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Contents

Foreword

This volume, the twenty-first to be published in the total series relatingthe history of the United States Army Medical Department in World War II, is thesecond volume to be published in the internal medicine group. The first volume,published in 1961, dealt with the activities of consultants in medicine in allparts of the world. This second volume deals with some of the infectiousdiseases encountered in a global war. The third and final volume in this group,now in preparation, will deal further with the infectious diseases and withgeneral medicine.

Of necessity, as the editor of the internal medicine group points out in hispreface, some of the material in this volume overlaps some of the material inthe first internal medicine volume. It also overlaps certain of the material inthe preventive medicine series. There has been, deliberately, no effort to alterthe situation. To do so would have resulted in rigid and artificial distinctionsand would also have deprived the reader of the benefit, in certain instances, ofpresentation of material on the same subject from more than one point of view.

As I read this book in manuscript, I was impressed with a number ofconsiderations, some peculiar to this volume, some shared by the other volumes.Let me list some of them:

1. The wisdom of our policy of utilizing the personal experiences of presentand former medical officers, who, as has been repeatedly pointed out, not onlyhelped to create but also to record the data upon which this whole history isbased. The authors of the various chapters in this volume were selected to writethem not only because of their eminence in their particular fields but alsobecause they had had wartime experiences in these fields. More valid sourcescould scarcely be imagined.

2. The expansion of knowledge of the etiology, clinical picture, control, andmanagement of certain diseases about which little-in some instances nothing-wasknown before the war. The list is incomplete but, as examples, one might mentionsandfly fever; Q fever; scrub typhus; Brill's disease; primary atypicalpneumonia; and cutaneous diphtheria.

3. The remarkable utilization of opportunities forinvestigation and the amazing amount of valuable data that emerged from thesestudies, which were often made under almost intolerable conditions, both in andout of combat. In addition to studies involving United States militarypersonnel, including released prisoners of war, were the studies involvingRecovered Allied Military Personnel; enemy prisoners of war; and, civilians.


In this connection one is impressed with the importance and value of the workdone by the various boards, commissions, and subcommissions appointed toinvestigate, and recommend action upon, certain aspects of infectious diseases.Their investigations included acute respiratory disease; influenza and otherepidemic diseases; typhus; neurotropic virus diseases; hemolytic streptococcalinfections; airborne infections; tuberculosis; and malaria. When one realizesthat some 15,000 drugsfor the suppression and treatment of malaria were investigated, some cursorilyand some definitively, during the course of the war, one can also realize thefruitless activities and actual chaos which might have resulted without theguidance of the Board for the Coordination of Malarial Studies.

4. The changing concepts of certain diseases and their management. In 1941,for example, no one would have dreamed that one of the most significant chaptersin a volume in the internal medicine series of the history would concernvenereal disease. In December 1943, the treatment of patients hospitalized with venerealdisease ceased to be a responsibility of the genitourinary service and became aresponsibility of the medical service in Army hospitals. Hospitalization thengave way to ambulatory treatment. In the case of syphilis, therapy evolved fromthe time-honored but cumbersome and hazardous methods with arsenicals andbismuth-impractical even under relatively static conditions of training andcompletely impractical in combat-to the resolute decision to use penicillin forthis purpose. This decision, made by The Surgeon General and applied Army-wideeven at a time when last-minute preparations for D-day in Europe were beingmade, solved a serious problem with greatest effectiveness. Trained manpower wasconserved; channels of evacuation were not clogged by this type of patient; and,many hospital beds were freed for more urgent purposes. Further, the use ofpenicillin simplified the treatment of gonorrhea and reduced the complicationsarising from that disease from 25 percent in 1937 to 1 percent in 1944.

The spread of knowledge of all these diseases required almost"evangelical efforts" on the part of the medical consultants andothers responsible for the training and indoctrination of medical officers. As to the troops, control of disease was a matter ofindividual indoctrination and to be effective required firm command support.Education concerning malaria and its suppressive management did not succeeduntil Atabrine discipline became an actuality. Then malaria rates fell from ashigh as 1,500 to2,000 per thousand per annum, or higher, to negligible figures.

A careful reading of this book makes clear that if thesediseases had not been controlled, the United States could have suffered a greatmilitary disaster without regard to enemy capabilities. Some of the authorsfrankly acknowledge that luck played a part in the happy outcome, and so it did.The epidemic of encephalitis did not occur on Okinawa until the island had beenoccupied, though sporadic fighting was still going on and troops were stagingfor the invasion of Japan. On the other hand, the Medical Corps canjustifiably assume credit for its brilliant work in a number of these dif-


ferent diseases. Epidemic typhus was rampant in civilianpopulations with which many troops were in close contact, but there were only104 cases in the United States Army and not a single death.

One or two comparisons with World War I figures are further proof of theimprovement of medical management of infectious diseases in World War II: InWorld War I, 46,640 deaths, 73 percent of all deaths from disease, were causedby influenza, lobar pneumonia, bronchopneumonia, bronchitis, and measles. InWorld War II, in an Army over twice the size of the World War I Army andmobilized over a longer period, there were only 1,285 deaths from these causes.In World War I, tuberculosis was the leading cause of disability separations; itaccounted for 11.1 percent of all separations and for 13.5 percent of allseparations from disease. In World War II, tuberculosis was thirteenth in thelist of disability separations and it was responsible for only 1.9 percent ofseparations for disease.

The primary mission of the Army Medical Service is to conserve and maintainthe fighting strength of the Army. After the difficult struggle for Buna-Sanananda in the New Guinea campaign, largely because of the ravages ofdisease, the 32d Infantry Division had to be taken out of the line for rest andrehabilitation and it was ineffective for many months. Extrapolation of thesefacts and others makes clear what might have happened had such situationscontinued. It is to the everlasting credit of the Medical Department-supportedby understanding line commanders-that they did not.

In retrospect, the Medical Department seems to have accomplished an almostimpossible task. It made its mistakes, and, to speak bluntly, some of themshould not have been made. What one of the authors of this book said of malariamight well be said of a number of other diseases, that the stages of educationin it were painfully alike in all theaters and areas. Nonetheless, medicalpersonnel conquered and held in check diseases that were bewildering in bothkind and number; that offered multiple difficulties of diagnosis anddifferential diagnosis, particularly in their very early stages; and thatsometimes were completely unknown and sometimes had been modified by environmentand by the changes in the clinical picture that occurred when non-immune personsentered areas of endemicity.

As a surgeon, I, as well as many of my surgical confreres, have had toconcentrate on the essential character of our specialty in dealing with combatcasualties. In my role as The Surgeon General of the Army, my outlook isnecessarily wider and my appreciation of this book is therefore much deeper. 

Quite properly, since our task is the preparation of a history of the ArmyMedical Department in World War II, the chief emphasis in this book is upon theenormous clinical military experience with infectious diseases in all parts ofthe world. That does not make the volume less valuable as a text on thesediseases for medical students, general practitioners, and specialists ininternal medicine. I recommend it to them, as well as to medical officers of theArmy and other armed services, as a compilation of data not readily come byelsewhere.


The nineteen authors of this volume deserve the grateful thanks of the ArmyMedical Service and of the medical profession in general. For a variety ofreasons, some beyond our competence, some due to our own culpability, thepreparation of these and other volumes of the history has been long delayed. Itis a tribute to the sense of professional duty and the patriotism of theseformer medical officers that in the midst of their busy civilian lives they haveadded to their wartime service by taking the time to set down this record, andto carry out the task with real enthusiasm. That is evident on every page.

It is therefore my pleasure to express my gratitude to the authors of thisvolume and to its editor, Dr. W. Paul Havens, Jr., and to the Advisory EditorialBoard of which Dr. Garfield G. Duncan is Chairman, for a mission wellaccomplished. It is my equal pleasure to express my appreciation to thepersonnel in my own office who are doing the prodigious work of producing thesevolumes.

LEONARD D. HEATON, 
Lieutenant General, 
The Surgeon General.

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