themselves to man for the purpose of sucking blood, and, although they are not dangerous in themselves, the site of their bite frequently becomes infected.

Precautions:

(1) Wear long trousers tucked into high shoes. The leech is capable of slipping through the eye-holes in shoes, or through coarse stockings; therefore the tongues of shoes should be sewn to the sides.

(2) Do not pull off the leech, for if the mouth parts are left in the wound, an infection may take place. Remove the leech by touching it with the lighted end of a cigarette, by prodding it with a knife, or by applying common table salt, wet tobacco, or other chemical irritant harmless to the skin.

(3) To prevent infection, immediately apply a suitable antiseptic to the bite.

4. VENEREAL DISEASES

Venereal diseases are prevalent throughout Asia. In some areas, up to 100 percent of the native population may be infected with one or more of these diseases, which include the following: Syphilis, gonorrhea, chancroid (or soft chancre), lymphogranuloma venereum (tropical bubo), and granuloma inguinale.

Briefly, it may be said that in the vast majority of cases venereal diseases are contracted through sexual contact, although syphilis may be acquired by kissing.

5. SUNBURN, SUNSTROKE, AND HEAT EXHAUSTION

Personnel accustomed to climatic conditions in the United States fail to evaluate the intensity of the sun's rays nearer the equator. As a consequence, serious skin burns and sunstroke may occur after relatively short exposure. It also must be remembered that severe sunburn may be acquired from the reflection of the sun, although protected overhead, when in small boats on tropical waters. Exertion in hot and/or humid climates, with resulting loss of fluid and salt by sweating may cause heat exhaustion even in physically fit individuals. Glare from water or sand in intense sunlight often results in severe eye irritation, and mechanical irritation may be produced by wind and blowing sand and dust.

Precautions: The following precautions are suggested:¹

(a) Wear suitable headgear (sun helmet) when exposed to the sun.

(b) Do not expose large areas of the body surface to direct rays of the sun for more than a few minutes at a time unless a thorough tan has been acquired and then only during the early morning or the late afternoon.

(c) The use of a superior grade of dark sun glasses is advisable. The Calabar lenses now widely used by Army Air Forces personnel are satisfactory.

(d) Early recognition of the warning signs of heat stroke and heat exhaustion (dizziness, headache, blurring of vision, nausea and/or vomiting) and early first-aid treatment of these conditions. Medical attention should be obtained as soon as possible.

(e) Avoid or reduce to a minimum the consumption of alcohol.

6. MINOR WOUNDS

Wounds do not heal rapidly in tropical climates and infection is likely to take place. Minor wounds (cuts, scratches, abrasions, insect bites, and so forth) should be treated by application of iodine or other antiseptics. Burns should be covered with boric-acid ointment or sulfanilamide powder and a dry dressing applied. All wounds should receive medical attention as soon as practicable. See FM 21-11.