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MEDICAL DEPARTMENT UNITED STATES ARMY IN WORLD WAR II


MEDICAL DEPARTMENT, UNITED STATES ARMY

PREVENTIVE MEDICINE IN WORLD WAR II  

Volume VI

COMMUNICABLE DISEASES

Malaria

Prepared and published under the direction of
Lieutenant General LEONARD D. HEATON
The Surgeon General, United States Army

Editor in Chief
Colonel JOHN BOYD COATES, Jr., MC, USA

Editor for Preventive Medicine
EBBE CURTIS HOFF, Ph. D., M.D.

Assistant Editor
PHEBE M. HOFF, M.A.

OFFICE OF THE SURGEON GENERAL
DEPARTMENT OF THE ARMY
WASHINGTON, D.C., 1963


PREVENTIVE MEDICINE IN WORLD WAR II

Advisory Editorial Board

Brigadier General JAMES STEVENS SIMMONS, USA (Deceased), Chairman, 1948-54
Brigadier General STANHOPE BAYNE-JONES, USA (Ret.), Chairman

JOHN E. GORDON, M.D.
WILLIAM A. HARDENBEEGH, B.E.
ANTHONY J. LANZA, M.D.
ELLIOTT S. A. ROBINSON, M.D. (Deceased)
PAUL F. RUSSELL, M.D.
THOMAS B. TURNER, M.D.
DOUGLASS W. WALKER, M.D.
COLONEL TOM F. WHAYNE, MC, USA (Ret.)
COLONEL ADAM J. RAPALSKI, MC, USA (Ex officio)
EBBE CURTIS HOFF, Ph. D., M.D., Editorial Director (ex officio)
Colonel JOHN BOYD COATES, Jr., MC, USA (ex officio)  

The Historical Unit, United States Army Medical Service

Colonel JOHN BOYD COATES, Jr., MC, USA , Director
Colonel REX P. CLAYTON, MSC, USA, Executive Officer
Colonel R. L. PARKER, MSC, USA, Special Assistant to Director
Lieutenant Colonel R. J. BERNUCCI, MC, USA, Special Assistant to Director
Major WARREN W. DABOLL, MSC, USA, Special Assistant to Director
Lieutenant Colonel DOUGLAS HESFORD, MSC, USA, Chief, Special Projects Branch
CHARLES M. WILTSE, Ph. D., Litt. D., Chief, Historians Branch
ERNEST ELLIOTT, Jr., Chief, Editorial Branch
Lieutenant Colonel LEONARD L. COLLIER, MSC, USA, Chief, Information Activities Branch
Major ALBERT C. RIGGS, Jr., MSC, USA, Chief, General Reference and Research Branch
HAZEL G. HINE, Chief, Administrative Branch

Library of Congress Catalog Number: 55-63522


Volume VI
COMMUNICABLE DISEASES
Malaria 


MEDICAL DEPARTMENT, UNITED STATES ARMY

    The volumes comprising the official history of the Medical Department of the United States Army in World War III are prepared by The Historical Unit, United States Army Medical Service, and published under the direction of The Surgeon General, United States Army. These volumes are divided into two series: (1) The administrative or operational series; and (2) the professional, or clinical and technical, series. This is one of the volumes of the latter series.  

VOLUMES PUBLISHED

ADMINISTRATIVE SERIES

Hospitalization and Evacuation, Zone of Interior 

CLINICAL SERIES

Internal Medicine in World War II:
    Vol. I. Activities of Medical Consultants
    Vol. II. Infectious Diseases

Preventive Medicine in World War II:
    Vol. II. Environmental Hygiene
    Vol. III. Personal Health Measures and Immunization
    Vol. IV. Communicable Diseases Transmitted Chiefly Through Respiratory and Alimentary Tracts
    Vol. V. Communicable Diseases Transmitted Through Contact or By Unknown Means

Surgery in World War II:
    Activities of Surgical Consultants, vol.1
    General Surgery, vol. II
    Hand Surgery
    Neurosurgery, vol. 1
    Neurosurgery, vol. II
    Ophthalmology and Otolaryngology
    Orthopedic Surgery in the European Theater of Operations
    Orthopedic Surgery in the Mediterranean Theater of Operations
    The Physiologic Effects of Wounds
    Vascular Surgery

Miscellaneous:
    Cold Injury, Ground Type
    Dental Service in World War II
    Veterinary Service in World War II
    Wound Ballistics 


Contents

FOREWORD

PREFACE

AUTHORS

Chapter

I         Introduction (Paul F. Russell, M.D., MPH., Sc. D.)
                Malaria in Past Wars
                Basic Malaria Epidemiology
                Malaria Lessons From World War II
                Advances in Malariology in World War II

II       War Department Provisions for Malaria Control (Oliver R. McCoy, M.D .)
                Organization in the Office of The Surgeon General
                Organization for Malaria Control
                Drugs for Suppressive Treatment of Malaria
                Supplies and Equipment for Insect Control
                Educational Activities
                Precautions Against the Introduction of Tropical Diseases into the United States
                Summary

III     Experience in the United States (Justin M. Andrews, Sc. D., and Jean S. Grant )
                Military Mobilization in Potentially Malarious Areas of the United States
                Malaria Incidence in the United States Before World War II
                Civilian Reservoir of Infection
                Mosquito Vectors
                Development of Military Malaria Control Plan and Policy
                Malaria Control Activities Within Military Areas
                Malaria Control Activities Around Military Areas
                Conclusions end Recommendations

IV     The South Atlantic and Caribbean Areas (Luther S. West, Ph. D.)
         Part I. General Considerations
                Incidence
                Antimalaria Organization
                Control Activities
                Military Development
                Area Characteristics

         Part II. Experience in South Atlantic Command
               Extent of Command
               Prevalence of Malaria on Brazilian Coast
               Summary of Administrative History (Medical)
               Organization
               Activities at Various Bases
               Extramilitary Relations

        Part III. Experience in the Caribbean Defense Command
               Organization
               Panama Canal Department
               Antilles Department
               Problems of 11.5. Army Air Forces in the Caribbean Defense Command
               Cooperating Organizations (Nonmilitary)
               Miscellaneous Matters

V     North Africa, Italy, and the Islands of the Mediterranean (Justin M. Andrews, Sc. D. )
               Military Development
               Area Characteristics
               Malaria Experience
               Antimalaria Policy and Organization
               Antimalaria Activities
               Conclusions and Suggestions for the Future

VI     Africa-Middle East Theater (John W. H. Rehn, Ph. D.)
               Military Development
               Area Characteristics
               Local Population
               Malaria Endemicity and Potentialities
               Vectors
               Malaria Experience
               Antimalaria Organization
               Survey Activities
               Antimosquito Measures
               Personal Preventive Measures and Malaria Discipline
               Suppressive Medication

VII   China-Burma-India Theater (John W. H. Rehn, Ph. D .)
               Military History
               Area Characteristics
               Local Population and Malaria Endemicity
               Malaria Vectors
               Malaria Experience
               Antimalaria Organization
               Antimalaria Activities
               Summary

VIII  New Hebrides, Solomon Islands, Saint Matthias Group, and Ryuhyu Islands (Paul A. Harper, M.D., Wilbur C. Downs, M.D., Paul W.  Omen, Ph. D., and Normon D. Levine, Ph. D. )
        Part I. New Hebrides, Solomon Islands, and Saint Matthias Group
               General Considerations
               Military Development
               Area Characteristics as They Pertain to Malaria and Its Control
               Malaria Experience
               Antimalaria Policy and Organization
               Antimalaria Activities
               Other Activities of the Antimalaria Organization

        Part II. Okinawa and Other Islands of Ryukyus
               General Considerations
               Military Development
               Area Characteristics
               Malaria Experience
               Antimalaria Policy and Organization
               Antimalaria Activities
               Other Activities of the Antimalaria Organization

IX     Malaria and the Defense of Bataan (Maj. Gen. James O. Gillespie, MC, USA (Ret.))
           Epidemiology of Malaria
               Pre-Worid War II Malaria Control Measures
               Medical War Planning
               Military Operations
               The Malaria Problem
               Impact on Defense Forces
               Impact on Civilian Refugees
               Impact on the Japanese Forces
               Impact on the Filipino-American Prisoners of War
               Comment

X     The Southwest Pacific Area. (Thomas A. Hart, Ph. D., and Col. William A.Hardenbergh, MSC, USAR (Ret.))
               Area Characteristics
               Medically Important Mosquitoes of the Southwest Pacific
               Establishing a Control Organization
               Important Factors in Developing the Control Program
               Malaria Control Activities
               Malaria Control Measures
               Sixth U.S. Army Training Center
               Malaria Research Group
               Personnel Training
               Combat Experiences and Lessons
               Case Study of Malaria Incidence
               Case Reporting
               Reduction in Hospitalization
               Japanese Malaria Experience
               Other Activities of the Malaria Control Organization
               Survey and Control Units
               Final Results    

APPENDIXES

A     Standard Operating Procedure for Control of Malaria and Other Insect-borne Diseases During a Combat Operation
B     Directive on Malaria Control


Illustrations

Figure

    1     Army School of Malariology, Fort Clayton, C. Z .
    2     Parasitology classroom, Army School of Malariology, Fort Clayton C. Z .
    3     Class in field exercises in anopheline breeding area, Chagres River
    4     Malaria control unit receiving instructions in drainage procedures
    5     Field laboratory established by malaria survey unit during training exercises
    6     Aerosol insecticide dispensers
    7     Mixing DDT in the field
    8     Preparation of DDT oil solution for use as a mosquito larvicide
    9     B-25 airplane spraying DDT oil solution over jungle area in Panama
  10     Cover and opening page of booklet explaining the facts about malaria
  11     Antimalaria poster
  12     Antimalaria poster
  13     Anopheles quadrimaculatus, the vector of malaria in the eastern and southern regions of the continental United States
  14     Anopheles freeborni, the vector of malaria west of the Rocky Mountains in the continental United States
  15     Area of Army installation before and after mosquito control drainage
  16     Knapsack-type sprayer developed by the Corps of Engineers for applying insecticides for mosquito control
  17     Portable power sprayer, gasoline engine driven, skid mounted, for application of insecticides for mosquito control
  18     Stearman biplane applying DDT to control anopheles over Stuttgart, Ark., Army Air Base
  19     Hand-spraying residual DDT in Army barracks
  20     Airplane application of larvicide over a waterchestnut infested area of the Potomac River
  21     Application of DDT residual spray in the interior of a rural home
  22     Aedes aegypti, the vector of yellow fever and dengue along the coastal areas of the continental United States from Virginia to Texas
  23     Anopheles albimanus breeding along the edges of a quiescent stream
  24     Bromeliad attached to tree, a typical breeding place for Anopheles bellator Dyar and Knab
  25     Horizontal section through a bromeliad to show water-holding area among leaf bases
  26     Parasitology class, Army School of Malariology
  27     Gypsy moth sprayer in use against bromeliads
  28     Dawn trap used in mosquito survey at Fort Read, Trinidad, B.W.I .
  29     Adult female of Anopheles maculipennis Meigen
  30     Enemy demolished pumping station near Licola, northwest of Naples
  31     Flooded area near Licola
  32     Allied Force Malaria Control School at Anzio-Nettuno beachhead
  33     Group at Anzio-Nettuno beachhead receiving field instructions in malaria control
  34     Power oil sprayer used to apply petroleum products
  35     A-20 airplane dusting paris green over flooded areas northwest of Naples
  36     A-20 dusting planes flying in formation
  37     Paris green mixing plant near Naples
  38     Filling 55-gallon drums with freshly mixed 5 percent DDT in kerosene
  39     A-20 airplane discharging DDT in oil over a small canal near Pisa
  40     PT-17 (Stearman) spraying a canal in Italy with DDT in oil
  41     DDT residual spraying with power spray
  42     Improvised paris green duster
  43     Dusting with paris green
  44     Type of barracks housing U.S. troops at Acera Airport
  45     Tank with aquatic vegetation, vicinity of Calcutta, Bengal, showing Anopheles philippinensis breeding area
  46     DDT air spraying at Myitkyina, Burma
  47     DDT residual spraying in native quarters, using spray gun with power spray, vicinity of Ledo, Assam
  48     DDT residual spraying in native quarters, using back pack spray with extension nozzle, vicinity of Ledo, Assam
  49     DDT residual spraying in native quarters, using hand spray, vicinity of Ledo, Assam
  50     DDT residual spraying in latrine, using continuous hand spray
  51      Mosquitoproofed tents, vicinity of Ledo, Assam
  52     Mosquitoproofing basha-type building, vicinity of Ledo, Assam
  53     Principal vectors of malaria in the South Pacific Area
  54     Recording results of microscopic examinations of blood smears
  55     Anopheles sinensis
  56     Open stream with grassy margins, in slight shade, a typical breeding place for Anopheles farauti , 17th Malaria Survey Unit, New Guinea
  57     Refilling knapsack sprayers with oil, 8th Malaria Control Unit, New Guinea
  58     Malaria control ditching and clearing crews furnished by the Australia New Guinea Administrative Unit to 12th Malaria Control Unit, New Guinea
  59     Digging drainage ditch, 8th Malaria Control Unit, New Guinea
  60     Completed drainage ditch, 8th Malaria Control Unit, New Guinea
  61     Cartoon, "Dont Be A Dunce"
  62     Cartoon, "Patch That Net Hole Today"
  63     Cartoon, "Watch Out for This Chow Hound"  

Tables

Number

    1     Projected status of malaria control organization for the oversea theaters, 13 February 1943
    2     Status of malaria control organization in oversea theaters, 15 July 1943
    3     Status of malaria units in oversee theaters, 15 February 1944
    4     Status of malaria control organization in oversea theaters, 30 September 1944
    5     Status of malaria control organization in oversee theaters, 1 April 1945
    6     Summary of continental mosquito control operations on military property, fiscal years 1941-45
    7     Summary of continental (and Puerto Rico) mosquito control operations near areas of military importance, fiscal years 1942-46
    8     Summary of entomological surveys on the extended (residual spray) program, 1945-46
    9     Admissions and attack rates of malaria acquired by U.S. Army personnel in continental United States, by month and year, 1917-21 and 1941-45
  10    Malaria as a reported cause of death in Central and South American Republics and neighboring States, with selected examples
  11    Number of cases and attack rates of malaria in the U.S. Army, worldwide and Latin America, by type of Plasmodium and year, 1942-45
  11    Continued
  12     Incidence of malaria in the U.S. Army, by area and year, 1940-41
  13     Deaths due to malaria in U.S. Army, by area and year, 1940-41
  14     Deaths due to malaria in the U.S. Army, worldwide and Latin America, by type of Plasmodium and year 1942-45
  15     Admissions and deaths from fever of undetermined origin in the total U.S. Army and in the Latin American area, by year, 1942-45
  16     Distribution of major mosquito vectors by zoogeographic subdivisions in the neotropical region
  17     Total cases of malaria in U.S. Army Forces, South Atlantic, by months, January 1943-August 1945
  18     Malaria in U.S. Army Forces, South Atlantic, 1943-45
  19     Average temperatures, relative humidity, and precipitation in the Canal Zone, 1943-45
  20     Malaria rates for primary and recurrent cases among U.S. Army personnel, Panama Canal Department, 1939-41
  21     Malaria rates for primary and recurrent cases among U.S. Army personnel, Panama Canal Department, by month 1941
  22     Malaria rates for primary cases only, in U.S. Army personnel, in permanent (sanitated posts) and outposts (unsanitated) areas, Panama Canal Department, January-November 1942
  23     Malaria rates of primary and recurrent cases among U.S. Army personnel, Panama Canal Department, by month, 1943
  24     Malaria rates of primary and recurrent cases among U.S. Army personnel, Panama Canal Department, by month, 1944
  25     Malaria rates of primary and recurrent cases among U.S. Army personnel, Panama Canal Department, by month, 1945
  26     Attack rates for malaria among U.S. Army personnel, Panama Canal Department, 1936-45
  27     Medical installations, Pan American Highway
  28     Malaria data for U.S. Army enlisted personnel in Puerto Rico, continental troops, and insular troops 1941
  29     Admissions for malaria, 161st General Hospital, San Juan, P.R., 1942-45
  30     Incidence of malaria, by months, in the U.S. Army in the Mediterranean (formerly North African) theater, 1942-45
  31     Admission rates, by weeks, hospital and quarters, for malaria and fever of undetermined origin in the Seventh U.S. Army, by major command, during the Sicilian Campaign, 16 July-20 August 1943
  32     Primary and total malaria attack rates in MTOUSA, hospital and quarters, by months, per 1,000 per annum, 1944-45
  33     Incidence of toxic reactions from Atabrine at the 59th Evacuation Hospital, 1943
  34     Results of winter DDT spraying in an endemic area, 1945
  35     Average rainfall in inches at selected localities, for various time periods
  36     Average temperature in degrees Fahrenheit at selected localities
  37     Malaria parasite index, Liberia, 1931
  38     Malaria parasite index, Liberia, 1942
  39     Attack rates for malaria and fever of undetermined origin, among U.S. Army personnel, Africa-Middle East area, 1942-45
  40     Attack rates for malaria and fever of undetermined origin, among U.S. Army personnel in Africa, 1942-43
  41     Attack rates for malaria and fever of undetermined origin, among U.S. Army personnel in Middle East, 1942-43
  42     Attack rates for malaria among U.S. Army troops, French West Africa, January 1944-December 1944
  43     Attack rates for malaria among U.S. Army troops, in the Gold Coast and Nigeria, British West Africa, January 1943-December 1944
  44     Attack rates for malaria and fever of undetermined origin, among U.S. Army personnel, Africa-Middle East area, January 1944-December 1945
  45     Attack rates for malaria and fever of undetermined origin, among U.S. Army personnel, Persian Gulf Command, January 1944-December 1945
  46     Attack rates for malaria among U.S. Army personnel, Liberia, 1942-45
  47     Average precipitation (in inches) at selected localities in China, Burma, and India for various time periods
  48     Average temperatures in degrees Fahrenheit, in selected localities, in China, Burma, and India
  49     Distribution of some of the important anopheline vectors of malaria in selected portions of India
  50     Distribution of important anopheline vectors of malaria in selected portions of Burma
  51     Distribution of important anopheline vectors of malaria in selected provinces of South China
  52     Attack rates for malaria and for fever of undetermined origin, China-Burma-India theater, 1942-45
  53     Attack rates for malaria and fever of undetermined origin, India-Burma theater and China theater, 1944-45
  54     Attack rates for malaria, Base Section, India-Burma theater, 1944-45
  55     Attack rates for malaria, Intermediate Section, India-Burma theater, 1944-45
  56     Attack rates for malaria, Advance Section, India-Burma theater, 1943-45
  57     Attack rates for malaria along the Stilwell Road, 1943
  58     Epidemic malaria in Karachi, India, July through December 1944
  59     Prevalence of malaria parasitemia on South Pacific islands
  60     Plasmodium species in South Pacific surveys
  61     Admission rates for malaria in combined Army, Navy, Marine, and Allied troops in selected areas of the South Pacific, by month and year, April-December 1942
  62     Admission rates for malaria in combined Army, Navy, Marine, and Allied troops in selected areas of the South Pacific, by month and year, January-December 1943
  63     Admission rates for malaria in combined Army, Navy, Marine, and Allied troops in selected areas of the South Pacific, by month and year, January-December 1944
  64     Admission rates for malaria in combined Army, Navy, Marine and Allied troops in selected areas of the South Pacific, by month and year, January-June 1945
  65     Malaria and insect control personnel, South Pacific Area, 15 May 1944
  66     Personnel available for work of malaria control units, South Pacific Area
  67     Estimated percent of quarters screened, South Pacific Area, June 1944
  68     Strength of Tenth U.S. Army and marine and naval forces, in the Ryukyus Campaign, 30 April-30 June 1945
  69     Air temperatures, Naha, Okinawa, 30-year observation period
  70     Rainfall (measurement in inches) and rainy days, Naha, Okinawa
  71     Results of blood examinations of natives during malaria outbreak in northern Okinawa, August-September 1945
  72     Airplane spraying activities, Okinawa, May-July 1945
  73     Splenic indices in natives of Netherlands New Guinea
  73     Continued
  74     Distribution of anopheline species of the Australasian Region
  74     Continued
  75     Comparison of gametocyte rate and malaria rate in selected troops. 1944
  76     Mosquito dissections (Anopheles punctulatus)
  77     Malaria attack rates in the 126th and 128th Infantry Regiments, January-July 1944
  78     Number of cases of malaria in the 41st Infantry Division, June-August 1944
  79     Number of cases and attack rates of malaria among U.S. Army personnel in the Southwest Pacific Area, by type of Plasmodium and year, 1942-45
  80     Deaths due to malaria among U.S. Army personnel admitted in the Southwest Pacific Area, by type of Plasmodium and year of death, 1942-45 

Charts

    1     Admission rates for malaria, U.S. Army, continental United States, World War I and World War II
    2     Admission rates for malaria, U.S. Army, by year, 1941-45
    3     Morbidity and mortality rates for malaria in all States reporting cases and deaths, 1926 to 1940 inclusive
    4     Malaria Control in War Areas, lines of authority and interrelations
    5     Headquarters organization of the Office of Malaria Control in War Areas
    6     Trend of dengue cases compared with rainfall and the Aedes breeding index during the dengue epidemic in Honolulu, T.H., 1943-44
    7     Table of organization, Headquarters, Medical Section, U.S. Army Forces, South Atlantic
    8     Special malaria control organization, North African theater, 15 August 1944
    9     Attack rates for malaria among U.S. Army personnel, Africa-Middle East area, 1942-4 5
  10     Attack rates for malaria among U.S. Army personnel in Africa and the Middle East, June 1942-August 1943
  11     Attack rates for malaria among U.S. Army personnel in the Africa-Middle East area (excluding Persian Gulf Command) and in the Persian Gulf Command, 1944-45
  12     Attack rates for malaria among U.S. Army personnel in Liberia, 1942-45
  13     Attack rates for malaria, China-Burma-India theater, 1942-45
  14     Attack rates for malaria, China theater, 1944-45
  15     Attack rates for malaria, Base Section, India-Burma theater, 1944-45
  16     Attack rates for malaria, Intermediate Section, India-Burma theater, 1944-45
  17     Attack rates for malaria, Advance Section, India-Burma theater, 1943-45
  18     Malaria control organization, Headquarters, China-Burma-India theater, 1943
  19     Malaria control organization, India-Burma theater, after October 1944
  20     Incidence of malaria in the Americal Division, January 1943 to May 1944, inclusive
  21     Incidence of malaria in the 147th Infantry, December 1942 to October 1944, inclusive
  21     Continued
  22     Incidence of malaria in the 25th Infantry Division, January 1943 to October 1944, inclusive
  23     Malaria and Insect Control Organization, South Pacific Area, 1 June 1944
  24     Island organization and command channels, Joint Army-Navy malaria and insect control
  25     Guadalcanal Malaria and Insect Control Organization
  26     Japanese and U.S. admission rates during February 1943

Maps

Number

    1     Areas of the continental United States believed to be malarious in 1882
    2     Areas of the continental United States believed to be malarious in 1912
    3     Areas of the continental United States believed to be malarious in 1932
    4     Areas of the continental United States believed to be malarious in 1934-35
    5     Geographic distribution of three species of anophelines associated with malaria transmission in the continental United States
    6     Location of Army installations in the continental United States, where mosquito control was carried out in 1941
    7     Location of Army installations in the continental United States, where mosquito control was carried out in 1945
    8     Geographic distribution and types of projects being carried on by Malaria Control in War Areas, 1 July 1943
    9     Geographic distribution and types of Malaria Control in War Areas control operations in 1945-46
  10     Caribbean area and South Atlantic theater
  11     North African Theater of Operations, 1944
  12     Principal cities of NATOUSA (MTOUSA), 1944
  13     Distribution of malaria in Italy, Sicily, and Sardinia, 1944, and in Corsica, 1925
  14     U.S. Army Forces in the Middle East, jurisdictional map, 1942
  15     U.S. Army Forces in the Middle East, jurisdictional map, 1943
  16     U.S. Army Forces in the Middle East, jurisdictional map, 1944
  17     Air Communications, U.S. Army Forces, Africa and the Middle East, 1941-45
  18     Regional map of Africa
  19     Southeast Asia, showing India-Burma theater with major administrative divisions and China theater in 1945
  20     Southeast Asia, showing geographic divisions in portions of India and Burma occupied by U.S. troops
  21     Malaria in India
  22     Malaria in Burma
  23     Pacific Ocean Area
  24     Malarious islands of the South Pacific Area
  25     Espiritu Santo, New Hebrides
  26     Guadalcanal, Solomon Islands
  27     Bougainville Island
  28     Okinawa Islands, showing localization of malaria outbreak of 1945
  29     Situation on Bataan, 8 January 1942, approximate U.S. battle positions
  30     New Guinea
  31     Distribution of the Anopheles punctulatus series
  32     Admiralty Islands