U. S. ARMED FORCES MEDICAL JOURNAL By the time the health survey was launched, however, health conditions were much improved. Theislanders had received medical care on an emergency basis immediately following American occupation in 1945, until July 1947 whenthe territory passed from military government to civil administration. In 1947 the health service policy —0f the Navy for the Trust Territory of the Pacific Islands, outlining a health programfor the trust territory, was adopted for the purpose ~of controlling preventable disease and rendering medical and dental eocare, By 1 August 1948, the date the health survey started, this cfyprogram was in full operation and rapid strides had been made in ix'the control of preventable disease. Measures to correct sanitary practices of the islanders were being enforced; treatments, inoculations, and vaccinations had been administered; and the food supply had been improved to the extent that malnutrition no longer existed except in a few areas. Diseases that were previously the most serious threats had been brought undercontrol. In many respects the health survey served as a means of evaluating the health program. A marked reduction in the prevalence of intestinal parasites was accomplished in the interval prior to the health survey. It is believed that at the time of the American occupation nearly 100 percent of the indigenous population was infested with hookworm. Ascaris and Trichuris were also extremely prevalent. Asa result of a mass deworming program, the controlof flies, and education regarding health habits, sanitation and particularly the use of sanitary latrines, the prevalence of intestinal parasites had been noticeably reduced throughoutthe trust territory. Yaws is another disease that. was brought under control withef- fective treatment. The large numberof inhabitants exhibiting multi- ple sears and the high proportion of positive Kahn tests bear testimony to the widespread prevalence of yaws. Very few primary lesions were noted during this survey, however, as these had been virtually eradicated by extensive treatment. with penicillin administered by Navy medical officers on field trips prior to the survey. The findings of the health survey revealed, however, that certain sanitation problems still remained. Most islands had community latrines that, in general, were clean and in good repair. It was evident, however, that. use of the beaches was still a commonpractice throughoutthe islands. In many places, leaves and coconutfiber used in lieu of toilet paper were thrown about promiscuously. Maloelap Atoll was the only place where no latrines were available but many islands had clean and well-constructed latrines that were seldomused. Even on Saipan Island, where virtually every household had its own 1206 VOLUME 10, NO. 10 HEALTH SURVEY IN PACIFIC latrine, use of the beach was evident. Garbage was usually buried in pits but on some islands it was burned or carried out. to sea and dumped. Ths most inadequate methods of garbage disposal -~were noted on Utirik Atoll and Namorik Atoll where the garbage was allowed to accumulate over long periods of time. In general, the fresh-water supply for the islands was furnished by rainfall. This was supplemented by wells wherever possible and, on the highislands, springs, streams, ponds, and reservoirs were also utilized. Rainwater was collected in old oil drums by meansof spouts and drains on houses and coconut. trees. The water was then stored in the drums, often without covers or other safeguards against debris. There were indications that the water supply on the following islands or atolls was contaminated: Babelthuap, Elato, Lamotrek, Yap, Tabal, Ebon, Kwajalein, Majuro, Mili, Maloelap, Namorik, and Ormed. Most. wells were contaminated and the natives were warned to boil water before using it. On Saipan Island all water was chlorinated. FINDINGS OF HEALTH SURVEY Stool examinations. Stool examinations were made for 2,252 inhabitants of the Saipan district, 4,584 of the Palaudistrict, and 3,495 of the Marshall Islands district, approximately 45 percent of the combined population. As shown intable 5, 52.4 percent of all stools examined were positive for intestinal parasites. One out of every five positive stools showed evidence of multiple species. The highest proportion of positives occurred among children from 5 to 14 years of age. “ Comparison of the three districts reveals that Saipan had the highest. proportion of positive examinations, 79.3 percent as comTable 5. Percentage of stools positive for intestinal Parasites by age group and sex Percentage positive Age group (years) All ages Male Female Under 5 § to 14 15 to 24 25 to 44 45 and over . OCTOBER 1959 Saipan Palau Marshall Total district district 52.4 79.3 64.5 19.3 53. § 51.4 79.5 79.1 64.9 64.2 18,9 19.6 47.7 60.3 74,6 88.7 51.6 68.8 20.9 23.6 48. 8 51. 4 51.5 76.4 17.2 74.4 65.3 64,9 65.7 Islands district 16.1 16.0 21.4 1207