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    This volume of the official history of the Medical Department, U.S. Army, in World War II concerns malaria, from the standpoint of the preventive medicine efforts which were undertaken, both in the United States and in oversea theaters, during the period in which the United States was engaged in war against the Axis Powers. It is a comprehensive story written in the main by authorities in malariology. particularly in the fields of survey and control. The authors. themselves, were intimately associated with the work which is related within these pages--work which required a highly technical knowledge of the subject; work which required time training of hundreds and thousands of other officers and men; work which required staff coordination at the highest as well as the lowest unit command levels; work which was hot, dirty, wet and which many times involved the dangers inherent in combat itself. It. was in the latter areas that prevention and control were not only most difficult to carry out. but for which the dire necessities of control were so obvious.

    During the peacetime years immediately before World War II, the Army Medical Department was generally alert to the problem of malaria and the potential noneffectiveness which could arise from this disease. Relatively small numbers of troops, however, were subjected to this danger-mainly in the Panama Canal Zone. Puerto Rico. the Philippine Islands, and the Southeastern United States. In these areas, a small group of Medical Department personnel working with command support. and to some extent with local civilian public health authorities had reduced the malaria attack rates among the military personnel and the American civilian employees to a low level. Individual malaria discipline, as it was called, supported by improved, strict, and adjunctive sanitary measures on military posts and surrounding areas, was effective. Army admission rates for malaria dropped from 130 per 1,000 per year in 1900 to about 4.6 in 1988. For example, aggressive control measures in the Panama Canal Department had reduced the rate for primary and recurrent cases in U.S. Army personnel to a satisfactory low just before World War II. Extensive malaria surveys had been conducted in the Philippines prior to the war by medical personnel of the Army in conjunction with the Rockefeller Foundation. Even on Bataan, the vector had been identified and the incidence of malaria in the native population had been determined. Unfortunately, because of lack of public health funds, little or no control measures on Bataan had been effected before the war. This, as discussed in Chapter IX, was later to contribute to a military catastrophe.

    The conditions and environment of a relatively static garrison life of an army in peace time are much different from those imposed by war. In the former, an orderly approach can be made to sanitation control and prevention of disease, such as malaria. In war, this setting changes abruptly and rapidly, and there arise many uncertainties, not the least of which are imposed upon us by the enemy, foreign and unknown terrains, climatic conditions to which our troops are unaccustomed, the various mores of Allied as well as hostile nationals, the great variances in global personal and public health standards, and many such other problems. In the control of malaria, which alone caused 500,000 hospital admissions in World War II, there were paramount obstacles to be attacked and surmounted.

    From the earliest days of the entry of the United States in World War II, in addition to the physical conflict in which the Army was engaged, there was also this constant battle at home and overseas between the Army and the causative agent of malaria and the mosquitoes which spread the parasites from man to man. As with bullets and high explosives, there was with malaria no respect for rank, color, sex, creed, or ethnic origin.

    Malaria control became, therefore, one of the major concerns of The Surgeon General and of the entire Medical Department, and it remained one of high priority throughout the war. In order to plan for and successfully implement the plans for the war against malaria, it was not only necessary to understand the basic facts of malaria epidemiology, but it was likewise necessary to understand the basic clinical considerations. Additionally, knowledge of the strategic concepts and plans and the place and timing of future tactical operations had to be gained. It was necessary to develop and evaluate medical intelligence on diverse and little-known areas of the world. Competent personnel had to be obtained to devise and direct the overall malaria program, and other trained personnel had to be located and dispatched to implement the program in the field. Training schools had to be established for officers as well as for enlisted men. The procurement of supplies and equipment and their shipment to appropriate destinations were of the utmost importance. It was necessary to organize and train special malaria survey and control units and to arrange for their movement and employment consistent with their mission. It was likewise necessary to orient and educate commanders at all levels with the need for control measures and malaria discipline for, obviously, command support is a must in any such undertaking. Where commanders understood the dangers involved and the methods by which these dangers could be overcome, the health of the troops was preserved--one might say in direct proportion to the command support given to the effort. For the troops, training programs and training media had to be prepared and presented, for as always, much of any success or failure depends upon the knowledge and motivation of the individual soldier. Not the least of the elements of necessity that arose was the time, effort, and money which was devoted to research in the field of antimalarial drugs, insecticides, larvicides, and repellents. This went into high gear by mid-1943, and the cooperative efforts of the Army and Navy, other Federal agencies, and civilian medical schools, industrial firms, research institutes, and other private health organizations were a causative factor in the final success of the malaria program. In all of these endeavors, every effort was made to keep our Allies informed of the technical progress and so provided an exchange of pertinent information and experience. Major benefits accrued for all concerned.

    As Dr. Paul F. Russell points out in chapter I, the greatest advances made in malariology during World War II were in the development and use of synthetic antimalarial drugs and residual insecticides. We learned to use Atabrine. Research into and clinical studies of other antimalarial drugs were made during and continued after the war and have resulted in even newer and more useful drugs. From the standpoint of the new insecticide, DDT, many trials were conducted. Large quantities were produced, distributed, and used in all theaters with outstanding success. The research, development, clinical study, and application of these products during the war was a massive joint effort by military and nonmilitary personnel, by Government and civilian agencies, with a great pooling of resources and cooperative spirit.

    As one reads this book, one can but be impressed with the tremendous number and scope of malaria surveys which were conducted by the various Medical Department survey units which were located eventually in every appropriate theater of operations, as well as in certain areas of the United States. These officers and men, under adverse conditions, steadfastly and unrelentingly studied and reported on the characteristics of the area where they were located, whether in South or Central America, Africa, Italy, Burma, or some strategically located island in the far reaches of the Pacific. Physiography, climate, native population, general health situations, habits, and distribution of the mosquito vectors were included. Basic knowledge and facts were sought and obtained. Based upon this information, malariologists, epidemiologists, entomologists, malaria control units, and combat and service troops, employing their individual and collective efforts and facilities, strove to improve malaria prevention. The Army Air Forces cooperated by providing personnel and airplanes by which the spraying of large areas of terrain was accomplished. In many areas, this proved of inestimable assistance.

    Many practical lessons learned from these war experiences are included within the pages of the various chapters of this volume. A few of the more pertinent are: The need for malaria, control enlightenment of line commanders; the requirement for utilization of medical supervision of, and didactic malaria control training for, all troops regardless of branch or service; the relative emphasis to be placed upon environmental control measures vis-a-vis the personal measures of the individual soldier, including suppressive medication; the use of special malaria control organizations; and the place and responsibilities of the malariologist in the overall medical framework and organization.

    In discussing these and other matters, the authors--as one might expect-- have been somewhat repetitious. In order that the individuality of the author's presentations might remain, the editors have intentionally permitted such repetitions to stand. There were other reasons, also. No two areas were exactly alike. Conditions of combat, terrain, environment, personnel, supply, and other factors were dissimilar. And, individual interests of participating personnel, as well as readers, in reality dictated the individual approach.

    In this great effort toward the eradication of malaria, resulting as it has in an improvement in mankind's environment, the Medical Department of the Army takes natural and justifiable pride in the role which it played on the antimalaria team during the war. Nowhere was its mission, "to conserve the fighting strength," more typified and of more importance than in the minds, souls, and bodies of the thousands of its dedicated officers and men wherever they were engaged in the battle against malaria. To these, our country and our Armed Forces are ever grateful.

Lieutenant General,
The Surgeon General.