1. GENERAL

Malaria remains the greatest obstacle to the success of military operations* in the tropics. In some highly malarious combat areas ten men have been rendered non-effective by malaria for each battle casualty. The importance of any disease which constitutes such a serious threat to the success of military operations cannot be overemphasized. This simplified question-and-answer article on malaria will be found useful for the instruction of units in training or en route to malarious areas or to those units already in such areas. The article was prepared by the Office of the Surgeon General.

2. THE ARTICLE

a. What is malaria?

Malaria is a disease caused by very small parasites. These parasites, or germs, feed on red blood cells and destroy them.

b. When should a man suspect he has malaria?

A man should suspect malaria when he has a chill followed by fever and sweating. The chills and fever may come at regular intervals, sometimes every day, sometimes every second day, and sometimes every third day, depending on which kind of malaria parasite is in the blood.

c. Does malaria always behave the same way?

No. The symptoms of malaria vary greatly in different persons and at different times. The symptoms of malaria may be anything from a headache to a delirious fever, or even sudden unconsciousness. In places where malaria is common, any fever or severe headache should suggest the possibility of malaria.

d. How can a man be sure whether or not he has malaria?

The only way to be certain that one has malaria is to have a drop of blood examined by microscope for parasites. Sometimes an experienced medical officer can recognize malaria without examining the blood.

e. Is malaria a serious disease?

Yes. Malaria destroys a man's blood and makes him weak. It may keep him in a hospital for ten days or longer. It may make him a chronic invalid for a year or more. It may kill one or two out of every hundred persons who catch it, if they are not properly treated.

f. Is malaria serious for armies?

Yes, malaria may be more serious for an army than its opposition. In the last world war British and French armies faced German armies in Macedonia for three years with neither side able to advance because of malaria. In one of these armies, which had an average strength of 124,000 men, there were more than 160,000 hospital cases of malaria in three seasons. Over 25,000 soldiers had to be evacuated because of chronic malaria in the spring of 1918. Malaria was far more important than the enemy, who caused a total of only about 27,000 casualties in the three years,

g. Has malaria appeared in this war?

Yes. Malaria has been a serious difficulty in the Caribbean area, in Africa, in the Southwest Pacific, in India, and elsewhere.

h. How does a man catch malaria?

A man catches malaria from a mosquito. Mosquitoes act like airplane transports for malaria parasites. They ferry these germs from one man to another. This is the only way in which malaria spreads.

i. Do all mosquitoes carry malaria?

No. Fortunately, only certain kinds of mosquitoes, called Anopheles, can carry malaria.

j. How do the Anopheles mosquitoes carry malaria?

Anopheles mosquitoes not only give the malaria parasites a free ride but also a comfortable home where they can breed. Anopheles mosquitoes stand on their heads on a man's skin, with their tails pointing up. They suck up a drop of blood, which they need for food, and then they fly away. If there are malaria germs in that drop of blood, these germs are taken with the blood into the mosquito's stomach. Then the malaria germs raise a large family in the mosquito's body. It is interesting that all other mosquitoes except Anopheles destroy the malaria germs in their stomachs. The Anopheles don't have the right kind of digestion to do this.

k. How soon can an Anopheles mosquito infect another man after it has fed on someone who has malaria?

Usually in about ten days. By this time the young family of malaria germs has grown up and is waiting in the mosquito's spit or saliva glands for a chance to infect a man.

l. How does the Anopheles mosquito infect a man?

Every time the mosquito drills a hole into a man's skin for blood it drools some saliva into the hole, and if malaria parasites are in the saliva they go into the hole and so into the man's blood.

m. How soon after a mosquito infects a man does malaria show up in this man?

Usually in from 8 to 14 days. It takes this long for the parasites to increase in numbers enough to throw their weight around and make a man ill.

n. How is malaria cured?

There are drugs called quinine and atabrine, either of which when given by a medical officer for a week will often cure malaria. A third drug, called plasmochin, is also used to treat malaria in some cases. But sometimes, even though a man feels well after treatment, the drugs have not destroyed all the germs. Some may hide away in the internal organs. Then, after ten days or a month, or sometimes longer, the disease appears again. There may be three or even more such attacks (called relapses) which have to be treated each time like a new infection.

o. Can malaria be prevented by keeping fit?

No. Malaria is one of the diseases that will hit the strongest as quickly as the weakest, and hit him just as hard. Mosquitoes are defeated by brain work, not by muscles.

p. Can malaria be prevented by keeping a camp clean?

No. Ordinary camp cleanliness, which is necessary to prevent bowel diseases, has no effect in preventing malaria. It takes special measures, to prevent malaria.

q. What is malaria control?

There are two kinds of malaria control in the Army. One kind includes measures which Medical and Sanitary Corps officers and the engineers carry out for the soldiers. The other kind includes measures which the soldier does for himself and which no one else can do for him.

r. How does the Army control malaria?

The Army controls malaria by attacking and outwitting the mosquito. It knows that the Anopheles mosquito must spend the first week or ten days of its life swimming in certain kinds of water collections, such as streams, ditches, ponds, and pits, so whenever possible this water is eliminated by draining or filling. It also knows that oil and Paris green will kill the young mosquito wrigglers in water, so, when filling or draining is not advisable, one or the other of these poisons is spread where it will do the most harm to mosquitoes. It also knows that adult flying mosquitoes cannot pass through screens, so the right size screening is put on barracks and hutments. It also knows that certain sprays will kill adult mosquitoes, so there is a program for spraying places where the mosquitoes are roosting. Finally, it knows that most malaria mosquitoes can fly only a mile or two, so camp sites are chosen which, if possible, are not near mosquito breeding places.

s. What can the soldier himself do to prevent malaria?

The soldier himself can use sleeping nets, protective clothing, and repellents, and he can stay out of malarious villages and get behind screens at night. The soldier must be able to think faster than a mosquito to prevent infection.

t. What are sleeping nets?

Sleeping nets are cloth nets used to protect a soldier when he is sleeping. This is the time most malaria is caught. The malaria Anopheles mosquito usually bites at night and, of course, can bite more easily when a man is asleep. It is important to use sleeping nets properly. They must be put up so that mosquitoes cannot get inside, and so arranged that a man does not sleep up against the side and thus allow the mosquitoes to feed on him through the net. Holes must be repaired promptly with adhesive tape or by sewing.

u. What is meant by protective clothing?

Protective clothing is any clothing which gives protection against mosquito bites. For example, leggings will prevent bites around the ankles, and rolling down the shirt sleeves at night will protect the forearms. There are also gloves for guard duty at night and head veils which, although sometimes hot and uncomfortable, will keep mosquitoes from drilling holes in the skin of the neck and face. Don't wear shorts at night or at any time in the jungle. Don't sit around with your shirt off at night outside screens. Don't go bathing at a malarious beach, swimming hole, or unscreened bathhouse at night.

v. What are repellents?

Repellents are chemicals which when spread over the skin will keep mosquitoes from biting. The standard Quartermaster repellents will keep mosquitoes from biting for from three to four hours after being spread over the skin. When needed, the repellent should be used liberally at night on all exposed skin. It should also be put on the clothing wherever it is thin enough or tight enough so that the mosquito can drill through it (for example, at the shoulders or seat). The repellent should be used as often and as freely as necessary.

w. Are native villages dangerous?

Yes. Stay out of malarious native villages after dark. They are deadly. Most natives in malarious places have malaria parasites in their blood, even if they look fairly healthy. The mosquitoes in such places are full of malaria.

x. What about taking drugs to prevent malaria?

Atabrine or quinine in small doses will postpone the chills and fever of malaria. But even large doses of these drugs will not prevent the mosquito from infecting a man. Sometimes it is very necessary to keep fit when away from base camps and in places where it is not possible to get sufficient protection from bed nets, clothing, and repellents. Under these conditions atabrine (or quinine) is taken in small doses to postpone any attacks of chills and fever. When the mission is completed, the atabrine (or quinine) doses are stopped. Then in about ten days or so, if a man has caught malaria, the chills and fever will show up and he can be given a regular treatment in a hospital.

y. Is all this talk about malaria important?

Yes. Malaria in an army can spoil a campaign. This is fact, not fiction. The Japanese know it and so do the Germans. They try to prevent malaria. Wherever they do a better job of malaria control than we do, they stand a good chance of winning a battle. In malarious places it is just as necessary to beat the mosquito as to beat the enemy. The mosquito's brain is smaller than a pinhead. We should be able to outsmart a mosquito if we use the brains with which we were born.