Malaria in American troops in the South and Southwest Pacific in World War II.

The control of infectious or communicable diseases generally demands in whole or in part management of the environment (water chlorination), law (immunization of school children), behaviour modification (safe sex), drugs (antibiotics, vaccines), and education or propaganda (television, posters). The eventual control of malaria in the South Pacific (SOPAC) and Southwest Pacific Area (SWPA) theatres in World War II required the application in combat of all these variables. It is an exemplary tale of the importance of medical research before and during a war and-more importantly-of the absolute necessity of combat commanders understanding medical advice and applying it through the command chain with military discipline. The reduction of malaria cases is a multi-factorial process. Military personnel must take the prophylactic drugs, use insect repellent, observe clothing discipline, and use bed nets where possible. Dedicated engineering, entomological and preventive medicine units must determine the significant mosquito vectors and destroy their breeding places, define any reservoirs in native inhabitants, and educate troops and their commanders. Civil affairs and medical units must assist in the treatment of any native reservoirs and advise command on the use of native labour as a transmission risk. Malaria was endemic to hyper-endemic in SOPAC and SWPA. It took three campaigns-Bataan, New Guinea and Guadalcanal-to demonstrate what a force destroyer this single disease was. As soon as combat commanders understood what a force multiplier malaria control could be, the resources and command support were given without stint. This paper discusses the operational and medical aspects of malaria in American forces. The lessons apply equally to the Australian army; their story is splendidly told elsewhere.1 Of necessity, the tactical and operational background must be sketched in. Those soldiers and marines were not in the jungles by choice; it was a war that put them there, it was a war that exposed them to malaria, and it was a war that forced the application of peacetime knowledge, and wartime research that eventually solved the military medical problem.