Malaria and the armed forces

Media

Part of The Philippine Educator

Title: Malaria and the armed forces
Language: Spanish
Year: 1953
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Fulltext: ~LA RIA l I . ~·· 4~ ; rM4?/flt.t hfcdt.., Malaria is a disease caused by minute p~asites which destroy ~uman blood cells. It occurs in two phases - the clinical phase, during which parasites rupture the red blood cells, causing chills, fevers and severe headaches; and the tissue phase, duril\I which the parasites are harbored in cells of the liver and other organs of the body and no symptoms are evident. The normal course of the disease is marked by recurring attacks, representing the clinical phase of malaria, which ~lternate with gradually lengthening tissue phases. Even without treatment, the patient is acutely ill only a small part of the time, although the disease may last for several years. Death is exceptional with benign tertian malaria, the type most frequently encountered in this country. and in .Korea. The two phases of the disease represent a major complication in the successful cure of malaria. The cure of the clinical phatte is accomplished by several drugs that remove the m.alarial parasites from the blood stream. Until recently, however, no effective agent against the parasites harbored in the tissue had been discovered. Three ·factors are necessary for the progagation of malaria: The presence of malaria cases, a supply of malaria-transmitting mosquitoes, and a temperature which permits the mosquitoes to reproduce and remain active. For ail practical purposes, the only way to prevent malaria is either to destroy the Anopheles mosquito, the principal transmitter of the disease, or to prevent them from bitting human beings. There is n~ vaccine or drug that will prevent the introduction of malaria parasites into the blood stream. Consequently, effective preventive measures are dependent on insect control measures and the use of insect repellents. How effective these are depends on the discipline of troops, the tactical situation, and the geography of the area involved. It is possible, howe~er, to suppress the 56 symptoms of m1aria through the use of several drugs. This suppression enables a soldier to continue his combat mission without any symptoms of malaria and without any ill effects to his health, and 'it permits the eventual tr~atment of the soldier from the malarious area where he can be cared for most expeditiously. • The relapset or clinical phase of all types of malaria can be treated effectively by drugs now in use. Several drugs now available will completely cure the most severe forms of malaria. The"permanent cure of the temperate zone va-. riety which is most common in Korea, however, still depends on an effective agent to combat the tissue phase of the parasite. Successful completion of tests now underway may make ~his cure possible. The Military Problem Despite the developments in recent years, both in the fields of insect control and effective suppressants, malaria remains a military problem. This is (primarily true because while an army in garrison can do much to control its environment, its efforts in combat must always be limited 'V and the prevention of malaria is entirely dependent on this environmental control. M~laria was a major factor during the Spanish-American War and unquestionably would have had a serious effect on the campaigns of that period if they had lasted longer. ·During World War I, American troops serving in 'temperate areas had little malaria, but Aflied and Central Powers troops in Macedonia were immobilized because of the disease. Durimg World War 11 Malaria during World War II posed one of the most serious health problems ever faced by the American Army. Much of the fighting was in the most malarious areas in the world, and the Japanese cap· ture of Java had sealed off much of the world's supply of quinine, which had been the standard malaria suppressant and treatment since early in the nineteenth century. In addition, neither insecticides ·L,· ~--------~----------------~-----rJr ~~~ ~eO'Jib~ r"~~tre tNJ rll~ '!!ell I ~!CJ!t! I!Oifi m ~-~ S~m~liil dllrnlti~ ciii!IP Jllt'lti ,:.1 [4!!Kil th!ilitil abrt.!tl II'.IINtai Ml!aril omthl . ' MALtlA AND ! nor repel1e~ were effer~ive enough at) , the outbreakv~) the war to combat jungle .' mosquitoes, although th1y were reason' • ·ably effective for dome11 ic use. .. 1 The early phase Qf t. e war reflected ~ 1 a decreased incidence of malaria among troops in the United States because of intensified control measures. At the same time, however, the rate was rising dramatically ;n overseas areas because > of inexperienced troops and inadequate wei\Pons to combat the disease. This was particularly notable in New Guinea where the initial onslaught on tile disease was almost catastrophic and caused many more casualties than Japanese bullets. ;• · M3laria remained a problem throughout the war in the Southwest Pacific, 'Africa, India, and the Carribean; but the development of new materials and methods soon resulted in declining rates thrt>ughout the '\vorld where American troops were stationed. The mater1'als included DDT, aerosol _sprays, improved repellents, and the nmt standardization of atabrine to replace ::1!11 ' quinine as a malaria suppressant. An intensive education program among troo,qs which emphasized the necessity for closely adhering to control rules was also launched. Soon the number of cases of malaria in an organization became a criterion of the unit's discipline. . ' Post-wQ/1' Ad11ances ' When the war ended, the Army had in atabrine an effective suppressant that had proved as effective as quinine in many ways and superior in others. Both atabrine and quinine had certain disadvantages, however, and neither provided a cure pr even a wholly satisfactory treatment for malaria. Consequently, the Army Medical Service and other government agencies continued intensive research for more effective antimalarial agents. A major victory was achieved in 1947 with the standardization of chloroquine after tests involving thousands of malaria cases. Chloroquine proved to have these advantages over atabrine and quinine: 1. As a suppressant it had to be taken only once a week instead of every day. 2. It did not discolor the skin. 8. It produced fewer "•ide ef::.eets." ... It Was more ef!ective in nlieving E ARMED FORCES 57 acute symptoms of the disease and eliminating mat' ' ial parasites from· the blood stre~ in as little as 24 hours. , Malaria in Korea Korea is a highly malarious countf.Y with much of the popqlation infected w1th the disease. In addition, the work of combating the Anopheles mosquito has been complicated both by the innumerable breeding grounds ,provided in rice paddies and by the frequently harrassing tactical situation. However, with the use of chloroquine, which became available throughout the entire combat area late in the summer of 1950, the incidence of malaria in Korea has been kept low compared with World War II rates. Chloroquine is an excellent suppres/ sant; but, like atabrine and quinine, it is neither a preventive nor a complete cure for malaria. Numerous cases may be expected therefore among returnees from Korea who have not previously experienced symptoms of the disease. AH returners have been warned at 'West coast ports of debarkation that if they develop chills, fevers and severe headaches while on leave, they are to inform their physicians that they have been serving in a malarious area. Present Anti-malaria ReseQ/T'ch Since the standardization of chloroquine in 1947, the U.S. Army Medical Service has concentrated much of its research on a new drug, primaquine, which seems to offer much promise in the treatment _of malaria. Primaquine appears particularly effective against the tissue phase of the disease because it attacks the stubborn parasites in the liver cells. It may thus be possible to effect rapid cures for malaria and prevent nu11_1erous relapses by simultaneously treatmg the parasites in the blood stream with chloroquine and those in the liver with primaquine. If primaqtine proves successful, it will not replace chloroquine as a s~ppress~~:nt, but it may be possible to adr~nmster 1t routinely to all persons :etummg from malaria-ridden areas and, m effect, cure the disease before the returnee knows ho had contracted it. Re~earch ~s also continuing on the developmg of 1mproved insecticides and insect r~pell~nts that .will aid in the equally ~ssent1al f1ght agamst the disease-carrymg mosquitoes. A number of thete items are already being field-tested in Korea.