WWII Military Health in the Pacific

Soldiers battled enemies, filthy conditions, foreign disease, and wounds that linger in the aftermath.

By Freda Brinson, CPC, CPC-H, CEMC

Dec. 7, 2013 marks the 72nd anniversary of the “date which will live in infamy,” the attack on Pearl Harbor that drew the United States into World War II. You’re probably familiar with the famous battles of WWII—Midway, Guadalcanal, the Battle of the Bulge—but you may not know that troops fought disease, just as surely as they fought enemy soldiers.

Armies in the early 20th century faced a variety of communicable diseases. By the 1930s, however, medical advances and simple hygiene had begun to turn the tide. Outbreaks such as the 1898 typhoid fever epidemic—which decimated the army, accounting for 15 percent of casualties and resulting in over 2,000 deaths during the Spanish American War—and 1917-1918 influenza that killed over 30,000 soldiers during World War I, were becoming less common with proper sanitation and isolation. In 1942, the U.S. military vaccinated all active duty personnel against tetanus, typhoid, smallpox, cholera, and yellow fever, curbing or eliminating these diseases during WWII.

But WWII introduced the United States to global war, exposing personnel to newly encountered foreign diseases. In the South Pacific, heat, incessant rain, insects, and vermin frustrated efforts to control disease. Despite medical advances, for every two men lost to battle in the Southwest Pacific theatre (Australia, New Guinea, Solomon Islands, Dutch East Indies, Borneo, and the Philippines), five men were lost to disease.

Diseases from Poor Sanitation

In battlefield conditions, proper sanitation is often sacrificed. As a result, WWII soldiers suffered from several prominent diseases.


Dysentery is typically the result of unsanitary water that contains micro-organisms, which damage the intestinal lining. To purify water, soldiers were given halazone tablets. It took several tablets added to one canteen to purify questionable water. Canvas water bags – also known as Lister bags – were hung around camps and used for dispensing water in which a dose of chlorine was added for purification.

Dysentery is infectious, and water is not the only cause. For example, the 374th Troop Carrier received canned turkey for Thanksgiving, but the meat was tainted. The entire group contracted food poisoning and dysentery. There was a footrace to see who could get to the slit trench first!

Soldiers also found out the hard way the importance of cleaning their mess kits.

Coding for Dysentery

ICD-9-CM chapter 1: Infectious and Parasitic Diseases
Section: Intestinal Infectious Disease (001-009)
Code category:
009 Ill-defined intestinal infections
009.0 Infectious colitis, enteritis, and gastroenteritis
Dysentery NOS

Mentioning food, the squadron had a mess tent. We would take our mess kits in and they’d plop down the fare of the day—usually something green, something gray, and something else. It was important to keep your kit clean. I learned the hard way that if you didn’t wash the little corners and crevasses of your kit, you could get sick. I didn’t and I did. I spent several days agonizing over the old GIs until I finally went to the dispensary and got a cup of castor oil. I downed it in one gulp and that took care of the problem—the hard way.

— Buck Brinson, 46th Troop Carrier Squadron


Cholera, which causes severe diarrhea and dehydration, is a bacterial disease usually spread through contaminated water (there have been experiments with cholera as a bio-weapon). Cholera vaccines and lectures were given, and the disease was limited among American troops during WWII. An outbreak linked to contaminated water did occur in August 1945 at Chihchiang, China. A previous outbreak in July 1945 was linked to cakes purchased from a bakery in Liangsham, China, where a serious epidemic of cholera was raging.

Coding for Cholera

ICD-9-CM chapter 1: Infectious and Parasitic Diseases
Section: Intestinal Infectious Disease (001-009)
Code category:
001 Cholera
001.9 Cholera, unspecified

Hepatitis A and B

More common were hepatitis A epidemics from contaminated food or water. Most reported cases of hepatitis B were due to infected inoculations (Yellow Fever vaccine) from tainted blood supplies. In March-April 1942, approximately 330,000 soldiers were injected, resulting in 50,000 hospitalizations.

Coding for Hepatitis A and B

ICD-9-CM chapter 1: Infectious and Parasitic Diseases
Section: Other Diseases Due to Viruses and Chlamydiae (070-079)
Code category:
070 Viral hepatitis
070.1 Viral hepatitis A without mention of hepatic coma
070.3x Viral hepatitis B without mention of hepatic coma


Even today in tropical environments, malaria is a common problem. The female Anopheles mosquito transmits the blood-born, microscopic malaria parasites from host to host. The treatment for Malaria during WWII was quinine. Quinine tablets do not cure malaria but only mask the effects. Quinine use could create ringing in the ears and a dulling of all senses, which caused additional problems in combat situations. Quinine was unreliable in more ways than one: It was grown only on the island of Java, which fell to the Japanese in January 1942. Quinine shortages proved disastrous for troops engaged in the early months of the war.

Coding for Malaria

ICD-9-CM chapter 1: Infectious and Parasitic Diseases
Section: Rickettsioses and Other Arthropod-borne diseases (080-088)
Code category:
084 Malaria
084.0 Falciparum malaria (malignant tertian)
084.1 Vivax malaria (benign tertian)
084.2 Quartan malaria
084.3 Ovale malaria
084.4 Other malaria
084.5 Mixed malaria
084.6 Malaria, unspecified
084.7 Induced malaria
084.8 Blackwater fever
084.9 Other pernicious complications of malaria

Malaria is one of those odd diseases. It comes and goes years after you have it, and you think you are OK and suddenly you are not. When you go down, you can go down hard. A week after I got back to the U.S., and before I was out-processed in December 1945, I came down with it again and spent a week in the hospital before I could go home.

— Buck Brinson, 46th Troop Carrier Squadron

Diseases in the Southwest Pacific Theatre

In addition to dysentery, cholera, hepatitis, malaria, venereal disease, and combat fatigue, common problems for troops in the Southwest Pacific theatre included beriberi, dengue fever, scrub typhus, leishmaniasis, and “jungle rot.”


Beriberi is a severe vitamin B1 (thiamine) deficiency. Symptoms include pain, loss of sensation in the hands and feet, vomiting, strange eye movement, mental confusion, difficulty walking, coma, and death. Troops isolated on the Bataan Peninsula, those on Guadalcanal, and American prisoners of war held by the Japanese subsisted on diets largely of rice. Without a variety of foods, soldiers became malnourished.

Coding for Beriberi

ICD-9-CM chapter 3: Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders
Section: Nutritional Deficiencies (260-269)
Code category:
265 Thiamine and niacin deficiency states
265.0 Beriberi

Dengue Fever

Dengue fever is also known as breakbone fever because it is said to feel like your bones and joints are breaking. It is carried by the Aedes mosquito (the same breed that causes yellow fever). Symptoms include a high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain and a rash. Word on the street about dengue fever was that it wouldn’t kill you, but you wished it would.

Coding for Dengue Fever

ICD-9-CM chapter 1: Infectious and Parasitic Diseases
Section: Arthropod-borne Viral Diseases (060-066)
Code category:
061 Dengue

Scrub Typhus

Scrub typhus, left untreated, is often fatal. Marked by high fevers, hallucinations, and severe (sometimes fatal) hemorrhaging, the disease is carried not by a mosquito, but a tiny chigger or mite. Ten to 12 days after being bitten, a reddish/pinkish lesion appears at the bite site, and symptoms of headache, fever, chills, general pains, and swollen lymph glands began. A week after the fever, a pinkish rash develops over the skin of the trunk, and sometimes of the arms and legs. This could last as long as four weeks. Long-term effects such as heart function and circulatory failure are common. Insecticide powder was used in WWII to prevent the spread of the mites.

Coding for Scrub Typhus

ICD-9-CM chapter 1: Infectious and Parasitic Diseases
Section: Rickettsioses and Other Arthropod-borne Diseases (080-088)
Code category:
081 Other typhus
081.2 Scrub typhus


Leishmaniasis is known by several names: Orient boils, Baghdad boil, black fever, sandfly disease, dum-dum fever, Jericho buttons, and espundia. It’s caused by protozoan parasites and is transmitted by the bite of a certain sand fly species. There are cutaneous (characterized by one or more skin sores, which could start out as bumps and end up as ulcers) and visceral (characterized by fever, weight loss, and enlarged spleen and liver) varieties. Leishmaniasis was not seen in Asia or South America prior to WWII.

Coding for Leishmaniasis

ICD-9-CM chapter 1: Infectious and Parasitic Diseases
Section: Rickettsioses and Other Arthropod-borne Diseases (080-088)
Code Category:
085 Leishmaniasis
085.0 Visceral (kala-azar)
085.1 Cutaneous, urban
085.2 Cutaneous, Asian desert
085.3 Cutaneous, Ethiopian
085.4 Cutaneous, American
085.5 Mucocutaneous (American)
085.9 Leishmaniasis, unspecified

 Jungle Rot

“Jungle rot” was a term used to describe conditions that resulted from an inability to stay dry. “New Guinea crud” or “the creeping cruds” were terms used by soldiers to describe all kinds of tropical skin disease. These could be similar to aggravated athletes foot—a fungus infection on the trunk, thighs, face, and scalp. Rashes, impetigo, and scabies also may occur. Treatments for soldiers were to clean the area, paint it with silver nitrate, dress it, and avoid sweating (easier said than done).

Coding for Jungle Rot

ICD-9-CM chapter 1: Infectious and Parasitic Diseases
Section: Mycoses (110-118)
Code category:
110 Dermatophytosis
110.0 Of scalp and beard
110.1 Of nail
110.2 Of hand
110.3 Of groin and perianal area
110.4 Of foot
110.5 Of the body

And Then, There’s War Aftermath

In addition to disease, there was the war itself. Many individuals involved with aerial warfare dealt with airsickness, strobe effect, inner ear problems (aerotitis media), digestive problems, oxygen deprivation (anoxia), and high-altitude frostbite. Aerial battle injuries included wounds from “FLAK” (anti-aircraft munitions), fire, and enemy aircraft; injuries associated with bailing out included injury upon leaving the aircraft, oxygen deprivation, cold, shock, and injuries upon landing.

WWII veterans recall the aftermath:

—    “The first year I was home, I never ordered soup at a restaurant. I had hand tremors from the emotions I stuffed inside.”

—    “I had to convince the whole town I didn’t have anything bad.” (sufferer of leishmaniasis)

—    “I’ve been living with jungle rot all these years. Have you ever had goose bumps? Let them weep and then the itch starts. I couldn’t even work at times.”

—     “Max killed himself in 1950; the war did not end for many of us in 1945. Maybe he had a well-meaning relative who told him to “get over it.” Death offered more promise and less pain than life, so he ended the pain.”

Wounds that Linger

Battlefield fatigue and post-traumatic stress disorder (PTSD) were common for WWII soldiers (just as it is for the veterans leaving the battlefield today). Long days, weeks, and months in combat, separation from family, the loss of friends and companions, diseases, heat, rain, lack of food and clean water—all contributed to everyday problems of  WWII soldiers.

August 14, 1945, victory over Japan (V-J) Day, marked the end of the war, but not the end of the suffering. Those brave men and women of WWII, who endured so much on the battlefields, came home with a variety of post-disease and post-war effects. Suffering from disease and wound complications, service related hearing loss and/or blindness, skin scarring disorders, and PTSD were common, but not always acknowledged. Long-term effects included skin cancer, alcoholism, adjustment disorders, and suicide.

Coding for Late Effects

ICD-9-CM chapter 1: Infectious and Parasitic Diseases
Section: Late Effects of Infectious and Parasitic Diseases (137-139)
Code category:
139 Late effects of other infectious and parasitic diseases
139.8 Late effects of other and unspecified infectious and parasitic diseases

ICD-9-CM chapter 5: Mental, Behavioral and Neurodevelopment Disorders
Section: Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders (300-316)
Code category:
309.8 Other specified adjustment reactions
309.81 Posttraumatic stress disorder

ICD-9-CM chapter 2: Neoplasms (140-239)
Skin NOS:
173.90 Unspecified malignant neoplasm of skin, site unspecified [primary]
198.2 Secondary malignant neoplasm of other specified sites; skin
232.9 Carcinoma in situ of skin; skin, site unspecified
216.9 Benign neoplasm of skin; skin, site unspecified
238.2 Neoplasm of uncertain behavior of other and unspecified sites and tissues; skin

ICD-9-CM chapter V Codes: Supplementary Classification of Factors Influencing Health Status and Contact with Health Services
Section: Persons with Potential Health Hazards Related to Communicable Diseases (V01-V06)
Code category:
V01.0 Contact with or exposure to communicable diseases; Cholera

Section: Persons with Potential Health Hazards Related to Personal and Family History (V10-V19)
Code category:
V12 Personal history of certain other diseases
V12.1 Personal history of certain other diseases; Nutritional deficiency
V12.0x Personal history of certain other diseases; Infectious and parasitic diseases
V12.03 Personal history of certain other diseases; Malaria
V12.09 Personal history of certain other diseases; Other [Dengue fever, scrub typhus, leishmaniasis, jungle rot, hepatitis]

Be patient if you are lucky enough to encounter one of our WWII vets in your office or hospital. It’s incredible how much they endured battling enemies, as well as disease and illness, to ensure the continued freedom we have today. Thank God for them, and thank them for their service.

Freda Brinson, CPC, CPC-H, CEMC, compliance auditor for St. Joseph’s/Candler Health System in Savannah, Ga., has been in healthcare for over 30 years. A member of AAPC since 1996, she is an active member with the Savannah AAPC local chapter, serving in various officer positions and on the AAPCCA board of directors from 2009-2012.

Phil Brinson, PE, is married to Freda Brinson and is a civil engineer, retired from the U.S. Army Corps of Engineers, and serves as the honorary historian for the 317th Troop Carrier Group, the Jungle Skippers, in which Phil Brinson’s dad, Buck Brinson, served.


Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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