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War Surgery and Medicine

Malaria in Troops after leaving Malaria Area and stopping Atebrin

Malaria in Troops after leaving Malaria Area and stopping Atebrin

Fairly accurate figures are available regarding the incidence of malaria after the cessation of atebrin administration. Troops began to return to New Caledonia from the Solomons at the end of April 1944, and the strength of troops in the malarious area dropped from 12,249 in April to 4121 at the end of May, and 637 at the end of June. Soon after their arrival in New Caledonia troops were sent back to New Zealand, some to essential occupations and others as reinforcements to 2 NZEF in Italy. As far as possible men were held in New Caledonia for four to six weeks after the cessation of atebrin. It was hoped that most of the cases of malaria would develop in that period. Actually the numbers of cases occurring in successive weeks were; 15, 32, 54, 62, 45, 17, 8, 7, 4— at the ninth week—after which there were only occasional cases. (Later Brigadier Fairley, AAMC, advised that atebrin in the ordinary suppressive dose of 0.1 gm. per day should be continued for one month after troops were withdrawn from a malarious area, and that such dosage would be effective in controlling falciparum infections.)

Actually hardly any falciparum infections developed in New Caledonia. Practically all the cases of malaria which developed following the cessation of atebrin were vivax infections. The page 542 atebrin had resulted in not only suppressing but in curing the falciparum infection, the vivax infection proving the more resistant.

In New Caledonia there were 250 primary cases, and 55 relapses were reported, while in New Zealand, up to December 1944, 218 cases were reported, of which 57 were primary cases, 79 were relapses, and 82 were not distinguished. Preparations were made in New Zealand for the hospitalisation of many more cases than actually occurred.

Early in 1944, by arrangement with the Department of Health in New Zealand, malaria was made a notifiable disease, and there is reason to believe that on the whole medical practitioners throughout the Dominion were conscientious about such notification. The importance of this was explained in a pamphlet sent to every practitioner. Practically all cases were treated in public hospitals where notification was automatic. The following are the figures for the total number of cases of malaria notified per annum from 1944 to 1948:

1944 397
1945 187
1946 50
1947 50
1948 12

These figures include all service personnel returned from all parts of the world and all civilians. When it is remembered that the troops in the Middle East also fought in the malarious areas, especially in Italy, it is clear that the number of malaria cases occurring in troops was extremely small.