The time has come when the Foundation's program in typhus control should be reconsidered and definite policies established.
When the invitation was received last September from AKG to get ready to do typhus control in Naples under the auspices and
in the uniform of the ARC, I realized in part the difficulties which might be encountered. Some of these could have been
avoided had approval for action been given immediately but there were others which could not be foreseen without much more
information than was then available to us.
We started to work with powder on December 15 with first class personnel and some transportation but found it impossible to
expand as rapidly as we wished because of a shortage of both these items from our one source of supply. In addition, there
was not in sight at that time an amount of insecticide which permitted the organization of a real mass delousing project.
These three items, personnel, transportation and insecticide are the three bottle necks which must be faced in the future.
Subordinate personnel for actual dusting operations can of course be easily trained locally but Davis and I have proved to
our own satisfaction that two on a team is not enough where these two face an emergency situation in which all details have
to be handled individually. There is now a group of Italian doctors all of whom know the way we work but there would undoubtedly
be considerable difficulty in transporting personnel from other countries later. On the other hand there are three young
Americans who were in Italy getting their medical degrees when war overtook them who are well trained reliable men who might
well be considered as second string international work.
Transportation and insecticide can be dismissed with a word; both are available only through official sources or with the
approval of official sources.
The bottle necks here were cleared only after typhus began to show an alarming rate of increase and after General Fox appeared
on the scene. Although the United States of America Typhus Commission took over the direct responsibility for the program
only on the 3rd of January its influence on the situation made itself felt during the preceding week.
Since January 3rd, the Foundation group has been responsible only for the Mass Delousing Section but has followed with a great
deal of interest the work of the other section. It may interest you to know that the other sections have been 1) Case Finding,
2) Contact Delousing, 3) Immunization, 4) Out-of-Town (Case Finding and Contact Delousing) and 5) Refugee Sections. You will
also be interested to know that the administration of the different sections is in the hands of USATC, AMG and RF directors.
The spirit of cooperation between the different sections has been excellent.
I have referred to bottle necks and difficulties above; but on the other side of the ledger is the recent demonstration here
that a rapidly rising epidemic curve can be checked at the beginning of the usual epidemic session more rapidly than was anticipated.
After the season is over we should be able to say something about the duration of the smoldering foci.
And so with an easy and rapidly method of blocking epidemic typhus not only available but proven in the field, the question
naturally must be faced of how best to coordinate the efforts of the agencies which are interested in this field of activity.
The ACC authorities expect to assume the responsibility for typhus control in this area again in the near future. Lt. Col.
W. C. Williams, previously state director of health for Tennessee, is to be the overall director of the project. Col. Williams
has requested that the Foundation group continue its activities here.
I have discussed the larger aspects of the problem of typhus control with General Fox and am writing this letter to bring
to your attention some of the points raised. It seems that the USATC has been given the responsibility of typhus control
in active military theaters but will expect to turn over this responsibility to civilian agencies as soon as possible. Under
these circumstances it is a matter of concern to the USATC to know what preparations are being made by other available agencies
to assume this responsibility. General Fox has also called attention to the possibility of important typhus problems in regions
where the USATC might no conveniently operate. He has raised the question as to how far the RF is willing to go in getting
ready to operate on as large scale as may be necessary. This of course forces the issue of a general working agreement with
AMG, UNRA, the War Department and possibly the Red Cross.
I am enclosing herewith a copy of a memorandum of Feb. 5 to Col. Bishop which covers some points not mentioned herein.
I shall talk further with Col. Williams before making recommendations for additional personnel in this field since arrangements
must be made for their transportation thither.