Measures Taken Against Malaria

Introduction to the Measures Taken

Malaria control is primarily dependent on avoiding bites from infected anopheline mosquitos. A variety of methods may be used to achieve this goal. Among the most common techniques are mosquito breeding site draining, filling, or larviciding, building screening, and pesticide spraying. The Army's success in combating malaria at base locations has been mostly due to the thorough and broad deployment of these established techniques.

Figure 17. Spraying of DDT

It cannot be stated that efforts implemented before the war were truly effective. In Bombay, for example, despite the Corporation's efforts beginning in 1902, almost no progress was made until 1909, and the outbreak of 1908 was exceptionally severe. Furthermore, despite the fact that the Health Department has devoted a significant amount of attention to the destruction of mosquito larvae and has reported a large number of wells to the Standing Committee for action, the measures taken by the Standing Committee were slow, as indicated by the Health Officer's quarterly reports, and the rate at which wells were dealt with was not fast enough to prevent the spread of disease.

The following general conclusions have been made by the officials and scientists regarding public measures:

1. The efforts should be focused against all mosquitos, but the suppression or decrease of the most prevalent species that carry the illness should come first.

2. The procedures must be devised and administered in such a way that autochthonous malaria is eliminated from the city, not only mitigated.

3. The faster the speed with which the measures are implemented, the greater the likelihood of their total success.

4. Even if the primary sources of infection are isolated, if adequate precautions are not implemented, they may spread again.

5. If any good is to be done and the money already spent is not to be considered lost, active and systematic action is essential.

6. Measures have to be regionalized with consideration of various factors such as climate as, for example, it is difficult to argue that an activity that has proven completely successful with the backward inhabitants of South American towns or small islands in the West Indies is going to have the same successful effect if implemented in Bombay.

Specific Measures Taken in the Public

As malaria has infected countless African villages, large sums of money were budgeted by airline companies to manage malaria surrounding airfields in malarious areas in order to maintain the flight and ground crews, as well as other people, in good form to execute their jobs.

When the United States first entered the war, federal and state health organizations began to enhance its malaria protection. The United States Public Health Service established an Office of Malaria Control in War Zones in early 1942, with headquarters in Atlanta, Georgia. According to the Atlanta office, roughly 1,875,000 gallons of larvicidal oil and 152,000 pounds of Paris green were treated to over 200,000 acres of mosquito breeding ground during the fiscal year 1942. Over 6,250,000 man-hours were spent on drainage and larvicide activities.

Figure 18. Man spraying kerosene oil in standing water, Panama Canal Zone, 1912

The United States was also accumulating totaquine, a medicine that is equally effective as quinine in the treatment of malaria, but in slightly greater doses as a replacement for quinine for civilians. Thousands of tons of cinchona bark were being imported from Central and South America and processed into totaquine.

Because public health education is critical to malaria prevention, health departments used educational strategies to refute myths about malaria and engage the cooperation of the people. Reducing the reservoir of malarial infection is only possible if those who are afflicted realize they need medical attention and seek it. To keep Anopheles away from the ill and the healthy, the officials relied on householders to accept the responsibility of mosquito-proofing their homes and protecting their families. To lower the amount of Anopheles, they also required the people's support in removing mosquito breeding sites and killing larvae.

Radio conversations on the "Jungle Network" and roadside billboards, which were created by antimalaria units to draw attention to the malaria warning, were involved in malaria control. These billboards, posters, lectures, and radio broadcasts were all intended to educate people about the risks of malaria and the best ways to protect oneself.

Figure 19. Anti-malaria poster "Don't be a dummy"

On December 1942, a malaria control unit had been organized in the Medical Department's Sanitary Corps, which comprised Malariologists, malaria survey units, and malaria control units:

1. Malariologists were malaria control experts and liaison officers between higher headquarters and malaria survey and control units in the field.

2. Malaria control units were made up of small mobile teams led by a Sanitary Corps commander who had been educated in sanitary engineering and malaria control.

3. Malaria survey units were fairly small teams working from mobile field laboratories supervised by two Sanitary Corps officers: one entomologist with special training in collecting and identifying mosquitos and a parasitologist trained in laboratory and field procedures for estimating the status of malaria in a population through blood examination, spleen rates, and epidemiological data interpretation. The survey units were tasked with tracking down and identifying malaria-carrying mosquitos as well as the type of malaria found in the native population. These data were made available to malaria control units, allowing them to set up and effectively carry out the control measures recommended for an endemic region. By February 1943, this group was operational in the field.

Figure 20. Members of the Malaria Commission collecting larvae

Specific Measures Taken Directly in Warfare

What can be done at the line of defense depends on the terrain and the activities, as, for example, a foxhole cannot be fitted with a screen door, but it can be sprayed with pesticide.

Nets, pesticides, sprays, and suppressive medications were the most effective techniques for protecting combatants. Efficient repellents that encourage mosquitos to avoid people who have been covered with them have been produced. The production of these repellents was restricted and reserved for use by the military forces for the duration of the war.

Special training sessions, lectures, moving picture films, posters, and pamphlets have been used to educate all levels and divisions of the Army on the significance of malaria, as the most important element influencing malaria rates in front-line troops has shown to be unit discipline in the implementation of individual preventive measures.

Figure 21. U.S. soldiers read a poster reminding them to refrain from removing their shirts as protection from malaria

The Army increased mosquito control at military bases and arranged for the US Public Health Service to execute control measures in a mile-wide zone surrounding the reservations. This massive endeavor lasted three years and cost around ten million dollars. Malaria rates have not only remained lower than during peacetime but reached a record low of 0.2 per 1,000 troops stationed in the continental United States in 1943. As a result, mosquito management has effectively prevented malaria from posing a threat to this country's Army.

It was made mandatory for men on duty in malaria-infected areas to wear protective clothing and maintain and repair the netting used to shield the sleeping troops, as, in the tropics, a single night's exposure to mosquito bites can result in a terrible outbreak.

Malaria follows in the footsteps of an army in the tropics: slit trenches, dugouts, abandoned gun emplacements, shell craters, wheel ruts, and borrow pits – all water-holding depressions that increase the number of locations for mosquitoes to thrive. As a result, the Army physically tore up the dirt on the field to attack the small vector, while malaria control teams deployed massive bulldozers and draglines. The bulldozer proved to be an effective instrument for flattening and leveling low, water-holding depressions, after draining out the water accumulations. With this engineering technology, whole marshes were removed.

Figure 22. Draining the marshes to prevent malaria on the Eastern Front

Malaria suppressive therapy was employed and was extremely useful in emergencies since it allowed soldiers infected with the parasite to participate in duties despite their infection. Because the limited amount of accessible quinine must be kept for therapy, atabrine was utilized for suppressive usage.

The army lowered the mosquito population by eliminating consecutive generations of larvae by spraying oil or Paris green on waterways chosen by Anopheles as breeders and maintaining the treatment at frequent enough durations during the breeding season to catch each new batch of larvae. Filling up or draining Anopheles-infested waterways were more permanent techniques of control. Sanitary engineers on international malaria duty had to be familiar with the behaviors of the various Anopheles species as one species prefers sunny water for egg laying, whereas another prefers shady areas.

Figure 23. A U.S. soldier is demonstrating DDT hand-spraying equipment

DDT, a potent chemical pesticide, was the most significant invention produced for use in antimalaria units. One of the major wartime contributions to the entire area of preventive medicine was the discovery of DDT's insect-killing qualities. Because it was effective in tiny doses, the problem of pesticide shipment and transportation was eased. Malaria control and survey units, backed by mechanical and chemical devices such as atabrine, decreased the frequency of malaria to a fraction of what it was in 1942.

Difficulties Faced when Executing those Measures

Although malaria units were not combat forces in the traditional sense, they were fighting a war - a war against disease as the actual field control labor was a "back-breaking" task.

Spraying oil containing DDT over every body of water down to the circle of a watch crystal was done with knapsack canisters attached to one's back. Slow-moving streams clogged with vegetation were cleaned out, sometimes using primitive methods. Men, supplies, and cars had to travel through dirt and strong rains to get to the task. Training fresh gangs of local workers each week, and often on a daily basis, was a test of patience. To these responsibilities was added the day-to-day challenge of housing, feeding, and protecting soldiers from sickness and Japanese action.

Figure 24. American Army in Dutch Guyana

They brought malaria treatment to the front lines and were there on D-Day with the beachhead landing teams. Their circumstances were not always ideal, but they were typically so engrossed in their work that no moment was "dull."