MEDICAL DEPARTMENT, UNITED STATES ARMY
INTERNAL MEDICINE IN VIETNAM
Volume II
GENERAL MEDICINE AND INFECTIOUS DISEASES
Editors for Internal Medicine
Brigadier General ANDRE J. OGNIBENE, MC, USA, and Colonel O`NEILLBARRETT, Jr., MC, USA (Ret.)
OFFICE OF THE SURGEON GENERAL AND CENTER OF MILITARY HISTORY UNITED STATES ARMY
WASHINGTON, D.C., 1982
Library of Congress Cataloging in Publication Data Main entry under title
General medicine and infectious diseases.
(Internal medicine in Vietnam; v. 2)
At head of title: Medical Department, United States Army in Vietnam. Includes bibliographies and index.
Supt. of Docs. no.: D 104.11/2:In8/v. 2
1. Communicable diseases-Vietnam. 2. Communicable diseases-Vietnam Statistics. 3. Vietnam Conflict, 1961-1975-Medical and sanitary aspects. 4. Tropical medicine-Vietnam. I. Ognibene, Andre J. II. Barrett, O`Neill. III. United States. Surgeon General`s Office. IV. Center of Military History (U.S.) V. United States. Army Medical Dept. VI. Series. [DNLM: 1. Military medicine-United States. 2. Internal medicine-Vietnam. 3. Communicable diseases-Occurrence-Vietnam. 4. Tropical medicine-Vietnam. WB 115 B274g]
INTERNAL MEDICINE IN VIETNAM
Advisory Editorial Board for the History of the U.S Army Medical Department in Vietnam and Southeast Asia
Major General JAMES A. WIER, USA (Ret.), Chairman
Major General SPURGEON H. NEEL, Jr., USA(Ret).
Major General EDWARD H. VOGEL, Jr., USA(Ret.)
Major General ROBERT E. BLOUNT, USA (Ret.)
Major General JAMES T. MCGIBONY, USA (Ret.)
Major General WILLIAM H. MONCRIEF, USA (Ret.)
Brigadier General OSCAR P. HAMPTON, Jr., USAR(Ret.)
Colonel HINTON J. BAKER, USA (Ret.)
Colonel JESSE N. BUTLER, USA (Ret.)
Colonel THOMAS P. CAITO, USA (Ret.)
Colonel ROBERT P. CAMPBELL, USA (Ret.)
Colonel JENNIE L. CAYLOR, USA (Ret.)
Colonel HERSCHEL E. GRIFFIN, USA (Ret.)
Colonel ARNOLD W. JOHNSON, USA (Ret.)
Colonel CHRIS J. D. ZARAFONETIS, USAR (Ret.)
CHARLES J. SIMPSON
Advisory Editorial Committee on the History of Internal Medicine
Brigadier General ANDRE J. OGNIBENE, MC, Chairman
Colonel ALFRED M. ALLEN, MC
Colonel O`NEILL BARRETT, Jr., USA (Ret.)
Colonel RONALD R. BLANCK, MC
Colonel RAYMOND W. BLOHM, Jr., USA (deceased)
Colonel NICHOLAS F. CONTE, USA (Ret.)
Colonel JOHN J. DELLER, Jr., USA (Ret.)
Colonel NORMAN W. REAM, MC
Center of Military History
Brigadier General JAMES L. COLLINS, Jr., Chief of Military History
MAURICE MATLOFF, Chief Historian
CHARLES J. SIMPSON, Director, Clinical History Program
Colonel ROBERT N. WAGGONER, Chief, Historical Services Division
Colonel JAMES W. DUNN, Chief, Histories Division
MEDICAL DEPARTMENT, UNITED STATES ARMY
The volumes comprising the official history of the Medical Department of the United States Army in Vietnam are prepared by the U.S. Army Center of Military History and published under the direction of Lieutenant General Charles C. Pixley, The Surgeon General, and Brigadier General James L. Collins, Jr., Chief of Military History. These volumes are divided into two series: (1) the professional, or clinical and technical, series; and (2) a series devoted to medically related subjects. This is the second volume of the former series; the first volume is entitled "Skin Diseases in Vietnam, 1965-72."
It should be the duty of every soldier to reflect on the experiences of the past, in the endeavor to discover improvements, in his particular sphere of action, which are practicable in the immediate future.
-B. H. Liddell Hart (Thoughts on War, 1944)
Authors
O`NEILL BARRETT, Jr., M.D.
Colonel, MC , USA (Ret.). Professor of Medicine and Assistant Dean for Academic Affairs, University of South Carolina School of Medicine , Colombia . Chief, Medical Service, and Chief, Professional Services, 8th Field Hospital, Nha Trang, Vietnam, 1962-63; Chief, Department of Medicine, Tripler General Hospital, and USARPAC Medical Consultant, 1968-71; Chief, Department of Medicine, Walter Reed Army Medical Center, 1971-73.
RAYMOND W. BLOHM, Jr., M.D. (Deceased)
Colonel, MC , USA . Formerly Chief, Professional Services, Fitzsimons General Hospital . USARV Medical Consultant, Vietnam, 1966-67; Assistant Chief, Department of Medicine, Walter Reed General Hospital, 1967-69; Chief, Department of Medicine, Walter Reed General Hospital, 1969-71; Clinical Associate Professor of Medicine, Georgetown and Howard Universities, 1969-77.
FRANCIS C. CADIGAN, Jr., M.D.
Colonel, MC , USA . U.S. Army Medical Liaison Officer to British Military Medical Services, London ; Lecturer in Military Medicine, Uniformed Services University of the Health Sciences. Deputy Director, SEATO Medical Research Laboratory, Bangkok, Thailand, 1964-67; Director, U.S. Army Medical Research Unit, Kuala Lumpur, Malaysia, 1969-72; Director of Medical Research, U.S. Army Medical Research and Development Command, Washington, D.C., 1972-76; Director, Biomedical Laboratory, Edgewood, Md., 1976-79.
DONALD CATING, M.D.
Adjunct Assistant Professor of Clinical Medicine and Community Medicine, Dartmouth Medical School, Hanover, N.H.; Chief of Internal Medicine, New London Hospital, New London, N.H. Formerly Captain, MC, USAR. Member , U.S. Army Medical Research Team, WRAIR, Vietnam , 1967-68.
DAN C. CAVANAUGH, Ph.D.
Colonel, MSC , USA (Ret.). Member, Expert Panel, Bacterial Diseases (Plague), World Health Organization. Chief, Plague Section, Medical Research Team, WRAIR, Vietnam , 1964-65; Chief, Department of Hazardous Microorganisms, Walter Reed Army Institute of Research , 1973-81.
EDWARD J. COLWELL, M.D.
Attending physician, Internal Medicine, Peninsula General Hospital , Salisbury , Md. Formerly Lieutenant Colonel, MC , USA . Member, U.S. Army Medical Research Team, WRAIR, Vietnam, 1967-68; Deputy Director, SEATO Medical Research Laboratory, Bangkok, Thailand , 1970-72; Member, Departments of Immunochemistry and Virology, Walter Reed Army Institute of Research, 1969 and 1973.
NICHOLAS F. CONTE, M.D.
Colonel, MC , USA (Ret.). Consultant in Internal Medicine to the Surgeon, USARV, 1967-68; Army Liaison Representative, Endocrinology Study Group, National Institutes of Health, 1969-72; Chief Medical Consultant to The Surgeon General, 1972-75; Governor (Army), American College of Physicians, 1972-75.
JOE A. DEAN, M.D.
Gastroenterologist, Medical and Surgical Clinic, Wichita Falls, Tex. Formerly Lieutenant Colonel, MC, USAR. Formerly Chief, Gastroenterology Service, Brooke Army Medical Center ; Chief, Army Medical Re-evaluation Program for Prisoners of War, Vietnam.
JOHN J. DELLER, Jr., M.D.
Colonel, MC , USA (Ret.). Director of Education and Research, Eisenhower Medical Center, Rancho Mirage, Calif. Chief, Department of Medicine, Letterman Army Medical Center, Presidio of San Francisco, 1969-76.
JAMES V. DONADIO, Jr., M.D.
Professor of Medicine, Mayo Medical School, and Chairman, Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, Minn. Formerly Captain, MC, USAR. Codirector, 629th Medical Detachment (Renal), Saigon , Vietnam , 1966-67; Member, Department of Medicine, Walter Reed General Hospital , 1967-68.
DAVID T. ENGLISH, M.D.
Associate Clinical Professor of Medicine, Department of Dermatology, University of Washington School of Medicine , Seattle . Formerly Major, MC, USAR.
RONALD P. FISHER, M.D.
Chairman, Departments of Surgery and Emergency Medicine and Trauma, Kino Community Hospital, Tucson, Ariz.; Adjunct Professor, University of Arizona Health Sciences Center, Tucson. Formerly Lieutenant Colonel, MC, AUS. Surgeon, 3d Field Hospital, and Surgeon, U.S. Army Dialysis Center, Vietnam, 1969; Chief, Department of Human Studies, Division of Surgery, Walter Reed Army Institute of Research, 1969-71.
LAYNE O. GENTRY, M.D.
Associate Professor of Internal Medicine, Microbiology, and Immunology, Baylor College of Medicine, Houston, Tex. Formerly Lieutenant Colonel, MC, USAR. Assistant Chief, Infectious Disease Service, Brooke Army Medical Center , 1971-74.
CARL R. GUITON, M.D.
Assistant Professor of Medicine, University of Minnesota Medical School , Minneapolis . Formerly Lieutenant Colonel, MC, AUS. Assistant Chief, Pulmonary Disease Service, Fitzsimons Army Medical Center , 1970-72; Chief, Professional Services, USAH, Saigon , Vietnam , 1972-73.
JAMES E. HANCHETT, M.D.
Assistant Professor of Clinical Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.; Director, ESRD Unit, Veterans Administration Medical Center, Pittsburgh. Formerly Captain, MC, USAFR. Member, Medical and Hemodialysis Service , U.S. Air Force Hospital , Tachikawa , Japan , 1965 68.
KENNETH W. HEDLUND, M.D.
Colonel, MC , USA . Chief, Division of Bacteriology, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Md.
JAMES H. KNEPSHIELD, M.D.
Associate Clinical Professor of Medicine, Georgetown University School of Medicine; Codirector, Hemodialysis, Hemoperfusion, and Transplantation Service, Georgetown University Hospital; Co-director, Metropolitan Washington Renal Dialysis Centers, Washington, D.C. Formerly Lieutenant Colonel, MC, USA. Chief, Medical Service, 3d Field Hospital, and Corn-
XI
mander, 629th Medical Detachment (Renal), Saigon, Vietnam, 1968-69; Chief, Renal Dialysis Service, Walter Reed General Hospital, 1969-72; Chief, Nephrology Service, Walter Reed General Hospital, 1971-72; Consultant in Renal Disease to The Surgeon General, 1971-72.
LLEWELLYN J. LEGTERS, M.D., M.P.H.
Colonel, MC , USA (Ret.). Professor and Chairman, Department of Preventive Medicine and Biometrics, School of Medicine , Uniformed Services University of the Health Sciences. Chief, U.S. Army Special Forces-WRAIR Field Epidemiologic Survey Team (Airborne), 1966-68; Preventive Medicine Officer and Deputy Post Surgeon, U.S. Army Training Center, Fort Ord, 1968-70; Chief, Training Evaluation Group, Directorate of Plans and Training, Fort Ord, 1971-72; Chief, Ambulatory Health Services, Silas B. Hays Army Hospital, Fort Ord, 1972-74.
DANIEL L. MACKEN, M.D.
Assistant Clinical Professor of Medicine, Colombia University College of Physicians and Surgeons, New York , N.Y. Formerly Lieutenant Colonel, MC, USAR.
JOHN D. MARSHALL, Jr.
Colonel, MSC , USA . Commander/Director, Letterman Army Institute of Research, Presidio of San Francisco , Calif.
WILLIAM E. MILLER, M.D.
Chief, Nephrology Section, Wilmington Medical Center, Wilmington, Del. Formerly Clinical Professor of Medicine, Thomas Jefferson University, Philadelphia, Pa.; Consultant in Nephrology, St. Francis Hospital, Wilmington; Kent General Hospital, Dover, Del.
WILLIAM L. MOORE. Jr., M.D.
Colonel, MC , USA . Chief, Department of Medicine, Eisenhower Army Medical Center , Fort Gordon , Ga. ; Clinical Professor of Medicine, Medical College of Georgia . Commander, 156th Medical Detachment, Southeast Asia Action Force, 1965; Assistant Chief, Department of Medicine, Brooke Army Medical Center , 1970-74.
ANDRE J. OGNIBENE, M.D.
Brigadier General, MC , USA . Commander, Brooke Army Medical Center, Fort Sam Houston, Tex.; Clinical Professor of Medicine, The University of Texas Health Science Center, San Antonio, Tex. USARV Medical Consultant, Vietnam, 1969; Assistant Chief, Department of Medicine, Walter Reed General Hospital, 1969-72; Chief, Department of Medicine, Brooke Army Medical Center, 1972-76.
ROBERT F. PROCTOR, M.D.
Formerly Lieutenant Colonel, MC, AUS. Chief, Medical Section , U.S. Army Medical Research Team, WRAIR, Vietnam , 1966-67; Chief, General Medicine Service, Martin Army Hospital , 1968.
ADOLF E. RAHM, Jr., M.D., M.P.H.
Colonel, MC, USA. Chief, Department of Medicine, Darnall Army Community Hospital, and Director, Brooke Army Medical Center Affiliated Internal Medicine Residency and Intern Training Program, Fort Hood, Tex. Commander, 20th Preventive Medicine Unit, and Assistant USARV Preventive Medicine Consultant, Vietnam, 1969-70.
PHILIP K. RUSSELL, M.D.
Colonel, MC, USA. Director, Walter Reed Army Institute of Research. Chief, Virology Department, U.S. Army Medical Component, SEATO, Bangkok, Thailand, 1965-68; Chief, Department of Virus Diseases, Walter Reed Army Institute of Research, 1968-73.
JAY P. SANFORD, M.D.
Professor of Medicine and Dean, School of Medicine, Uniformed Services University of the Health Sciences. Civilian Consultant in Medicine to The Surgeon General, U.S. Air Force, 1963-75; Civilian Consultant in Medicine, Brooke Army Medical Center, 1964-75.
DALLAS E. SMITH, M.D.
Assistant Professor of Medicine, Eastern Virginia Medical School, Norfolk; Consultant in Rheumatology, Kecoughtan Veterans Hospital, Virginia; Lecturer in Rheumatology, Portsmouth Naval Hospital, Virginia. Formerly Major, MC, USAR.
EDWARD G. SOUTH WICK, M.D.
Clinical Instructor, Division of Dermatology, University of Utah School of Medicine, Salt Lake City. Formerly Lieutenant Colonel, MC, USAR.
FRED R. STARK, M.D.
Colonel, MC, USA. Chief, Department of Medicine, Letterman Army Medical Center, San Francisco, Calif.; Associate Clinical Professor of Medicine, University of California, San Francisco.
WILLIAM J. STONE, M.D.
Professor of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn. Formerly Major, MC, AUS. Member, 629th Medical Detachment (Renal),Saigon, Vietnam, 1968-69.
RALPH F. WELLS, M.D.
Colonel, MC, USA (Ret.). Clinical Professor of Medicine, University of Texas Health Sciences Center, San Antonio, Tex. Commander, 61st Medical Battalion, 1967; Commander, 17th Field Hospital, 1968; Consultant in Internal Medicine to the Surgeon, USARV, 1968; Chief, Gastroenterology Service, Brooke Army Medical Center, 1968-76.
JAMES E. WILLIAMS, Ph.D.
Major, MSC, USA. Chief, Plague Section, Department of Hazardous Microorganisms, Walter Reed Army Institute of Research.
ANDREW WHELTON, M.D.
Associate Professor of Medicine, The Johns Hopkins University School of Medicine. Formerly Major, MC, USAR. Co-director, 629th Medical Detachment (Renal),Saigon, Vietnam, 1966-67; Civilian Consultant in Renal Disease to The Surgeon General, U.S. Air Force, 1971-76.
Contents
Part I. BACKGROUND
Chapter
1 Setting (Colonel O`Neill Barrett, Jr., MC, USA Ret.)
Geography and People
Vietnamese and French Medical Experience
2 U.S. Medicine in Vietnam: The Early Years (Colonel O`Neill Barrett, Jr., MC USA (Ret.))
8th Field Hospital
Administration and Patient Evacuation
Hospital Construction
Laboratory and Radiology Support
Medical Problems
Summary
3 Full-Scale Operations (Brigadier General Andre J. Ognibene, MC, USA)
Command Structure
The Consultant System
Problems of Area Medical Service
Education and Training
Hospitalization and Evacuation
Scope of Disease
Part II. CLINICAL DISORDERS: INFECTIOUS DISEASES AND GENERAL MEDICINE
4 Fever of Undetermined Origin (Colonel John J. Deller, Jr., MC, USA Ret.)
History and Military Significance
Incidence and Epidemiology
Hindrances to Early Specific Diagnoses
The Spectrum of FUO
Clinical Conditions Presenting as FUO
Lessons Learned
Section I. Dengue and Dengue Shock Syndrome
History
Epidemiology
Etiology
Pathogenesis
Clinical Features
Laboratory Diagnosis_
Prevention and Treatment
New Advances
Section II. Japanese B Encephalitis
Materials and Methods
Clinical Data
Discussion
6 Other Viral Diseases (Jay P. Sanford M.D., and Colonel Adolf E. Rahm, Jr., MC, USA)
Section I. Acute Respiratory Disease
Historical Perspective
ARD Overview
ARD in Vietnam
Lessons Learned
Section II. Infectious Mononucleosis
Etiology
Vietnam Experiences
Lessons Learned
Section III. Rabies
Section I. Scrub Typhus (Tsutsugamushi Fever)
History and Military Significance
Epidemiology
Etiology, Pathogenesis, and Pathology
Clinical Manifestations
Laboratory Diagnosis
Treatment
Prevention
Summary
Section II. Murine Typhus
History and Military Significance
Epidemiology
Clinical Manifestations
Treatment and Chemoprophylactic Measures
Section III. Leptospirosis
Incidence and Epidemiology
Clinical Features
Laboratory Diagnosis
Prevention and Treatment
Conclusion
Section I. Plague
History and Military Significance
Etiology and Pathogenesis
Incidence and Epidemiology
Clinical Features and Treatment
Laboratory Diagnosis
Prevention
Vietnam Experiences
Lessons Learned
Section II. Melioidosis
History and Military Significance
Incidence and Epidemiology
Etiology, Pathogenesis, and Pathology
Clinical Manifestations
Laboratory Diagnosis
Prevention and Treatment
New Advances
Section III. Tuberculosis
History and Military Significance
Incidence and Epidemiology
Clinical Features, Complications, and Treatment
Summary
Section IV. Gram-Negative Infection
Serratia marcescens
Chromobacterium violaceum (janthinum)
Neisseria meningitidis
History and Incidence
Control of Disease
Clinical Spectrum
Section I. Urethritis Syndromes
Gonorrhea
Postgonococcal Urethritis
Nonspecific Urethritis
Reiter`s Syndrome
Section II. Non urethritis Syndromes
Lymphogranuloma Venereum
Chancroid
Syphilis
10 General Medicine (Brigadier General Andre J. Ognibene, MC, USA)
Diseases of General Medical Significance
Snakes and Leeches
Staffing Requirements
Part I. CLINICAL DISORDERS: MALARIA
12 Malaria: Epidemiology (Colonel O`Neill Barrett, Jr., MC, USA (Ret.))
Species and Vectors in Vietnam
Incidence in American Troops in Vietnam
Malaria in Enemy Troops
Malaria in the United States
Clinical Manifestations
Diagnosis
Initial Experiences, 1960-65
Experiences With Quinine-Pyrimethamine-Dapsone Therapy, 1966-68
Vivax Malaria
Treatment of Malaria, 1968-72
Part IV. CLINICAL DISORDERS: GASTROINTESTINAL DISEASES
15 Gastrointestinal Diseases: Background and Buildup (Colonel Ralph F. Wells, MC, USA (Ret.))
History and Military Significance
Gastrointestinal Diseases in Vietnam
Section I. Shigellosis
History and Military Significance
Epidemiology
Etiology and Pathogenesis
Clinical Features, Course, and Complications
Summary
Section II. Typhoid Fever and Other Salmonelloses
Typhoid Fever
Other Salmonelloses
Section III. Cholera and Vibrio parahemolyticus Gastroenteritis
Cholera
Vibrio parahemolyticus Gastroenteritis
Section IV. Pathogenic Escherichia coli Diarrhea
History and Military Significance
Incidence and Epidemiology
Etiology and Pathogenesis
Clinical Features, Course, and Complications
Laboratory Diagnosis
Prevention and Treatment
New Advances and Lessons Learned
Section I. Amebiasis
History and Military Significance
Incidence and Epidemiology
Etiology and Pathogenesis
Clinical Features, Course, and Complications
Section II. Other Parasitic Diseases
Incidence
Hookworm
Filariasis
Other Parasites
Treatment
18 Hepatitis (Joe A. Dean, M.D., and Brigadier General Andre J. Ognibene, MC, USA)
History
Etiology
Epidemiology
Clinical Features
Complications
Chronic Hepatitis
Vietnam Experience
History and Background
Pathology
Etiology
Radiology
Diagnosis and Treatment
Vietnam Studies
Part V. CLINICAL DISORDERS: RENAL DISEASES
Section I. The 629th Medical Detachment (Renal)
Section II. Renal Center Operation in a Combat Zone
Location
Personnel
Clinical Results
Summary
21 Posttraumatic Acute Renal Insufficiency (William J. Stone, M.D., and James H. Knepshield, M.D.)
Materials and Methods
Results
Discussion
Section I. Acute Renal Insufficiency From Falciparum Malaria
Materials and Methods
Results
Discussion
Section II. Acute Renal Insufficiency in Other Medical Disorders
Section III. Toxic Effects Following Ingestion of C-4 Plastic Explosive
INDEX (NOT POSTED)
Illustrations
Figure
1 Can Tho, a principal city of the Vietnam Delta
2 Aerial view of flooded rice paddies in the Mekong Delta
3 Grazing cattle on the open plains near Pleiku in the Central Highlands
4 Small fishing village near Nha Trang, nestled to the east of the Chane Annamitique
5 Nha Trang, situated along the east coast of the fertile lowlands
7 Typical dwelling on a levee in the Mekong Delta; sampans
8 Commercial activity on crowded Cho Lonstreet
9 Typical Montagnard tribesman seen in Central Highlands village
10 Leprosy patients: Characteristic leonine facies; deformed hands of lepromatous leprosy
11 Christian Mission Alliance Hospital, Nha Trang, 1963
12 HU-IA aeromedical helicopter of the 57th Medical Detachment, Nha Trang, 1963
13 U.S. Air Force C-123 cargo plane used for aeromedical evacuation in-country
14 U-1 Otter of the 20th Aviation Company, Nha Trang, 1963
15 Headquarters area of the 8th Field Hospital "under canvas" in 1962
16 Aerial photograph, 8th Field Hospital, 1963
17 Wood and screen facility near Headquarters, 8th Field Hospital, 1963
18 The 8th Field Hospital, 1965: Typical ward unit; mess hall and walkway
19 The 8th Field Hospital, 1965: Aerial view of the permanent construction of the hospital
20 Province Hospital, Nha Trang
21 Severely injured child being attended in a U.S. medical facility
22 A makeshift croupette at the 24thEvacuation Hospital
24 Dustoff arriving at the 24th Evacuation Hospital helipad
25 Typical aid station supporting a firebase; aid station in an advanced area
26 The 45th Surgical Hospital, Tay Ninh
28 Aerial view of the 3d Field Hospital complex
29 Aerial view of the 6th Convalescent Center on the beach of the South China Sea at Cam Ranh Bay
30 Patients arriving for rehabilitation at the 6th Convalescent Center
32 The evacuation process: Patients await loading on buses; ambulance bus after loading patients; unloading patients directly into MAC aircraft; four-deep loading technique
32 The evacuation process continued
33 Aeromedical evacuation is accomplished with onramp loading in a Sikorsky helicopter HH
34 The 24th Evacuation Hospital dedicated a Quonset but to ambulatory outpatient care
35 X-ray reception center at the 24th Evacuation Hospital
36 Typical hospital-support laboratory
37 Typical aid station or clearing company pharmacy cabinet
38 Patient with Japanese B encephalitis under therapy at the 93d Evacuation Hospital
41 Characteristic spiking or sawtooth temperature pattern in scrub typhus
42 Typical temperature response to tetracycline therapy in scrub typhus
43 Typical eschar seen in scrub typhus
44 Maculopapular rash showing dull red, discrete macular eruptions
45 Rattus norvegicus, the typical reservoir host for the Oriental rat flea, Xenopsylla cheopis
46 Typical femoral bubo as observed in Vietnam; femoral bubo showing drainage and early healing
47 Axillary bubo observed in acutely ill Vietnamese patient
48 Bloody sputum in advanced pneumonic plague
50 Plague bacilli in clinical specimen of peripheral blood
51 Typical culture appearance of Pseudomonaspseudo mallei on blood agar plate, 48 hours 52 Histopathologic material from a lung showing inflammatory cell infiltration in the area o fan abscess
52 Histopathologic material from a lung showing inflammator cell infilgration in the area of an abscess.
53 Typical X-ray of cavitary melioidosis
55 Inflammatory cell infiltration causing micro abscess formation in the myocardium
56 Typical micro abscesses in the brain
57 Inflammatory cell infiltrate in the pectoralis muscle causing abscess formation
58 Initial X-ray in a case of pulmonary melioidosis, untreated
59 X-ray showing sequential improvement in a case of pulmonary melioidosis, partially resolved on tetracycline therapy
60 Final X-ray showing improvement in a case of pulmonary melioidosis, near complete resolution following tetracycline therapy
61 Typical urethral discharge, gonococcalurethritis
62 Typical desquamation of the scrotal and penile areas in Reiter`s syndrome
63 Typical scaling and nail changes of Reiter`s syndrome: feet; hands
64 Typical inguinal bubo in a patient with lymphogranuloma venereum
65 Typical penile ulcer in a patient with chancroid
66 Typical cutaneous lesions of secondary syphilis; typical palmar lesions of secondary syphilis
67 Cardiac monitoring equipment in 3d Field Hospital coronary care unit, Saigon, 1969
69 Green coloring of the bamboo viper
70 Malaria experience, 1st Cavalry Division, September 1965-December 1966
72 Trophozoites of Entamoeba histolytica invading intestinal wall
74 Anteroposterior film of chest and upper abdomen demonstrating elevated right hemidiaphragm; lateral view of chest showing sub diaphragmatic abscesses with fluid levels75 Anterior and right lateral views of the liver using colloidal gold scanning
75 Anterior (top) and right lateral ( bottom views of the liver using collodial gold scanning at Camp Zama, Japan
77 High power microscopic views of hepatic parenchyma in acute viral hepatitis
81 Low power microscopic view of post necrotic(macronodular) cirrhosis
82 Mucosa from proximal jejunum of a patient with tropical sprue
83 Mucosal biopsy from jejunum of more severely ill tropical sprue patient
84 Barium radiographs from a patient with tropical sprue
85 View of the 629th Medical Detachment, 3dField Hospital, 1969
86 U.S. Army Sergeant Osborn, ARVN Sergeant Chew, and Maj. James H. Knepshield with patient
87 The Teflon-Silastic arteriovenous shunt used by the 629th Medical Detachment
90 Cross section of lung obtained at necropsy
91 Renal tissue obtained at necropsy from patient with falciparum malaria
93 Rounds of 105 mm white phosphorus placed on top of C-4 explosive at an ammunition dump
94 Saigon Hospital, scene of the first U.S. military participation in a renal transplantation
95 The renal transplantation team
Charts
Number
3 Seasonal occurrence of meningoencephalitis and group B arbovirus infections in Vietnam, 1967
4 Mental status of Japanese B encephalitis patients in Vietnam, 1969
5 Reported incidence of acute (common)respiratory diseases in USARV,1965-70
8 Incidence of human plague in the Republic of Vietnam, 1906 to 1 September 1967
9 Major plague outbreaks in the Republic of Vietnam, 1962-67
10 Relationship between the occurrence of plague and climatic factors in the coastal lowlands of the Republic of Vietnam, 1962-66
11 Drug sensitivity of sixty-one Pseudomonas pseudomallei isolates studied in Vietnam,1969
12 Cases of malaria reported in the United States, 1935-60
13 Admissions to hospital and quarters for malaria among U.S. Army personnel in Vietnam,1965-69
15 Cases of malaria in the military and civilian populations, United States, 1959-70
16 Distribution of total leukocyte count in404 cases of malaria
17 Response of primaquine-sensitive patient to a single C-P tablet
20. Mean platelet counts of falciparum malaria patients treated with supplemental folates or placebo
21 Incidence rate per month of falciparum and vivax malaria, USARV,1965-71
22 Number of cases per month of falciparum and vivax malaria, USARV,1965-71
23 Course of typhoid fever of a previously immunized American patient in Vietnam
25 Monthly diarrheal disease rates, U.S. Army in Vietnam, January 1966-December 1968
26 Courses of acute viral hepatitis
27 Hepatitis incidence rates during the Vietnam war
28 d-Xylose excretion and 5-hour urine volume at initial examination of Americans in Vietnam
Maps
1 U.S. Army hospitals in South Vietnam, 31December 1968
2 Geographic distribution of scrub typhus, 1964
3 Known and probable foci and areas of plague, 1969
3 Known and probably foci and areas of plague, 1969 continued
4 Extension of the human plague epidemic in the Republic of Vietnam, 1962
5 Extension of the human plague epidemic in the Republic of Vietnam, 1967
6 Distribution of proven and suspected malaria vectors in Vietnam
7 Geographical occurrence of malaria, 29February 1968
8 Relative malaria endemicity in Vietnam, 1966
Tables
1 Incidence of amebiasis by race and combat status, French forces, 1945-54
2 Venereal diseases in French troops in Vietnam, 1946-54
3 Data pertaining to U.S. Army medical and surgical patients in the 6th Convalescent Center, FY 1969
5 U.S. Army medical and surgical patient evacuations from South Vietnam to Japan, 1966-70
6 Final dispositions of active-duty Army patients initially admitted to hospital in Vietnam,1965-70
8 Probability of acute febrile disease acquisition by American soldiers in Vietnam
9 Results of five FUO studies in Vietnam, 1966-68
10 Miscellaneous diagnoses recorded in FUO studies in Vietnam, 1966-68
12 Serological diagnoses of FUO cases in Vietnam, by month, 1969
13 History and symptoms of serologically confirmed FUO cases in Vietnam, 1969
13 History and symptoms of serologically confirmed FUO cases in Vietnam, 1969 continued
14 FUO cases, by medical facility and diagnosis, Vietnam, 1969
17 Clinical and laboratory data of ten confirmed Japanese B encephalitis patients in Vietnam, 1969
18 Clinical and laboratory data of four suspected Japanese B encephalitis patients in Vietnam, 1969
20 Review of 553 Special Forces troops with fever of undetermined origin, Vietnam, 1963
22 Animal bite cases and anti rabies treatment, USARV,1969 and 1970
23 Areas of known occurrence of scrub typhus with identified hosts and vectors
24 Incidence of scrub typhus among cases off ever of undetermined origin in Vietnam,1966-67
25 Comparison of clinical manifestations of scrub typhus from five studies
26 Comparison of clinical features of murine typhus from three studies in Texas and Vietnam
27 Melioidosis in Vietnam,1965-71
29 Serratia marcescens infection in eight patients in Vietnam
30 Sensitivity of Neisseria meningitidis strains from Vietnam
31 Incidence rates for all venereal diseases among U.S. Army personnel, 1963-June 1972
32 Incidence rates for types of venereal disease among U.S. Army personnel inVietnam,1963-June 1972
33 Admission rates for all venereal diseases among U.S. Army personnel, 1963-June 1972 34 Gonorrhea treatment schedules given clinical trials by the U.S. Army in Vietnam
34 Gonorrheal treatment schedules given clinical trials by the U. S. Army in Vietnam
35 Relative efficacy of various schedules of therapy in aborting incubating syphilis
36 Admissions for medical causes to USARV hospitals, December 1970
37 Comparative incidence of relapse in treatment of Korean vivax malaria, 1951-52
38 Deaths from infectious diseases in South Vietnam, 1955-65
39 Distribution and relative importance of Anopheles species as malaria vectors in Vietnam
40 Total cases and deaths caused by malaria, U.S. Army, 1965-70
41 Malaria in military personnel returning from Vietnam to the United States, 1970
42 Results of malaria chemoprophylaxis survey in 671 U.S. servicemen returned from Vietnam
44 Summary of symptoms, signs, and laboratory data in 621 cases of malaria acquired in Vietnam
45 Distribution of leukocyte count, by patient source, in 404 cases of malaria
47 Evaluation of five drug regimens for Plasmodium falciparum in U.S. Army troops in Vietnam, 1965
50 Malaria admissions, 85th Evacuation Hospital, September 1966-August 1967
52 A comparison of 10- and 14-day quinine in multidrug therapy for acute falciparum malaria
55 Relapse rates in malaria patients, by hospital and geographic area of troop deployment, Vietnam
56 Therapy of patients who had one relapse after treatment of falciparum malaria
57 Weekly disease admissions, Army Task Force201, Lebanon, 1958
58Diarrheal disease admissions, U.S. military personnel in Vietnam, January-July 1965
62 Number of diarrheal cases reported to USARV medical consultant, January-March 1966
64 Antibiotic resistance of 505 Shigella strains, Vietnam, 1968-69
65 Admissions and deaths from typhoid fever during the Spanish-American War and World War I
66 Salmonella infections, active-duty Army, 1942-45 and 1950-53
67 Incidence of typhoid fever and salmonellosis in U.S. Army troops in Vietnam, 1965-70
68 Relation of Salmonella species and representative serotypes to human disease
69 Incidence of paratyphoid fever in the U.S. Army, by area and year, 1942-45
70 Composition of intestinal fluid
71 Laboratory test used to distinguish classical from El Tor biotypes of Vibrio cholerae
72 Effect of tetracycline on stool volume in cholera patients, 1963 study
73 Monthly diarrheal disease rates, U.S. Army, Vietnam, January 1966-December 1970
74 Site of action of amebicides used for acute amebic colitis in Vietnam
78 Treatment schedule for amebic disorders caused by Entamoeba histolytica
79 Incidence of intestinal parasites in 75American servicemen returning from Vietnam
80 Treatment schedule for parasitic infestations in Vietnam, 1971
80 Treatment schedule for parasitic infestations in Vietnam, 1971 continued
81 New cases of hepatitis, by month, among active-duty Army personnel in Vietnam, 1965-72
84 Jejunal mucosal measurements of 48 Americans on arrival in Vietnam
87 Incidence of tropical sprue in Vietnam
89 Clinical picture and laboratory data of 13 tropical sprue patients, Vietnam
91 Dialysis procedures, 629th Medical Detachment, September 1966-September 1967
95 Organs or organ systems injured, 629th Medical Detachment, August 1967-February 1969
97 Selected statistics,629th Medical Detachment, August 1967-February 1969
104 Symptoms and signs of six patients with C-4 intoxication
105 Laboratory data of patients with C-4 intoxication
