ARRC JOURNAL
THE MOSQUITO IS MIGHTIER
THAN THE MORTAR:
LESSONS FOR COMMANDERS
ON FORCE HEALTH PROTECTION
Colonel Jeremy Tuck, British Army
Major Glen Bullivant, British Army
It is a military truth that any force will suffer more attrition due to disease and non-battle
injury than combat. Amongst the many diseases that have affected military forces over
time, malaria, spread by the female anopheles mosquito, has arguably had the most
decisive impact.
Despite great efforts over the past 20
years to reduce the incidence of malaria,
it still remains a risk to half of the world’s
population in 91 countries, some of
which our participating nations and we
are currently serving in.
“I only had to sack
three [commanding
officers], by then
the rest had got my
meaning.”
Field-Marshall Viscount Slim
Historical Impact
The armies of the Goths and the Huns
both succumbed to malaria at the walls
of Rome in the 4th century. The disease
affected Genghis Khan’s army in the
12th century. The British campaign to
the Walcheren in 1809 was defeated by
malaria after Napoleon had deliberately
flooded the area in order to encourage
the spread of the disease; while some
100 fatalities were combat related,
just over 4,000 fatalities were ascribed
to malaria. In the British West African
campaign of 1849 the deployed force
was defeated by disease without ever
coming into contact with the enemy. In
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ALLIED RAPID REACTION CORPS
the French campaign in Madagascar in
1895, 13 soldiers died by enemy action,
4,000 by malaria.
Perhaps the most significant episode
in which malaria played a part was
George Washington’s campaign during
the American War for Independence.
The end of the Siege of Yorktown on 19
October 1781 was the culminating point
of the war. Having lost Yorktown, the
British position in the American colonies
was untenable and the fledgling United
States finally won its independence.
However, what is frequently overlooked
is that 50 per cent of the British garrison
was not fit to fight because of malaria.
The Continental Army, in contrast, was
taking an infusion of the Cunchina
tree, then known empirically to prevent
and cure the disease even if it was not
understood how the disease spread or
how the Cunchina infusion worked. The
active component was identified later as
Quinine by French researchers Pelletier
and Caventon in 1820, but still the
causative parasite and the vector for its
spread were unknown.
While the Romans had understood the
importance of poorly drained land as a
factor in the spread of the disease (known
in some areas as Marsh fever), it was
Laveran who first described the malaria
parasite in 1880. When Grassi and
Ross published, almost simultaneously
(1897/1898), their research that identified
the female anopheles as the vector
responsible for transmitting the disease,
the means of preventing the disease
through insect control finally became
clear. Yet for military forces, malaria
remained a major threat. British, French
and German troops in Macedonia during
the First World War were affected heavily
by malaria. So much so that one French
commander in particular was unable
to make an attack as his “Army was in
hospital” with malaria.
The Role of the Commander
It is arguably Field Marshall Slim who
was the first commander who understood
the importance of maintaining the force
through health protection. He changed
the approach to malaria management
through prevention and treatment. At
the time, malaria treatment was given
in the base area. This almost rewarded
soldiers for catching the disease. Slim
moved malaria treatment units forward,
making the prospect of being admitted
for treatment far less appealing. He also
understood that good doctors were of
little use without good officers to take
the lead in enforcing health discipline. To
reinforce this message, Slim introduced
unit inspections to assess compliance
with malaria protection policy. If the
unit failed to achieve 95% success, he
sacked the commanding officer. In two
years, Slim reduced the incidence of
malaria in the Burma Army six fold.