World War II: Typhus Fever and Malaria in the Mediterranean

In 1942, as the Allied armies prepared to push into Europe from the Mediterranean the following year, several groups of medical officers and civilian advisors worked on ways to control or eliminate the typhus fever that had already emerged in some parts of eastern Europe and North Africa. Louse-borne typhus fever was a familiar by-product of wartime troop and refugee movements, crowding in camps and prisons, undernourishment, and lack of bathing and laundry facilities. Although the causative microbe and its vector had been discovered, efficient methods of preventing typhus fever had not. Methods of delousing were still cumbersome, and would not prevent reinfestation. Fred Soper was assigned to the U.S.A. Typhus Commission (USATC) to help develop an efficient, direct chemical attack on the body louse, and thus contain or prevent epidemic typhus.

The USATC project (which Soper later dubbed "my lousy adventure") began in February 1943 by testing the Army's standard louse powder, code-named MYL, in two Egyptian villages known to have typhus. Due to difficulties of de-lousing people, USATC workers powdered the seams of villagers' clothing, then kept track of the reinfestation rates. Early results were excellent; dusting all villagers every two weeks produced a striking reduction in lice, thus in typhus. Later trials (conducted without Soper, who was in the hospital with typhus for six weeks!) were not as successful, perhaps due to sub-standard manufacture or deterioration of the louse powder used. This convinced the USATC chief, General Leon Fox, that louse powder was useless, and he decided to discontinue village de-lousing work, and concentrate on typhus control in hospitals. Soper believed the village work worth further trials, and went to Algiers to work with the Rockefeller Foundation's Typhus Team (RFTT).

The various authorities overseeing operations in the region--civilian and military, American and British--sometimes failed to agree, or to communicate clearly about the typhus projects. This made it difficult for Soper to get established in North Africa, delaying personnel, housing, travel, and supply orders for several months. In late July, he was finally able to settle down to work with the staff of the Pasteur Institute in Algiers. The Institute provided office space for the RFTT, and access to nearly 1,000 inmates in the Maison Carrée prison for controlled comparative testing of insecticides. These included the MYL louse powder and the newly-available DDT insecticide. Both gave excellent results; MYL killed lice faster, but DDT's effects lasted much longer.

Following this success, the Typhus Team chose several Arab villages for further insecticide trials. For this, a French colleague warned, they would need to find a way to apply louse powder to the inner seams of clothing without undressing the wearer. The solution proved simple: using a hand duster, they pumped the DDT or MYL dust up sleeves and skirts, down neck openings and waistbands. The air space between garment and skin allowed for the even dispersal of the powder under pressure, and the procedure was much faster. Once the villagers discovered how effective this treatment was, they enthusiastically turned up for treatment. In fact, louse powder became a black-market commodity and acquired a reputation as a cure for insomnia, since those treated were able to sleep without the distraction of the lice, often for the first time in their lives.

From this experience, Soper drafted the RFTT's standard operating procedure for delousing with insecticide powders, which became the basis for Circular Letter No. 43, "Typhus Fever Control," issued in late 1943 by the Office of the Surgeon, North African Theater of Operations, U.S. Army. The new techniques and procedures developed by Soper and his team soon proved critical in containing typhus fever in Italy.

Cases of typhus were reported in Naples in September 1943, while Allies were moving into Italy. Soper began talking to the Allied Control Commission and other authorities about proposals for RFTT intervention, and ordering louse powder and hand pumps. Again, his efforts were delayed at several points by jurisdictional wrangling (between the Allied Military Government (AMG), the Allied Control Commission (ACC) and the USATC), even after a typhus outbreak in Naples in early December. Mass dusting of civilians finally began in mid-December. By January 10, 1944, the dusting stations were treating over 50,000 people per day. New typhus cases began to fall off, and by late February the problem was nearly resolved. RFTT stayed on until the war's end, continuing de-lousing on a diminishing scale, and maintaining surveillance.

Besides the typhus control work, Soper also found himself assisting with malaria control in Egypt. Just after arriving in Cairo in January 1943, Soper had learned of malaria outbreaks along the Nile River valley and investigated. With the recent lessons from Brazil in mind, he advised British and Egyptian authorities to launch an eradication program immediately, but went unheeded. A second epidemic of malaria developed later in 1943, and in early 1944, Egypt asked the Rockefeller Foundation to send an advisor. In May 1944, Soper recommended the eradication system that worked in Brazil, got the campaign launched, then left Rockefeller colleague J.A. Kerr in charge. By December 31, 1945, no gambiae mosquitoes or malaria could be found along the Nile.