Our Family History

 Maleria for troops fighting out in Greece was very common.

 

In Macedonia, British, French, and German armies were immobilized for 3 years by malaria. Nearly 80 percent of 120,000 French troops in this area were hospitalized with malaria. In an average British strength of 124,000, there were 162,512 admissions to hospital for malaria during the years 1916 to 1918, in contrast to 23,762 killed, wounded, prisoner, and missing in action.

 

In the spring of 1918, about 25,000 British soldiers were sent home from Macedonia with chronic malaria, and, apart from these evacuees, over 2,000,000 man-days were lost to the British Army in this area in 1918 because of malaria.

 

The conditions were awful as this account shows:

 

We lived in redoubts in comfortable little iron tunnels, and had Greek infantrymen to share our guard with us. Once we were marched to the village of Yenekoi, where we dug ourselves in. We were acting as a sort of infantry screen to a flying battery. There was no attack through the hot and thirsty night. We drank all our water and then lay and endured till dawn.

 

We had kit inspections, we scrubbed our shorts and helmets with the wonderful sandy Struma mud, and went out on patrol. On these patrols we actually carried stretchers. We hacked down the lush green grass, which might harbour malarial mosquitoes, and poured cresol in pools to kill the larvae.

 

The night patrols had a ritual of their own. Each man anointed his face and neck with almond-smelling mixture of the appearance of floor polish. This was to make us unpleasant to the mosquitoes. Then we put on a muslin veil and tucked the loose ends into our tunics. The tout ensemble was surmounted by the good old tin hat, and off we went like the female portion of an Eastern Bridal Part

 

In 1916 - 17 a concentration of over 500,000 British, French and Serbian troops was based in Salonika (Macedonia) when an epidemic of malaria broke out in the town, which became to be known as the 'Bird Cage', and its environs. Of the 300,000 British and French troops, around 120,000 (40%) became unfit for active service due to malaria. Allied with other diseases, at one point it reduced the strength of the Allied force to only 100,000 effectives.

 

In the 1918 battles, through Bulgaria to the Danube, there were only 200,00 battle cases compared with the 450,000 men who had been invalided out of the area suffering from malaria, or its aftermath.

 

Out of the total Allied force of one million who were in the theatre from the end of 1915 to 1918, there were 1.3 million hospital cases, mainly malaria. In the Autumn of 1916, the French Commander of the Expeditionary Force, General Maurice Paul Emmanuel Sarrail, sent a telegram to Army HQ in Paris 'Mon armée est immobilisée dans les hôpitaux = My army is hospitalised'. The casualties of the Central Powers in the war zone were also dramatic, but reportedly considerably lower: probably due to its forces holding the healthier higher ground, allied with better anti-malarial drug regimens and disease control measures.

 

The hugely disruptive effect of war could be highly favourable to the increase in mosquito numbers. The normal man-made, or natural, means of mosquito control were interrupted, and huge numbers of water-holding excavations and containers were created that were favourable for mosquito breeding. Domestic animals, which normally provided the preferred feeding sites for mosquitoes, were distributed elsewhere or destroyed, and the huge numbers of potential human feeding sources took their place.

 

Nevertheless, an efficacious treatment regimen for malaria was always dependent on the proper administration of an appropriate antimalarial drug in good time. The only effective treatment for malaria from 1914 - 1918 was the drug quinine. The source of the drug was limited so obtaining adequate quantities of the drug was often difficult.

 

In addition, quinine had side effects. One of which was tinnitus (a persistent ringing in the ears) which many patients found difficult to tolerate over the full seven days or so of the treatment. Whilst other often distressing side effects were giddiness, blurred vision, nausea, tremors and depression. Whenever possible patients were hospitalised to ensure compliance with the full regimen of treatment, even if the patient felt fit enough to leave hospital. The cumulative effect of these long hospitalisations could be crippling on military strength at crucial times in the fighting.

 

Another, much more life threatening side effect was a disorder called Black Water Fever; so named because of the black coloured urine produced by the patient. It was a result of a complex reaction of the haemoglobin of the patient's RBCs with the malaria parasite Plasmodium faciparum and the drug quinine. Upto 40% of Black Water Fever cases died, and under arduous conditions of war the death rate was often significantly higher.

 

Apart from the use of quinine as a malaria preventative and a curative, other means to control the transmission of malaria were used by the armies of all sides

 

Since Ross's discovery in 1897 of the chain of malaria infection through the mosquito, attempts had been made around the British cantonments and encampments of the world aimed to reduce both the numbers of the mosquitoes breeding in water and the airborne adults. One anecdotal Great War control measure was reported from Salonika, where it is said the bushes, and the air itself, were beaten with leafy branches in an attempt to reduce the swarms of mosquitoes.

 

With the clear understanding that epidemics of malaria were often associated with concentrations of troops, various more effective malaria control measures were employed by the belligerent armies.

 

Prime amongst these were drainage schemes to eliminate the mosquito larvae breeding places, and the use of mosquito bed nets and netting to prevent mosquito biting - malaria vector mosquitoes mainly feed at dusk, during the night and at dawn.

 

Also less common at the time, was the application of insecticides, such as mineral oil for the water-borne mosquito larvae, and a knockdown pyrethrum spray - an extract of the Chrysanthemum spp. plant mixed with kerosene oil - for the adult mosquito. The pyrethrum spray was known to the British and Americans as 'Lefroy's Liquid'.

 

Other more readily available toxic products were used ranging from carbolic acid to chlorine gas. All these measures were expensive, by the values of the time. This, plus the difficulty of widespread application and the contingencies of war, limited their use on the battlefield.

 

Personal protection measures, other than the use of the bed nets, and the enforced wearing of veiled hats, long sleeved shirt/jackets, long trousers and mosquito boots, were rather limited. They mainly required the use of mosquito repellent oils, such as Citronella (a lemon-scented oil extracted from South Asian grass Cymbopogon nardus) which was generally considered as being the most efficacious.