MEDICAL AND SANITARY DATA ON CELEBES

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP79-01144A002600020002-0
• Release Decision: RIFPUB
• Original Classification: R
• Document Page Count: 20
• Document Creation Date: December 19, 2016
• Document Release Date: August 2, 2005
• Sequence Number: 2
• Publication Date: July 19, 1944
• Content Type: BULL

,_ . [TB MED 611
WAR DEPARTMENT TECHNICAL BULLETIN
Approved For I ale 0 10 : CIS-RD7%O D02 OA0 0002-0
MEDICAL AND SANITARY DATA : . ? C 8
ON CELEBES
War Department, Washington 25, D. C.
Paragraph
Section
1. Public Health and Environmental
Factors Influencing Health and
Sanitation.
Public Health Department-------
I
Water--------------------------
2
Sewage-------------------------
3
Insects and Animals of Importance
to Man and Their Control------
4
Food and Dairy Products in Rela-
tion to Health----------------
5
Miscellaneous Problems of Sanita-
tion--------------------------
6
H. Medical Facilities.
Hospitals-----------------------
Medical Practitioners ------------
Laboratories--------------------
III. Disease Information.
Diseases of Special Military Im-
portance---------------------
10
Diseases of Potential Military Im-
portance---------------------
11
Serious Diseases of Nonmilitary'
T
Af
Lik
l
b
-
e
y
o
ut
Importance
fect Small Numbers of Troops__-
12'
1. PUBLIC HEALTH AND ENVIRONMEN-
TAL FACTORS INFLUENCING HEALTH
AND SANITATION
19 July 1944
Paragraph
Section III. Disease Information-Continued.
Diseases Causing High Morbidity
or Mortality Rates Among Na-
tive People------------------- 13
Miscellaneous Diseases ----------- 14
IV. Supplemental Data on Islands Off
Southeastern Celebes.
General------------------------ 15
Health and Medical Service------- 16
Water-------------------------- 17
Mosquitoes--------------------- 18
Nutrition----------------------- 19
Malaria------------------------ 20
Dysentery---------------------- 21
Skin Diseases------------------- 22
Frambesia---------------------- 23
Filariasis----------------------- 24
Leprosy-------------------- --- 25
Measles------------------------ 26
Infectious Jaundice-------------- 27
Leptospirosis-------------------- 28
V. Summary and Recommendations.
Health and Sanitation------------ 29
Tables.
Bibliography.
encies, with Makassar as capital. To the resi-
dency of Manado belonged the Sangihe and
Talaud Islands off northern Celebes. To the
residency of Celebes belonged the Salajar Islands
off southern Celebes, the Banggai Islands east
the Toekangbesi Archipelago off
of Celebes
,
1. Public Health Department. a. Organization. southeastern Celebes, and the islands of Boet-
(I) The island of Celebes was divided into two oen Moey,~ and Kabaena. The islands of
administrative regions called residencies. On Boetoeng, Moena, an abaena and the Toek-
the north was the residency of Manado, which angbesi Archipelago, together with the coun-
had the city of Manado as its capital. , On the ties of Poleang, Roembia, and Laiwoei of the
south was the residency of Celebes and depend- southeastern pgninsula, constitute the adjninis-
f p,alssmcartox cANCE141u
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trative district of Boetoeng and Laiwoei, with
capital at Kendari and. a total population of
310,500 persons.
?(2) Both in Manado and Makassar there were
chief public health physicians. These officials,
together with the chiefs of the Public Health
Services of the Moluccas in Amboina and of the
Timor Archipelago in Koepang, were responsi-
ble to the Inspector of the Public Health Serv-
ice located in Makassar, The latter reported
immediately to Batavia,
(3) In Celebes, as in other parts of the Nether-
lands East Indies, the Public Health Service
was inseparably interwoven with the curative
functions of the government physicians. Areas
of this character had virtually no medical serv-
ice other than that furnished by the govern-
ment. Consequently, the medical officer acted
both as health officer and as physician to the
territory he served. Other medical personnel,
nurses, vaccinators, and midwives served under
his direction.
(4) At the beginning of 1939 the medical per-
sonnel of the Public Health Service for the
residency of Mana.do consisted of 2 European
physicians, 10 Indonesian physicians, 3 civil-
ian physicians who did a certain amount of
public health work, 6 military physicians who,
in addition to their military duties, acted as
public health physicians, 2 European nurses, 15
Indonesian nurses, 1.9 vaccinators, and 3 mid-
wives (table I). One of the government phy-
sicians in Manado directed the leprosarium of
Malalajang, one the tuberculosis sanitarium in
Noongan, one the government hospital in Ma-
nado. One of the European nurses was head
nurse in the hospital of Manado and the other
served in the psychopathic hospital.
(5) In the residency of Celebes and dependen-
cies, the medical personnel of the Public Health
Service consisted of 4 European physicians, 10
Indonesian physicians, 1 civilian physician who
performed public health duties, 5 military phy-
sicians who, in addition to their military duties,
acted as public health physicians, 1 European
nurse, 40 Indonesian nurses, 38 vaccinators, 1
midwife, and 2 technicians (table I). One of
.the physicians of Makassar was director of the
Regional Central Laboratory, one was director
of the psychopathic hospital, and one was, the
consulting ophthalmologist of the Public Health
Service.
b. Scope and estimate of effectiveness.
In view of the vastness of Celebes (76,000 square
miles), the size of the population (more than
4,200,000 inhabitants), and the difficulties of
communication and transportation, the medical
personnel of the Public Health Service can
hardly have been sufficient
most essential duties.
to cope with the
2. Water. a. The average annual rainfall
ranges from 21 inches on the west coast of cen-
tral Celebes to 184 inches in the eastern moun-
tain area of central Celebes. Over most of the
island the rainfall is more than 60 inches, and
it exceeds 100 inches over a considerable area.
Rainfall is quite evenly distributed throughout
most of the Celebes. As a result, water is
abundant, there are numerous streams with
steady perennial flows, and many springs.
Ground. water is readily obtainable from shal-
low dug or. drilled wells in many parts, especially
in the alluvium-filled valleys and coastal plains.
There are free-flowing artesian wells on several
parts of the island, notably the tip and central
portion of the north arm and the north part of
central Celebes at the base of the east arm.
The yield of most of these wells would be in-
creased by pumping. In some areas, however,
such as southeastern Celebes, there is a water
shortage during the dry season. The plain. of
Paloe has been one of the driest areas of the
Netherlands East Indies,
b. Most existing wells are primitive, uncased,
dug wells only a few feet deep and yield small
quantities. Natives commonly drink untreated
river or shallow well water. During the - dry
season, such wells in the southwestern penin-
sula often run practically dry. Near the coast
and on many of the nearby islands, the wells
deliver brackish water, and drinkingwater has
to be imported.
c. Stream water is usually turbid and highly
contaminated. Spring water is somewhat more
mineralized than the surface. water, occasionally
is warm, and is apt to be contaminated, partic-
ularly in limestone regions, where the streams
often flow underground for some distance and
come to the surface as great springs. Shallow
well water is also apt to be contaminated as is
also the water from existing deeper wells and
artesian wells. Properly constructed and lo-
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cated drilled wells should deliver a safe water
supply.
d. Twenty-four towns are reported to have
municipal water supplies. Most of these sys-
tems provide small quantities of water from
wells, springs and sometimes surface sources,
which in most cases is not treated. In many
cases one or, at most, a few wells serve the whole
[TB MED 67]
village. In general, less than one-third of the
population is served, and the quantity available
is less than 10 gallons per capita per day on the
basis of the total population and less than 40
gallons per capita per day on the basis of the
population served (estimated). Additional data
concerning the municipal water supplies are
given in the following tabulation. '
Public Water supplies of Celebes
Source '
n
Number ~ onec-
Consumption (gallons per day)
Place
9i
y~
ygd~,a
4CI
m
e~
a
.55,2
y
as
ao~ o
91
o
73
0.
q
E.
oA.
dq
"
q
a
o
d
m~ ?wq
o
a
E~
a
a
Manado---------------
23,700
x
x
______
_
x
1, 511
33
275, 400
12. 0
36
Tondano--------------
14,270
x
x
x
185
13,000
.9
14
Gorontalo-------------
9,400
x
x
x
------
-I-
--------
------
-------
-----
Kampoengbaroe (Toli-
toll)----------------
--------
------
------
x
Donggala-------------
2, 200
x
x
_-___
---
19
1
5
080
2. 3
51
Paloe-----------------
33,259
x
-_---_
_-__-_
__---_
___
137
,
22,700
.7
33
Poso------------------
2,100
x
x
---
----
------
-
Loewoek--------------
7,906
___
64
______
21,700
2.7
53
Banggai---------------
--------
x
x
s -
Kendari---------------
29, 911
______
_-_ _-
x
---
136
1
14, 950
. 5
22
aoebaoe-------------
1,500
______
x
-_____
______
___
163
16
76,000
5.1
93
Palopo----------------
2,900
------
------
x
x
---
-----
P repare______________
k
M
3,600
x
x
_
______
22,500
6.3
21
a
assar-------------
84, 000
x
, 699
349, 700
42
26
Watampone-----------
--------
x
x
------
-----
-
------
------
------
Total-----------
-------
10
7
9
3
-
--------
There are also public supplies at Kokas,
olaka, Kolonodale, Madjene, Makale, Malili,
K
Mamoedjoe, and Raha, but no details are
available concerning these supplies.
3. SEWAGE. Some of the houses of the
Europeans and the richer Chinese had cesspools
or septic tanks. The rest of the people had no
provisions for sanitary waste disposal. The
result was intense pollution of the soil around
homes. In many areas even the simplest type
of privy was unknown.
4. INSECTS AND ANIMALS OF IMPOR-
TANCE TO MAN AND THEIR CONTROL.
a' Vectors of disease. (1) Mosquitoes. (a)
Anopheles. In Celebes at least 15 different
arophelines are found (table II). Twelve of
these are potential malaria carriers. Anopheles
sundaicus is an important vector in the coastal
areas of southern Celebes, where the sea has
formed salt water lagoons. Here A. subpictus
also transmits malaria, but it has recently
become apparent that in southern Celebes, as
in other regions, A. sundaicus is a much more
active vector than is A. subpictus. A. sundaicus
breeds chiefly in brackish waters. This fact
has been used to aid differentiation from the
closely related A. ludlowi, which breeds in sweet
water. A. sundaicus is found chiefly in coastal
accumulations of stagnant saline waters, includ-
ing not only lagoons but also fish ponds and
similar collections. Such bodies of water are
partly or wholly protected from tidal fluctua-
tions. Since the larvae of A. sundaicus prefer
sunlit waters, breeding usually does not occur in
mangrove swamps. The presence of algae,
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however, favors breeding. A. barbirostris, ordi-
narily regarded as a, vector of limited impor-
tance, has recently been found to show a high
rate of natural infection in the interior of
southern Celebes. It transmits filariasis as
well as malaria. In some areas this species was
found to be the sole vector of malaria; in other
areas it was found in ' association with A.
hyrcanus (nigerrimusf), both species showing a
high index of infection. A. barbirostris breeds
by preference in shaded vegetated stagnant
waters, in rice fields, swamps, and fish ponds.
A. hyrcanus nigerrirnus likewise breeds in rice
fields, swamps, and other collections of still or
slowly moving water protected by vegetation.
In the Netherlands East Indies this species
shows marked preference for the blood of man
and itenters houses readily.
In Minahasa the chief vector is A. minimus.
This species is highly adaptable but is predom-
inantly a stream-breeder. It prefers clear, cool,
-slowly flowing waters which are exposed to the
sun or lightly shaded. It is avid for the blood
of man and is a dangerous vector. In Minahasa
A. aconitus is regarded as an accessory vector.
This mosquito is able to breed in both stagnant
and running water. Adults tend to enter
human habitations. Minahasa is the long
northern peninsula of Celebes between the Gulf
of Tomini and the Celebes Sea.
(b) Aedes. Eight different species of -Aedes
have been described from this area (table III).
Aedes aegypti and A. albopictus, the two vectors
of dengue, are widespread. Aedes aegypti is a
domestic mosquito. It breeds in small collec-
tions of water, especially artificial collections,
such as' are formed in tanks, roof gutters, flower
vases, or tin cans.
(c) Culex and others. Eleven different species
of Culex have been reported (table III). Culex
quiraquefasciatus (syn. C. fatigans) is widespread.
This is a nocturnal species and is commonly
found in human habitations. It breeds in any
small collection of stagnant water. Two species
of Mansonia have been found. The latter are
vectors of Wuchereria malayi but are less effi-
cient vectors in the Celebes than is Anopheles
barbirostris.
(2) Lice. Pediculus capitis is frequent in
Celebes, but P. corporis and Phthirus pubis are
rare, as is the case in the rest of the Netherlands
East Indies.
(3) Flies. Musca conducens, M. ventrosa, Al.
vetustissima and M. xanthomelas have been
reported from Celebes. It seems probable
that most of the flies of Java would also be
found on Celebes. Therefore, Musca sorbens,
M. crassirostris, M. planiceps, and M. corvina
can also be expected, together with Orthellia
chalybea. In the harbors which have regular
contacts with the outside world, occasional
specimens of M. domestica may be found. Of
the bloodsucking flies, Tabanus atrimaculatus,
T. factiosus, T. ceylonicus, T. fieailis, T. humilli-
mus, T. immixtus, T. reducens, T. speculum, T.
malayensis, T. fumifer, T. fuscicaudata, T. im-
manis, T. indianus, T. rufiventris, T. striatus, T.
xanti, T. optatus, T. rubidus, T. succurvus, and T.
spoliatus have been described. Chrysops dis-
par, C. fasciata, C. fixissima, C. flaviventric,
and C. signifer also occur. Chrysozona cingu-
lata, C. irrorata, C. javenica, C. pungens, and
the rare Lissimas moestus and Neobolbodymia
argentata have been reported. Large numbers
of Phlebotomus perturbans and P. angustipennis
may be expected on Celebes. Although they
do not play a role as vectors of disease in this
area, they may be exceedingly disagreeable
because of their numbers.
(4) Fleas. Pulex irritans has not been de-
scribed from Celebes, but Xenopsylla cheopis,
X. astia, Ctenocephalides canis, and C. felis
all occur. The two species of Xenopsylla have
been found in large numbers on the rat popula-
tion of Makassar and neighborhood.
(5) Mites and ticks. Unfortunately, the infor-
mation available about the mites of Celebes is
unsatisfactory. In view of the occurrence of
mite-borne typhus on this island, more com-
plete data would be highly desirable. Of the
mites which attack man, Trombicula pseudo-
akamushi has been found on Celebes, but no
reports have been found on the occurrence of
T. deliensis, the vector of mite-borne typhus in
the East Indies Archipelago. Sarcoptes scabiei
is common. The ticks Boophilus annulatus
and Rhipicephalus haemaphysaloides have been
described from Celebes. The latter species
occurs especially in southwestern Celebes and
in the central part of western Celebes. Chig-
gers abound in the jungles and the woods.
(6) Rodents. In Makassar, Rattus norvegicus
and R. concolor are by far the most frequent.
Rattus diardii, the house rat, is less prevalent.
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In this city R. concolor has replaced R. diardii
as house rat. In the fields R. brevicaudatus is
found in large numbers. From southeastern
Celebes R. offmanni and different species of
the Chrysocomys, Xanthurus, and the R. hell-
waldii rajah group have been described. In
northern Celebes R. dammermanni, R. pesticulus
and R. norvegicus have been found.
b. Snakes and other dangerous animals.
Poisonous snakes in Celebes are the common
krait, Bungarius candidus, the hooded cobra,
Naja bungarus, the red-tail snake, Doliophis
intestinalis, and a viper Lachesis wagleri. No
poisonous snakes have been reported from the
Salayer islands and from the Boetoeng group.
On the Sangihe islands Lachesis wagleri has
been found. In the sea around Celebes, poi-
sonous sea snakes are Platurus colubrinus, Hy-
drus platurus, Hydrophis brugmansi, and the
small water snake, Enhydris hardwickei, which
is mildly poisonous.
The scorpions of Celebes are only slightly
poisonous. Hormurus australasiae, Chaerilus
variegatus, and C. celebensis can be expected.
Crocodiles are numerous. The babirusa, a
wild boar with dangerous tusks, is native to
Celebes.
c. Pests. The bedbud, Cinex hemipterus,
occurs in large numbers. Leeches are extremely
common in the forests.
5. FOOD AND DAIRY PRODUCTS IN RE-
LATION TO HEALTH. In the greater part
of Celebes rice is the staple food. Rice, how-
ever, is usually not planted on irrigated fields
but on dry soil, where its development depends
on sun and rain. Corn is grown in the hills,
where it is the main part of the popular diet.
In marshy areas sago woods occur. In Kondari,
for instance, the people depend chiefly on sago
and fish. The chief domestic animals are
buffaloes.
6. MISCELLANEOUS PROBLEMS OF SANI-
TATION. a. Data about general death rates
and infant mortality are sketchy. In 1930
Makassar had 85,000 inhabitants and a general
death rate of 32.3 per 1,000. In 1934 this rate
was 29.3, in 1937 it was about 27, and in 1938 it
was 31 per 1,000. In Manado with 27,500
inhabitants the death rate was 22.4 per 1,000
in 1934, about 18.0 in 1937, and about 21 in
1938. The death rate in Tondano in Minahasa
in 1930, during a measles and dysentery epi-
demic was 34 per 1,000. In 1931 it was only
27, and in 1932 it was 22 per 1,000. The
death rates in the other districts of Minahasa
also varied between 22 and 30 per 1,000. Not
only measles and dysentery but especially ma-
laria outbreaks always caused a sudden rise in
the mortality figures. In southern Celebes the
disastrous malaria epidemic of 1936 caused
general death rates of 70 to 80 per 1,000.
b. Infant mortality rates in Minahasa in
1930, 1931, and 1932 averaged 196 per 1,000
live births, a rate which for tropical conditions
was not too unfavorable.
7. HOSPITALS. a. In the residency of
Manado there were 28 general hospitals with
1,040 beds in 1939. In the residency of Celebes
there were 32 general hospitals with 1,015 beds
(table IV). One of these was located on Salajar
island, one on Boetoeng, and one on Moona.
Many of these hospitals were small and un-
satisfactorily equipped. The military hos-
pital in Makassar, where civilian patients were
also admitted, and the government hospital at
Manado, were satisfactorily equipped, as were
a few of the smaller new hospitals, as for in-
stance, the hospital in Parepare.
b. In addition, there were eight leprosaria
in Celebes (table V). In Minahasa there were
five leprosy clinics (Manado, Amoerang, Kakas,
Tomohon, and Airmadidi). A psychopathic
hospital with 305 beds was located in Makassar
and one of 34 beds in Manado. In Noongan in
Minahasa there was a tuberculosis sanitarium
with 70 beds. Seven tuberculosis clinics were
spread over Minahasa (Manado, Tondano,
Airmadidi, Tomohon, Amoerang, Gorontalo,
Kotamabagoe).
c. Outpatient clinics were widely scattered
throughout the island.
8. MEDICAL PRACTITIONERS. a. Physi-
cians. Almost all the physicians in this area
belonged to the Public Health Service (see par.
la and table I). Three European physicians
and two Indonesian physicians practiced pri-
vately in Manado, and three European physi-
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cians and four Indonesian physicians in Makas-
sar (table I). Outside of the cities of Makassar
and Manado the physicians not connected with
the Public Health Service were missionaries
working in small hospitals.
b. Dentists. In Makassar there were three
dentists; in Manado two dentists were in
private practice.
c. Nurses. In addition to the nurses men-
tioned in paragraph la, few Europeans worked
in Makassar and Manado as private nurses.
It seems reasonable to surmise that in the mis-
sionary hospitals, nurses not mentioned among
the public health personnel were also working.
d. Midwives. Apart from the public health
midwives, 16 midwives practiced privately in
the residency of Manado and 6 in the residency
of Celebes.
e. Pbarmacists. There was only one phar-
macist in Makassar. In all the other cities and
villages the physicians performed the duties of
pharmacists.
9. LABORATORIES. A well-organized and
well-directed Regional Laboratory was located
in Makassar. In 1938 this laboratory examined
42,300 specimens, only one-third of which were
sent from the city of Makassar proper. The
work consisted of bacteriological cultures,
microscopic examination of blood and stool
specimens, serological tests, examination of
arthropods and rodents, and examination of
water and food.
10. Diseases of Special Military Importance.
a,. Malaria. (1) Celebes is a highly malarious
island. There were only a few places where
malaria did not occur or where it was rare. In
recent years, the city of Makassar has been
practically free of malaria and ih the northern
arm of Celebes, in Minahasa, the so-called
lake districts near Tondano and Kakas have
been malaria free. Many other districts in
Minahasa, however, were highly malarious, as,
for instance, Tonsea and Airmadidi.
(2) The southwestern arm of Celebes was
devastated by serious epidemics almost every
year. In 1936 such an outbreak was reported
from Boeloekoemba, Sindjang, Watampone,
and Loewoek. In 1937 Watampone and Djene-
ponto were seriously affected; in these areas the
parasite index rose to 70 percent. In many
villages of Bira the parasite index was 100.
The southeastern arms and the central part
(Toradja area) of Celebes are also notoriously
malarious.
(3) The vectors of malaria differ in different
areas of Celebes. In Minahasa, especially in
the mountainous interior, Anopheles minimus
is the main vector. In southwestern Celebes
it had always been thought that A. subpictus
was the anopheline that transmitted malaria.
In recent years new data have been collected
indicating that A. sundaicus is a much more
important vector in this area than is A. sub-
pictus. In many parts of the coast of Celebes,
salt water lagoons are favorite breeding places
for A. sundaicus. In 1938 in Djeneponto, 2.5
percent of A. subpictus was naturally infected
with malaria, whereas 54 percent of A. sun-
daicus was infected.
(4) In southwestern Celebes A. 'barbirostris has
recently been proved to be an important vector.
Until a few years ago it was not believed to play
an outstanding role in the transmission of
malaria. A. barbirostris had been found to be
naturally infected only in a few areas of Sumatra
(Kisaran on Sumatra's east coast and Groot
Mandailing in Tapinnoeli), but even in these
regions the natural infection rate was very low
(0.36 and 0.55 percent). Then in 1938, in three
different epidemics in southwestern Celebes,
A. barbirostris was shown to be the main vector.
In the Javanese immigration colony of'Wono-
redjo near Malekoe in Malili, it was the only
vector and showed a natural infection rate of
13 percent. In Boetoong near Parepare the
natural infection rate was found to be 11 per-
cent. Here, however, A. barbirostris was not
the only vector, because A. hyrcanus showed a
natural infection rate of 8.7 percent. The
population affected in this area consisted of
laborers imported from parts of southwestern
Borneo. South of Lake Tempe in Singkang in
Watampone, during a malaria epidemic among
the local population, the only infected mosquito
was A. barbirostris, but the natural infection
rate in this area was only 1.6 percent. Finally,
in 1939, A. barbirostris was the vector in epi-
demics in Bonthain and in Boeloekoemba. In
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all these areas A. barbirostris attacks man with
great ferocity. Whereas in the rest of the
Netherlands East Indies A. barbirostris prefers
cattle, it is strongly anthropophilic in Celebes.
It has been stated that slight morphological
differences exist between A. barbirostris found
in southwestern Celebes and A. barbirostris
found in the rest of the Netherlands East Indies.
(5) Information about malaria vectors in the
rest of Celebes is much less specific. The inci-
dence of malaria in many other areas, including
parts of the southeastern peninsula and the
interior, is however as high as in southwestern
Celebes.
b. Bacillary dysentery. (1) In Celebes bacil-
lary dysentery' was a common disease. In the
northern part of Celebes no differentiation of
the dysentery bacilli has been made, but the
laboratory in Makassar has given ample infor-
mation about the strains of southwestern
Celebes. In the city of Makassar, Flexner
bacilli were more frequently found than were
Shiga bacilli; outside of Makassar the reverse
was true. Of 862 strains isolated in the regional
laboratory off' Makassar, 600 belonged to the
Shiga strain, 231 were Flexner bacilli, 25 Sonne,
and 6 Schmitz bacilli. Even in the city of Ma-
kassar, Shiga bacilli were not rare as they con-
stituted about 20 percent of the strains isolated.
(2) The frequency of bacillary dysentery is in-
dicated by the fact that in 1937 in southern
Celebes 4,040 cases were reported. Specific
figures are available for the following sub-
divisions:
Boeloekoemba-----------------------
375
Bone-------------------------------
355
Bonthain------------------=---------
140
Djeneponto--------------------------
284
Pangkadjene-------------------------
194
Rantepao---------------------------
199
Sindjang----------------------------
624
Watampone-------------------------
775
In the same year the subdivision of Loewoek in
the southern part of Manado residency reported
284 cases.
(3) In 1938 in the southern part of Celebes,
4,520 cases were reported. In this part of Cel-
ebes, not only the Sbiga but also the Flexner
bacilli have given rise to dangerous epidemics.
In the Javanese colony of Wonoredjo, near
Malekoe, a Flexner-Y epidemic caused many
fatalities in 1938. Prospecting expeditions in
the Roembia-Poleang and Kendari areas of the
southeastern peninsula are reported to have
suffered severely from dysentery.
(4) In the northern part of Celebes, dysentery
was not less frequent. In 1939 Gorontalo
reported more. than 100 cases, other districts
in the northern arm more than 200. The
disease was especially common in Tomohon.
c. Typhus. (1) Scrub typhus. In 1934 the
laboratory at Makassar reported one case of
scrub (mite-borne) typhus in a European.
This was the first case reported from Celebes.
In 1939 it was reported that the disease occurred
regularly in Minahasa, where it was even more
frequent than flea-borne typhus. Most of the
patients had no "scrub history" and primary
lesions were only rarely found. Although
systematic investigations in this field are not
available, it seems probable that this disease is
a frequent cause of fever in Celebes. The local
vector has not been determined. Trombicula
pseudo-akamushi has been reported from
Celebes, but T. deliensis, the probable vector
in New Guinea, has not been described.
(2) Murine typhus. In 1939 flea-borne murine
typhus, the so-called shop typhus, was recog-
nized as occurring regularly in Minahasa. The
disease must also occur in the southern part of
Celebes as the laboratory at Makassar has
occasionally recorded a few cases.
d. Filariasis. Filariasis has been reported
from nearly every part of Celebes. Only a
few areas were known to be virtually free.
No cases have been found in the city of Makas-
sar itself. Near Minahasa the infection occurs
on the north and south coasts of the subdivision
of Corontalo, but the infection rate is not high.
There are several heavily infected areas within
Minahasa, as for instance, the region around
Manado and Bolaang-Mogondow. Other dis-
tricts with a high filaria index are the southern
part of the plains of Paloe, Donggala, the
Todjo coast near Poso, the hills near Madjene,
Simpang, Malili, Kolonadale, Kawata, Kendari,
and the Roembia-Poleang area. In those
regions the infection index varies between 15
and 50 percent, and a good deal of elephantiasis
has been seen. Most of the cases in Celebes
are due to Wuchereria malayi. W. bancrofti is
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relatively rare but is found together with W.
malayi in the southern part of the area around
Mamoedjoe and near Kolonadale. It is the
sole form found in Boetoeng, Moena, and
Kabaena, the islands off the tip of the south-
eastern peninsula. Filariasis is especially fre-
quent in marshy regions near stagnant water
-and becomes rarer with increasing altitude.
In Celebes infection with W. malayi is trans-
mitted by Anopheles barbirostris and by species
of Mansonia, especially M. annulipes. Care-
ful. investigation has shown that in Celebes
A. barbirostris is the most active vector. In
Mamoedjoe 3.7 percent of A. barbirostris have
been found to be naturally infected. Another
survey showed that in this area 8:9 percent of
A. barbirostris harbored filariae, whereas M.
annulipes was found. to be infected to the
extent of 2.7 percent. Experimental infection
has shown that the filariae developed much
more constantly and much- more rapidly in A.
barbirostris than in Mansonia.
e. Venereal diseases. Specific information
about venereal diseases in Celebes is scanty.
Gonorrhea is frequent among natives through-
out the island. Syphilis among natives is said
to be limited mainly to the harbor cities.
f. Skin diseases. As in the rest of the
Netherlands East Indies, scabies, fungus dis-
eases, tropical ulcers, and pyodermatitis are
frequent ailments. Fungus infections are com-
monly acute and quite resistant to treatment.
Minor skin lesions are likely to become infected
and to result in prolonged subacute or chronic
ulcers.
11. DISEASES OF POTENTIAL MILITARY
IMPORTANCE. a. Amebic dysentery. Ame-
bic dysentery is common throughout Celebes.
In Minahasa it has been estimated that about
25 :percent of the patients with dysenteric stools
suffer from amebic dysentery.
b. Common diarrheas. Diarrhea of un-
known cause is one of the most frequent
ailments in this area. It may well be that
some of these diarrheas are caused by Salmon-
ella. On the other band, the rarity with which
paratyphoid A, B, and C have been isolated in
the laboratory of Makassar should be kept in
mind. A great many of these so-called com-
mon diarrheas may :possibly have been cases of,
undiagnosed bacillary dysentery.
c. Dengue. Dengue occurs regularly, es-
pecially among new arrivals, but serious
epidemics have not been reported for several
years. As both Aedes aegypti and A. albopietus
abound in this area, occasional -epidemics must
be expected.
d. Respiratory tract infections. Epidemics
of a disease resembling influenza have been re-
ported every year from Celebes, though the
exact etiology has not been determined. Other
infections of the respiratory tract are not un-
common. The night temperature in the moun-
tains may be low, and considerable differences
between day and night temperature may
favor the development of acute respiratory
infections. In this part of the tropics pneu-
monia occurs frequently among the natives;
the fatality rate is high. The pneumonia
mortality rate in Minahasa in 1931 was more
than 200 per 100,000.
12. SERIOUS DISEASES OF NONMILITARY
IMPORTANCE BUT LIKELY TO AFFECT
SMALL NUMBERS OF TROOPS. a. Tuber-
culosis. (1) As in the rest of the Netherlands
East Indies, tuberculosis is common in Celebes.
The most detailed data had been obtained from
Minahasa. It should be pointed out that in
this area the population has reached a higher
stage of civilization than in the rest of Celebes,
and sanitary conditions there are better than
anywhere else in the island. It can, therefore,
be assumed that the tuberculosis figures in
Minahasa are somewhat more favorable than in
the other divisions of the island.
(2) In 1931 the tuberculosis mortality rate was
167 per 100,000 in Minahasa. In the same year
the death rate in the registration area of the
United States for all forms of tuberculosis was
67.8. Tuberculin tests (Pirquet) performed on
nearly 11,000 individuals in Minahasa showed
that of 1,554 children between 11 and 15 years,
31 percent had a positive reaction, whereas
among persons 20 to 30 years of age, 50 percent
of the reactions were positive. In 1938, in a
study of 1,083 of the 1,200 inhabitants of the
village of Noongan in Minahasa, only 16 percent
of the children between 5 and 14 years and. 40
percent of the older adults had a positive Pir-
quet reaction. Active tuberculosis was found
in 0.64 percent of the population. It should be
stressed that the latter somewhat more favor-
Am
A
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able data were obtained in an isolated rural-
population.
b. Leprosy. (1) In 1939 there were 4,518
known cases of leprosy in Celebes. In the
subdivisions of Madjene and Mamasa (popula-
tion 184,000) there were 638 leprosy patients in
1029. About 700 lepers were known in Mina-
hasa. In 1937, the following cases of leprosy
were reported from various parts of Celebes:
Gorontalo___________________________
127
Kotamabagoe________________________
11
Madjene----------------------------
210
Makassar--------------------------
117
Manado-----------------------------
420
Paloe-------------------------------
70
(2) During 1937, examination of different body
fluids and excreta in the Makassar laboratory
revealed 157.new cases of leprosy. It may be
assumed that the total figure of 4,518 lepers is
much smaller than the actual number of leprosy
cases present in Celebes.
c. Cerebrospinal meningitis. ' Although in
recent years no serious epidemics have been
reported, the disease has occurred regularly in
large areas of Celebes. Every year the lab-
oratory in Makassar' reported a few cases,
three in 1937 and four in 1938.
d. El Tor cholera. (1) Much interest has
been shown in a few cases of a cholera-like
condition that has been described from south-
western Celebes. The Netherlands East Indies
were free from cholera from 1921-1937 except
for nine cases which occurred at Batavia in
1927, all imported from Singapore. Between
September 1937 and 1940, however, a small
"cholera" outbreak developed in some native
hamlets situated along the coast of southwest
Celebes and somewhat inland in the government
districts of Pangkadjene, Gowa, Barroe, and
Maros. Cases.also occurred on Salerno, Sa-
nana, and Samatelloe-laoe, small islands, of the
Spermonde Archipelago off the coast about 40
miles north of. Makassar, and two cases
occurred in Makassar itself.
(2) The clinical picture was typical for cholera.
The case fatality was 65 percent, as is usually
seen in this disease. Wells and water jars used
by "cholera" patients in southern Celebes were
examined and found to be contaminated,
where wells belonging to the neighboring houses
were not contaminated. Of 217 contacts of 40
"cholera" cases, 29 were found to excrete
"cholera" bacilli. A few of these infected con-
tacts later showed characteristic signs of cholera
but none of them died. Of 183 probable con-
tacts examined in 1937-1938, not one was
infected, but in 1940 some healthy noncontacts
were found to be carriers. In one village
where there had not been a single suspected
case, 1.3 percent of the population were found
to be carriers. Of 17 carriers, 11 were under
the age of 16 years.
(3) Epidemiologically and bacteriologically,
this "cholera" epidemic in Celebes showed a
few remarkable points. There was hardly any
tendency to epidemic spread. In each of 14
villages, only 1 case occurred, in each of 4
villages 2 cases, while in only 1 village were 5
cases observed. With a few exceptions there
was never more than 1 case per family. These
epidemiological data indicate differences from
usual cholera epidemics. In. addition, bacte-
riologic examinations showed the presence of
cholera-like vibrios which were definitely hemo-
lytic, if examined in 2- or 3-day broth cultures
according to the hemolysin test of Greig. Al-
though as,far as the immunological reactions
were concerned, these Celebes vibrios belonged
to the genuine cholera organisms (subgroup 01
of Gardner and Venkatraman, Heiberg type I),
their hemolytic properties seemed to indicate
that they belonged to the El Tor vibrio (type
Ogawa). It should be added that the vibrios
were only weakly hemolytic and that their
hemolytic properties could be demonstrated
only by the technic of Greig. When they were
tested by the hemolysin test of Taylor in 2-day-
old peptone water cultures no hemolysis oc-
curred. Even so, in the opinion of most Dutch
bacteriologists, these Celebes vibrios were
identical with El Tor vibrios. This vibrio,
which was first recognized in 1905, had been
considered up until 1937 as nonpathogenic and,
as far as known, had never been isolated in
typical cholera cases.
(4) In view of extensive studies of this organ-
ism, it was concluded that there was hardly any
reason to distinguish the disease in south
Celebes as "enteritis choleriformis Tor" as had
been proposed, but the conclusion was that in
south Celebes cholera actually occurs, probably
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endemically. The two cases discovered in the
harbor town of Makassar were reported as
cholera and have been mentioned as such in the
"Bulletin de l'Offrce International d'Hygiene
Publique." The harbor was, however, not
officially declared infected. The question why
weakly hemolytic cholera strains have been re-
covered from cholera patients only in southern
Celebes and not in other areas may well be
connected with the widespread interest which
for 25 years has existed in the Netherlands in
the problem of the El Tor vibrios.
e. Plague. In Java plague has been endemic
since 1911, when the disease -started in the
eastern part of the island. The disease began
to extend westward in 1935, but has shown only
a slight tendency to .spread to the other islands
of the archipelago. In 1922, cases occurred
in Tandjoengbalei, an island of the Riouw
archipelago, in Palembang. on Sumatra and in
Makassar on Celebes. In Makassar 115 cases
occurred between .1922 and 1930, but none
have been reported since 1930. The peak of
this small epidemic was in 1927 when 40 cases
were observed. No cases have been reported
from Celebes outside Makassar. Whereas the
plague bacillus reservoir in Java consisted of
the Malayan house rat (Rattus diardii), in
Makassar R. norvegicus and R. concolor were
infected just as frequently as was R. diardii.
13. DISEASES CAUSING HIGH MORBID-
ITY OR MORTALITY RATES AMONG NA-
TIVE PEOPLE. a. Frambesia (yaws). Fram-
besia is common in natives throughout Celebes.
The districts of Loewoek, Bira, and Singkang
have been especially mentioned for their high
incidence of frambesia, but in the rest of
Celebes the incidence is probably just as high.
In Singkang in 1 year, 16,600 injections of
neoarsphenamine were given for the treatment
of frambesia.
b. Typhoid fever and paratyphoid fevers.
(1) Although accurate statistics are not avail-
able, typhoid fever is fairly common in Celebes.
In 1935 there were 153 cases of typhoid fever
reported in Manado, in 1936 there were 148,
in the next year-79. In 1936 there were 26
cases in the city of Makassar and 14 cases
around Makassar. In: 1937 there were 26 cases
reported in Makassar. In Minahasa the ty-
phoid mortality rate amounted in 1932 to 14.3
per 100,000 (the rate for the United States for
the same year was 3.6).
(2) Paratyphoid fevers were said to be much
less frequent than typhoid. In contrast to the
rest of the Netherlands East Indies para-
typhoid A apparently was extremely rare.
Paratyphoid B and C were reported but only
occasionally. Whereas the regional laboratory
in Makassar reported hundreds of cases. of
bacillary dysentery each year, paratyphoid
bacilli were found only very rarely. '
c. Trachoma. Trachoma prevails through-
our Celebes. It is frequent along the rivers
and relatively rare in the isolated mountain
villages. In 1935 in the - Watampone area
4.7 percent of 13,882 inhabitants were proved
to suffer from trachoma. None of the villages
was free from the disease. In Tempe the
infection was found in 8.9 percent, and in
Lengkang in 8.4 percent of the people examined.
Even these figures are lower than the infection
rate found on Java. In the rest of the villages
of southern Celebes, 1 to 5.7 percent of the
inhabitants suffer from trachoma. The disease
is much less frequent in northern Celebes. In
Gorontalo, trachoma is even said to have been
rare.
d. Conjuctivitis. During the East monsoon
which brings the dry weather between June
and September the atmosphere is often dusty;
conjunctivitis is of common occurrence at this
time.
e. Helminthiasis. (1) Nematode infections.
Ascaris lumbricoides and Ancylostoma duodenale
are common intestinal parasites in Celebes.
Infection rates vary, but in many areas more
than 50 percent of the people carry these
parasites. From the reports published the
impression is obtained that Trichuris trichiura,
Enterobius vermicularis, and Strongyloides in-
testinalis occur less frequently.
(2) Schistosomiasis. Schistosoma japonicum has
been found in only one area of Celebes, around
isolated Lake Lindoe in the mountains of the
Toradja region (2,700 feet). About 50 percent
of the population living on the shores of this
lake have been found to carry the ova of S.
japonicum. Intestinal signs were not observed,
but many people had remarkably large spleens,
larger than could be explained by chronic
malaria alone. Two autopsies showed splenic
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and hepatic lesions due to schistosome infection.
Human beings, dogs, and deer were found to be
infected. No snails of the genus Oncomelania
were found in Lake Lindoe, nor was any other
snail, discovered shedding furcocercous cer-
cariae, Such cercariae were, however, found
in snails of the genus Lymnaea in Lake Poso
(1,500 feet) in central Celebes. From no other
area in Netherlands East Indies have infections
with schistosomes been reported.
(3) Echinostomiasis. Around Lake Lindoc in
Celebes the Toradjas are heavily infected with
Echinostoma lindoense (37 spines). The first
intermediate host in Celebes is a planorbis-like
snail, Anisus sarasinorum the second inter-
mediate host is the freshwater mussel, Corbicula
linduensis. The patients acquire the parasite
by the consumption of insufficiently cooked or
raw fresh water mussels. There is also another
snail which can act as the second intermediate
host, Viviparus javanicus rudipellis. As this
snail is not eaten in this part of Celebes, its
practical importance in the transmission of the
disease must be negligible. In the coastal
area near Makassar and near Lakes Poso and
Rano Dompelas snails infected with the meta-
cerceriae of a 37-spined echinostoma have been
found, but no human carriers of Echinostoma
lindoense could be discovered. Sporadic in-
fections with Euparyphium ilocanum are en-
countered in the coastal areas of Celebes and
near Lake Poso.
14. MISCELLANEOUS DISEASES. a. Small-
pox. Widespread vaccinations have almost
stamped out smallpox in the Netherlands East
Indies. In Celebes a small epidemic of small-
pox occurred in 1931 in Kawangikatan in
Minahasa. In 1936 there were 75 cases in
Boeol in the residency of Manado and three
cases in Paloe. Between 1936 and 1.940 no
cases were reported,
b. Diphtheria. Diphtheria occurs regularly
in Celebes. Although no serious epidemics
have been described recently, the laboratory in
Makassar reported a certain number of positive
cultures . every year. There were 25 cases in
1936 and 33 cases in 1938. In the same year 18
carriers were discovered.
c. Leptospirosis. Weil's disease was first re-
ported in Celebes in 1933, when four cases were
recognized. In 1934 there was one case, in
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1938 another. All cases observed in Celebes
were due to Leptospira bataviae. In 1938 it
was found that 18 percent of 77 Rattus norvegi-
cus in Celebes were infected with leptospira, 10
percent of 211 R. concolor, 1.5 percent of 212 R.
diardii, and several dogs. In R. ncrvegicus,
Leptospira bataviae were present, in Rattus
concolor, the nonpathogenic L. javanica, which
was also found in the few infected house rats.
From a dog in Makassar a strain was cultivated
which was serologitially identical with the
Australian type "Ballico." Neither in human
beings nor in animals has L. icterchemorrhagiae
been discovered.
d. Rhinoscleroma. In the Netherlands East
Indies several foci of rhinoscleroma are known.
There are at least two in Sumatra, one in
eastern Java, and one in Minahasa, near
Tomohon. The main focus in this latter area
is in Kasoeratan, a small and isolated village.
Cases have also been found in Tombatoe, in
Leilem, and in Malelajang.
e. ~ Nutritional diseases. (1) In general,
nutritional diseases have not been frequently
recorded in Celebes. Occasionally the crops of
maize have failed, and scarcity of food has
resulted. This is probably less frequent in
Celebes than in other parts of the Netherlands
East Indian Archipelago. In 1936 scarcity of
food occurred 'in Loewoek where cases of
beriberi were also observed.. There was a
scarcity of food in Rampi in Masamba in 1937.
In Kendari in southeastern Celebes, the people
live mainly on sago and fish. Here malnutrition
and beriberi are not rare. Xerophthalmia
occurs regularly in the mountains of the
Minahasa.
(2) Goiter is endemic in extensive areas of the
mountainous interior of Celebes. The f6llow-
ing districts have been especially mentioned:
Bolaang Mongondow
Mountains near Manado
Tomata (Manado)
Majoemba (Manado)
Upper and southern Mori
Paloe
Bone (Bitoeng and Tjinenoeng)
The mountains near Koclawi
Galoempang
Masamba
Parepare
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Rantepao
Enrekang
In some of these places (Rantepao, Galoem-
pang) many cases of cretinism have also been
found.
SUPPLEMENTAL DATA ON ISLANDS OFF
SOUTHEASTERN CELEBES
15. GENERAL, it. The islands off the tip of
the southern peninsula consist of four groups,
Boetoeng Island, Moena Island, Kabaena
Island, and the Toekangbesi Archipelago.
Administratively these islands were joined
with Poleang and Roombia counties and the
Laiwoek region, the most eastern part of south-
eastern Celebes (capital. Kendari), to constitute
the Boetoeng and :Laiwoek district. About
139,000 people live on Boetoeng. There are
78,000 on Moena and about 60,000 on the
Toekangbesi Archi.pel.ago.
b. Boetoeng Island is about 100 miles long
and 35 miles broad at its widest part. It has
an area of 1,500 square miles. It is separated
from the island of Nloena by the narrow
Boetoeng Strait through which runs a strong
current. The island consists mainly of elevated
coral and limestone covered with poor, dry soil.
Water is obtained with difficulty; the population
relies on shallow wells. Along the axis of
Boetoeng Island runs a chain of limestone hills
600 or 700 feet high covered with woods. Ex-
tensive areas of humus can be used to grow coin
and taro-like roots; the cultivation of rice is
impossible. Associated with Boetoeng Island
are many other small. islands, including Kada-
toeang (North Island), Sioempoe (South Is-
land), Watoeatas (Lizard Island), Matassa,
Pandjang, Pendek, and Kaholibans.
c. Moena Island has an area of 1,230 square
miles. It is le?s mountainous than Boetoeng
and in the northwestern part is flat and has
fertile clay soil. The southeastern part is very
hilly. The capital is Raha.
d. Kabaena Island, 300 square miles in area,
is very mountainous and consists partly of
limestone, partly of volcanic rock. The south-
ern part is completely uninhabited. In the
northern part a certain amount of agriculture
is possible on small table lands. between the
mountains. The largest' village is Dongkala,
situated on the east coast
e. The Toekangbesi Archipelago consists of
numerous coral islands, which have a total area
of 180 square miles. The most important is-
land is Binongko, which has 12,500 inhabitants.
16. HEALTH AND MEDICAL SERVICE.
The Public Health Service in this region was
taken care of by a public health physician on
Kendari, one in Baoebaoe on Boetoeng, and
one in Raha on Moena Island. These officials
were responsible to the inspector of public
health in Makassar. Hospitals were situated
in Kendari (30 beds), Baoebaoe (42 beds), and
in Raha (32 beds).
17. WATER. In many of these areas water is
scarce; the population relies upon rainwater
and dug wells. Water is more difficult to ob-
tain in the southern part of Boetoeng than in
the northern.
18. MOSQUITOES. Data about the mos-
fauna of this region are shown in tables VI
and VII.
19. NUTRITION. The general nutritional
condition of the population of this area has
been hardly satisfactory. The people eat sago
or corn and sometimes taro. Beriberi out-
breaks were not rare and in recent years,
especially from Kendari, outbreaks of beriberi
have been reported.
20. MALARIA. This whole area is notorious
for its high malaria rate. The people of Boe
toeng, for instance, avoid the northern part of
the island because of the frequent fevers,
though the southern part of the island appears
to have nearly as much malaria. In 1922 the
splenic index of the coastal villages of Boetoeng
varied between 50 and 100 percent. There is
no area in this region where cases of malaria
do not occur in great numbers.
21. DYSENTERY. Statistics about dysentery
cannot be obtained. It seems certain, how-
ever, that the disease is frequent in this area.
The inhabitants of Boetoeng, for instance,
never drink river water during the dry season
because they know that this practice may lead
to dysentery.
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22. SKIN DISEASES. Skin disease- ire very
frequent. Travelers in these islands comment
upon the frequency of skin ailments. Many
of these diseases are probably due to secondary
infections.
23. FRAMBESIA. This is notoriously fre-
quent in the Toekangbesi Archipelago, and
there is no reason to surmise that the incidence
of this disease is lesson the other islands.
24. FILARIASIS. Filariasis is common
throughout these islands. Conditions here
have been studied carefully since it has been
found that on the island of Celebes itself, al-
most all the filaria cases are caused by Wu-
'ehereria malayi, whereas on the islands to the
south of Celebes. only W. bancro fti is found.
In Kamaroe on northeastern Boetoeng,
seven patients with lymph scrotum were
studied, four of whom were infected with W.
bancrofti. In Ereke on Boetoeng, six out of
eight cases with lymph scrotum had W. ban-
crofti. In Baoebaoe, however, 39 inhabitants
were examined, but no microfilariae were found.
In one of the villages near Raha on Moenar
Island, 71 percent of the population were found
to be suffering from filariasis, and on Kabaena
Island 28 of 96 people examined showed the
presence of W. bancrofti. During a survey of
this island 30 patients with lymph scrotum
were encountered. On Wowoni, an island off
Kendari, 45 percent of the inhabitants were
suffering from filariasis.
On Kabaena Island Anopheles aconites, A.
leucosphyrus hcickeri, Culex fatigans, and C. alis
(vishnui?) have been found to be naturally in-
fected with filaria. As in the rest of the Neth-
erlands East Indies Culex quinquefasciatus is
not an effective vector; of 201 specimens
caught, only one was found to be infected.
25. LEPROSY, Leprosy is widespread in this
area. In 1937 enough chaulmoogra oil to treat
50 patients with leprosy was sent to Baoebaoe.
26. MEASLES. Formerly dangerous measles
epidemics raged in this area. In 1921 an
epidemic of this character with a fatality rate
of 10 to 30 percent was reported from Boetoeng.
27. INFECTIOUS JAUNDICE. Infectious
jaundice was observed on Moena Island in 1935.
AQO 347.
[TB MED 67J
28. LEPTOSPIROSIS. The possibility of
leptospirosis was seriously considered, but sero-
logical and bacteriological tests proved to be
negative.
Section V
SUMMARY AND RECOMMENDATIONS
29. HEALTH AND SANITATION. a. Dis-
eases. The chief diseases of military impor-
tance in Celebes are malaria, bacillary dysentery,
filariasis, and scrub typhus. Most of Celebes is
highly malarious, and the southwestern part
of the island has had serious outbreaks almost
every _ year. Bacillary dysentery is common
and many of the cases are severe. Scrub ty-
phus is probably much less common than ma-
laria and dysentery, but little exact information
is available. Filariasis occurs in almost every
part of Celebes. There is much gonorrhea
but probably little syphilis, except in the ports.
Dengue occurs regularly among new arrivals.
b. In addition to those precautions ordinarily
carried out for military forces, the following
recommendations are considered of special
.importance.
(1) Water. Although before the war water
from the few available public supplies could be
consumed without additional treatment, it is
doubtful whether the normal supervision has
continued during Japanese occupation. Even
safe water may be contaminated through dis-
tribution in unsanitary containers. Therefore,
all water should be regarded as potentially
dangerous and should be boiled or chlorinated
before use. Ice made from local water supplies
should be considered unsafe for drinks.
(2) Sewage. No reliance should be placed
on the availability of any sewage-disposal
facilities. Plans must therefore be made for
local disposal of sewage and other wastes. In
view of the prevalence of enteric diseases,
special attention must be given to the careful
disposal of sewage by approved methods in
order to guard against pollution of water and
soil and access by flies. Native employees
must be provided with their own toilets and
must be compelled to use them.
(3) Malaria control. Because of the vital im-
portance of. malaria (and secondary importance
of dengue and filariasis), careful plans for mos-
quito control should be made before troops
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embark for any part of this area. Such pre-
liminary plans should include provision for
specialized personnel., antimalaria supplies and
indoctrination of all troops in preventive
measures. Specific control measures should
include-
(a) Use of bed nets issued as individual
equipment at the port of embarkation and thus
available for use immediately upon arrival until
proper screening of buildings and barracks has
been accomplished.
(b) Use of head nets, gloves, and other
protective clothing where indicated.
(c) Liberal use of insect repellents.
~d) Proper selection of camp sites. Location
on high ground affords no absolute protection
because in all of these areas malaria often occurs
in the hills. Camp sites should be chosen pref-
erably 1 or 2 miles from important breeding
places and from native habitations, barns, and
cowsheds, so as to be beyond the. effective flight
range of mosquitoes. Stream banks should
also be considered as possible storehouses of
infected malaria carriers. Sites should be
selected so that native villages are not on the
windward side of the camp and doors of all
buildings should open away from the wind, if
possible. If for military reasons it is necessary
to make permanent camp sites in areas in close
proximity to native villages, consideration
should be given to moving these villages to
other locations.
(e) Thorough screening of all quarters, not
merely of those to be occupied in the evenings
or at night. Entrance vestibules with a
screened door at each side (mosquito lock) will
be necessary to exclude the mosquitoes. Strict
avoidance of outdoor moving picture shows is
essential.
(f) Use of pyrethrum sprays in native habi-
tations within mosquito flight range of camps (1
to 2 miles) and in all tents, barracks, mess halls,
recreational and other buildings. The new
insecticide spray (QM Insecticide, aerosol) is
especially suitable.
(g) Although antimalarial measures may
have to be varied according to the specific area
and the vector that is locally important, careful
clearing and draining of ditches and gutters is
necessary in all mal.arious districts. Fish
ponds are dangerous breeding places. Salt
water fish ponds and salt water lagoons .must be
drained or connected with the ocean in order
that the tide may enter freely. Fresh water
fish ponds must be cleaned or drained. The
same must be done to fish ponds on rice fields.
Rice fields should not be in continuous cultiva-
tion. Sufficient time should elapse between
crops to permit complete drying of the fields.
Oiling of the salt water lagoons is usually un-
satisfactory because of the prevailing winds.
The results with Paris green are somewhat bet-
ter, but the material must be applied once every
week.
Measures like clearing, draining, and filling
of potential breeding areas should be used with
discretion. Unless competent entomological
advice is available, clearing should not be used
as a malaria control measure in Celebes as it is
often followed by man-made malaria in the
areas where A. sundaiees acts as vector (coastal
zones of South Celebes) and in the hills and
mountains of the coastal areas of Celebes where
A. maculates is an important vector. When
clearing is necessary, special mosquito-control
measures must be instituted at once and vigor-
ously maintained. Draining of stagnant water,
although always advisable, may not be suffi-
cient; running brooks are habitats of A. macu-
latus larvae and it is often necessary in the
maculates area to transform brooks into sub-
terraneous passages. The filling of marshes in
areas where A. maculates acts as vector is an
excellent measure but requires special precau-
tions. It is quite possible to dig away enough
of a hill to expose the ground water and thus
produce an area of seepage eminently suitable
for A. maculates.
(h) Adequate supplies of antimalarial drugs
sufficient for 100 percent suppressive treatment
should be available for use everywhere in this
area and should be employed at the discretion
of the surgeon.
(4) Filariasis.. Filariasis occurs in almost every
part of Celebes. The most important vector
is Anopheles barbirostris, which breeds in rice
fields and in deep shaded swamps. Camps
should not be placed near such bodies of water.
The irrigation of rice fields should be interrupted
from time to time. Swamps should be drained
or oiled. Both rice fields and swamps can
often be treated with Paris green. Habitations
should be sprayed, and contact with natives
should be kept to a minimum.
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(5) Dengue. Under ordinary conditions the
mosquito-control measures recommended in
(3) above will be of assistance in the control of
dengue. In addition, the policing of buildings
and grounds and the regular inspection of
water containers will be necessary. It'will be
remembered that Aedes aegypti frequents small
collections of water, such as vessels and gutters
in and around human habitations.
(6) Venereal disease control. Venereal diseases
are prevalent, sexual contacts easily made, and
the native population little disturbed if signs of
these ailments develop. Venereal disease pro-
grams with comprehensive educational cam-
paigns and adequate recreational facilities for
troops are urgently necessary. Large supplies
of approved prophylactic materials should be
provided, and prophylactic stations should be
easily accessible to-all troops. Contacts with
the local health authorities aiming to increase
the opportunities for treatment of the civilians
may sometimes be advisable.
(7) Food. If local eating establishments are
used by military personnel, thorough inspection
of these places, including those vending soft
drinks and dairy products, should be carried
out. Even in these establishments, however,
raw fruits and vegetables should be avoided.
Troops should be cautioned as to the dangers of
eating in unapproved establishments or in
native homes. Because of the high incidence of
intestinal infections, unusual care must be
exercised in the collection, storage, and prepara-
tion of food in Army mess and post exchanges.
Kitchens and mess halls should be carefully
screened. The presence of native food handlers
about Army messes should be considered as a
potential danger. If their help cannot be
avoided, their number should be maintained at
a minimum, those so employed should be care-
fully selected by physical and bacteriological
examination in accordance with Army regula-
tions, and strict discipline maintained as to
cleanliness of person.
(8) Control of rickettsioses. Mite-borne (scrub)
typhus is present in Minahasa and very possibly
JTB MED 671
elsewhere in Celebes. As seen in New Guinea,
the disease occurs especially in workmen and
soldiers who have been clearing grassy areas
(kunai grass), since mites live in the moist zone
at the base of the grass stalks. All prospective
camp sites should be thoroughly cleared of
grass and the areas burned over before they are
occupied. As far as possible, native laborers
should be used for clearing. In New Guinea
infection has not been found in the deep jungle.
Liberal use should be made of available insect
repellents. The current Army typhus vaccine
does not protect against scrub typhus. Special
attention should be given to bathing and to
inspection of the lower parts of the body,
especially after men have been in grassy land.
Troops in these areas should be cautioned as to
the importance of protective clothing, that is,
trouser legs should be tucked into boots and
long sleeves should be worn.
(9) Cholera. Although cholera has not oc-
curred in this area for several years, under
present conditions the disease would spread
rapidly if introduced. In neighboring areas a
few cases have occurred. In the fall of 1943
approximately 150 cases occurred in Japanese
troops in Mainal; a cholera-like disease is ende-
mic in - southern Celebes. The procedures
outlined in previous paragraphs for the pro-
tection of food and water are applicable.
Immunization is required, and in areas where
cholera cases occur stimulating doses may be
necessary periodically.
(10) Diseases of the skin. Serious infections
often follow minor wounds. All personnel
should be impressed with the necessity for
giving immediate first-aid treatment to all
wounds, burns, abrasions, and insect bites
regardless of size and apparent harmlessness.
Daily bathing is highly desirable where water
supplies make this possible. Thorough drying
of all skin folds (toes, crotch, scrotum, armpits,
groin) is imperative for the prevention of fungus
infections. Army issue foot powder should
always be applied after the bath.
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ITB MED 67)
Table L Physicians in Celebes and dependencies Table Il. Anophelines of Celebes
Govern-
ment
public
health
physi-
cians
Residency of Celebes:
Banggai (Banggai Islands)__
Baoebaoe (Boetoeng Is-
land) ------------------
Boentoeng (Salayer Island) -
Boeloekoemba _ _ _ _ _ _ _ _ _ _ _ _
Bonthain_________________
Kendari__________________
Makassar-----------------
Madjene_________________
Mamoedjoe______-_--._-___
Masamba----------------
Palopo--------------?-----
Pangkadjene______________
Parepare_________________
Raha (Moena Island)______
Rantepao_________________
Rapang------------------
Singkang-----------------
Watampone--------------
Residency of Manado:
Airmadidi_ _ ______-_-.--___
Amoerang________________
Beo (Talaud Island) _ -.. _ _ _ _
Gorontalo________________
Kolonodale_______________
Kolongan Atas_______..____
Kotamabagoe_____________
Langoan_________________
Liroeng------------------
Loewoek_________________
Manado-------------??----
Noonggan----------------
Paloe--------------------
Poso---------------------
Tahoena (Sangihe Island) _ _
Tolitoli____________ _______
Tomohon______----.-_.._-__
Tondano_ _____--_-.-_..-___
Wangkoy-----------------
Wantampone-_-_-_.---____
Military
physi-
cians
acting as
public
health
physi-
cians
Private
practi-
tioners
From: GeneeskundlgJaarboekle voor Nederlandsch indi8,1939. volume
IT.
16
1. A. aconitus: widespread.
2. A. barbirostris: widespread.
3. A. barbumbrosus: Poso, Madjene, Paleleh, Ma-
nado.
4. A. hyrcanus: widespread.
5. A. karwari: Toradja area, Madjene, Mandar.
6. A. leucosphyrus: Paleleh.
7. A. leucosphurus hackeri: Mamoedjoe, Toradja area,
Madjene, Tolitoli.
S. A. maculatus: Toradja area, Watampone, Balang-
nipa.
9. A. minimus: Minahasa, Paleleh, Poso, Paloe.
10. A. parangensis: Manado, Minahasa, Paloe, Ma-
kassar.
11. A. subpictuo: widespread.
12. A. sundaicus: Southwestern Celebes.
13. A. tesselatus: Manado, Minahasa, Paleleh, To-
radja area, Polewali.
14. A. umbrosus: Poso, Madjene.
15. A. oagiss: widespread.
From: Swellencrebel, N. H., and Rodenwaldt, E.: Die Anophelinen
von Niederldndisch Ostindlen. 3d edition. Jena, Gustav
Fischer, 1543.
1. Aedes aegypti.
2. A. albolineatus (Sangihe Island only).
3. A. albopictus.
4. A. lineatopennis.
5. A. poicilius.
6. A. scutellaris.
7. A. vexans.
8. A. vigilax.
9. Armigeres malayi.
10. A. obturbans.
11. Culex annulirostris.
12. C. bitaeniorhynchus.
13. C. fuscana.
14. C. fuscocephalus.
15. C, gelidus.
16. C. quinquefasciatus.
17. C. sinensis.
18. C. sitiens.
19. C. tritaeniorhynchus var. siamensis.
20. C. vishnui.
21. C. whitmorei.
22. Mansonia annulata.
23. M. longipalpis.
From: Bonne-Wepster, J., and Brag, S. L.: Nederlandsch-Indisebe
Culicinen, Geneesk. tildschr. v. Nederl.-India 77:615-619,1937.
Akk
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[TB MED 671
Table IV. General hospitals of Celebes and dependencies
1. RESIDENCY OF CELEBES (1,015 beds):
A. Celebes Proper:
1. Bonthain-----------------------------
Government____________________________
50 beds.
2. Enrekang-----------------------------
District________________________________
24 beds.
3. Kaboengka---------------------------
Estate----------------------------------
30 beds.
4. Kendari------------------------------
District--------------------------------
30 beds.
5. Kolaka-------------------------------
District--------------------------------
20 beds.
6. Madjone-----------------------------
District--------------------------------
150 beds.
7. Makassar-----------------------------
Military--------------------------------
160 beds.
Salvation Army_________________________
Private---------------------------------
Mission--------------------------------
14 beds.
16 beds
(7)
8. Malili--------------------------------
District, Auxiliary HospitaL______________
20 beds.
9. Mamoedjoe_-------------------------
District---------------------------------
20 beds.
Military------------------=-------------
(7)
10. Mara--------------------------------
District________________________________
10 beds.
11. Maros-------------------------------
Private---------------------------------
13 beds.
12. Masamba----------------------------
District--------------------------------
30 beds.
13. Palopo------------------------------
District--------------------------------
40 beds.
14. Pangkadjene_________________________
Military Infirmary_______________________
Private---------------------------------
12 beds.
15 beds.
15. Parepare----------------------------
District--------------------------------
40 beds.
16. Rantepao----------------------------
Military Infirmary_______________________
Mission------------------------______---
8 beds.
52 beds.
17. Rappang____________________________
District--------------------------------
-
14 beds.
18. Sinbkang____________________________
District--------------
------------------
45 beds.
19. Watan Soppeng______________________
District --------------------------------
20 beds.
20. Watampone--------------------------
District ---------------------------------
60 beds.
21. Wawotobi___________________________
Military Infirmary ------- _______________
District--------------------------------
8 beds.
24 beds.
B. Salayer Island:
1. Boetoeng-----------------------------
C. Boetoeng Island:
1. Baoebaoe-----------------------------
District--------------------------------
42 beds.
M ilitary Infirmary ----------------------
(7)
D. Loena Island:
1. Raha--------------------------------
II. RESIDENCY OF MANADO (1,040 beds) :
A. Manado Proper:
1. Ambang------------------------------
Estate---------------------------------
14 beds.
2. Amoerang----------------------------
Mission--------------------------------
16 beds.
3. Gorontalo____________________________
Government____________________________
44 beds.
4. Kaloewatoe___________________________
Mission--------------------------------
(7)
5. Kolonodle----------------------------
District-------------------------------
32 beds.
6 . Kolongan Atas (in Sondar near Manado)_
Military Infirmary_______________________
Mission--------------------------------
8 beds.
44 beds.
7. Kotamobagoe-------------------------
District--------------------------------
35 beds.
8 . Liroeng------------------------------
District--------------------------------
20 beds.
9. Loewoek-----------------------------
Estate ---------------------------------
58 beds.
10. Nlalinso-----------------------------
Military Infirmary_______________________
Estate---------------------------------
12 beds.
8 beds.
11. Manado-----------------------------
Government----------------------------
124 beds.
12. Modajak----------------------------
Mission --------------------------------
Military Infirmary----------------------
Estate---------------------------------
8 bedes.
80 beds.
13. Palace------------------------------
District- -------------------------------
50 beds.
14. Poigar------------------------------
Military Infirmary_______________________
Estate---------------------------------
8 beds.
20 beds.
15. Poso--------------------------------
District--------------------------------
50 beds.
16. Talawaan____________________________
Military Infirmary_______________________
Estate---------------------------------
8 beds.
40 beds.
17. Talisse------------------------------
Estate---------------------------------
8 beds.
18. Tiniawangko_________________________
Estate---------------------------------
25 beds.
19. Tentena-----------------------------
Mission--------------------------------
22 beds.
20. Tobelomgng_________________________
----------------------------------------
21. Tolitoli------------------------------
District--------------------------------
IS beds.
-22. Tomohon----------------------------
Military Infirmary_______________________
Mission--------------------------------
180 beds.
23. Tondano----------------------------
Mission--------------------------------
80 beds.
B. San he Islands:
1. Tahoena------------------------------
Mission--------------------------------
From: Geneeskundig Jaarboekle voor Nederlandsob Inds@, 1939, volume II.
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[TB MED.67]
Table V. Special hospitals in Celebes and
dependencies
A. Leprosaria:
1. Lerang (Lariang)_..________________
2. Madjene (Kampong Baroe)_________
3. Malili----------------------------
221
4. Malalajang-------- -----------------
120
5. Palopo (Kalang.Kalang)____________
41
6. Rantepao---------------------------
57
7. Singkang------------------------
7
Watoesampo
8
49
..
------- B. Psychopathic hospitals:
1. Makassar_________________________
305
2. Manado---------------------------
35
C. Tuberculosis sanitaria:
1. Noongan--------------------------
From: Geneeskundig Jaarbeekje voor Nederlandsch Indic, 1939,
volume H.
Table VI. Anophelines of the islands off south-
eastern Celebes
Boe-
toeng
MeansI
Ra-
b&.-
A. aronitus-------------------
-
-
+
A. a"itkenii aitkenii_____________
+
-
-
A. barbirostris_________________
-
+
+
A. kochi----------------------
-
-
+
A. teucosphyrus-----------------
+
-
-
A.ieucosphyrus hackeri_________
-
-
+
A. maculatus__________________
+
-
+
A. minimus___________________
_}-
+
+
A. subpictus__________________
_f-
+
-
A.sundaicus ------------------
+
-
-
A. tesselatus__________________
-
-
+
A.vagus -------------?---------
-
+
+
From: I Swellenerebel, N. H., and Rodenwaldt, E.: Die-Anophelinen
von Niederlandlsch. OstindiOn, Jena, 1932.
2 Drug, S. L.: Filaria ban crotti-overbrengers op Kabeena, Mede-
deel. v. d. dienst d. volksgezondh. In Nedpr1.-lpdie 27: 88-98,
1938.
Table VII. Culicine fauna of Boetoeng and Kabaena
Islands
Aedes aegypti_______________'_____
A. albopictus____________________
A. annandalei___________________
A. soutellartis____________________
Culex alis (vishnui(?))____________
+
C. annulirostris__________________
+
C. fuscgephalus__________________
+
C. quienouefasciatus______________
+
C. tritaeniorhynchus______________
+
C. whitmorei_____________________
+
From: I Bonne-Wepster, J., and Brug, S. L.: Nederlandsch-Indische
Oulicinene, Geneesk. tijdschr. v. Nederl.-India 77: 615-117,
1937.
Brug, S. L.: Filerla bancrottloverbrengers op Kabaena, Mede.
deel, v. d. dlenet d. volksgezondh. in Nederl: Indi6 27: 88-98,
1938.
Table VIII. Celebes-average rainfall
Makassar
(inches)
Bonthain
(inches)
-Rantepao
(driest area
in N. E. I.)
(inches)
Pales
(inches)
Tondaro
([nebes)
Manado
(inches)
January -------------------------------
27. 8
5. 6
18. 4
1. 8
7. 6
18. 4
February______________________________
21.8
4.7
16.5
1.6
6.5
14.1
March________________________________
17.2
4.9
20.6
1.8
6.5
12.1
April----------------------------------
5. 7
5.2
21.0
1.7
8.7
8.0
May----------------------- - ---------_
3.5
8. 3
14.2
2.0
8.3
6.4
June -----------------------------------
3.2
8.5
9.3
2.6
6.4
6. 8
July -----------------------------------
1.6
5.4
6.8
1.8
4.0
4.8
August ---------------------------------
0.5
2.0
4.9
2.0
3.1
4.0
September -----------------------------
0.6
1.1
5. 2
1.7
4.2
3.5
October_______________________________
-- 2.0
. 2. 1
8.2
1.4
5.7
4.8
November -----------------------------
7.6
3.2
12.0
1.8
8.6
8.8
December ------------------------------
25.4
4.3
18.3
1.6
8.0
14.9
Average annual__________________
116. 8
55. 2
, 155. 3
21.8
77. 1
106. 5
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 Approved For Release 2005/08/10.: CIA-RDP79-01144AO02600020002-0
Prepared by the Office of The Surgeon General, United States Army, from data on file in the
Medical Intelligence Division, Preventive Medicine Service. This matter is supplemented by
the following reports and texts:
1. Annual Reports of the Public Health Service of the Netherlands East Indies in Mededeel. v. d.
dienst d. volksgezondh. in Nederl.-Indie.
2. BONNE, C., and SANDGROUND, J. H.: Bilharzia japonicum aan het Lindoe meer, Geneesk,
tijdschr. v. Nederl.-Indie 80: 477-481, 1940 and 82: 21-37, 1942.
3. BONNE, C.: Echinostomiasis aan Het Lindoe Meer in Celebes, Geneesk. tijdschr. v. Nederl.-
Indie 81: 1139-1167, 1343-1357, 1941 and 82: 3-21, 1942.
4. BRUG, S. L.: De Overbrenging van Filaria malayi to Kalawari (Paloe Manado), Geneesk.
tijdschr. v. Nederl.-Indie 77: 1462-1470, 1937.
5. BONNE-WEPSTER, J., and BRUG, S. L.: Nederlandsch Indische Culicinon, Geneesk. tijd-
schr. v. Nederl.-Indie 77: 515-617, 1937.
6. BRUG, S. L.: Filariasis in Nederlandsch-Indie III, Geneesk. tijdschr. v. Nederl.-Indie 71:
210-240, 1931.
7. BRUG, S. L., and DE ROOK, H.: Filariasis in Nederlandsch-Indie, Geneesk. tijdschr. v.
Nederl.-Indie 73: 264-279, 1933.
8. VAN EERDE, J. C.: De Volken van Nederlandsch Indie. Elsevier, Amsterdam, 1921.
9. JURGENS, A. L.: De Overbrenging van F. malayi in de Onderafdeeling Mamoedjoe, Geneesk.
tijdschr. v. Nederl.-Indie 72: 953-960, 1932.
10. KISMAN, M.: Nier en Uretersteenen en het Voorkomen daarvan in de Minahassa (Celebes),
Geneesk, tijdschr. v. Nederl.-Indie 81: 2682-2693, 1941.
11. KRYGSMAN, B. J., and PONTO, S. A. S.: De Teken van den Oost Indischen Archipel.
Departement van Landbouw, Nyverheid en Handel. Veeartsenykundige Mededeelingen
No. 79, 1932.
12. KtNDIG, A.: Eenige Statistische Gegevens uit de Minahassa, Mededeel. v. d. dienst d.
volksgezondh. in Nederl.-Indie 23: 167-194, 1934.
13. MACHSOES, M.: A. Barbirostris als Malaria Overbrenger in de Residentie Celebes. Geneesk.
tijdschr. v. Nederl.-Indie 79: 2500-2515, 1939.
14. DE MEYERE, J. C. H.: Studien fiber Siidostasiatische Dipteren, Tijdschr. v. Entomol. 60:
275-369, 1917.
15. DE MOOR, C. E.: Epidemic Cholera in South Celebes caused by vibrio El Tor, Mededeel. v.
d. dienst d. volksgezondh. in Nederl.-Indie 28: 320-356, 1939.
16. OOMEN. Report of Meeting of the Minahassa Medical Society, Geneesk. tijdschr. v. Nederl:
Indie 81: 99, 1941.
17. Peace Handbooks issued by the Historical Section of the Foreign Section Vol. XIV. No. 85
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AGO 347A 19
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[T:B MED 67]
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[A. G. 300.5 (6 Jul 44).]
BY ORDER OF THE SECRETARY OF WAR:
OFFICIAL:
J. A. ULIO,
Major General,
The Adjutant General.
DISTRIBUTION:
G. C. MARSHALL,
Chief of -Stag.
As prescribed in paragraph 9a, FM 21-6: Armies (3) ; Corps (3) ; Def Comds (3) ; D (3) ;
SvC (Surg) (3) ; Sv C (Tng Div) (1) ; ASF, UTC (3) ; Med Sv Sch for 0 (1) ; Med Tech
Sch (1); Med Dept RTC (1); AAF Sta in Continental U.-S. (1).
For explanation of symbols, see FM 21-6.
1.5. GOVERNIENT PRINTING OFFICE: 1544
Approved For Release 2005/08/10 : CIA-RDP79-01144AO02600020002-0
Alk