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Going through my father’s old army footlocker, I ran across this bottle of quinacrine antimalaria pills. An earlier version of hydroxychloroquine—in the news recently surrounding the Covid-19 virus—I thought it was an interesting find. My father, Technician Fifth Grade William Harold Beard, was in the 86th Infantry (Blackhawk) Division, 343rd Regiment, Cannon Company. The division was one of the last to go to Europe, and when Germany surrendered it was one of the first to be sent back home—but after a few weeks’ furlough, they were sent to the Philippines to prepare for the invasion of Japan. I am not even sure that these pills were issued to him during the war, but was wondering if all soldiers going to the Philippines were issued quinacrine. 

—Glenn Beard, Tifton, Ga.

The antimalarial drug Atabrine (above) was vital but loathed. (Courtesy of Glenn Beard)
The antimalarial drug Atabrine (above) was vital but loathed. (Courtesy of Glenn Beard)

 

The global nature of World War II introduced Americans to a wide range of environments and the diseases present there. Malaria proved to be one of the deadliest for Allied troops—an opponent that several U.S. commanders declared more dangerous than the enemy’s bullets. A serviceman can’t be at his fighting best with a fever of 106 degrees, and up to 65 percent of American troops who served in the Pacific reported suffering from the mosquito-borne disease, which causes high fever, chills, nausea, and fatigue. Malaria plagued troops not only in the Pacific Theater but also in the Mediterranean.

For Allied troops, the most common treatment for malaria was quinacrine, commonly known by the brand name Atabrine. Atabrine was a synthetic version of quinine—derived from the bark of species of trees of the Cinchona genus—which became unavailable to the Allies following the Japanese occupation of Java and the Dutch East Indies, where the Dutch had produced almost 90 percent of the quinine sold in world markets. During World War II, American Atabrine makers were able to produce the enormous quantities needed to supply Allied forces in the Pacific. A staggering 1.8 billion doses were delivered in 1943 and an even more impressive 2.5 billion in 1944.

Atabrine did not cure malaria but suppressed its symptoms. Once Atabrine usage was suspended, the effects of the disease returned, even if one was removed from the area where infection was rampant. The military learned lessons in early Atabrine usage that informed later practice and led to more successful employment of the drug.

The troops hated it, though, so Atabrine’s effectiveness also depended on enforcement of use. The side effects of the drug read like the long list of ailments following any pharmaceutical commercial, including nausea, headaches, diarrhea, skin discoloration, and neurological problems resulting in nightmares, anxiety, and full-blown psychosis. Of those, the most common side effect was skin discoloration: Atabrine caused the user to turn yellow. In a letter in The National WWII Museum’s archives, Sergeant Gordon Sill wrote to his family from the Philippines in March 1945: “I do wish they would vary our diet of fish and Corned Willie [canned corned beef] and Atabrine—I’m almost as yellow as this paper.” This side effect was enough for many to suspend use. In addition, rumors circulated widely that Atabrine caused impotence—a falsehood spread by Japanese propaganda.

Enforcing Atabrine usage was difficult, especially when troops were in combat areas. Compliance was left up to the command, and this sometimes resulted in supervised mandatory ingestion or in surprise compliance checks. In hospitals, on bases, or in other staging areas, Atabrine dosing was monitored during meals. In the mess, when going through the chow line, each diner would be given a pill. As Carl Marca, a 2nd Lieutenant in Military Intelligence, recalled in an oral history with The National WWII Museum about his time in Finschhafen, New Guinea, “they would have a WAC [Women’s Army Corps member], and you’d come down the line and you’d open your mouth and she’d toss in an Atabrine.”

There were even antimalarial units like the 209th Malaria Survey Unit, which was deployed on the island of Morotai, in present-day Indonesia, to identify areas of infection and carry out DDT-spraying. Despite their efforts, the use of antimosquito nets, and Atabrine ingestion, servicemen reported suffering from bouts of malaria not just once, but multiple times. In some cases, malaria continued to attack American troops long after the war; in order to still the effects of malaria acquired in wartime, some remained on an Atabrine regimen for as long as six years. Although Atabrine—quinacrine—is no longer manufactured on its own, the use of antimalarial drugs like quinacrine and the later-synthesized hydroxychloroquine is one of the medical legacies of World War II. To this day, malaria remains a global problem, causing 440,000 deaths annually. 

—Kim Guise, Assistant Director for Curatorial Services, The National WWII Museum  

This article was published in the August 2020 issue of World War II.