Foreword
The first volume on thoracic surgery in the history of the U.S. Army MedicalDepartment in World War II was published in 1963. This is the second and finalvolume of that special series.
In addition to administrative considerations, the first volume set forth theroutine of management of chest injuries from emergency care on the battle fieldto final rehabilitation in a chest center. It dealt with special types of woundsand with complications only incidentally. This second volume deals in detailwith both of those subjects, both of which deserve most careful attention, formany of the concepts set forth were unknown in World War I and in civilianthoracic surgery and were recognized for the first time in World War II.
The syndrome of the wet lung, for instance, undoubtedly existed in World WarI, but it went unrecognized and untreated, and its sequelae-often its lethalsequelae-were massive atelectasis and pneumonitis. Yet, once the existence ofthe syndrome was recognized and its pathophysiology elucidated, its preventionbecame a relatively simple matter and its management almost equally simple.
Similarly, hemothorax undoubtedly existed in World War I, butagain its importance in military surgery was not realized, and such concepts aswere developed about it were later proved to be fallacious. Correct management-that is, simple aspiration of the chest-did not always prevent organization ofthe retained blood and did not always prevent infection of the organizing clot,or even hemothoracic empyema, but it usually aborted most of these pathologicprocesses. If organization of the clot did occur, decortication was the solutionof the problem of infection and hemothoracic empyema. The chest cripples afterWorld War I were happily absent after World War II.
The results achieved in these potentially dangerouscomplications of chest trauma as well as in foreign bodies retained in the lung,the heart, and the great vessels, constitute a record of real brilliance.Exactly how brilliant it was is evident in the final chapter of this volume, inwhich there appears the record of a really unique endeavor, the followup, in1960-61, of a small group of casualties who sustained their chest injuries in1943-45. The series is small, it is true, but there seems every reason to assumethat the excellent status of this small group, whose wounds were truly critical,is an index of the status of most other casualties whose wounds were similarlycritical.
Once again, as in the first volume of the series, I wouldexpress my thanks to the authors and editors whose devoted work has madepossible the production of this and other volumes of the history of the U.S.Army Medical Department
in World War II. And also, as in the first volume, I would pay particulartribute to the fine work of Dr. Frank B. Berry, Editor for Thoracic Surgery,whose enthusiasm, patience, and wise guidance carried this project past itsinitial difficulties and discouragements to a highly successful conclusion.
LEONARD D. HEATON,
Lieutenant General,
The Surgeon General.
