MANZANAR Historic Resource Study/Special History Study

HEALTH

Medical Hospital Services

During 1943-45, the health section, which operated under the direction of Principal Medical Officer Dr. W. Morse Little, provided extensive hospital services to the evacuees at Manzanar. All medical cases were cared for in the camp hospital or clinics, except those requiring specialized care. Advanced cancer, genito-urinary surgery, neurosurgery, chest surgery, and psychiatric cases were generally referred to the Los Angeles County Hospital. The total cost of operating the health section during 1943 was $132,675.24; 1944, $193,088.71; and 1945, $118,139.33.

Daily ward rounds in the hospital were conducted by the attending physician each afternoon, except for Saturday and Sunday. at 1:00 P.M. Present on the rounds were the complete medical staff, consisting of the chief nurse, medical social worker, public health nurse, and nurse in charge of the floor on which the patient's room was located.

Out-patient services were offered daily and non-hospitalized patients were required to attend public health clinics serviced by the health section. The work of the clinics was directed toward preventive medicine. Daily clinics were conducted for general medical, optometry, dental, school health, surgical, and eye, ear, nose, and throat problems. A schedule was established for the clinics: Monday, child health, food handlers; Tuesday, maternal health, chest, gastro-intestinal; Wednesday. child health, food handlers; Thursday, maternal health, chest, gastro-intestinal; Friday. child health, venereal disease; Saturday. maternal health. In addition, three-day orthopedic and ophthalmological clinics were conducted at the center every two months in cooperation with the California State Health Department.

According to medical officials, Manzanar had a generally low incidence of serious disease, other than degenerative diseases. Because of the larger number of older evacuees in the center, these diseases "were moderately increased." Since medical services were free, patients came in for treatment early. and thus comparatively few developed "the fulminating cases often seen in private practice in which the patient fails to come to the physician until he is seriously ill." This factor increased the number of out-patients, but saved much of the doctors' time in having to treat more severe disease arising from neglect.

There was, however, a "high incidence of psychoneurosis, hypertension, and peptic ulcer" at the camp. Psychoneurosis tended to improve as the adjustment to camp life progressed and as home follow-up was carried out by the medical social worker and public health nurse.

The laboratory at the Manzanar hospital was "well-equipped." It performed all laboratory functions, "including Kahn and Kline tests, and water and sewage-control tests." The only laboratory work sent out consisted of the "pre-marital and pre-natal Wasserman tests, which were sent to the state laboratory in accordance with state law."

Ambulance service was available 24 hours daily and required the employment of six evacuee drivers. Two ambulances and one station wagon were used to pick up and take home emergency, pregnancy, and infant and preschool cases for whom walking was "contra-indicated." The ambulances also transported handicapped children for the special hospital school and "all women workers on the swing and night shifts."

The hospital laundry operated every day but Sunday and employed 26 persons. Laundry services were provided for all units of the health section, Children's Village, and the motor transport and maintenance sections. Blankets for the entire camp were laundered at least twice yearly.

Special kitchens were established to feed children under five years of age and prepare special diets. The mess hail in Block 28, adjacent to the hospital, was set aside for special diets for ambulatory cases and their families. The mess hall was operated by the mess section with diets served on individual order of the attending physician. A kitchen in every four blocks was operated as a formula kitchen, in addition to the usual meal service, to prepare and serve infant and preschool diets. Baby formulas and children's foods were prepared by the mess chef on special order from the attending physician and were given to the mother at 10:00 A.M., 2:00 EM., and 6:00 P.M. All formulas and food were dispensed by diet aides who were trained by the health staff but who worked under the supervision of the mess section.

A morgue was established, but it did not provide embalming services since there were no undertakers in camp. Autopsies were conducted on approximately 30 percent of the cases. The evacuee residents of the camp, according to the Final Report, Manzanar, "were so cooperative in this that about 90 percent autopsies could have been performed if there had been enough medical personnel."

Mortuary services were performed by an undertaker in Bishop. Upon a death at the center, the body was placed "in a refrigerator in the morgue, where an autopsy would be performed if requested by the attending staff." If the case had not been under treatment, or if the circumstances attending death were suspicious, an inquest was by the county coroner in Lone Pine. Bodies were picked up by the undertaker within eight hours of death and taken to Bishop for embalming. After embalming, the body was returned to Manzanar where it was "inspected both before and after being clothed.

Funeral or memorial services were held according to the religious affiliation of the deceased. The body was then cremated or buried according to the wishes of the next of kin. If cremation was requested, it was shipped to a crematorium in southern California, and the ashes were later returned to the Manzanar columbarium.

Cases involving infectious disease could not be shipped for cremation because adequately sealed coffins were not available. These bodies were interred for later cremation when the special coffins would become available. All costs, including a regulation casket, were paid for by the WRA.

Public Health Services

The health section, according to the Final Report, Manzanar, provided a "full array of public health services under physical conditions that were sub-standard."

Maternity cases were seen for the first time usually two to three months into the pregnancy, and every two to three weeks thereafter. Except for a few precipitate deliveries who were later hospitalized, all cases were hospitalized for delivery. Minimum hospitalization after a birth was ten days.

Caudal block anesthesia was used during childbirth. In approximately 90-95 percent of the cases, this anesthesia was effective. Since there continued to be shortage of physicians and nurses in the camp, this anesthesia proved especially useful as its use "allowed careful control of the case and proper after care with a minimum of professional aid." Because of lack of space, an inadequate nursing staff, and construction large wards in the hospital, it "was impossible to segregate the abortions, other than to use a separate obstetrical room, or the labor room, or a separate nursery.

Pediatrics was treated "as a separate part of medicine." All children up to 14 years of age were hospitalized "separately in a ward which allowed partial segregation." In spite of the large number of communicable disease cases handled at the hospital and the use of a single nurse and several nurses' aides in the communicable-diseases and pediatrics wards, "only two cases of cross infection (chickenpox) occurred."

All children in the center were "followed in well-baby clinics and school health clinics." A "100-percent immunization for pertussis, diphtheria tetanus, and typhoid" was conducted. Thus, the incidence of communicable diseases, which had been high during the first few months of the camp's operation "began to decline and in general, it continued low thereafter." Well babies were seen every month up to one year of age, every six months to three years of age, and once at five years of age. Booster doses of triple vaccine were administered just before admission to school. In 1943, all elementary and secondary school children were examined by a physician and a dental assistant. The following year, children in grades 1, 3, and 6 were examined only, "together with those children who had previously revealed defects."

A dental chair was set up in the school clinic, where a dental aide examined and corrected minor tooth problems. During 1943-44, an orthopedic surgeon was present at the hospital for three days every two months at which time he examined all crippled children and operated on those requiring it. By 1945, however, the patient load declined "appreciably." and only two clinics were held during the war.

Food handlers in the Manzanar mess halls were given a complete physical examination. In "suspicious cases among women, a pelvic examination was made, and in all other cases a fluoroscopic with plates was taken." Blood serology was conducted on a routine basis, but "positive blood" did not preclude working so long as the patient was considered non-infectious and remained under medical treatment.

Although the prevalence of venereal disease in the camp was low, venereal disease clinics were held weekly. During 1943-45, only three cases of gonorrhea were found, and the majority of the venereal disease cases were categorized as syphilis.

Tuberculosis cases were numerous at Manzanar, and a large number of evacuees were hospitalized. Medical officials believed that this development was probably the result of overcrowded living conditions, and the "social stigma which the Japanese attached to" the disease. A person who suspected that he had tuberculosis would conceal his symptoms until the disease was "so well established that he had spread it to others." Consequently, all persons showing even a slight "suspicion" of chest pathology when seen in the chest clinic were X-rayed for tuberculosis, In addition, all food handlers were fluoroscoped, and, upon the slightest suspicion, were X-rayed. All pediatric cases admitted to the hospital were routinely skin-tested, and all reactors and their families were X-rayed. These procedures, together with a rigorous program of "contact checking," resulted in a large percentage of the camp population being X-rayed.

During the first 18 months of the center's operation, the number of active cases of tuberculosis was high. After late 1943, however, few new cases were discovered.

Generally, tuberculosis patients were placed "at bed-rest" and given a "hi-caloric, hi-vitamin diet for from two to three months." If indicated, pneumothorax treatment was initiated. In cases of cavitation, pneumothorax was commenced as soon as the patient's general condition permitted. During the last six months of the health program in 1945, a specialist in tuberculosis from the Los Angeles County Hospital visited the center every two months and advised the health staff on specialized care.

During the operation of Manzanar, two tuberculosis patients died and six were transferred to Hillcrest Sanitarium in the Los Angeles area for specialized care. In November 1942, two babies died of tuberculous meningitis within three weeks of infection. However, no other similar cases occurred.

Sanitation for the camp, a subject of utmost concern to public health officials at Manzanar, was "in general, unsatisfactory." This was due in part to the lack of sanitary facilities in the barracks, and the fact that the services of a sanitarian were not continuously available.

Nevertheless, only two cases of mass food poisoning occurred during the camp's operation, both of which took place "in the early days of the Center's existence." This low incidence of gastro-intestinal disease was attributed to "the excellent cooperation given by intelligent persons in the Engineering and Mess Sections," the "high type of sanitary work carried on when a sanitarian was available," and the "loyalty of a small number of evacuees, who in the absence of a sanitarian, served as sanitary aides often with inadequate guidance and supervision."

Because of the "large number of cross connections in the Center's mains, the water supply" was frequently "under suspicion" However, most of these connections were eventually eliminated. Acceptable chlorine residuals were maintained in the water supply at all times. At the time of the spring and fall rains, a high organic content in the water supply was recorded which led to many complaints of "too much chlorine." Although large amounts of chlorine were needed during these periods, the "residual was kept constant."

Sixteen Japanese baths that were installed in the center to accommodate the desires of the Issei were "chronic offenders of the sanitary code." WRA authorities continuously attempted to ameliorate this problem by urging that submerged inlets be raised 18 inches above the tub, but "protest and appeal to the evacuees did not improve matters." According to the Final Report, Manzanar, "a respectable Japanese bath" was "taken only from a submerged outlet." As "usual when scientific progress comes into contact with deep-seated mores, educational efforts produced no relief."

Sewage disposal, after processing in the camp treatment plant, was discharged into a dry creek bed. Traces of chlorine were kept until the water disappeared. The sludge was transferred to a digestion chamber and later to drying beds. Sludge digestion constituted a continuing health problem, and adequate temperature pH and digestion was not achieved until late 1944.

Medical Social Work Activities

The work of the medical social service was integrated with other units of the health section, as well as with social welfare agencies both inside and outside the project. According to the Final Report, Manzanar, the WRA conducted medical social work on "an intensive scale" in the center, because it was dealing with "a population suffering from the impact of forced migration." Basic functional duties of the medical social service included: (1) making office and home visits with the patient and patient's family to assist the attending physician in the proper care of the patient; (2) certifying clothing grants for patients who were chronically ill; (3) obtaining glasses as recommended by an ophthalmologist; (4) serving as liaison person in social problems affecting the medical care of patients; (5) issuing and keeping marriage health certificates safe; (6) keeping files and records of patients hospitalized outside the center; (7) closely coordinating the medical and social care of chronically ill patients; and (8) handling all sickness and compensation cases. [60]

Closing Health Section Procedures

During 1945, as the number of evacuees declined, the proportion of ailing and helpless individuals in the population increased, throwing "an additional burden upon the diminishing hospital staff." Although the clinic attendance dropped off, "it continued heavy, as organic disease became masked and complicated with psychosomatic disorders which accompanied the growing sense of insecurity of the residents." As a result, patients required "more thorough investigation."

To cope with this situation, the health section formulated a two-pronged course of action. It provided "fullest cooperation to the relocation program by making estimates of the medical need of each dependency case, by reassuring the insecure through a 24-hour program of mental hygiene that their medical and personnel needs would be taken care of, and by tracking down irresponsible rumors and referring excited inquirers to the most likely source of accurate information." In addition it eliminated "non-essential services so that the undersized staff could give adequate care to the greatest number of persons."

The curtailment of medical services coincided with the arrival in August 1945 of Dr. Agnes V. Bartlett as principal medical officer. The entire evacuee medical staff also relocated with the exception of an evacuee physician, Dr. Takahashi, who, though ailing and frail from long service and advanced years, carried a "magnificent share of the medical work" during the last 4 1/2 months of the center's operation.

In July 1945 all elective surgery in the Manzanar hospital was discontinued. Most of the tuberculosis cases had previously been relocated to institutions near the Pacific Ocean, and all chronic "bed-to-bed" cases had been processed by the medical social worker and the welfare section for placement in their counties of residence "at such time as residence verification" could be made. As far as possible, after the completion of these cases, all patients with serious illness which showed need for long hospitalization were sent to the Los Angeles County General Hospital for care until convalescent, when they were to be converted to terminal departure status and cared for by their county of origin. All prosthetic work, not in process and authorized by June 30, was eliminated from the evacuees' financial aid. The public health clinics were curtailed and limited to a general medical clinic, a minor surgery clinic during the mornings, and an eye-nose-throat clinic during the afternoons. Immunization of infants was continued until November 1, but well-baby conferences were limited to periodic weighing by an evacuee graduate nurse and conferences with mothers whose children appeared to need a physician's attention. All emergency cases coming to the hospital for medical care at non-clinic hours were screened by the nursing supervisor. In-patient hospital care was conducted by rounds every morning at which the nursing service, the principal medical officers, and the medical social worker were present.

With the lifting of the exclusion ban in January 1945, the remaining tuberculosis patients were moved to Hillcrest Sanitarium in the Los Angeles area and Ward 4 in the Manzanar hospital was closed. The hostel across the way from the hospital was closed in August at which time its residents were transferred to the hospital. In October, the relocation of "bed-to-bed" patients to outside hospitals began, because the stationary engineer and crew had relocated, thus resulting in termination of hot water service and steam heating to the hospital wards and the closing of the laundry. Thereafter, contract hospital laundry services were secured in Bishop.

On ten days' notice, the final consolidation of hospital service was completed on October 6 with the closing of Wards 1, 2, 3, 4, 6, and 7. The hospital mess hall was closed on November 2, and thereafter bed patients were served with trays from the Block 34 mess hail, and the ambulatory hostel patients were escorted there for meals three times a day. The last "bed-to-bed" patients were transferred out of the center on November 12.

During the last week of evacuee occupancy, the health section consisted of one physician, one administrator, one nurse, three duty nurses, and one secretary. The hospital census showed six hostel patients, two maternity patients, and two nursery infants. The last evacuee employee of the health section terminated on November 19, and voluntary assistance was given by an evacuee woman who was not on the payroll up to 4:00 P.M. the last day of center occupancy. The last two confinement cases and babies were delivered at Manzanar before the center and hospital services closed on November 21, 1945.

On November 10, the principal medical officer took personal charge of the 27 boxes of ashes remaining in the Buddhist Church at Manzanar. These remains were stored in the camp pharmacy, and permits for their transfer were obtained. The last ashes were transferred from the health section to the evacuee property section for shipment on November 21.

Statistical data for the health section in the Final Report, Manzanar provided information on the number of patients, bed occupancies, clinics, births, and deaths from December 1942 to September 1945. The totals included: