Yap Dist. 30 Sept 1947 B (Health and San) (A) Field Trip to Ulithi

, v B (Health and San) 30 Sep t 1947 Yap Dis t . 4 ( Pr- ev ent ,) (a ) Field t rip t o Ul ithi Ato l l , Fa is,I f alik, Sor ol , and Ngulu. (1 ) Nine days (7-20-47 t o 7- 30-47 ) were spen t maki ng a f ield tri p to the i s lands of Ulithi At oll, Fais, I f alik, and Sorol . The Me di cal Of f i cer du t i e s c ons i s t ed of the usua l r ou ti ne. Upon meet i ng the ch i efs, a sh or t publ ic h ealth l ec tur e was gi ven . Empha sis was pl aced on the i mpor t anc e of good fecal and waste disposal , and the r el ati onship of ·this prac tic e to r a t s and f lies . The cus tom of dispos ing was tes into the s ea was endorsed as the saf est and eas i e s t by r eason tha t the se isl ands are s mall; the currents ar e swift and access i ble ; and that th e pe ople live c l ose t o the shor e . The Chief s wer e encouraged t o construc t the natl. ve over-wat er heads further out i n t h e wat er s o they would be over wa ter at al l t i mes ~her than at hi gh tide onl y .

( 2 ) An adequat e new suppl y of firs t aid supy l i es wer e l e f t at each i sland wi th i ns truc t i ons. A dr um of 5%D.D . T. i n Kerosene and Red Squi l l were al s o l e f t on each island excep t Sorol . The chi ef s appear ed thankful f or these provisions and there wer e indications that tbey were us ed pr eviously an d we ~ e ef f ec tive. Sorol on l y has a popul ation of t en people and al l are c l os e l y r elat e d. I t would appe ar tha t they could give us some advic e on ho w t o keep healthy . The ch ief although ab out 60 y ears of age i s a f ine physical specimen . He has t wo sons Who wei gh appr oxima t ely 225 I bs . ~ piece. One of thes e 80ns has a 15 year ol d daughter who we i gh s abou t 1 65 Lba , end a 10 ye ar Ot;),) old son vmo weigh s about 140 Ibs. B (Hea l th and San ) 30 Sept 1947 Yap Df s t , 4 (Prevent. )- 2 All accessible peopl e a ppeared at s i c k ca l l . Eac h pe r s on ' s compla i nt and treat ment was r ecorde d on his or her r espective card; Al l chl 1cren manl fes t ine ques t l o n a~ le s igns or s ymp tomB of h elml n e thl a sls received t r ea t ment nl t h cry stolds and ~ag­ n esium sulfate i n t hre e h ours . Per sons n ever bef or e v acc i nated for pox by an Amer i can Do~ tor wer e vacci nated . ( 4 ) The h eal th o f t h e people i n gen er a l ap?ear ed good . One l a dy , ap prox i matel y 55 y ear s of a ge on t h e island o r Ullthl 1:og -I.:og , wa s sus pee t e d of havi ng me nl ngi t is . '!he na tiva s se t a kerosene r eef er into operation and 2, 000, 000 uni ts of pen i c i l l i n were l ef t with the newl y re turned Health Aide f or trea t men t . The history of t he c ase was a bi t obs cure an d i t Is possible she vms a victim o f apoplexy . A qut t e common comp l aint on the is­ l a nds was occasiona l ge n~ ra 1 1z e d abdominal cramps . Consider ing the po s s ibi l i t y of chroni c dy sentery a consider ab le number of s pecific trea tment s wer e prescribed . The po s s ibi l ity o f he l~~n ­ t hiasis being t h e e t iology ttU s t be considered . I f the inci dence of this comp lai nt has not subsided by t he next vi s i t , i t may be pr oper to a dm i ni s ter cr y s toids to the adul t s also . Sever al cases of b i l a t er al catarac t wer e diagno s ed . Medi aa l pr actitioners should be t aught the operati onfbr t he conditi on. A cachetic mal e of I f a1ik , age approximately 35, havi ng an abdomi na l fistula in R . L.Q . refused t o c orne to Yap for fur ther trea t men t . The woman on U1 i t h i (Fo ssere ) having a l arge l esion on her l ef t br ea s t died . The eti o logy, appaaent l y being car ci no ma. B (Hea lth and San ) 30 Sept 1947 Yap Dt e t , 4 (Prevent. )-3

(5 ) The s a me pr oc edure WB.a f ollowed when l and i ng on Ngu l u Isla nd . The Sanl tary eand! tion of t h e isl a n d i n ge n er a l a p pe a rs g ood . There wa s no ev i dence of not di s po s ing f ec es an ywh e~ o ther than i n to the s ea. Althou gh there appeared to b e an e xc ess o f :fl ies, i t is pr omi sing t o not e that t h e ch i ef i nquir ed abou t br i ngi ng D.D. T. which wa s l eft. The Ngul u Hea l t h Aid wa s r e t u:zre d after compl et l ng 6 mon th s in t he Ya o Na t i ve di spens ary . I n a dd! t i on t o first a i d supp l ies , h e was gi v en a f e w o t h er drugs which he pr oved hirrs el f qual ified to use . The i n cidenc e of n o och er- di s eas e wa s no t e d , A few cas e s presc n :te d s i gns a nd s yrr.p toms whi ch s i mul ated pos sib l e t ub er c u l o s i s . 'lh ey we r-e not brought b ack because () f thc inadequa te hospitaliza t ion facilities on Ya p . Ch i ldren wer-e d e wormed wi th c rys t oi d s and magnesi um s ulf a t e i n :3 hours . .lher e we r e no c a s e s of obvi ous dysentery . The i r pr emi s e s wer e c l ean . lher e wa s , a n appa ren t s l i gh t decr ea se i n the i nd1d on c e of Yaws s i nce l a s t visi t , (b ) Medi cal Fi el d 'Iri p t o Satelli t e I sl ands • ( s . ~ 6c1. ("r~ J . b< 1= ) . 1 . Introduc tion . (". <.1 . J ) . (a) Thi s i s t he second t i me tha t t he I sla n d s i n the We s t er n Carol ines have b e en v :Lsit ed b y the Yap CAU . TIle s t a t i on s h ip l e f t YaP on 28 Au gus t a nd a fter v i s i t ing Sor o l , ~o l e ai , a n d Ifa l i k , r e turned on th e 4 t h of Septemb er enrout e t o Gu am f or r e p airs . On 1 1 September the r e lief station ship l e f t Yap t o c omp l e t e the f ield trlp a n d r e t urn ed on 20 September . B (Health and San ) 30 Sept 1947 Yap Dt s t., 4 (Prev ent . )-4 (b) The purpose of t h i s trip wa s to check the Islands for i mprovement of s anl t a~J condi tions; i f po s sible , t reat the d i sea ses enc ountered , determine the ben ef ! ts ob tain ed from prev i ou s treatment s , d istribute f i rst a i d and sanit a t i on sup plies, a n d to con t i nue v ital statistic r ec ords .

(c) The procedure ~n each I sland was as follows : Each per son available, wh e t her b edridden or ambul a tory , was exami n ed a nd t h e necessary trea t men t giv en . Ne w f i le cards were made on t h e persons no t s een on the firs t f ield t rip and a l l newcorns . Then the I s land wa s i n s pec t e d for its s t a t e of sanitation. Re pr e s e n ­ tat ive s of the c h i ef s were edvts ed a s t o c or r ec t v e mea sure s a nd on e mal e on each I slan d designated b y each ch i ef ?ffiS then i n­ str ucte d I n t h e use cr t h e s anitati on a nd med ical suppl ies l eft on each island . .

2 . l!.e dical Fi nding s : Se l9 Tab ulation. ( a ) On this t r i p, open Yaws was treated with Pe nic i l l in in bee s ­ wax and peanut Oi l , c ontaining 300 ,000 U p er e c , '!his was use d bec a us e of the obvt ous advan tage over a queous sodium penic i l l i n on s uch F iel d tri ps . (b) Al l chi ldren or per s on s wh o had never r eceived co \~ox vaccine were vaccinated. (c ) Every per s on with ev i d en c e o f h e l~i n thi a s l s vms d ewo r ~e d . B (Heal th and San ) 3 0 Sept 1947 Yap Dds t , 4 (l're ve n t .)-5 Cd ) On this trip, Car barsone and Eme t i n e Hydrochl or i de were t aken al ong f or treat~ent of amebiasis a nd its co mp lica t i ons . Chief Jodquin of Lamo t r ek was i l l with ameb ic h epatiti s . A r e l i ab le native was c areful ly instructed 1n t h e admi ni s tration of Em e t i n e and Carbars one . He was to treat the c h ief and two other s uch ca s e s on the Island . To al l suspected cas es of amebic dysenter y , Car barsone and Sulfaguanidine wer e given . (e ) N.os t r epor t ed deaths on the l s 1 ~~d s a re believed to be du e to ( a ) Tuber cu los i s or (b ) amebiasis . I falik was the on l y i s l and where persons a f f l i c t ed wi th tub er culo s!s (pulwonar y ) were i sola t ed f r om the r est of the f ami l y I n smal l ad j ac en t hous es as advised b y t he Db c to~ on t he prev i ou s field t rip . The Chiefs of the o ther isl ands we r e also ur ged t o follow the s ame pr ocedure . (f) I f ali k has t wo lepers isolated on t h e uninhabited El l s I s l and of t he I f a lik Group. ~h e #l ·ch ief o f t h e Wol ea i Group was again urged to sen i h i s l e p er s to Raur Island . (g ) I t was f ound tha t some cases of Ya ws t r eated wibh p en i c i l l i n on t h e l ast trip have b ecome ar-r-e st.ed cases, h owever, na ny di d not s een to b en efi t greatl y . ~Q on the h ospi tal aide s being t rai ned at the Yap hospital will be ret urned t o t h e i r r esp ec tiv e island s and t h en t h e treatment of Ya ws and other di s ea s es can b e pursued Vi gorousl y and he lp con s ider abl y in wiping out the d i s ea s e . B (Health and San) 30 Sep t 1947 Yap Di s t . 4 (Prevent. )-6 (h) Most na t i ve s have poor oral hYei ene wi t h ext ensive c ase s of pyr roh ea. Sever a l ma r kedl y dec8;ed t eeth wer e ex t r ac t ed on t his t rip. 3 . Sa n i t a t i on Fi nd ings : See Tabul a t i on . (a ) The we edi ng and c l eanl ine ss about t he hous e s and the i mmedi a t e v i c i n iti e s has i mpr o ved c ons i d er abl y s i nc e t h e l a s t tri p . The na tive s are wor king s lowly b ut pr ogressivel y towar d ge t t i ng their houses i n t o b e t ter conditi on . (b ) A few closed, l ar ge a i r pl ane \dng ga sol ine t anks wer e l ef t on ea ch i s lan d f or the s torage of fresh r ain wa ter . Still, mos t of t h e i s l a nd s r ely on water hol es f or wat er us ed f or bathing and cook i ng. As s oon a s 6nou Bh dr ums , t anks , e tc ., can be dis t r ibuted to t h e s e i sla nds, ~~ny of t h ese wat er h ol es ca n b e el i mina t ed and mos qu i t o popul a tion pr o p o rt i o n a t~ ly dec r eas ed . (c ) The number of s tagnant po ols i s sti l l gr-ea t , Chie f s were advi s ed t o s pread DDT i n k eros ene over a l l wa ter i n water h oles not i n us e . (d ) The r a t po pu lat ion ha s b een no t iceable dec r ea s ed on Sa t a wal s i nc e t h e natives have pu t the Red Squi l l i nto us e . It wa s also noted t hat sev ~ r a l of t h e islands h ave cats an d t raps vmich hel p c onsi derabl y i n keepi ng do ~m t he r a t population. (e) Ifalik, Wol eai , a nd s everal of the ot her i s l and s h ave bui lt mor e over water heads . I t ~~ s not ed howe ver, t hat bo t h di rec t s ea and ov er water h eads are us ed f or fecal di spos a l . B (Health and San) 30 Sept 1947 Yap Df a t , 4 (Prevent . )- 7

4 . R e c o~~en d a t i o n s : (a) A Den t al Unit should be sent along of a f ield t r i p to gi ve the nati ve s advice as to oral hygiene, gi ve i mpe rat i ve tre atmen t, and he l p cut dovm th e incidence of pyorrhea by inst r ucting mout h \?) (b ) It has been recommended to CIVAD Yap tha t an effort should be r. ada to reduc e the number of water h oles and thereby the number of mo s qui to bre e d i ng holes by distributing more drums and s torage tanks t o th e i slands f or storage or rain water . (e ) A portab le pho tof luoros copic lm it mi g ht be taken a long to X_Ray the suspec ted t uberculosis cases, at l east , in order to pi ck up all ac tively i nf ec ted individuals who should be isolated. (d ) Ear l y comp l etion of t he Yap dispen s ary so ill patients may be r e t urne d f or f urt h e r t r e a t ment .

MEDI CAL TR EA TI ,~TS AND DISEA SES V/OLEA I SOHOL I FALIK EAUHIPIK ELATO LAiWTHEK SATA WAL FAHALEIP FAIS I slan d in the gr oup 17 3 3 2 4 3 1 3 1 Island s Inhahi ted 9 1 2 1 1 1 1 2 1 Pop .obtained354 10 214 121 36 1.34 21 6 115 250 t:a1e 185 5 94 61 17 59 118 47 129 Fen:ale 169 5 1110 64 19 75 98 68 121 B (Health a nd San ) 3 0 Sep t 194 7 Ya p Df s t , 4 ( Prev e nt. )- 8

WOLEAI SOR OLI FALIK EAURI PI K ELA TO LA /cOTI1EK SA TA ViA L FARALEUP FAI S

No . o f people acc e ssi b le 2 71 10 198 115 34 116 183 1 02 220 li:al e 148 5 93 5 6 1 6 4 7 98 42 1 08 Fema le 123 5 1 05 59 18 69 85 60 112

Vacc i na t i ons 2 6 1 5 1 2

Cry s tolds 3 9 7 1 1 1 1 6 9

Pe ntel111n c c , ln Beeswax and PEBnlt 011 (300, OOOU) 17 1 0 8 1 5 1 0 1 Pe n lclll1n 2cc (600, OOOU ) 10 1 9 5 3 7 7 7 1

Ac t i v e Ya ws 27 1 19 13 4 .12 12 8 1

Enac t l v e Yaws 1 0 24 3 3 5 12 9 19

Gango s a 1 1 2 2 1

Pu'lnona r-y t.b , 1 2 2 2 1 6 B (Health and Sa n ) 30 Se p t 1 94 7 Ya p 8is t . 4 (Prevent. )-9

VlO LEA I SOROL I FALI K EAURI PIKELATO LA ~' O 'rn EK SATA"iAL FARALEtrP FIAS

Ex t rapul. t b • 1 3 2 4 1 1 5

Eleph a n t i a s i s 6 2 3 1 1

Amebi asis (dys )2 1 3 2 1 1 2

Amebi c Hepa t iti s 1 4 3 2

Lepros yApparent 5 2

II Suspec t ed 9 3 1

Uni l ater al , t hyro id Adenoma 1

Cataracts 6 2 1 1 2

Un dLa t s HLdnd , 1 2 1 1 1 1

Bd La t . Blin d!>e s s 1 1 1 1

Paralys is, t rauma t ic 1 2 1 1 B (Health and Sa n ) 3 0 Sept 1 947 Yap Di s t . 4 (Prev ent . )'.10

• \\\)LEA I SOROL I FALIK EAURIPIK ELA TO LA1·0 TREK SATAVlA L FARA LEU P FIAS

Hemip legia 1 2 AtJPutation hand , trauma tic :5 Arthri tis , de- g en er a t i ve j o i n t di s eas e 2 2 1 2 6

Demen tda 2

Albinlsh, Corepl ete 1

Goiter 1

As t hma 2 4 1 2 3

Saber shi ns 1

Dea f mu t e 1 1

De af nes s 1 4 B (He a lth a n d San ) 30 Se pt 1 947 Yap Dis t , 4 (Prevent . )- 11

IVOLEAI SOHOLI FALIK EAURIPIK ELA TO LA?.'A TREK SATA VIAL FARAL!:.'UP F IAS

Cor ne al Opac i ties 1

Myo seti s 1 3 1 12 3 2 6 2 5 2 0

Bir t h s 9 3 2 3 4 3 3 1~ a l e 5 1 1 2 2 1 1 Fen:ale 4 2 1 1 2 2 2

Dea ths 4 1 4 1 3 2 ~..:a l e 3 1 4 1 1 1 Fema le 1 1 2 1 Caus e s of deaths (a ) 1ubercu1osis2 1 1 1 ( b)A",ebi a s i s 1 3 2 (c )Booby trap Ja p . 1 (d)Ap p end i c e a1 Abs c ess 1 Le )Bor n dead 1 ( f)Cerebr al va scular acc i dent 1 General Heal th Good Good Fai r Exc ell ent flood Fai r Good Good Good B (Health a nd San ) 3 0 Se pt 1 947 Yap Di s t , 4 (Prevent. )- 12

\\0LEA I SORO LI FALI K EAUR IPIK EIA TO IAfW TREK SATA WAL FARAULEU P FM No spr-egnan t Femal e s 4 4 2 1 4 4 The di f fer en ces i n populati on on the i s l ands f r om the l a s t quarter l"y r epor t are due ma i nl y to the r eturn o f s everal nati ve s from th e i r migra t i on and some natt,:> na tiv e s comi ng t o s i c k c al l who di d no t appe ar on t he firs t visit.

~ SANI TATION I NSPECTI ON Burn· I e t r as h d i s po s al. Fair Fa i r Good Fair Fa i r Good Poor Poor Fa ir Garbag e d f s p , Poor Good Good Poor Fa i r Good Fai r Good Poor Cond . o fhous e s . Fa ir Poor §ood Good Fai r Good Good Excel . Good We e ding about ho u ses . Good Fa i r Excel . Good Good Good Goo d Fai r Good El eva t i on o f hous es _ F e \'! Non e None 1(;0 8 t Non e Ma ny None Some r:'any ' St agna n t p o o l s . 1~ny Some Many Fe w Ma ny Many Ma ny Few Rar e Type o f wa t ar Ght chmen t s . Drums Drums Holes Drums Hol es Hol e s Hol e s Drums Drums Idl ole : Co ver ov er dr i nki ng wa t er . Few Non e Some None None Sorr. e None Several Fe w Stagnant wa t er f or t ar o . M.uch Little Much Much Much Much r,:uch Some J.:uch r-r- B (Health and San ) 30 Sept 1947 Yap Di.t. 4 (Prevent. )- 13 '/IOLEA I SOROL I FALIK EAURAPIK ELA TO LAIWTREK SA TA\\A L FARALEUP FIAS Condi t i on of walks . Poor Poor Exc el Poor Fair Exc e l Fair Fair Good Preval ance of F11 e, • Great Great Great Gre a t Gr eat Moder . Great Gr- eut Great Preval anc e of 1:o s qu i toe s . Grea t Great Grea t Great Great Great Grea t r,~od . S11 . Pr- ev eLanc e o f r a ts . Gr eat Gr eat Great none Gr eat Great Coder . Gr eat Gr eat Use o f r a t t rap Rare None "~ o d e r • None Some Some So:ne None None a nd po i s o n i n g . Yes Yes Yes No Yes Yes Yes Yes Yes Us e of c ats . Some it- a ny None None None Few Ba ndi ng of Pan- dan o. t rees . None None Rar e None None None 1I7any None NODe Type of f ec al Over Di r ec t Direc t Di r ec t Ove r Direc t Di r e c t DirectDirect dispo s a l . Wa t er Y.a t er ov er Wa t er Wa t er &over wat er Wa t er i.tar ' 'la t er "at er Ef f i c acy of 'fecal dispo sal Fa i r Goo d Good Good Good Good Fari Go od Fa i r B (Health a nd San ) 30 Sept 1 94 7 Ya p Dis t , 4 ( Preven t . }- 14 SAN I TATI ON AND MEDI CAL SUPPLIES DISlFI BUTED

WO LEAI SOHO L I FALI K EAURAPI KELA TO LH Om EK SATAWA L FAHALJ,,-UP FIAS Ba ttle dres sings Larg e 5 II 2 0 2 3 2 11 Med ium 5 " 2 2 2 3 2 Small 5 2 0 2 3 2 'IR . o f Iod l n eAppl1c ator s Box of 3 5 1 1 2 3 1 Ba nd age , Gauze 3 1n. b ox of 1 2 3 1 1 1 1 Bandage, Gauz e 21n. b ox of 12 4 1 1 . 1 2 1 Bandage, Gauze l i n . .l.. box of 12 1 1 2 1 1 1 Pe trol a tun, 1 l b . c a n 3 1 1 1 2 1 Tongu e d e pres - sor s 1 50 50 50 1 00 100 100 B (Health and San ) 30 Sep t 1947 Yap Di a t . 4 (Prev ent. )- 15 \\lJLEA I EAUR I PIK ELA TO LAm TREK SATAWA L FARALEUP Aspir in, bo t of 1000 2 1 1 1 1 1 Co tton , l arg e r oll 2 1 1 1 1 1 Sulfanll1mi de cr y stals box of 25 3 1 1 1 1 1 Wood Applica t or s 200 50 50 100 100 75 Triangu lar bandages 4 1 1 2 2 2 Peroxide , bottle 8% 2 1 1 1 1 1 APe, bot tle of 1000 2 1 0 I , 1 1 Drum of DD T in ]ter osene 2 1 1 1 1 1 Red Squi ll, 1 lb. 2 0 1 1 1 1

UThe s e I slands wer e l e ft suprdL es duri ng a f iel d tri p i n the l at t er part of July 1947 .