Remembering the war in New Guinea
Japanese Medical Corps-malaria (General page)
Module name: Operations (Japanese perspective)
This page was contributed by Mr Alan Hawk (National Museum of Health and Medicine)
Malaria was the most widespread disease in New Guinea and almost all soldiers were soon infected. Malnourished soldiers had a diminished antibody response to malaria and a greater mortality risk.  The most common strain, falciparum malaria was also the most lethal. Infected patients complained of a chilly sensation that lasted 20–36 hours, prostration and headache. Complications, usually fatal, included cerebral malaria, which resulted in severe headache and delirium, and blackwater fever, which caused the destruction of red blood cells, shock and anaemia. Beriberi increased the patient’s chances of contracting cerebral malaria.  Although vivax malaria had a lower mortality rate, it was more persistent. The patient initially complained of chills followed by recurring fever and sweats, which lasted from 1–8 hours. If untreated, the symptoms subsided spontaneously in ten to thirty days, but could recur at varying intervals.
Cause: Malaria is a bloodborne disease spread by a mosquito bite. It is caused by the parasites Plasmodium faliciparum or Plasmodium vivax, which attack the red blood cells (erythrocyte) in the bloodstream.
Epidemiology: A 1935 survey of malaria patients along the North Coast of New Guinea found that 75 per cent were infected with Plasmodium faliciparum and 25 per cent were infected with Plasmodium vivax.  Since the mosquitoes that spread malaria required sunlight for breeding, Japanese soldiers were more likely to become infected in the coastal regions of New Guinea rather than in the dense jungles further inland, although mosquitoes that carried malaria had been found inland at altitudes up to 3,000 feet. Large numbers of Japanese soldiers became infected with malaria. In late 1942, Sergeant KONDO Yuso noted that 50 per cent of the troops in the rear echelon had malaria  and Medical 2nd Lieutenant SAVATARI Zengoro reported 100 per cent incidence at the front lines with morbidity rate of at least 10 per cent. 
Prevention: Rear-echelon Japanese troops attempted mosquito eradication, mostly by digging ditches to drain stagnant water where mosquitoes breed. However, the highly saturated soil in New Guinea thwarted their efforts. Soldiers were issued insect repellent and mosquito head-nets, although many did not use them due to the heat. Mosquito netting was issued for use with bedrolls, although the American internee reported that some Japanese officers discarded their mosquito netting and used white surgical gauze, which they believed to be more becoming of their rank.  In an effort to prevent malaria, Japanese soldiers were required to take 0.2 gm of quinine for six days and one tablet of Plasmochin every seventh day,  a dosage incapable of suppressing neither strain of malaria. 
Treatment: According to Kondo, patients were treated with two to six 0.5 gm quinine tablets three times a day, sometimes in combination with Atabrine and Plasmochin,  which approximated dosages found effective by western physicians.  Malaria patients who could not retain or respond to oral medications were treated with intravenous injections of quinine. Unlike their western counterparts, Japanese physicians routinely included stimulants in the treatment of malaria, which may have impaired liver function and worsened the patient’s chances of recovery. 
1. Anuraj Shankar, "Nutritional modulation of malaria morbidity and mortality", The journal of infectious diseases: 182, supplement 1 (September 200): S37–S53.
2. S. Krishna, "Thiamine deficiency and malaria in adults from southeast Asia", The lancet, 353: 9152 (13 February 1999): 546–49.
3. Ebbe Curtiss Hoff (ed.), Preventative Medicine in World War II, vol. VI, Communicable Diseases: Malaria, (Washington: Office of the Surgeon General, Department of the Army, 1963): 520.
4. Interrogation report 50: 5.
5. Interrogation report 86: 5
6. SWPA-1: 1.
7. Enemy publication 24: 4.
8. American clinical trials in New Guinea showed that daily doses 0.6 gm of quinine failed to prevent attacks of falciparum malaria and 0.3 gm was incapable of preventing vivax malaria. Harry Most, "Clinical trials of anti-malarial drugs," in John Coates (ed.), Internal Medicine in World War II, vol. II Infectious Diseases, (Washington: Office of the Surgeon General, Department of the Army, 1963): 525–98.
9. Source gave dosage as 5 grams per tablet, considerably higher amount than reported by other American and Japanese sources, which would probably been toxic. Interrogation report 50: 6.
10. In 1947, American doctors proscribed 1 gm three times daily for the first day, 0.65 grams three times a day for six days. War Department, "TB MED 72, treatment of clinical malaria and malarial parasitemia", 4 March 1947: 5.
11. Nicholas Day et. al., "The effects of dopamine and adrenaline infusions on acid-base balance and systemic haemodynamics in severe infection", The lancet: 348: 9022 (27 July 1996):219–23.