Anti-Malaria Control

Notes On American Experiences In The Solomons

By G. R. Y.

THE landing of American Forces at Tenaru, Guadalcanal, took place on August 7, 1942, and the island was finally secured on February 9, 1943.

The first troops found few mosauitoes— August is a dry month in the Solomons and little malaria occurred. But the desperate military situation in September al KgMl t n o g to swamps,‘jungles and grass lands, in battle areas with shell holes. bomb craters and debris oi battle, malaria broke out in epidemic form. The local natives and the Japanese had made seed beds of malaria for the mosquitoes and there was little or no Malaria control.

The peak rate was in November 1942 — 1.800 cases of malaria per 1,000 per annum.

Bad conditions were aggravated by air r nir]c wViipVi mpflnt hours scent at nisht in and treSes, wdth mosqli -IXI IUA nuico a u yi

toes. Bad sanitation and loss of sleep took toll of the troops. There were 100,000 cases of malaria, an average of two attacks to each man—five time as many as battle casualties.

The Japanese also suffered badly with malaria. Being under battle conditions, they had little or no anti-malarial con trol. They had plenty of quinine (latterly, atebrine) insect repellant (with a cit ronella base) and mosquito nets. Cap tured records show their malaria rate at Munda and Kulambangra, February, 1943, was 1,600 cases per thousand per annum, and in Rabaul in April, 1943, 2,053 cases per thousand.

THE military situation prevented the start of control operations until November, 1942. Base sites were approved or condemned by medical offi cers, who picked out newer and healthier sites. Native camps were removed to a mile away from w T hite personnel where practicable. Huts were sprayed, jungles cleared and swamps drained or oiled.

Atebrine discipline was enforced. Officers saw that every man of their units took the allotted dose. Quarters and bath houses were sprayed and screened and patrols were required to carry mosquito nets with them. Long trousers and shirt sleeves buttoned down were required— in the open air between 6 p.m. and 6.30 a.m.

This brought the malaria figures down.

In October, 1944, the figure was 38 per thousand p.a.

Costs were high, naturally. An esti mate for the year for the SP Area was nearlv nine million dollars. Against this, an estimated loss for non-malaria control of 100,000 men was 2,240,000 days at eight dollars per day, some 18 million dollars.

The sick-rate for the South Pacific Area from October, 1942, to August, 1944, was 78,000 cases of malaria, primary and re lapsing, with the low mortality of 0.04 per cent.; 34 deaths were due to malaria.

SUPPRESSIVE treatment ordered for all troops was, per week, 0.1 gram daily of atebrine for six days, omit ting Sundays. Clinical treatment for non complicated attacks was 0.2 grams every six hours for five days, and then 0.1 gram three times a day for six days.

A small percentage of individuals showed intolerance to atebrine: but the effects invariably disappeared when the treatment was continued.

There is no evidence of toxicity from long-continued use and no medical evi dence that impotence or sterility is caused by taking this drug. No parasitic resistance to atebrine is known.

Faulty atebrine discipline should be looked for in the case of any increase in malaria rates. One or two individuals per thousand may have malaria and have relapses despite suppressive treatment.

There is no drug known that will pre vent mosquito-borne infection, but ate brin will suppress the disease.

In the early days of the Occupation confusion and uncertainty prevailed re garding the use and dosage of atebrine.

Some authorities had warned that ate brine should only be taken under medical supervision. The routine use of this drug, as a basic malarial drug, was ordered to conserve the rapidly dimin ishing stocks of quinine. This gave rise to the suspicion that atebrine was a drug more necessary than desirable.

Furthermore, suppressive doses were given to troops on shipboard, when ap proaching malarial islands. Seasickness, diarrhoea and emotional states were all attributed to atebrine. Later, when clinical cases were treated and relapses occurred, both medical men and others, accustomed to regarding quinine as a certain cure for malaria, were disillu sioned in regarding atebrine as a sub stitute. Atebrine discipline had not been enforced thoroughly and some soldiers, knowing that an attack of fever would mean their evacuation to a place of safety and comfort, made little effort to Tke their suppressive doses. Later when discipline tightened up, malaria was at least got under control.