Australian casualties from malaria were 9250, compared with 2037 killed and 3533 wounded.
—Australian–Japan Research Project, Australian War Memorial
Adeadlier foe than aerial bombing imperilled both armies: the mosquito. At night swarms of anopheles mosquitoes—carriers of malaria—swooped on the troops’ unprotected skin. Neither army was prepared for this medical catastrophe.
Malaria is caused by a tiny parasite of the genus Plasmodium, which is transmitted through the sting of the female anopheles mosquito. As the troops descended from the mountains to the mosquito-infested swamps of the Papuan coastline, exhaustion and hunger overrode their concern about malaria. The disease levelled entire army units.
Blamey miserably failed to take the war to the mosquito. Yet he had ample warning of his tiny new enemy at Milne Bay, for example, where malaria was hyperendemic. Now, on the Papuan beaches, the extreme malaria risk threatened to destroy his army.
The Allies were woefully ill equipped to deal with malaria, but not because medics were negligent or lazy. They lacked suppressant medication, and troops ignored basic preventative measures. The Japanese were even less prepared—or willing—to combat the disease.
With no vaccine against malaria in 1942, quinine and Atebrin were the most effective suppressants. Fortunately the American company Winthrop had a licence to produce Atebrin, because Allied supplies of quinine—derived from the cinchona tree—were finite. The sole source of the commodity in South-East Asia was the island of Java, which fell to the Japanese in early 1942.
The loss of the island handed 1000 tons1 of quinine per year to the enemy. America would have to make 200 tons, and Britain 50 tons, of Atebrin annually to compensate for the shortfall, ‘conditional on [factories] not being destroyed by enemy action’,2 according to an Allied sub-committee on tropical diseases. But this decision was not taken until October 1942.
Meanwhile, a massive consignment of Javanese quinine was lost. On 22 April the Australian army placed a huge order with the Dutch East Indies for £62,500 worth of quinine—Java then produced 95 per cent of the world’s supplies. The Australians paid for but never received the consignment, because Japan invaded the country.
To meet the acute shortage, arrangements were made ‘to purchase available stocks from drug stores in Australia’.3 Drug stores were unreliable, and US shipments were held up. On 22 September, 17 million Atebrin tablets awaited shipment for Australia, at a time when the American forces had decided to adopt Atebrin ‘for the first time’.4 Demand soon easily exceeded supply.
Even when it arrived, many Australian soldiers, suspicious of anything the army fed them, refused to take Atebrin. Some even refused quinine. Anti-malarial control measures were ‘extremely slack’, complained Major-General Sir Samuel Burston, director-general of the medical service.5
He blamed ‘a very universal idea amongst the troops that…quinine will cause impotence’. Perhaps bromide-laced tea had given them pause for thought. The non-observance of anti-malarial measures, Burston insisted, was an easy way of getting evacuated: ‘in fact, a much easier and safer method than a S.I.W. [self-inflicted wound].’6
There is no clear evidence to suggest that Australian troops deliberately exposed themselves to malaria to escape battle—although there were probably isolated cases. Rumours of the suggestion infuriated the men, however, and fuelled their simmering hatred of High Command.
As early as 5 October, Burston was alerted to ‘the widespread intensity of hyperendemic malaria’7 in the south-west Pacific. Colonel N. Hamilton Fairley, of the Australian Military Mission in Washington, wrote that no one in the US army or navy realised the gravity of the risk. Nor did the Australians at Gona and the Americans at Buna.
These trans-Pacific negotiations were too late to affect the situation on the ground. Tens of thousands succumbed to malaria in Papua and New Guinea. As the beach battles worsened, Blamey responded to the crisis on 18 December with a set of instructions as perfunctory as they were ineffectual. He recommended giving the troops dummy tablets: ‘[They] should be trained to take…dummy Atebrin or quinine tablets…in order to create in them the habit of taking tablets…’
Repellents and mosquito nets were ‘to be rigidly insisted upon’; ‘The wearing of correct clothing should be enforced’; and ‘Failure…to carry out these measures…should be treated as a serious breach of discipline.’8
The mosquitoes did not recognise the new regime. They went about their hungry business, swarming over exposed flesh at night, blackening a man’s arm as they feasted. Bare skin drew colonies of the parasites.
By the end of December, some 85 to 90 per cent of the troops complained of symptoms of the disease. Many suffered repeated attacks; their shivering, sweat-drenched bodies and feverish eyes became drearily commonplace. Some form of dire tropical illness racked almost everyone—both Australian and Japanese. Dysentery was simply the norm, and it reduced the men to trouserless spouts of liquid. To have both dysentery and malaria at once was usually a death sentence.
If Blamey’s medical supply department needed a live example of the ravages of malaria, they had only to look at Milne Bay. Four months after the battle there, the Australian troops who remained (and who had not been evacuated with malaria) registered a near 100 per cent affliction rate. On 26 December Cyril Clowes, commander of Milne Force, plaintively reported: ‘…The number of cases of malaria treated is high…the rate shows NO sign of decreasing, and is, in fact, increasing…There are cases of individuals having had five attacks, and quite a large number have had three.’9
It was too late to start teaching men how to pop pills. The Australian troops, many with incipient symptoms, were expected to fight on. They were sent to the rear only when their temperature passed 103 degrees Fahrenheit.
One Australian soldier described the symptoms: ‘You get a fever. You shake like you’re going to rattle the teeth right out of your head. You’re freezing. Then you’re roasting…You feel like you have to defecate. You try but all you do is dribble some water.’10
‘First, one is afflicted by an attack of chill tremors,’ said Second Lieutenant Rinzo Kanemoto, observing its effects on Japanese troops. ‘No matter how many blankets are used, the body shakes uncontrollably. Body temperatures “red line” the thermometer, with 42 degree celsius fevers not uncommon. The liver becomes swollen and the stomach region distended.’ In the case of tropical malaria, ‘severe diarrhoea results. If this…continues for four days, the result is almost certainly death. Bodily resistance in soldiers with malnutrition is nil.’11
The parasite, which lodges in the red blood cells, can stay in the human system for years. Australian troops experienced bouts of fever more than five years after the war ended. Bill Crooks, of the 2/25th Battalion, later said: ‘I had it for about six years, three to four attacks per year. One just lay in bed and sweated it out…it left one [feeling] like a wet dishcloth with the gutsy threads gone out of it.’12
A survey of the prewar malarial victims on the north coast of Papua showed that 75 per cent suffered from the most virulent strain of the disease, which can lead to cerebral malaria and blackwater fever, and was usually fatal.13
Malaria was the most devastating of several life-threatening diseases on the Papuan coast. A parasite carried by the aedes mosquito inflicted the debilitating dengue fever, of which throbbing pains in the joints were the chief symptoms. Scrub typhus, borne by tiny swamp mites, was the most feared illness, because it struck an otherwise fit man suddenly, and usually killed him within hours, after violent convulsions and a soaring body temperature. One rare survivor of scrub typhus recalled measuring his body temperature as 108 degrees Fahrenheit.14 He lapsed into a coma for ten days.
Losses due to malaria—either dead or incapacitated—were staggering. Australian casualties from malaria during the entire campaign were 9250, compared with 2037 killed and 3533 wounded. (Among 14,500 US troops of the 32nd Division, 8600 cases of malaria were reported.15)
By December 1942, about 5000 of a total force of 15,000 had been treated for malaria, notes Steve Bullard of the Australia–Japan Research Project. However, ‘practically the whole force’ were carrying diseases temporarily held at bay by suppressive drugs.16
An alarmed Blamey wrote to Curtin on 4 December: ‘It will be quite impossible to maintain the army at its existing strength. The wastage in tropical warfare is immense. At least one third of our force at Milne Bay is already infected with malaria. The Buna area is an equally evil one for this disease.’17 He belatedly told the War Cabinet that malaria placed the Allied armies ‘in a very precarious position’.18
So, too, were the Japanese. They mismanaged their Java windfall of quinine, putting it in the hands of a civilian trading company that failed to meet supply targets. The Southern Army was forced to commandeer the factory—and double production rates to 600 tons in the 1943 financial year. That was too late for the troops on the Papuan beaches.
Like the Australians, they knew of the disease’s power to kill. It levelled whole units in the aftermath of the invasion of Rabaul. Nearly the entire 1st Battalion of the 144th Regiment was infected. Cases reached epidemic levels due to the complacency of the troops and the failure to take precautions. Many simply did not report the symptoms, partly due to a military culture that frowned on soldiers who succumbed to illness.
In Rabaul, many thousands of soldiers perished, and ‘others were left exhausted and prone to recurrences of the disease,’ wrote Steve Bullard.19
Horii’s order to leave all non-essential equipment behind—including mosquito nets—to make room in haversacks for ammunition and food, ensured that most of his men got the disease.20 Others simply threw away their netting and headgear.
Malaria sufferers packed the ghastly Kokoda field hospital during the Owen Stanley campaign: ‘These patients were seriously afflicted,’ wrote one Japanese officer, ‘with many having lost their minds. Their cries and moans in the middle of the night had an other-worldly feel…the faces looked demented, and among them were some who had got up to defecate and urinate but had left their clothes buttoned up. Here and there were rows of freshly dug graves.’21
While the Allies eventually contained the disease with emergency measures in December, the Japanese rates of malaria rose. They reached a biblical scale in the final battles, due to the troops’ complacency and the indifference of officers.