War Surgery and Medicine
Early Experience of American Troops
Early Experience of American Troops
The first contact of the American armed forces with the malaria problem in the South Pacific was when they landed at Efate, in the New Hebrides, on 29 March 1942. These troops were ill-prepared for the conditions obtaining in a malarious country and both combatant and medical officers were inexperienced in malaria control. Taking into consideration all the troops on the island, the incidence of malaria in April 1942 was 2677 per 1000 per annum, the highest figure recorded in the South Pacific area. This is all the more remarkable when it is remembered that there was no combat on the island.
The United States Marines landed on Guadalcanal in August 1942 and were under severe combat conditions from the beginning. Their initial record was good, partly owing to the favourable time of the year and partly owing to the absence of any considerable native page 530 population. These factors can be contrasted with the position at Efate, where the season was unfavourable and where there was a large native and Oriental population.
However, by October the rate was 1660 per 1000 per annum and in November 1780 per 1000 per annum. This rate was not permanently reduced below 1000 per 1000 per annum until May 1943. Combat conditions ceased on this island early in February 1943. Both Marine and Army divisions who fought on Guadalcanal showed an infection rate of approximately 80 per cent of total strength on being removed to a non-malarious zone. It will thus be seen that in the early campaigns in the South Pacific area malaria was a formidable enemy—indeed, it was the most serious factor to be reckoned with.
It would appear that when Allied troops first entered the South Pacific area they were quite unprepared for a campaign in a malarious country. There was no malaria control organisation and there was no appreciation of the need for strict anti-malaria discipline. Nets were not always available on landing and atebrin was not well taken. The supply position was unsatisfactory, and on Guadalcanal troops were short of essential anti-malaria drugs. Little faith was placed in atebrin.
Nothing is easier than to be wise after the event, and it must be remembered that many things which became commonplace and well established later were not so well known to the medical and combat staffs of the troops taking part in early campaigns. Take, for example, the whole question of atebrin suppression. We now know that in adequate dosage atebrin will suppress malaria, and we also know that such a dosage is safe and non-toxic. Neither of these facts was known with any degree of certainty in the early days. The correct dosage of atebrin had not been determined.
There is no finer chapter in the history of malaria control than the record of American malaria control in this area. In each new campaign the incidence of malaria progressively decreased. Some of the largest bases, e.g., Espiritu Santo in the New Hebrides, became almost malaria free and it was not necessary for the troops occupying the island to be on suppressive atebrin. In June 1944 the primary rate at Espiritu Santo was only 2.7 per 1000 per annum. This was a most remarkable achievement.
It should be emphasized that control of malaria occurred only when an efficient malaria control organisation came into being.
The pre-war experience and malaria records of Lieutenant-Colonel E. G. Sayers were helpful to the Americans in reducing malaria rates after the conquest of Guadalcanal.page 531