CHAPTER 1
Introduction
Paul F. Russell, M.D., M.P.H., Sc. D.
But, as to public matters, it is clearly in military service that the ravages made by thediseases of malaria have been frequent, serious, and often ruinous; whileif those have sometimes been inevitable, they have much too often been theresults of neglect, or of what should be called ignorance * * * --MACCULLOCH,1829.
At first, in this series on the history of preventive medicine in the U.S. Army in WorldWar II, it was planned to include in one volume accounts of all the arthropodborne diseases that afflicted our troops throughout the world. But because ofthe size, scope, and attractiveness, as well as the importance of the manuscripts prepared by malariologists with wartime experience, the editors decidedto devote an entire volume to malaria and a subsequent volume to be entitled "Arthropodborne Diseases Other Than Malaria." This volume will includeaccounts of some 15 diseases spread by mosquitoes, mites, ticks, lice,and fleas.
The following chapters tell the story of the life and death battling that went on continuouslyat home and overseas during World War II between the U.S. Army and the plasmodia of malaria together with certain species of Anopheles mosquitoes that spread the parasites from man to man. In many engagements, arthropodborne diseases, especially malaria., sent more soldiers to hospital beds than did the armies of the Axis with all their guns, planes, and tanks. For example, as noted in chapter V (p. 362), from 9 July to 10 September 1943, during the fierce Sicilian campaign, there were 21,482 hospital admissions for malaria compared with 17,375 battle casualties. Because most of the infections were withPlasmodium vivax, there were many incapacitating relapses during the springof 1944, a time when every man was badly needed at Cassino and Anzio.
Naturally, malaria control became one of the main concerns of the Preventive Medicine Service of the Office of The Surgeon General. The importance in the Army's final conquest of malaria in World War II of the massive and steadily maintained primary administrative attack, initiated by Brig. Gen. James S. Simmons, and fully supported by The Surgeon General and by the Chief of Staff ofthe Army, can hardly be overemphasized. Details have been given by Hardenbergh 1 and by McCoy (see chapter II).
1 Hardenbergh, William A.: Control of Insects. In Medical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955, pp. 179-232.
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The power of the mosquito to knock out our soldiers was particularly manifest in the South and Southwest Pacific. I shall not forget Gen. Douglas MacArthur's statement to me in May 1943: "Doctor," he said, "this will be a long war if for every division I have facing the enemy I must count on a second division in hospital with malaria and a third division convalescing from this debilitating disease!" The general was not at all worried about defeating the Japanese, but hewas greatly concerned about the failure up to that time to defeat the Anopheles mosquito. Thanks to this understanding of the power of the Plasmodium-arthropod axis and thanks to the superb attack on these enemies by American and Australian antimalaria personnel, as recounted in chapters III and X, U.S. Forcesfrom mid-1943 onward waged a fast and successful war through some of themost malarious areas on earth.
Nearly all of the chapters that follow were written soon after the war by men who took anactive part in the struggle. Place names, epidemiological facts, and authorstitles appear as they existed during the period of World War II. The authorshave not glossed over early mistakes and omissions which permitted malariarates in U.S. Forces to climb, at times, to such appalling heights as 2,700per 1,000 on Efate, in the second month of occupation; 1,781 per 1,000 onGuadalcanal, in November 1943; 4,000 per 1,000 at Mime Bay, in late 1942;and the fact (as noted in chapter IX) that malaria hastened the surrenderon Bataan. Each author has attempted to give an accurate account of thedifficulties and the errors--and of the ways in which these were overcome.There are valuable lessons in these chapters, published not merely for therecord but in the hope that some of the pitfalls may be avoided in the future,although perhaps one is unduly optimistic to believe that the lessons ofone war are ever remembered in the next. That memory is a sieve has beendemonstrated over and over again with regard to military malaria control.Quoting Macculloch, 2 " * * * and still it would seem, as iffatal, that the wisdom and experience of one generation should be forgottenby the next, that peace should extirpate the knowledge that had been gainedin war * * *."
MALARIA IN PAST WARS
For centuries, it has been recognized that there must be command responsibilities if preventive measures against disease are to be successful in military forces. In 1764 for example, John Pringle noted the fact in the preface of his classical book on diseases of the army that he was writing "for the information of officers as well as physicians."3 Both in his preface and inthe text, he wrote that "the prevention of diseases cannot consist in theuse of medicines, nor depend upon anything a soldier shall have it in hispower to neglect, but
2 Macculloch, John: Malaria; an Essay on the Production and Propagation of This Poison and on the Nature and Localities of the Places by Which It Is Produced:With an Enumeration of the Diseases caused by It, and of the Means of Preventing or Diminishing Them, Both at Home and in the Naval and Military Service, Philadelphia: Thomas Kite, 1829.
3 Pringle, John: Observations on the Diseases of the Army. 4th edition. London: A.Millar, 1764.
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upon such orders as shall not appear unreasonable to him, and such as he must necessarily obey." In 1910, Col. C. H. Melville,4 professor of hygiene, Royal Army Medical College, London, wrote for Ronald Ross a chapter on malaria prevention in war. In this, he commented that as regards antimalaria measures: "A specially selected medical officer should be placed in charge of these operations with executive and disciplinary powers, a step that has proved to be soeffective by the officers of the U.S. Army in Cuba and elsewhere."
It is a simple truth that, in an army, discipline is as important in fighting disease as infighting the human enemy. But this seemingly obvious fact was almost completelyforgotten in the early months of World War II when there was often whatMacculloch referred to in 1829 as "a contempt and an incredulity respectingmalaria." The attitude of all too many command officers was at first similarto that reported of a general officer in a highly malarious area who, ata time when some 40 percent of his forces were already ill with malaria,resented all suggestions of malaria prophylaxis and said that if one hadto play with mosquitoes in wartime that person should go back to Washingtonand stop bothering him while he was so busy getting ready to fight the Japs.Unfortunately, before his forces did any fighting at all, they were ignominiouslyrouted by anopheline mosquitoes and were all evacuated to a rear area formalaria therapy and convalescence.
Most line officers and all too many medical officers at the beginning of World War II wereignorant about malaria and its potential for disrupting military operations.This was understandable in newly recruited personnel but hard to excusein regular officers presumably trained to fight in any part of the world.For the history books are full of examples of malaria's military power.As Melville wrote: "The history of malaria in war might almost be takento be the history of war itself, certainly the history of war in the Christianera." He mentioned the fevers in the French and Austrian armies in the Italiancampaigns of 1859 and the disastrous Walcheren Expedition a century earlierin the Low Countries when the British were conquered by malaria before abattle could be fought. Melville commented on the 1864 West African campaignsas follows: "It can scarcely be called a war, as an enemy was never seen,or a grain of powder expended; our troops were defeated by disease, muchof which was preventable." Then, there was the French campaign in Madagascarin 1895 when there were 13 deaths in action and over 4,000 deaths "due almostentirely to malarial fevers and their sequelae."
Numerous other examples could be cited, such as that of Macedonia in World War I when malaria immobilized British, French, and German armies for 3 years. On one occasion, when the French commanding general was ordered to attack, he replied: "Regret that my army is in hospital with malaria." Nearly 80 percent of 120,000French troops in this area were hospitalized with malaria. In an averageBritish strength
of 124,000, there were
4 Melville, C. H.: The Prevention of Malaria in War. In The Prevention of Malaria by Ronald Ross. 2d edition. London: John Murray, 1910, pp. 577-599.
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162,512 admissions to hospital formalaria during the years 1916 to 1918, in contrast to 23,762 killed, wounded,prisoner, and missing in action. In the spring of 1918, about 25,000 Britishsoldiers were sent home from Macedonia with chronic malaria, and, apartfrom these evacuees, over 2,000,000 man-days were lost to the British Armyin this area in 1918 because of malaria. 5
BASIC MALARIA EPIDEMIOLOGY
To understand why malaria can so seriously disrupt an army, one must know a few basic principles of malaria epidemiology. For example, except for occasional accidental infections, as by blood transfusion, man acquires malaria only through the bite of an anopheline mosquito. No other genera can transmit the disease, and, in practice only, about 50 of some 200 species of Anopheles are closely enough associated with man to be dangerous. Most anophelines feed on animals. There was no malaria in New Caledonia because. there were no Anopheles mosquitoes there. No malarial infections occurred on the flat coastal plain or mangrove swamp areas of the Philippines because the anophelines in those areas do not feed on man. In the Philippines, malaria is transmitted by a species of Anopheles that breeds chiefly in foothill streams
Secondly, therecan be no malaria transmission if there are no malaria parasites in manavailable to the mosquitoes. For example, there are potent malaria vectormosquitoes in many areas of our Southern States but no malaria transmissionbecause none of the residents has malaria parasites in his blood. When soldiersbivouac in communities where there are parasites in the blood of the residentsand vector mosquitoes in the area, it is a foregone conclusion that manyof the soldiers without protection will become malarious. This, in turn,will increase the parasite reservoir, and there will be an epidemic amongthe soldiers unless preventive measures are taken promptly. Another important fact is that anophelines are rarely effective vectors over a radius much longer than a mile and a half. Yet time and time again, troops were allowed to bivouac in highly malarious surroundings when safe locations could have been utilized a mile or two away.
It is also important to know that different species of anophelines have different breeding habits. All develop only in water, but some prefer rice paddies, some pools andpuddles, some foothill running streams, some swamps or ponds, some marshes,some wells, some fresh water, some brackish, some sun, and some shade. Therefore, malaria control requires the help of trained entomologists or malariologists who know or can find out the habits of the mosquitoes. For example, onGuadalcanal and in West Africa, where the vectors breed in pools, puddles,and wheel ruts, U.S. Armed Forces created
5 (1) Russell, Paul P., West Luther S., and Manwell, Reginald U.: Practical Malariology .Philadelphia: W. B. Saunders Co., 1946. (2) MacDonald, A. G.: Prevention of Malaria. In History of the Great War Based on Official Documents. Medical Services, Hygiene of the War, edited by W. G. Macpherson, W. H,Horrocks, and W. W. 0. Beveridge. London: His Majesty's Stationery Office,:1928, vol. II, pp. 189-238.
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thousands of breeding places for the local malaria vectors and thus greatly increased the numbers of malariamosquitoes and so the eases of malaria.
The fact that most anopheline vectors feed only at night is important. In West Africa and elsewhere, U.S. Forces suffered from much preventable malaria by permitting unprotected soldiers to attend night movies where they were easy prey to the night-biting malarial mosquitoes. Air Forces personnel taking planes front the United States to the United Kingdom via South America and West Africa were often billeted in unscreened or poorly screened quarters at EknesField and in the Dakar-Rufisque area of French West Africa where the malariarates among the base personnel, in the autumn of 1943, sometimes exceeded1,500 per 1,000. Many Air Forces officers who had spent a night or two inthese areas, therefore, developed malaria in nonmalarious England and sowere out of action when badly needed.
The epidemiology of malaria and the technical application of control measures are basically the same in military as in civilian communities. But there are some differences. The following features, for instance, tend to make malaria control easier under wartime military conditions than in civil life: Complete authority of the commanding officer, uniformity of living habits of the personnel, and ample antimalaria funds and supplies. But other features impose handicaps; for example, troop mobility and dispersion, necessarily based on tactics and not on sanitary conditions; a great deal of vital nocturnal activity; difficult logistics, especially in combat zones; enemy action, mines, and boobytraps; and combat tension when the chief concern is not malaria control but immediate life and death. Moreover, a military force operating where malaria is endemic generally finds the malaria potential greatly increased. In jungly areas, necessary clearing opens up breeding waters for anopheline vectors that prefer sunlight, and other operations often tend to multiply breeding places. In civilized areas, war often forces the people out ofcities into the malarious countryside where they live in shelters exposedto infective mosquitoes. Local health services are disrupted or abandonedso that there is no civilian malaria control. Thus troops may be exposedto malaria incidence much greater than normal for the area. Trenches, foxholes,tank traps, gun emplacements, vehicle ruts, shell, bomb and mine craters,sabotaged irrigation projects, streams ponded by bridge rubble and improvisedcauseways, drainage blocked by hastily built airfields and highways, allmay provide additional breeding places for malaria mosquitoes. An army mustdepend largely on its own efforts to prevent loss of manpower due to mosquitoaction.6
MALARIA LESSONS FROM WORLD WAR II
The following chapters make it clear that out of World War II came certain fundamental lessons regarding military malaria control. The principal general lesson was that it is impossible to control malaria effectively in military
6 See footnote 5 (1), p. 4.
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forces in highly malarious areas unless commanding officers from highest to lowest echelons are malaria conscious. Training and education of both medical and line officers in regard to malaria and its control are essential. Malaria control in the army is a military problem. A malaria policy must not only be formulated: it must be enforced. Malaria discipline is absolutely necessary to an army's success in fighting the Plasmodium-mosquito axis. This malaria discipline is a partof what Sir Neil Cantlie, Director General of British Army Medical Services, called "Health Discipline" and which he defined as "measures that concern the preservation of health and the prevention of disease which are enforced by disciplinary means."7 Cantlie tells of one commander who,when he had grasped the importance of Brig. N. H. Fairley's proof that clinical malaria could be prevented by taking a tablet of Atabrine (quinacrine hydrochloride or mepacrine hydrochloride) a day, said: "You doctors think you can prevent malaria, but you can't. I can and I'm going to." This lay officer's declaration that he was going to prevent malaria signified a vital turning point that made victory possible. Again quoting Cantlie: "When for the first timein history a combatant officer was considered unfit to command a unit onthe grounds that he had allowed his men to become ineffective through disease, a new day in military medicine dawned. The clouds of forgetfulness mustnot be allowed to overshadow the brightness of that day."
The second general lesson was that it is scarcely possible to control malaria successfullyin any but lightly endemic areas, or in small units, unless there is a special military malaria control organization to survey, plan, execute, supervise, amid maintain the numerous and technical measures that must be carriedout continuously if malaria is to be defeated. Personnel charged with allmanner of sanitary duties cannot give the time and care to malaria thatis required for its control. Full and undivided attention by a speciallytrained malaria control organization is absolutely essential.
A third lesson was that malaria supplies and personnel require priority of movement commensurate with their importance. For example, in some areas of New Guinea, malaria supplies and personnel were more important to the success of the fighting than was much of the materiel being sent forward. Yet early in 1943, malaria supplies for use in the Southwest Pacific were mostly piled up on the piers of the west coast of the United States. The few supplies that went to Australia stayed there and were not moved on to New Guinea because malaria supplies were about tenth down the list of priority of movement. In wartime, everything moves from the rear toward the front on strict priorities set by the theater command. When the need became obvious in May 1943, the priorities for malaria supplies and personnel were raised to first place, and thereafter no serious shortages occurred. This action, together with the enforcement of malaria discipline and the provision of specialist malaria control and survey units, turned the scales, and malaria was thoroughly defeated. These were thefundamentals: (1) Malaria discipline, (2) special-
7 Cantlie, N.: Health Discipline. U.S. Armed Forces Med. J. 1: 232-287, February 1950.
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ized malaria control organization,and (3) high priorities for movement of malaria personnel and supplies.The military experience taught once again that the prevention of malariais neither automatic nor simple but is compounded of law and persuasion,organization and training, supplies and technical application. Once thefundamental lessons were learned, the military malaria problem was solved.
ADVANCES IN MALARIOLOGY IN WORLD WAR II
Certain advances in malariology during World War II should be briefly mentioned. The greatest were in the development and use of (1) synthetic antimalarial drugs and(2) residual insecticides.
Antimalarial drugs.-- As regards antimalarial drugs, World War II liberated us from quinine, taught us how to use Atabrine, and led us to such powerful new antimalarials as chloroquine and amodiaquin, primaquine, proquanil, and pyrimethamine. Quinine and its source, cinchona bark, had been the only effective medicament in malaria therapy and prophylaxis for over 300 years. Then, when the Germans were unable to obtain quinine during World War I, they began to experiment with synthetic substitutes, producing Plasmochin naphthoate (pamaquine naphthoate),in 1925; Atabrine, in 1930; Resochinor Aralen (chloroquine diphosphate),in 1943; and Sontochin or Sontoquine,a little later. 8 Resochin, strange to say, was discarded bythem as apparently too toxic.
After the entryof Japan into World War II, the Allies were quickly cut off from Indonesia, the principal source of quinine, and so they began an extensive programof research on antimalarials both in the United Kingdom and in the UnitedStates. The secrets of Atabrine manufacture had been kept in Germany butwere soon solved by Allied chemists, and the drug was put into large productionin the United States. Atabrine immediately gained widespread recognitionas an excellent therapeutic agent, but there was some confusion about itsuse as a prophylactic until the classic experiments of Brigadier N. Hamilton Fairley in Australia in l943. 9 These proved beyond doubt that one tablet of Atabrine (100 mg.) a day would prevent overt attacks of malaria, curing those due to Plasmodium falciparum. and postponing clinical manifestations of P. vivax infections until the drug was withheld. Withrelatively few exceptions, this suppressive Atabrine could be administeredfor many days without serious toxic effect. The evidence is clear that thetaking of suppressive Atabrine, when strictly enforced by suitable malariadiscipline, enabled our forces to fight in highly malarious surroundingswithout being hampered by clinical malaria.
8 (1) Covell, Gordon, Coatney, G. Robert, Field, John W., and Singh, Jaswant: Chemotherapy of Malaria. Monograph Series No. 27. Geneva: World Health Organization,1955. (2) Most, Harry: Clinical Trials of Antimalarial Drugs. InMedical Department, United States Army. Internal Medicine in World War II.Volume II. Infectious Diseases. Washington : U.S. Government Printing Office, 1963.
9 Fairley, N. H.: Researches on Paludrine (M. 4888) in Malaria. Tr. Roy. Soc. Trop. Med. & Hyg. 40 (2) : 105-161, October 1946.
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After the Allied occupation of North Africa, the Allies learned that the French had found Sontoquine to have high antimalaria value. This led to the explorationof a large series of 4-aminoquinolines by investigators in the United States. They determined that Camoquin (amodiaquin) and Resochin or Aralen wereexcellent antimalarial drugs comparable to Atabrine. Neither drug becameavailable to the Army in any quantity before the end of the war.
Other wartime studies were directed to the 8-aminoquinolines and led to the discovery of primaquine in 1945. In the overall U.S. wartime program up to 1946, more than 15,000 compounds were studied for antimalaria values.
British investigators also carried out extensive studies on malaria drugs, and these led to the synthesis of quite different but highly effective compounds, proguanilor Paludrine (chlorguanide hydrochloride) in 1944 and Daraprim or malocide (pyrimethamine) in 1952, reported by Covell and others.
DDT.-- Dichlorodiphenyltrichloroethane (DDT) was first synthesized in 1874 by a Viennese pharmacist, Othmar Zeidler, who at the time was a chemistry student in Strasbourg interested in thethen new phenomena of organic synthesis.10 He did not investigatethe properties of the new substance but simply published his synthesis.Then in 1939 in Switzerland, Paul Müller of the Geigy Company, searching for a toxicant that would kill clothes moths, resynthesized this compound and made his Nobel Prize-winning discovery that it was an insecticide of remarkable versatility. The Geigy Company began in 1940-41 to market the substance in two forms: (1) A 5-percent dust called Gesarol spray insecticide, at the time principally for use against potato beetles, and (2) a 3-percent dust called Neocid dust insecticide, for use as a lousicide.
Due in large measure to the U.S. Military Attaché at Berne, Maj. A. R. W. de Jonge, samples of these products were sent to the Geigy Company's New York branch andto London, in the autumn of 1942. Studies at the Orlando, Fla., laboratoryof the Bureau of Entomology and Plant Quarantine demonstrated beyond question that this new insecticide had tremendous possibilities not only againstlice but also against several other noxious insects, such as mosquitoesand houseflies. 11 With the help of the War Production Board,the new insecticide was put into large production as soon as possible. Thenow universally used name, DDT, was first applied by the British Ministryof Supply in 1943. 12 DDT was first added to U.S. Army supplylists in May 1943. 13
Gahan and colleagues, in August 1943, appear to have made the first practical tests of DDT asa residual insecticide against adult vector mosquitoes.14
10 Russell, Paul F.: Man's Mastery of Malaria. New York: Oxford University Press, 1955.
11 Knipling, E.F...: The Development and Use of DDT for the Control of Mosquitoes. J. Nat. Malaria Soc. 4: 77-92, June 1945.
12 West,T. F., and Campbell, G. A.: DDT. The Industrial Chemist and Chemical Manufacturer 20: 461-465, September 1944.
13 Bishopp, F. C.: Present Position of DDT in the Control of Insects of Medical Importance. Am. J. Pub. Health 36: 592-606, June 1946.
14 Gahan, J. B., Travis, B. V., Morton, P. A., and Lindquist, A. W.: DDT as a Residual-Type Treatment to Control Anopheles quadrimaculatus: Practical Tests.J. Economic Entomology. 38 (2) : 251-235, April 1945.
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They sprayed the interior surfacesof various types of houses and found the procedure to be quite effectiveagainst Anopheles quadrimaculatus. The first field test in whichresidual DDT was applied to the interior surfaces of all habitations andoutbuildings of a community to test its effect on Anopheles vectorsand malaria incidence was begun in Italy in the spring of 1944. This experimentwas carried out in the town of Castel Volturno at the mouth of the VolturnoRiver, north of Naples, by the Malaria Control Demonstration Unit of theMalaria Control Branch of the Public Health Sub-Commission, Allied ControlCommission, Italy. Spraying began on 17 May 1944, and this experiment, togetherwith a second one started later in the Tiber Delta area, lasted 2 years. 15 The Malaria Control Demonstration Unit, under the direction of Dr. F. L. Soper, consisted largely of members of the Rockefeller Foundation Health Commission who had brilliantly carried out their first assignment--that of assisting in typhus control in Naples.
These highly significant experiments, the first to prove the practical usefulness of residual DDT in malaria control, were possible only because of the support given to them by the ranking U.S. medical officer in the theater, Maj. Gen. MorrisonC. Stayer, and his preventive medicine officer, Col. William S. Stone,MC, and by the commanding officer of the Public Health Sub-Commission, Brigadier George Parkinson.
As DDT suppliesbecame more abundant many other trials under military and civilian auspiceswere carried out in 1944 and 1945 in various parts of the world. They leddirectly to the concept of "nationwide malaria eradication" now being appliedpractically in so many countries. DDT no doubt would eventually have foundits place in malaria control, but the war needs and experiments greatlyaccelerated its acceptance and use and led to the discovery and applicationof similar insecticides such as benzene hexachloride and dieldrin.
Allied malaria control units demonstrated the value of malaria control by modern methods all over the world with such striking success that civilian authorities were willing after the war to budget large funds for antimalaria programs. There canbe no doubt that antimalaria activities of World War II constituted a prime factor in the development of the present move for worldwide malaria eradication.
Other advances .--Besides the major advances in preparation and use of synthetic antimalarials and insecticides just described, there were certain others as, for example, the improvement in repellents represented by dimethyl phthalate; the increased scope of airplane larvicidal dusting with paris green, due to wartime research which raised the prewar maximum load of 700 to 3,000 pounds, applied from the air with great efficiency; the development of pressure cylinders using liquid Freon-12 as a propellant for pyrethrum insecti-
15 Soper, F. L., Knipe, F. W., Casini, G., Riehl, L. A., and Rubino, A.: Reduction of Anopheles Density Effected by the Pre-Season Spraying of Building Interiors with DDT in Kerosene, at Castel Volturno, Italy, in 1944-45 and in the Tiber Delta in 1945. Am. J. Trop. Med. 27: 177-200, March 1947.
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cide expelled as an Aerosol mist; the broadening of taxonomic and biologic knowledge of the genus Anopheles around the world; and increased understanding of the Plasmodium and its growth in vivo, in vitro, and in tissue culture.16
The devising, manufacturing, and distributing of antimalaria. supplies and equipment was notable inWorld War II from mid-1943 onward. Unusually effective cooperation fromthe beginning of the war was maintained among the Army, Navy, U.S. Public Health Service, National Research Council, Bureau of Entomology and Plant Quarantine of the U.S. Department of Agriculture, War Production Board, Institute of Inter-American Affairs, industrial firms, medical schools,research institutes, and foundations. Information was freely exchangedbetween the United States, United Kingdom, and Australia; moreover, thethree Governments effectively supported vital laboratory and field experiments.Seldom, if ever, have research and practical application in preventivemedicine come closer together. 17
Man's net losses from World War II were so enormous that these lessons and advances canhardly be called dividends or be pointed to with pride. The progress inmalariology, such as it was, constituted a sort of salvage, undoubtedlyof considerable value.
But we can very definitely point with pride to the skill, courage, and devotion to dutyof the personnel, officers and men, of the malaria organizations of theArmy in World War II. Tribute is best expressed in the following messagewhich Brig. Gen. (later Ma]. Gen.) Guy B. Denit,18 Chief Surgeon,Southwest Pacific Area, published at his headquarters in December 1944:
The reduction of the malaria attack rate in this theater to a point at which it no longer constitutes a dangerous handicap to our military effort is an achievement of historical importance in preventive medicine. It has been the resultof a joint effort which is to the great credit of all who have participated. In this accomplishment the malariologists and the malaria survey and malaria control units have played the major role. Despite hardships and often danger, their achievements have been notable. The Medical Department is proud of your initiative and perseverance, of your professional contributions, and of the striking success of your efforts.
The following 18th century quotation from Pringle (p. 2) seems appropriate in closing this introduction: "Yet, however, imperfect these sheets may be, I hope theymay serve as a foundation for others to build upon; who, by making improvements on this subject, will concur with me, in attempting to draw from the calamities of war some benefit to mankind."
16 Russell, P. P.: Lessons in Malariology from World War II. Am. J. Trop. Med. 26:5-13, January 1946.
17 Symposium on a National Malaria Program for the Control of Malaria. In J.Nat. Malaria Soc. 3 (1) March 1944. Papers presented at the Joint Sessionof the National Malaria society and the American Society of Tropical Medicine,meeting with the Southern Medical Association, at Cincinnati, Ohio, 16-18Nov. 1943 by J. S. Simmons, O. R. McCoy, 0. J. Brown, S. B. Freeborn, H.S. Cumming, G. C. Durham, H. B. Meleney, F. C. Bishopp, G. A. Carden, Jr.,W. A. Sawyer, and J. W. Mountin.
18 Denit, G. B.: Message from the Chief Surgeon in the Far East. Bull. U.S. Army Med. Dept., No. 86, p. 53, March 1945.
