Malaria and the Defense of Bataan
Maj. Gen. James 0.
Gillespie, MC, USA (Ret.)
The
surrender of the Filipino-American Forces at Bataan
occurred, after 4 months of defensive operations, on 9 April 1942. Defeat was
inevitable because of the limited resources in men and materiel and inability
to replenish them, but malaria and lack of food also played a significant role
in the tragedy.1 The will to fight was
weakened and this hastened defeat. Complications of disease led to appalling
death rates in prison camps.
A
brief review of the epidemiology of malaria, problems of malaria control,
medical war planning, and military operations may enable one to appreciate the
devastating effects of disease and malnutrition on U.S. Forces, the enemy,
civilian refugees, and Japanese-held prisoners of war during the long years of
captivity.
EPIDEMIOLOGY OF
MALARIA
The
mountainous terrain and climate of Bataan provide ideal conditions for the
propagation of the vector of malaria.2 From
the two chief mountain masses on Bataan, numerous streams course in all
directions toward Manila Bay and the China Sea.
The transition from the higher altitudes to the flat and narrow coastal plain
through the foothills insures a rapid flow of water in the streams. The
rainfall is sufficiently adequate to maintain a large number of permanent
streams through the dry season, which extends from November through May. These
provide adequate breeding grounds and support protective vegetation in which
adult mosquitoes survive throughout the dry season.
The
chief vector of malaria in the Philippines
is Anopheles minimus flavirostris
3 This mosquito breeds most readily in
the protected areas of rapidly flowing rivers, streams, and irrigation ditches,
preferring shady places and clear, fresh water. Breeding does not normally
occur in salt water, rice paddies, or in water above 2,000 feet altitude. Thus,
malaria in Bataan, as throughout the Philippines, is a disease
contracted in the foothills, especially between the flat coastal plain and the
higher ground below 2,000 feet altitude. Seasonal variations in the incidence
of malaria are related to the effects of the
1
Hewlett. F.: Troops on Bataan
Routed by Malaria. New York Times, 18 Apr. 1942, p. 5.
2 Russell, P. F.: Epidemiology of Malaria in the Philippines.
Am. J. Pub. Health 26: 1-7, January 1936.
3 Russell. P. F.: Malaria in the Philippine
Islands. Am. J. Trop. Med. 13: 167-178, March
1933.
drying of the small tributaries of streams and
irrigation canals and to the flushing of the breeding grounds during the
heaviest rainfall. Thus, Bataan constituted a
potent hazard for malarial infection during the season when military operations
were feasible.
PRE-WORLD WAR II
MALARIA CONTROL MEASURES
Before World War II, malaria control measures in Bataan
had not been impressive, although surveys had identified the vector and
determined the incidence of malaria in the native population.
In
1930, Headquarters, U.S.
Army, Philippines,
authorized malaria reconnaissance throughout the Islands
to determine the location of maneuver areas of relative safety from malarial
infection. Holt and Russell carried out a rather complete survey of Bataan
during 1930 and 1931 and included Corregidor
in their observations. 4 They collected mosquito larvae, made blood
film examinations for malaria plasmodia, and determined splenic
indices. Corregidor was found to be relatively free of malaria, but Bataan was found to harbor a large reservoir of disease. Splenic indices varied from 3 percent in the villages of
the flat east coastal plain of Bataan to over 50 percent in the populated areas
of the foothills in the vicinity of Limay. Lamao. Cabcaben, Mariveles. Sisiman,
and Bagac.
After 1926, the Malaria Control Division, Philippine Health Service, had
carried on demonstrations and local control programs throughout the Philippines including Bataan Province.
5 The excessive cost of this program had imposed an insoluble problem,
and only moderate progress had been made in the eradication of breeding areas.
Military maneuvers involving small forces had been carried out in Bataan during the dry season for many years. The
contracting of malaria had been an annually recurring phenomenon of varying
magnitude. In 1940, the surgeon of the Philippine Division reported an
appreciable lessening of the incidence of malaria in troops engaged in
maneuvers in Bataan.6 He attributed this to proper use of mosquito
bars and to a more careful selection of campsites. He emphasized the importance
of locating sites, preferably on the beaches, in the coastal swamplands, or in
rice paddies, and of avoiding the higher ground in the vicinity of rapidly
flowing streams. Quinine prophylaxis was continued for 14 days after
termination of the maneuver. The Philippine Division surgeon believed that it
was impracticable to eradicate all of the potential breeding areas. Virtually
no antimosquito control measures were carried out by
the Army in Bataan at any time.
4 Holt, R. L., and Russell, P. F.:
Malaria and Anopheles Reconnaissance in the Philippines. Philippine J. Science
49: 305-371, November 1932.
5 See footnote 3, p. 497.
6 McMurdo, H. B.: Malaria, 1940 Maneuvers, Luzon, Philippine Islands. Mil. Surgeon 87: 252- 255, September 1940.
MEDICAL WAR PLANNING
The
developers of War Plan Orange-3 for the defense of Luzon envisioned an attack
on the Philippines by a
superior enemy force, withdrawal of U.S. Forces from central Luzon, fall of Manila, and delaying defensive action in Bataan to protect
the key defenses of Corregidor until the arrival of naval reinforcements from
the United States.
The plan called for a force of 40,000 men for the defense of Bataan
and the removal of the civilian population upon outbreak of war.
Prewar implementation of this plan in Bataan
was meager indeed. This was due in part to the provisions of the National
Defense Act passed by the Philippine National Assembly in 1935, which
authorized the formation of a 400,000-man Filipino Army to assume the
responsibility for defense in 1946 when Philippine independence was to be
achieved. Prewar preparation on Bataan
included the storage of ammunition, fuel oils, and a limited quantity of canned
food.7 Potential defense lines had been agreed upon, but no
fortifications had been built. Reliance for the control of malaria was vested
in quinine prophylaxis rather than on an antimosquito
control program. This was considered the only feasible procedure in view of the
size of the peninsula, which measured 25 miles by 18 miles, most of which was favorable
to the breeding of malarial mosquitoes.
In
May 1941, the Philippine Department surgeon appointed a board of officers at Steinberg General
Hospital, Manila, to prepare estimates of the
quantities of antimalarial drugs needed, based upon
the April revision of War Plan Orange-3. Col. Rufus L. Holt, MC, the president
of the board, had had extensive experience studying the incidence of malaria
throughout the Philippine Islands. Guided by his advice, estimates were
prepared and submitted at a level 100 percent above anticipated requirements.
Gen. Douglas MacArthur, in July 1941, expounded a more aggressive concept for
the defense of the Philippines.
One aspect of this concept was to defeat the enemy at the beaches rather than
merely delay them to permit the withdrawal of troops to Bataan.
Revision of medical plans during 1941 included requirements for the expansion
of all Regular Army hospitals and plans for the construction of 10 station
hospitals for the 10 Philippine Army divisions, the relocation of the
Philippine Department Medical Supply Depot from the port area in Manila to a
less vulnerable spot at Quezon City, and the construction of medical subdepots at Taríac, Los Baños, and Cebu. On the basis of these considerations,
requisitions were made to The Surgeon General for drugs, medical supplies, and
aid station and hospital equipment. During the fall of 1941, moderate
quantities of medical supplies and the equipment of two general hospitals and
five station hospitals were received. One general hospital was stored at a
battalion post which had been constructed at Limay
7 United States Army in World War II. The War in the
Pacific. The Fall of the Philippines. Washington:
U.S.
Government Printing Office, 1953.
to house the troops guarding military stores on Bataan. This construction was planned so that the
utilities would be suitable for operating rooms, laboratories, wards, and
storage areas. Before the outbreak of war, a tentative site was selected in the
Real River Valley
at kilometer point 162.5, near Cabcaben, for the
location of an additional general hospital. Plans were also formulated for the
development of a medical center in Manila
of approximately 3,000 beds as stabilized warfare was anticipated. 8
MILITARY OPERATIONS
There were 78,000 military and 6,000 civilian employees available in Luzon for defense when war began on 8 December 1941; a
force more than twice as large as provided for by War Plan Orange-3. Also,
there were approximately 25,000 civilians in Bataan
whose feeding and medical care became the responsibility of the military.
The
defense forces in Luzon consisted of the
Philippine Division (composed chiefly of Philippine Scouts), a U.S. Army unit,
nine partially mobilized Philippine Army Divisions, and miscellaneous U.S. Army
troops. The Philippine Army Divisions varied from 4,000 to 6,000 men each and
were organized into the North Luzon Force and the South Luzon Force with the
mission of defeating the enemy at the beaches. The Philippine Division was
immediately ordered into reserve in Bataan,
and the Luzon Forces were moved forward to previously chosen sectors. The
Japanese Forces, supported by an overwhelming air force, succeeded in driving
the Filipino-American Forces back from the beaches and prevented them from
establishing any successful defense positions in central Luzon.
By late December 1941, both of the Luzon Forces had been forced to withdraw
from southern and central Luzon and were entering Bataan
preceded by several thousand civilians. 9 During this phase of
military operations, the effects of malaria on the troops were negligible.
On
8 December 1941, the Philippine Department surgeon instructed the medical
supply officer of the Philippine Department to purchase all available antimalarial drugs, hospital supplies, and equipment which
could be procured in Manila, and a similar program was begun at Cebu.
The amounts procured proved to be a valuable supplement to the limited stocks
on hand. Remarkable progress was made in the establishment of a hospital center
in Manila, but,
in view of the rapid withdrawal of the Filipino-American Forces, War Plan
Orange-3 was placed in effect on 22 December 1941, and it became an urgent
necessity to transfer all available medical resources to Bateau. On 22 December,
a medical cadre was transferred to Limay to establish
General Hospital Number 1. On 25 December, a similar cadre was transferred to
kilometer point 162.5, near Cabcaben, to establish
General Hospital Number 2. The
8 Cooper, Wibb
E. : Medical Department Activities in the Philippines
from 1941 to 6 May 1942, and Including Medical Activities in Japanese Prisoner
of War Camps. [Official record.]
9 See footnote 7, p. 499.
movement of medical supplies and equipment to Bataan was accomplished during the period 23 December to
31 December, inclusive. Approximately 100 truckloads of medical supplies were
moved by road, and many barges were sent both to Corregidor and Bataan.
Unfortunately, much equipment and some drugs and medical supplies were abandoned
in Manila because of limited time, extreme
congestion of the single road into Bataan, and
limited shipping facilities. The Philippine Army medical units lost much of
their medical equipment and supplies during the early contact with the enemy
and in their precipitate withdrawal to Bataan.10 The
Philippine Army soldier was not provided with a mosquito bar. Many of the U.S.
soldiers who were. provided with this item
discarded it as they considered it to be a useless inconvenience.
When the withdrawing Filipino-American Forces arrived in Bataan, they assumed a
defense line across the northern part of the peninsula from Abucay
on the east coast to Moron
on the west coast (map 29). The central and western sectors of the defense line
were mountainous, and the jungle was extremely dense on the lower slopes. An
all weather highway, located 15-20 kilometers to the rear, connected the east
and west roads at Pilar and Bagac
and provided an excellent route for the evacuation of casualties.
Elements of the Japanese 14th Army carried on a sustained frontal attack
beginning early in January 1942, on the east side of the main line of
resistance combined with penetration of the mountainous center and infiltration
to the rear of units on the west coast (map 29). This caused the U.S. Forces to
withdraw on 24-25 January 1942 to a new line through the waist of the
peninsula, parallel to and slightly below the east-west Pilar-Bagac
road. Use of this road was then precluded, and the development of trails and
roads became mandatory to provide egress to the main east and west roads. The
transportation of casualties from forward units to the general hospitals in the
rear then posed an almost insoluble problem. General Hospital Number 1 at Limay was abandoned, having come within range of Japanese
artillery, and personnel and equipment were moved to Little Baguio, kilometer
167, in the general vicinity of Mariveles.
The
Japanese made repeated attacks during February with several penetrations of the
Filipino-American line and also attempted coastal landings to the south and
rear. All of these efforts were defeated, and, by the latter part of February,
the Japanese 14th Army had become ineffective from casualties and
disease and was withdrawn. Similarly, the Filipino-American Forces were now in
dire straits from disease and malnutrition. During March,,
the Japanese 14th Army was reinforced with fresh troops and resupplied
while the Filipino-American Forces remained in position awaiting the final
blow. This came early in April and resulted in total collapse of the Bataan defense forces with surrender on 9 April 1942.
10
See footnote 8,
p. 500.
MALARIA PROBLEM
One
estimate, which was probably conservative, judged the number of cases of
malaria in Filipino-American Forces at the time of surrender, on 9 April 1942,
to be 24,000.11 No estimate is available of the number of cases in
civilian refugees or in the Japanese Forces on that date. In a survey of 1,252
U.S. patients at General Hospital Number 2, made 3 weeks after the surrender of
Bataan, 817 (65 percent) gave a history of having been treated for malaria
during the preceding 4 months.12 Early in March, the commanding
officer of General Hospital Number 2, had reported an estimated 60 percent
incidence of malaria in personnel assigned to the hospital. The appalling death
rate in Japanese-held prisoners of war during the first 6 months of captivity
is further evidence of the catastrophic effects of infection contracted in Bataan. A substantial number of these deaths is attributable to malaria.
Malaria reconnaissance of Bataan before World
War II had clearly demonstrated that it was a formidable reservoir of malaria.
The military situation required the placement of some 80,000 troops and several
thousand displaced civilians in areas of high malarial endemicity.
Some of the military units were located on the flat coastal plain, immediately
adjacent to Manila
Bay, which is relatively
free of malaria, but the majority were located on
higher ground within flight range of A. minimus flavirostris which preyed upon a heavily infected
native population.
The
civilian health authorities before 1941 had not been able to carry out an
effective control program in Bataan. The
military personnel did not have the authority nor the
resources to carry out an antimosquito campaign
throughout the entire extent of Bataan and had
planned to rely chiefly on prophylaxis and careful campsite selection for
peacetime needs. Aside from a limited program of prophylaxis, no antimalaria control measures of any significance were
carried out during the campaign.
Quinine prophylaxis consisting of .650 gm. once daily was instituted for the
Philippine Scouts of the Philippine Department upon their arrival in Bataan early in December 1941 and for service units
working in the rear areas. The application of quinine prophylaxis to the
Philippine Army divisions was not authorized because of an insufficient supply
of quinine. Approximately 4,500,000 five-grain (.325 gm.) tablets of quinine
sulfate were available in the Philippine Department Medical Supply Depot at the
outbreak of war. This was only sufficient for 30 days' prophylaxis on the basis
of 10 grains (.650 gm.) of quinine per man per day. In spite of the lack of a
formal program of prophylaxis for the Philippine Army, many of the officers and
men procured sufficient quinine for their personal use. The limited program of
prophylaxis was hampered by inaccessibility of units, difficulty in medical
supervision, and sus-
11
See footnote 8,
p. 500.
12 Memorandum, Chief; Medical Service, to the
Commanding Officer, Bataan General Hospital
Number 2, Bataan. P.I., 7 May 1942.
tained combat. Many breaks
in quinine discipline occurred. After 15 February 1942, quinine prophylaxis had
virtually ceased except for personnel of the general hospitals, certain rear
service units, and division, corps, and force headquarters.13
The
diagnosis of malaria in the general hospitals in Bataan
was made by the demonstration of the plasmodia in stained blood films. Positive
film diagnosis was based on the presence of standard, well-documented,
identification characteristics of the individual species. Approximately 60
percent of the blood films were positive for Plasmodium vivax,
35 percent for Plasmodium falciparum, and
5 percent for both types of Plasmodia. An occasional case of quartan malaria was diagnosed. It is likely that blood
films taken earlier in the course of malaria and at frequently repeated
intervals would have resulted in the finding of a higher incidence of mixed
infections. Limited facilities precluded more comprehensive studies but were
sufficient for fairly adequate screening until the final chaotic days preceding
surrender. The degree of parasitemia in the falciparum cases was strikingly more evident
when contrasted with the number of plasmodial forms
seen in positive vivax blood films.14
Microscopes were not available in the forward medical units initially, but, for
a limited period, a few were provided as the military operations stabilized. On
the whole, in the forward areas, reliance had to be placed on clinical acumen
for diagnosis.
The
treatment of malaria in vogue in 1941 consisted of 2 gm. of quinine sulfate
daily by month for 5 days followed by .030 gm. of Plasmochin
naphthoate (pamaquine naphthoate) daily in three divided doses for 5 to 7 days. Atabrine was an acceptable substitute for quinine. The long
quinine treatment calling for .650 gm. of quinine daily for 8 weeks, after the
initial 5-day treatment of the acute phase, was considered effective but
difficult to supervise. The short quinine treatment consisting of 1 gm. to 1.3
gm, of quinine daily for 4 to 7 days, repeating for relapses, was considered to
be acceptable in that it avoided the disadvantages of prolonged quinine therapy
and was fairly successful. As Plasmochin and Atabrine were available only in limited amounts, a short
quinine treatment was most commonly prescribed.
IMPACT ON DEFENSE
FORCES
The
deleterious effects of malaria on the troops in Bataan
became strikingly evident in February 1942 and were aggravated by the universal
state of malnutrition. Within less than 1 month after the outbreak of war, 8
December 1941, the defense forces were confronted with an acute food shortage.
On 5 January 1942, the entire force was placed on half rations. The basic
ingredient, of necessity, was rice, mostly of a poor quality. This was supple-
13 Memorandum, Lt. Col. James O.
Gillespie, MC, to Gen, George C. Marshall, 26 Jan. 1942, subject: Medical
Supplies.
14 Personal communication, Maj. Harold W. Keschner,
MC, AUS, formerly Chief, Laboratory Service, General Hospital No. 2, Bataan,
P.I, to Col. James O. Gillespie, MC.
mented by small amounts of
white flour, canned goods (salmon, meat, tomatoes), evaporated milk, and irregular
issues of fresh carabao. Tea, coffee, sugar, and
butter were unavailable after 1 month. The ration was grossly deficient in
protein, fat, and vitamins. It provided a maximum of 2,000 calories in January,
gradually diminishing to 1,000 calories by early March and almost to the
vanishing point by 1 April 1942.
The
ill effects of semistarvation on the troops had
become critical by late February 1942. The Surgeon of the Advance Echelon of
USAFFE (U.S. Army Forces in the Far East), Bataan, advised the Surgeon, USAFFE,
on Corregidor, in a memorandum dated 27 February 1942, that the diet of troops
on Bataan was grossly deficient and urged increased allowances of beef,
vegetables, milk and the procurement, if possible, of native fruits and
vegetables, and in their absence the procurement of vitamin supplements.
By
the third month of operations, weight loss in the range of 20 to 30 pounds was
commonplace. Men complained of weakness, lassitude, lack of endurance, and
shortness of breath. Moderate exertion caused tachycardia and palpitation.
Those nominally listed as effective for combat could not engage in sustained
exertion, so it became increasingly difficult to accomplish necessary work on
airstrips, maintenance of roads, clearing of trails, hand carrying of supplies
over mountainous terrain, and patrol activities. Gradually, the high morale and
confidence of January was replaced by a loss of spirit and apathy. Dire
predictions for the future could be heard. To lessen the morale- further, the
men began to note swelling of the ankles with pitting on pressure which was
particularly evident toward evening. The pangs of hunger became more insistent.
Beginning about mid-February 1942, the sickness rate began to rise abruptly.
The majority of patients were medical cases suffering from malaria or dysentery
and showing evidences of malnutrition and avitaminosis.
Some showed loss of subcutaneous fat and muscle wasting. Others appeared with a
considerable degree of edema of the lower extremities. A few patients from
isolated units who had undergone more severe deprivations showed marked
peripheral neuritis with footdrop and wristdrop. Patients with wounds and fractures began to show
a slower rate of healing. 15
Up
to the first week in March 1942, the evacuation of the sick and wounded had
been accomplished in an orderly fashion. Certain patients who ordinarily would
have been transferred to the general hospitals had been treated by medical
units because of inaccessibility to motor vehicles. The general hospitals had
expanded to meet the continually increasing demand for beds through the device
of manufacturing bamboo cots and clearing larger areas of the jungle to provide
space for them. Then, beginning approximately 7 March 1942, patients by the
hundreds began to arrive daily at the re-ar
hospitals. Most of them appeared to be suffering from malaria. Shortage of
quinine
15 History of General Hospital No.
2, Bataan, P.I., 28 Dec. 1941 to 9 Apr. 1942, from personal papers of Maj. Gen.
James O. Gillespie.
then required the adoption of a modified short quinine
therapy utilizing 15 gm. or less of quinine rather than the standard treatment
of 35 or 40 gm.
Admissions for cerebral malaria became evident early in March 1942. These were
chiefly men from isolated units who were in unusually poor physical condition
from stress and malnutrition and for whom medical attention was not available.
The number of these cases reaching the general hospitals was not large; in all
they did not exceed 100 cases. Cerebral manifestations of malaria were usually
associated with P. falciparum. The symptomatology was variable but frequently appeared with
coma and a shocklike state or with delirium,
convulsions, and maniacal reactions. Responses to intravenous
quinine was dramatic. More often the lack of that item required the
administration of 3 or 4 gm. of quinine sulfate by stomach tube. Usually the
mental component of the disease was relieved in 3 or 4 days.
Malarial patients who were severely depleted from diarrhea and malnutrition did
not respond well to massive antimalaria therapy.
Occasional patients receiving 2 gm. of quinine sulfate daily by mouth continued
to have fever and positive blood films. Other individuals on
suppressive therapy of .650 gm. of quinine daily developed chills and fever and
positive blood films. The same phenomena were noted frequently at prison
camps during the summer of 1942. One case of blackwater
fever was seen at general Hospital Number 2 in a civilian who lived in Bataan. Two cases in Japanese-held prisoners of war (one
British and one Dutch) were seen during 1943 in a prison camp in Formosa.
Early in March 1942, Col. Arthur F. Fischer, USAR, while convalescing from
malaria in Bataan, called the attention of Maj. Gen. Jonathan M. Wainwright's
headquarters to 100,000 kilograms of high-grade quinine bark available in
Mindanao, from which totaquine could be extracted.16
Dr. Fischer had pioneered the introduction of cinchona into the Philippines and
had worked with that program for 18 years. He was flown to Mindanao
for the purpose of beginning large-scale extraction of the quinine bark.
Penetration of the area by Japanese Forces prevented completion of the project,
and Dr. Fischer was flown to Australia
carrying seeds for the establishment of cinchona plantations in South America.
The
catastrophic impact of disease and semistarvation on
the combat effectiveness of the Filipino-American Force in Bataan
was recognized to be of the utmost gravity by all levels of staff and command.
On 10 March 1942, the commanding officer of General Hospital Number 2, directed a letter regarding malaria control to the
Surgeon, Philippine Department, a portion of which is quoted.
I
would like to point out a grave problem pertaining to the Medical Department
and the USAFFE. Malaria is rapidly increasing: some 350 cases were under
treatment in this hospital as of March 5th. The admission rate is alarming,
sonic 260 patients
16 Personal communication.
Col. Arthur F. Fischer, USAR, to Maj. Gen. James O. Gillespie, 24 July 1956.
arriving March 9th. Most of these are
medical and a large proportion have malaria.
* * *. Quinine prophylaxis having stopped we anticipate
additional hundreds or even thousands of cases * * * . We are urgently in need of a tremendous stock of quinine
for treatment arid prophylaxis. The General Staff should understand the extreme
gravity of the malaria problem and give priority to quinine above that of any
other critical item. If the malaria situation is not brought under control the
efficiency of the whole Army will be greatly impaired; in fact it will he unable to perform its combat functions. It is my
candid and conservative opinion that if we do not secure a sufficient supply of
quinine for our troops from front to rear that all other supplies we may get,
with the exception of rations, will be of little or no value.
The
USAFFE Surgeon, Corregidor, in a memorandum to the Assistant Chief of Staff,
G-4 (logistics), USAFFE, on 22 March 1942, stated that there were 3,000 cases
of malaria in Bataan and that the numbers were
increasing at an alarming rate. He referred to the extremely high noneffective rate in combat units and recommended that 3
million quinine tablets be sent from Australia by air at once with a
like quantity thereafter each month.
To
deal with the overwhelming flood of patients in the forward units and to
relieve pressure on the general hospitals, the Surgeon, Luzon Force, early in
March, directed that battalion aid stations and clearing and collecting
companies assume the responsibility for the treatment of all patients except
those whose condition was of the utmost gravity.17 The aid stations
were expanded to 200 to 300 beds (bamboo construction) while the clearing and
collecting companies handled from 600 to 900 patients each.
The
Surgeon, Luzon Force, reported on 23 March 1942, in a letter to the commanding
general, that the daily admission rate for malaria had reached 500 to 700 cases
and that the available supply of quinine at the medical depot in Bataan was sufficient, using a short course of treatment,
only for approximately 10,000 cases of malaria. He anticipated exhaustion of
the stock in 3 or 4 weeks and predicted a mortality rate of 7 to 10 percent in
untreated cases. Extreme concern was expressed regarding the sharply rising noneffective rate in relation to combat potentialities of
the Force. Writing to the Chief of Staff, USFIP (U.S. Forces in the
Philippines), on 31 March, the Chief of Staff, Luzon Force, referred to a
malaria admission rate reaching 1,000 cases daily and to the imminent loss of
combat effectiveness.
By
the end of March, some 7,000 patients were hospitalized in the forward medical
units, a mere mile or so behind the main line of resistance. These represented
only those who were severely incapacitated. Actually, at least 80 percent of
the troops had become unfit for duty. One regimental surgeon described the
situation as follows:18
To
give an accurate word-picture of conditions as they actually existed at the
time immediately preceding the surrender of our forces on Bataan would tax the
descriptive powers of a rhetorical genius, hut in simple language, almost every
man in Bataan was suffering, not only from the effects of prolonged starvation,
but also from one or both of the acute infections that plagued us throughout
the campaign, viz, dysentery and malaria. I
17
See footnote 8,
p. 500.
18 See footnote 8, p. 500.
have seen men brought into the battalion aid stations
and die of an overwhelming infection of dysentery or cerebral malaria before
they could he tagged and classified for evacuation. Of the supposedly well men
in the field, all were thin and weak from starvation. Many were swollen with
nutritional edema; a large percentage were pale and
anemic from repeated attacks of malaria or dysentery.
As
early as January 1942, General MacArthur had made urgent requests to the Chief
of Staff, U.S. Army, for food and medical supplies to be sent through the
Japanese blockade by any possible means. General Wainwright in March reiterated
the extreme urgency of his requirements for both items and, in response., Gen. (later General of the Army) George C.
Marshall, Chief of Staff, requested that maximum amounts of quinine be sent
from Australia
by air. This could not be accomplished, but 1 million tablets of quinine
sulfate were brought by air from the medical depot at Cebu to Bataan.
This supplement proved to be sufficient to provide at least a short type of
therapy, and no hospitalized patients were denied quinine before surrender. The
death rate from malaria before capitulation therefore was extremely low.
When the final Japanese attack began on 3 April 1942, it became imperative to
move all patients from forward medical units to the rear hospitals.
Approximately five thousand patients were absorbed at General Hospital Number 2
between 5 April and 8 April; other thousands were directed to a convalescent
camp in its vicinity. 19 On 9 April 1942, all surviving members of
the Filipino-American defense force, including patients and medical personnel,
were categorized as captives and thereafter were required to submit to the
orders of the Imperial Japanese Army.
IMPACT ON CIVILIAN
REFUGEES
The
situation of the several thousand civilian refugees behind the
Filipino-American lines became increasingly desperate during the period 7
January to 9 April 1942. Most of these refugees were located in the Limay Mariveles Cabcaben areas which previously had been established as
regions of severe malarial infection. There they lived in refugee camps and
were issued the same meager rations as the Army received. Medical attention was
provided by refugee Philipino physicians in crudely
improvised hospitals. These people were without protection from malarial mosquitoes,
and they suffered severely from malaria having no antimalarial
drugs for treatment. These unfortunates were often threatened by bombing raids
on nearby villages and military installations. Many were wounded and killed.
A
mass evacuation from Bataan of refugees and
Filipino military patients began immediately following capitulation on 9 April
1942. These individuals trudged along the east road leading out of Bataan. Many of them were ill with malaria and dysentery.
Among them were old men, women, and children, carrying their total possessions
in assorted bundles, bags, and cans. The pro-
19 See footnote 15, p. 505.
cession continued for days. Often, the seriously ill
would fall by the roadside to die, and after a few days several hundred bodies
could be counted along the road between Cabcaben and Limay.
The
disruptions caused by war resulted in a considerable increase in the incidence
of malaria in Bataan and adjacent provinces
after the conclusion of the campaign in 1942. This was brought about by the
huge increase in the numbers of human carriers who had become infected and for
whom proper treatment was not available, and by the complete breakdown of
control measures. Studies made on the civilian refugee population evacuated
from Bataan in 1942 showed a large increase in
the malaria rate, and it was noted that the disease was more difficult to treat
with the higher death rate. Over 24,000 cases of malaria were diagnosed in
civilian emergency hospitals in Bataan and
surrounding provinces during the fall of 1942.20 The
overall mortality rate was 2.2 percent. Before the war in 1941, the fatality
rate in the same provinces had been 0.64 percent. An intensive malaria control
program was carried on in Bataan from 1942-44
by direction of the Japanese military command.
IMPACT ON THE
JAPANESE FORCES
The
impact of malaria on the Japanese Forces can only be partially documented. The
Japanese Army had planned for a quick operation in Bataan,
expecting to overcome the Filipino-American troops in a week or 10 days. When
they met with firm resistance which continued during January and February,
their troops began to suffer from some of the same deprivations and diseases
which harassed the Filipino-American Forces. The Japanese ration for their troops
on Bataan was meager, although it did not
reach the low point of the Filipino-American ration. The Japanese were exposed
to the same hazards from malaria, diarrhea, and dysentery. By mid-February, the
Japanese 14th Army was definitely depleted, chiefly from malaria.
21 An interpreter who served with the Japanese 14th Army in Bataan
stated to the senior Japanese-held U.S. medical officer in July 1942, that the
Cabanatuan prison camp situation, where over 3,000 seriously ill Americans were
incarcerated, reminded him of the illness suffered by the Japanese troops in
Bataan. He asserted that in some units of the Japanese Army the noneffective rate from malaria and dysentery reached 90
percent and that the death rate from malaria was very high. He stated that the
former U.S. military
hospital, Steinberg General Hospital,
was packed to capacity with Japanese soldiers who had become ill in Bataan.
On
10 April 1942, a Japanese guard of 20 men was assigned to General Hospital
Number 2. Approximately 60 percent of these soldiers were acutely
20 Urbino, Cornelio M.: Epidemiology of
Malaria in Bataan Before
the War and During the Japanese Occupation, and Malaria Control From 1942 to
1944. Philippine Islands Health Service
Monthly Bulletin 23: 297-344, 1947.
21 See footnote 7, p. 499.
ill with malaria within 3 weeks. No medication was
provided for them by the Japanese Army. They were treated however, by U.S. medical
officers at the direction of the Japanese Army. It was estimated by Horiguchi, surgeon of the Japanese 14th Army, that
10,000 to 12,000 Japanese soldiers were ill with malaria, dysentery, and
beriberi in February 1942 and that less than 3,000 effective men remained. The
Japanese 14th Army had begun their campaign with only 1 month's supply
of quinine, and in January its use for prophylaxis was discontinued except for
frontline troops; after 10 March, quinine was available to them only for
therapy. Thus, it seems clear that the firm resistance of the Filipino-American
Forces in Bataan, combined with extensive infestation of the Japanese troops
with malaria, resulted in an upsetting of the Japanese timetable for the
prosecution of the war in the Philippines.
This was a significant matter as Japanese troops had to withdraw from Singapore to complete the campaign in Bataan.
IMPACT ON THE
FILIPINO-AMERICAN PRISONERS OF WAR
The
tragic story of the appalling loss of life in the Filipino-American Forces
after the surrender is directly related to malnutrition and disease experienced
in Bataan. Malaria contributed significantly
to the impressive mortality. Other significant factors included prolonged
marches to the prison camps in tropical heat, inadequate food, lack of potable water, lack of medical supplies, deplorable
sanitary conditions, extreme overcrowding, and overwork. Twenty-nine thousand
five hundred eighty-nine deaths occurred in 1942 at Camp
O'Donnell in Japanese-held prisoners
of war from Bataan. Six thousand one hundred
twenty-nine (20.7 percent) clinically were attributed to malaria.22
Four hundred ninety-eight deaths occurred in U.S.
prisoners at Cabanatuan
Prisoner-of-War Camp Number 1 during June 1942. One hundred twenty-eight were
diagnosed as caused by malaria. During July 1942 in the same camp 789 U.S. prisoners
died. Beginning approximately 1 August 1942, sufficient quinine was provided by
the Japanese to treat 1,600 cases of active malaria, using 14 gin. of quinine sulfate per
patient.23 Deaths decreased to 240 during the month of August. On 31
August 1942, the senior Japanese-held U.S. medical prisoner of war requested in
a letter to the Japanese camp commander, Cabanatuan Prisoner-of-War Camp Number
1, that 750,000 3-gram tablets of quinine sulfate be furnished to treat an
estimated 3,119 cases of malaria. The quantity desired was not obtained, and
needless deaths continued. Two thousand four hundred deaths occurred in
Japanese-held U.S. prisoners
of war at Cabanatuan
Prisoner-of-War Camp Number 1 from 1 June to 1 December 1942. Approximately 25
percent of these deaths clinically were attributed to malaria.
22
See footnote
20, p. 509.
23 Diary, Col. James O. Gillespie. MC, U.S.
Army, Prisoner of War Camp No. 1, Cabanatuan, P.I., 31 May-31 Aug. 1942.
Japanese-held prisoners of war in the Philippines
were subjected to an extreme degree of stress during the first 6 months of
captivity. Semistarvation, begun in Bataan,
continued for many months after capture. Nutritional edema (wet beriberi),
multiple avitaminosis, burning feet syndrome, and
pellagra affected 95 percent of prisoners to a greater or less degree.
Diarrheal conditions, including specific dysenteries, were commonplace. Two
hundred twenty-three prisoners contracted diphtheria between 10 June and 8
August 1942 at Cabanatuan
Prisoner-of-War Camp Number 1. Ninety-one of these died. Men depleted by such a
variety of conditions did not respond to antimalarial
drugs in the manner observed in healthy individuals. The failure to respond may
have been due to poor absorption of quinine from the gastrointestinal tract.
When intravenous quinine was given, response was satisfactory. Unfortunately,
almost none was available.
The
protean manifestations of malaria in the prison camps caused much confusion in
the presence of dysentery and malnutrition with avitaminosis.
Gastrointestinal symptoms such as nausea, vomiting, and severe diarrhea were
frequent in proved cases of malaria. Others showed symptoms of acute
appendicitis or other acute abdominal crises. These were soon recognized as
manifestations of malaria requiring search of a blood film for plasmodia as the
most important laboratory procedure. Response to antimalaria
therapy often was dramatic in these cases.
Throughout more than 3 years of captivity, malaria recurrences were very
frequent in prisoners in the Philippines,
Formosa, Japan, and Manchuria.
A few individuals had as many as 20 relapses. As a cause of death, malaria
became less important during 1943-44 not only because of the better conditions
of diet and improved therapy but also because of the tremendous death rate which
had eliminated the most severely ill. As late as 1945, an appreciable number of
prisoners of war were suffering from malaria relapses.
COMMENT
The
defeat of the Filipino-American Forces in the Philippines undoubtedly was
hastened by the conditions resulting from a semistarvation
ration with the additional deleterious effects from common diarrheas,
dysentery, and malaria. The Surgeon, Luzon Force, expressed his opinion as
follows:
The
capitulation of Luzon Force represents in many respects a defeat due to disease
and starvation rather than to military conditions. Malnutrition, malaria, and
intestinal infections had reduced the combat efficiency of our forces more than
75 percent. The Bataan campaign can best he
described as a campaign of attrition, a campaign in which consumption without
replenishment was the rule. The physical fitness of Our
troops was so seriously impaired by 1 March that it became a determining factor
in tactical Operations. From that date onward the physical deterioration of our
forces was so rapid that by 2 April a successful defensive stand was no longer
possible.24
24
See footnote 8,
p. 500.
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Bataan