Malaria

Some of the officers of the New Zealand Corps were called to a meeting at 1 Mobile CCS on 1 March 1944 to arrange for the establishment of a Corps Malaria Committee. Information was given that the country was not particularly malarious till the Garigliano River was reached, but west of Route 6 it was malarious, the marshy area north of Rome was highly malarious, and the flooded Pontine page 562 marshes particularly so. All hilly regions were moderately malarious. The general policy advised was:

1.	The enforcement of personal protection and use of mepacrine tablets.
2.	The killing of adult mosquitoes.
3.	Larvae control.

Discussion emphasised the importance of unit discipline, besides protection by suitable clothing, mosquito-proof bivouacs, and bushnets. A high incidence of malaria was forecast, unless rigid discipline was enforced, if the troops remained during the season in the areas south of Rome. The taking of mepacrine was to be started on 1 May. The smoking out or spraying of cattle sheds, outhouses, and barns by the MCUs (Malaria Control Units) was arranged. The Corps Malaria Committee co-ordinated the activities of the divisional units and arranged for supplies of equipment and stores and the preparation and distribution of maps showing the local incidence of malaria. Malaria officers were appointed for each division, the OC Field Hygiene Section being appointed for 2 NZ Division. His duties were to educate the troops, to train personnel of the malaria control units and to direct their operations, and to supervise and report on the malaria control activities of the Division. Hand-sprayers were distributed to the control units as were supplies of anti-mosquito fluid, flysol, malariol, and Paris green. A container for the fluid was supplied to every soldier. Anti-mosquito cream had been discarded as ineffective and di-methyl thyrlate fluid substituted.

A circular sent to all medical officers by Colonel King, DDMS Corps, on 8 March 1944 set out clearly the preventive measures to be adopted:

1.	The whole of Italy is to be considered a malarious area. While the central and northern mountainous regions contain non-malarious areas the coastal plains on both sides are malarious and in certain known regions highly malarious, including the pontine marshes where demolitions have neutralised previous preventive work, and the area north of rome to the apennines.
2.	Unless precautions are taken during the malarial season from may to november casualties may be so high as to interfere with operations.
3.	It is the responsibility of the medical services to teach Regimental Officers, NCOs and men the fundamental principles of protection. Each MO must be fully conversant with all methods in use, and with all orders relating to the control of malaria.
4.	Measures to be adopted: (i) OsC and units must be made malaria minded, as the OC is responsible for anti-malarial measures within his own unit lines, and for the enforcement of all orders for the prevention of malaria. page 563 (ii) OsC Fd. Hyg. Secs. will act as Special Malaria Officer for Division. (iii) RMO is the advisor to OC Unit on all measures in respect of malaria control, the most important of which are outlined: (a) Camp Sites: Where possible 2000 yards from swamps and local inhabitants. High sloping ground always preferable. (b) Personal Protection: This includes long trousers and rolled down sleeves from sunset to sunrise; proper use and care of bushnets and mosquito-proof bivouacs etc., instruction in the use of mosquito repellent, use of head veils and gauntlets for sentries etc., where practicable. (c) Unit Anti-mosquito Squads: To be trained by RMO and Fd. Hyg. Sec. on a basis of 1 NCO and 3 ORs per Inf. Coy. or equivalent sub unit plus 100% reserve. These will carry out anti-mosquito measures such as spraying of huts, tents, etc., and anti-larval spraying with Malariol on casual water within the unit's area of responsibility, or of appropriate drainage. By the middle of April necessary personnel should be trained and employed on Anti-Malarial work and the crucial period for larval destruction from May 1 to Aug. 31 fully exploited. Every effort to destroy temporarily the breeding place of A. Maculipennis must be made, and there must be no july and august peak in malaria in 1944. Unit B Echelons must not be lost sight of in this regard. (iv) Protective Medication: Mepacrine (ASC Supply) will be taken daily, during or after meals, 7 days a week, preferably after the evening meal. (v) Fever Cases: (a) Officers and men to report sick at once. On no account to treat themselves if they have a fever. (b) Cases evacuated to a Medical unit.
5.	The Sicilian campaign has shown that the reasons for the large outbreak of malaria were slackness in mepacrine administration in some instances, failure of MCUs to arrive early, and lack of appreciation by the troops of personal protection methods. Every individual officer and man must be taught to realise that the prevention of malaria is primarily the concern of the individual. Every officer and NCO must realise that it is their responsibility to see that the men under their charge adopt the measures of personal protection advised.
6.	If all precautions are taken and medical advice followed the rate should not exceed 40 per 1000 per annum. Not as in last war in macedonia 100,000 cases in a force of 120,000 men; or in the brief Sicilian campaign where malaria cases (excluding those also among many BCs) exceeded battle casualties by 4000 cases.
7.	An instance is quoted of one AA Regt. of 1300 men, living in highly malarious sites during the malarial season, having only 23 men down in six months. This was due to a good CO, a careful RMO and loyal cooperation by all ranks. CHIEF CAUSES OF MALARIA— IGNORANCE—LAZINESS AND PLAIN STUPIDITY. CHIEF PREVENTIVES ARE DISCIPLINE—KEENNESS AND INTELLIGENCE.

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It is up to Medical Officers to supply the facts, stimulate all ranks to keenness, and if discipline is lacking to bring the matter to the notice of higher authority.

The OC 4 Field Hygiene Section and another medical officer had attended a course of instruction in malaria control at AFHQ, Algiers. The OC, Major Knights, had long experience of conditions in West Africa and he arranged short courses of lectures and practical work. One hundred NCOs and men attended the courses during March, and arrangements were made for all units with a strength of 150 men or more to have at least ten men trained in anti-malaria duties.

During April two New Zealand AMCUs were formed and were at work, one in the 2 NZ Division area and one attached to 4 Armoured Brigade, and full anti-malaria precautions became effective on 28 April. One hundred and fifty officers and four hundred and fifty other ranks had by then received courses of instruction at the New Zealand Malaria School which had been set up in the Division. A poster and newspaper campaign was inaugurated and the courses were continued. The control units had been working hard, the divisional unit having sprayed 76 square miles of country adjacent to the Volturno River. Larval breeding had been noted in the area and draining operations were carried out. The control unit attached to 4 Armoured Brigade experienced some difficulty in the vicinity of Cassino and the Rapido River where, under enemy observation by day and harassing fire at night, it could not carry out complete measures. Wherever possible houses were sprayed with flysol and fumigated with sulphur. Ditches and shell holes were treated with Paris green or malariol. A small lake was dusted with Paris green and streams were dammed and flushed out, cleared of overgrowing vegetation, and treated with anti-larval oil. Regular inspection was carried out by members of the MCU and reports submitted through the OC 4 Field Hygiene Section to commanding officers of units.

As a result of these measures the Division became malaria-minded, and the quality of the discipline was shown by the very small incidence of infection during the Italian campaign. In April only two cases of malaria were reported and in May only seven.