Foreword
This volume of theofficial history of the Medical Department, U.S. Army, in World War II concernsmalaria, from the standpoint of the preventive medicine efforts which wereundertaken, both in the United States and in oversea theaters, during theperiod in which the United States was engaged in war against the Axis Powers.It is a comprehensive story written in the main by authorities in malariology.particularly in the fields of survey and control. The authors. themselves,were intimately associated with the work which is related within these pages--workwhich required a highly technical knowledge of the subject; work which requiredtime training of hundreds and thousands of other officers and men; work whichrequired staff coordination at the highest as well as the lowest unit commandlevels; work which was hot, dirty, wet and which many times involved thedangers inherent in combat itself. It. was in the latter areas that preventionand control were not only most difficult to carry out. but for which thedire necessities of control were so obvious.
During the peacetime years immediately before World War II, the Army Medical Department was generallyalert to the problem of malaria and the potential noneffectiveness whichcould arise from this disease. Relatively small numbers of troops, however,were subjected to this danger-mainly in the Panama Canal Zone. Puerto Rico.the Philippine Islands, and the Southeastern United States. In these areas,a small group of Medical Department personnel working with command support.and to some extent with local civilian public health authorities had reducedthe malaria attack rates among the military personnel and the American civilianemployees to a low level. Individual malaria discipline, as it was called,supported by improved, strict, and adjunctive sanitary measures on militaryposts and surrounding areas, was effective. Army admission rates for malariadropped from 130 per 1,000 per year in 1900 to about 4.6 in 1988. For example,aggressive control measures in the Panama Canal Department had reduced therate for primary and recurrent cases in U.S. Army personnel to a satisfactorylow just before World War II. Extensive malaria surveys had been conductedin the Philippines prior to the war by medical personnel of the Army in conjunctionwith the Rockefeller Foundation. Even on Bataan, the vector had been identifiedand the incidence of malaria in the native population had been determined.Unfortunately, because of lack of public health funds, little or no controlmeasures on Bataan had been effected before the war. This, as discussed inChapter IX, was later to contribute to a military catastrophe.
The conditions andenvironment of a relatively static garrison life of an army in peace timeare much different from those imposed by war. In the former, an orderly approachcan be made to sanitation control and prevention of disease, such as malaria.In war, this setting changes abruptly and rapidly, and there arise many uncertainties,not the least of which are imposed upon us by the enemy, foreign and unknownterrains, climatic conditions to which our troops are unaccustomed, the variousmores of Allied as well as hostile nationals, the great variances in globalpersonal and public health standards, and many such other problems. In thecontrol of malaria, which alone caused 500,000 hospital admissions in WorldWar II, there were paramount obstacles to be attacked and surmounted.
From the earliest days of the entry of the United States in World War II, in addition to thephysical conflict in which the Army was engaged, there was also this constantbattle at home and overseas between the Army and the causative agent of malariaand the mosquitoes which spread the parasites from man to man. As with bulletsand high explosives, there was with malaria no respect for rank, color, sex,creed, or ethnic origin.
Malaria control became,therefore, one of the major concerns of The Surgeon General and of the entireMedical Department, and it remained one of high priority throughout the war.In order to plan for and successfully implement the plans for the war againstmalaria, it was not only necessary to understand the basic facts of malariaepidemiology, but it was likewise necessary to understand the basic clinicalconsiderations. Additionally, knowledge of the strategic concepts and plansand the place and timing of future tactical operations had to be gained.It was necessary to develop and evaluate medical intelligence on diverseand little-known areas of the world. Competent personnel had to be obtainedto devise and direct the overall malaria program, and other trained personnelhad to be located and dispatched to implement the program in the field. Trainingschools had to be established for officers as well as for enlisted men. Theprocurement of supplies and equipment and their shipment to appropriate destinationswere of the utmost importance. It was necessary to organize and train specialmalaria survey and control units and to arrange for their movement and employmentconsistent with their mission. It was likewise necessary to orient and educatecommanders at all levels with the need for control measures and malaria discipline for, obviously, command support is a must in any such undertaking. Where commandersunderstood the dangers involved and the methods by which these dangers couldbe overcome, the health of the troops was preserved--one might say in directproportion to the command support given to the effort. For the troops, trainingprograms and training media had to be prepared and presented, for as always,much of any success or failure depends upon the knowledge and motivationof the individual soldier. Not the least of the elements of necessity thatarose was the time, effort, and money which was devoted to research in thefield of antimalarial drugs, insecticides, larvicides, and repellents. Thiswent into high gear by mid-1943, and the cooperative efforts of the Armyand Navy, other Federal agencies, and civilian medical schools, industrialfirms, research institutes, and other private health organizations were acausative factor in the final success of the malaria program. In all of theseendeavors, every effort was made to keep our Allies informed of the technicalprogress and so provided an exchange of pertinent information and experience.Major benefits accrued for all concerned.
As Dr. Paul F. Russellpoints out in chapter I, the greatest advances made in malariology duringWorld War II were in the development and use of synthetic antimalarial drugsand residual insecticides. We learned to use Atabrine. Research into andclinical studies of other antimalarial drugs were made during and continued after the war and have resulted in even newer and more useful drugs. From the standpoint of the new insecticide, DDT, many trials were conducted. Largequantities were produced, distributed, and used in all theaters with outstandingsuccess. The research, development, clinical study, and application of theseproducts during the war was a massive joint effort by military and nonmilitarypersonnel, by Government and civilian agencies, with a great pooling of resourcesand cooperative spirit.
As one reads this book, one can but be impressed with the tremendous number and scope of malariasurveys which were conducted by the various Medical Department survey unitswhich were located eventually in every appropriate theater of operations,as well as in certain areas of the United States. These officers and men,under adverse conditions, steadfastly and unrelentingly studied and reportedon the characteristics of the area where they were located, whether in Southor Central America, Africa, Italy, Burma, or some strategically located islandin the far reaches of the Pacific. Physiography, climate, native population,general health situations, habits, and distribution of the mosquito vectorswere included. Basic knowledge and facts were sought and obtained. Basedupon this information, malariologists, epidemiologists, entomologists, malariacontrol units, and combat and service troops, employing their individualand collective efforts and facilities, strove to improve malaria prevention.The Army Air Forces cooperated by providing personnel and airplanes by whichthe spraying of large areas of terrain was accomplished. In many areas, thisproved of inestimable assistance.
Many practical lessonslearned from these war experiences are included within the pages of the variouschapters of this volume. A few of the more pertinent are: The need for malaria,control enlightenment of line commanders; the requirement for utilizationof medical supervision of, and didactic malaria control training for, alltroops regardless of branch or service; the relative emphasis to be placedupon environmental control measures vis-a-vis the personal measures of theindividual soldier, including suppressive medication; the use of specialmalaria control organizations; and the place and responsibilities of themalariologist in the overall medical framework and organization.
In discussing theseand other matters, the authors--as one might expect-- have been somewhat repetitious.In order that the individuality of the author's presentations might remain,the editors have intentionally permitted such repetitions to stand. Therewere other reasons, also. No two areas were exactly alike. Conditions ofcombat, terrain, environment, personnel, supply, and other factors were dissimilar.And, individual interests of participating personnel, as well as readers,in reality dictated the individual approach.
In this great efforttoward the eradication of malaria, resulting as it has in an improvement inmankind's environment, the Medical Department of the Army takes natural andjustifiable pride in the role which it played on the antimalaria team duringthe war. Nowhere was its mission, "to conserve the fighting strength," moretypified and of more importance than in the minds, souls, and bodies of thethousands of its dedicated officers and men wherever they were engaged inthe battle against malaria. To these, our country and our Armed Forces areever grateful.
LEONARD D. HEATON,
Lieutenant General,
The Surgeon General.
