War Surgery and Medicine
Few soldiers who suffered from sandfly fever will forget the three days of misery they suffered, and many will remember the page 556 days or weeks of debility and depression which followed the illness. The main clinical features were as follows:
Following an incubation period of three to six days the disease commenced with explosive suddenness. The temperature rose abruptly to between 102 and 104 degrees F. and remained there for between two and four days. Occasional cases were febrile for somewhat longer periods, and occasionally there was a slight recrudescence of fever after the temperature had become normal.
Headache was usually severe and distressing and was retro-orbital and frontal. This was associated with malaise and prostration and general aching of the limbs and back. Many patients complained of a feeling of stiffness in the neck and occipital pain.
The eyes were sore and movement of the eyes was very painful. On inspection there was usually marked conjunctival infection.
During the course of the disease, and indeed frequently for some days or even weeks afterwards, there was almost complete anorexia, and some patients complained of nausea. A minority vomited.
In some cases there was a slight congestion of the throat, but, generally speaking, this was not a marked feature. Although there was often a distinct flushing of the head and neck there was no rash such as one sees in dengue. Unlike dengue, too, lymphatic glands were not generally enlarged. After the temperature had returned to normal many patients still felt weak, mentally depressed, and had little appetite. Many lost a considerable amount of weight. There were no deaths from the disease and no known sequelae.
Blood examination usually showed a leucopenia with a shift to the left of the neutrophils.
After the epidemic at the Helmieh hospital in June 1941 real progress was made in the control of sandfly fever. Great care was taken in making camps not to create suitable breeding places for the mites, and whenever possible the area round sleeping quarters was freed of walls, banks, rubble, and other likely breeding sites.
It was proved that dimethyl-phthalate was an effective repellent against phlebotomi and that DDT spraying would apparently almost eliminate the infecting insect.
Sandfly nets were provided at times in 2 NZEF, and DDT-impregnated mosquito nets were used later. Nursing patients with sandfly fever under nets diminished the risk of spreading the infection. In Italy few cases were recorded and in the Pacific none.