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War Surgery and Medicine

Incidence in Italy

Incidence in Italy

No large area in Italy was free from malaria, and, as always, this mosquito-borne infection was unevenly distributed geographically, seasonally, and from year to year. Malaria was generally found below 2000 feet altitude and in rural rather than urban areas. Such cities as Naples and Rome were not malarious, although the disease might approach the city limits and occasionally penetrate them. It was generally correct to assume that the communities of Italians farming the plains, river tracts, and marsh areas were the reservoirs of malaria. The seasonal upswing due to new infections made its appearance in May and the curve climbed page 524 steeply in June and July, reaching a peak in late July or in August. Thereafter it declined in September, though some areas showed a modest secondary peak in October (following September rains) and then fell sharply.

While at Burg el Arab prior to embarking for Italy the Division was provided with dual containers holding mepacrine tablets and Mark II anti-mosquito cream. Mepacrine was to be taken at the rate of one tablet a day for six days of the week; at evening mess was the best time. Mosquito-proof tentage and nets were also issued. Mepacrine was the synthesised substitute for quinine, the sources of supply of which in the East Indies had been lost to the Japanese.

The arrival of the earlier formations in Italy on 9 October was attended by some disorganisation, mainly through lack of transport. This resulted in troops being without mosquito nets, mosquito-proof tentage, or even slacks during the first night. The units were then camped in a malarious district close to Taranto. This unfortunate breakdown, repeating on a minor scale some of the events of the invasion of Sicily, occasioned the main part of the divisional incidence of malaria for the later part of 1943 and some of the first cases of 1944.

Flysol was at first difficult to obtain, the supply of hand pumps for spraying was poor, while no power sprayers were available. In view of these shortages, the decision to avoid buildings for billeting for the first few weeks of the campaign, at the end of the malaria season, was a wise one. The risk of contact with the anopheline mosquitoes, which tended to hibernate in buildings, was thus reduced. The onset of winter in the Sangro area ended another malaria season.

With the example of Sicily fresh in their memories, army authorities set out as early as February 1944 to prosecute the anti-malaria campaign. The New Zealand Corps was in being at this time in the Cassino area, and a conference of officers was held on 1 March to implement a policy for the prevention of malaria. The Corps was not totally ignorant of the principles of malaria control, but although many officers and men had had prior experience of malarial conditions, many had not. It was agreed that all endeavours had to be made to establish a regime of strict and efficient malaria control. A Corps Malaria Committee was formed and proceeded to elaborate the desired programme. All personal precautions were enforced from 1 May. Unit squads were responsible for controlling their own unit area extending to two kilometres beyond the unit circumference. A Divisional Malaria School was conducted by OC 4 Field Hygiene Section.

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The first supplies of DDT became available at this time and also the first of the power sprayers, but 2 NZ Division did not receive any DDT until July, when it had joined up with the Eighth Army again, and power sprayers (some made by 2 NZ Division workshops) were not in good supply until September. The two NZ MCUs had continued to use Flysol, which was found to be preferable even when DDT came to hand as its much easier application enabled more ground to be covered, and it had immediate effect on the mosquito. DDT was found preferable for the spraying of buildings occupied by troops for any length of time.

During the 1944 season the Division was not in any particularly malarious area as its operations were mainly in inland areas away from the malarious coastal regions, especially the Pontine Marshes. When it moved across to the Adriatic coast in September to engage in operations at Rimini and north of that town it came within a highly malarious area again. Under peace conditions the highest incidence of malaria in the Po valley occurred in the coastal belt from Rimini to Trieste, especially the marshes north of Ravenna. Again the Division was fortunate as the malaria season was nearing its end, though sufficient time remained for the enforcement of precautions to be vitally necessary. In July 1944 the two malaria control units were incorporated as sections of 4 Field Hygiene Section, and this change enabled a more complete measure of malaria control to be exerted.

The beginning of the 1945 malaria season found the Division in the Trieste and Monfalcone areas after a lightning advance across the highly malarious area of the Po valley. Trieste was non-malarious, but the Monfalcone area was malarious. The taking of mepacrine tablets had begun on 7 April, and personal precautions were ordered to be enforced from 1 May. With the reaction following the cessation of hostilities, malaria discipline tended to become lax. There was a sad lack of co-operation among certain units, who were inclined to ignore expert advice and form their own appreciation of the mosquito menace. The units took the mepacrine tablets, but the use of the repellent (now changed to DMP—dimethyl phthalate) had never found favour. However, the coverage by anti-malaria squads and malaria control sections with power sprayers and Flysol and DDT, coupled with the general Eighth Army offensive on adult mosquitoes and larvae, was such that the incidence of malaria in the Division was lower than that of the previous, or any other, season.

When the Division moved to Lake Trasimene in Central Italy at the end of July, it came into an almost non-malarious area. page 526 Personal precautions were continued, but large-scale spraying was not necessary. With the move to the non-malarious city of Florence, precautions ceased at the end of September.

Persistent educational campaigns originated in the Medical Corps had made the Division malaria-minded, but troops had never had first-hand knowledge of a malaria epidemic to lead them to apply personal precautions to the fullest detail. The activities of the Hygiene Company and malaria control sections were an important factor in keeping the divisional malaria figures down to a level which equalled those of base camps. It could be claimed that divisional troops were more malaria-minded than those in base camps where the threat of the disease was never great, but where there were victims each season.

Altogether the incidence of malaria in 2 NZEF was low, partly because no troops were in a highly malarious area throughout a season, although preparations had been made regularly for such an eventuality. There were only two deaths from malaria in the Force.