Foreword
History of medical experience looks in two directions: insurveying and reporting on the past it suggests, by inference and implication,the impact that past experience will have on future practice.
This observation is dramatically illustrated by the manyvolumes now published in which are recorded the activities of the MedicalDepartment, U.S. Army, in World War II. The stresses of global war imposeextraordinary responsibilities on the physicians and surgeons charged withmaintaining the combat capabilities of the Nation's fighting men. Meeting anddischarging these responsibilities often means compressing into months or evenweeks the formulation and testing of new medical concepts involving unfamiliaror obscure medical conditions-tasks that under normal circumstances might takeyears. It means, too, the opportunity to evaluate results under unifieddirection and under controlled circumstances to the ultimate benefit of allmankind; and on a scale that finds no counterpart in civilian medical practice.
This volume is the third and last in that medical seriesreporting on the experience of the U.S. Army Medical Department with internalmedicine in World War II. The first of the internal medicine volumes, publishedin 1962, dealt with the activities of consultants in medicine in all parts ofthe world. The second volume (1963) contained an account of the infectiousdiseases encountered in a global war. This final volume continues the account ofinfectious diseases and considers various aspects of other internal medicineproblems. It continues, also, the impressive account of the expansion of ourknowledge of the etiology, clinical picture, control, and management of a widevariety of infectious diseases, including some about which little or nothing wasknown before the war. Such a disease is "Bullis Fever," a tickborneillness which is described in chapter VI. The account of the discovery of thisnew disease entity, and of the clarification of its epidemiology within a veryshort period of time, is a tribute to the Army medical officers who participatedin its clinical and laboratory investigation.
In the broad field of internal medicine, military medicalpractitioners were provided an unparalleled opportunity to study disease and toacquire new knowledge in a variety of climes and circumstances. In hot climates,we had to rediscover that man has remarkable heat adaptation mechanisms and thatadherence to sound physiological principles permits him to work hard,efficiently, and effectively in any naturally occurring hot environment. Theproblem of living and working under these adverse climatic conditions was solvedat the expense of a considerable number of casualties and with some loss oflife, but the basic principles, once learned, should not be for-
gotten and should form the basis for the proper handling oftroops in hot climates in future years.
During the Second World War, to the fevers and fluxes ofprevious wars were added the hazards of exposure to high altitudes and thedevastating effects of blast and bombs. It was, therefore, inevitable that thediseases and disorders, which affect the stability of the circulatory system,should have attracted particular attention and detailed study. Thus, the specialattention given to the heart and vascular system in the process of selection ofpersons for military service provided an insight into the strength as well asthe weakness of our eligible population. Although this effort proved disturbingin certain respects, it stimulated the thoughtful planning of special studies inthe fields of hypertension and of latent coronary disease.
An outstanding example of medical effort in World War IIwhich had significance both in the spheres of infectious disease andcardiovascular physiology was the new and detailed information gained abouttsutsugamushi fever (scrub typhus). This acute and serious disease was widelyencountered by the Army in the Southwest Pacific Area and in Burma, where morethan 5,000 cases were reported. Three major epidemics occurred in northern Burmaand in Netherlands New Guinea in 1944, and as a direct result of the Armyexperience, several concepts of the nature of this rickettsial disease werechanged. It was discovered that there were no typical scrub typhus areas, awider geographic distribution of the disease was established, the etiology wasconfirmed, vector species were proved, strains were isolated, a new complementfixation test was developed, and the clinical pattern and pathological featureswere described.
War, with its characteristic situation changes, dramaticallybrings to the forefront the environmental aspects of man's struggle forexistence. The chapter on nutritional diseases presents a vivid description ofthe progressive states of starvation following improper or inadequate foodintake, as seen in the unfortunate inmates of prisoner-of-war and concentrationcamps during World War II. The findings, initial, intermediate, and terminal,provided clinicians with a clear portrayal of the pathognomonic symptoms of thevarious vitamin nutritional deficiencies, which they could utilize in predictingthe effects of various restricted diets.
Dermatological diseases, although seldom severe enough tocause death, nevertheless are among the most common and chronic medicalconditions with which an army in the field must cope. Particularly is this truein semitropical and tropical climates where heat and humidity favor suchdiseases. Under these circumstances, crippling results requiring prolongedhospitalization are not unusual. We are fortunate, indeed, in having a splendiddescription of our experience in this regard based on the report andrecommendations of Dr. J. Gardner Hopkins, following his tremendously helpfulconsultant visit to the Southwest Pacific Area for The Surgeon General duringWorld War II.
In addition to a better understanding of symptoms andcomplaints referable to bodily dysfunction or defect, military physicians inWorld War II learned to appreciate psychological and sociological influencesupon disease and adjustment. This experience in military medicine fostered thegrowth of the psychosomatic viewpoint, so well recognized today. Althoughpsychosomatic concepts had some vogue before World War II, they received amajor impetus during the war years, for here was a vast laboratory of stresswhere physicians could observe firsthand the effects of mind-bodyinterrelationships upon symptoms, treatment, and disposition in a wide varietyof diseases and injuries.
The evolution of military medical practice, as related inthis third volume of the internal medicine series, is interesting andprofessionally highly informative reading. Much of the experience was gained inremote and unfamiliar areas of the world. It is, also, a record of achievementand progress which is a testament to the devotion to duty and the diligence ofmedical personnel, and especially to the many experienced physicians andinvestigators, both military and civilian, who pursued their studies undercircumstances which were always difficult and frequently dangerous.
As with the other volumes in the history of the MedicalDepartment, I take great pleasure in expressing my gratitude to the many authorswhose contributions made possible this additional volume; to its editor, Dr. W.Paul Havens, Jr.; to the Advisory Editorial Board on the History of InternalMedicine of which Dr. Garfield G. Duncan is chairman; and to the Director andhis staff of The Historical Unit who are doing the prodigious work of producingthese volumes.
LEONARD D. HEATON,
Lieutenant General,
The Surgeon General.
