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Preface

Table of Contents

Preface

This volume, the second of three in the Internal Medicine in Vietnam series, encompasses those disorders generally recognized as belonging to the broad field of internal medicine, with special emphasis on infectious and tropical diseases. Its purpose is to serve as both a historical document and a text providing present concepts of the diagnosis and treatment of those conditions which were of special importance in Vietnam. By comparison with classical textbooks of internal medicine, disproportionate emphasis on certain topics is apparent. Some diseases, like melioidosis, are highlighted because they were previously unheralded disorders which suddenly became serious and because they present unresolved therapeutic problems. Others, such as plague and cholera, are treated in detail not because their potential as serious threats actually developed but because U.S. experience with them in Vietnam reflects the response of Army research capability to unusual challenges and demonstrates how investigations in one area may lead to progress in others. Scrub typhus, amebiasis, and tropical sprue are given generous attention, not because they were difficult to diagnose or treat but because they were common problems relatively, or absolutely, unique to Southeast Asia and particularly uncommon to the experience of most American physicians. Diseases commonly recognized in the United States, such as tuberculosis, receive but brief mention since they did not become a serious problem among U.S. troops in Vietnam, either in terms of incidence or in the development of drug resistance.

This volume follows "Skin Diseases in Vietnam, 1965-72," written by Lt. Col. (later Col.) Alfred M. Allen, MC, and published separately (1977) because of the magnitude of the problem with skin disorders and the highly specialized material which was developed. Volume III, "Drug Abuse in Vietnam," currently in preparation, deals with a topic which is serious and unique as a medical as well as a command problem.

Some background information concerning the planning for the series may assist the reader. The first meeting of the Advisory Editorial Board for the History of the U.S. Army Medical Department in Vietnam and Southeast Asia was held at The Historical Unit, Forest Glen, Md., on 7 May 1970. The purpose of the meeting, chaired by Maj. Gen. James A. Wier, MC, was to establish a clinical and administrative historical series to chronicle the medical events of the war. The editors chosen for the Internal Medicine series were Col. Thomas W. Sheehy, USA (Ret.), and Lt. Col. (later Brig. Gen.) Andre J. Ognibene, MC. In the months that followed, the editors selected an Advisory Editorial Committee for the Internal Medicine series; on 1 May 1972, that group gathered at The Historical Unit for the initial working meeting. Lieutenant Colonel Allen was given the responsibility for "Skin Diseases in Vietnam." Col. O'Neill Barrett, Jr., USA (Ret.), was to develop material on the early years and on rickettsial diseases, while Col. John J. Deller, Jr., MC, was to provide material for all other infectious diseases. Because of the scope of the malaria story, both Col. Raymond W. Blohm, Jr., MC, and Col. Nicholas F. Conte, MC, agreed to write that part. Sections on evacuation and support were to be written by Lt. Col. Thomas A. Verdon, Jr., MC, and the section on gastrointestinal disorders, by Colonel Sheehy and Col. Ralph F. Wells, MC. Unfortunately, personal commitments did not permit Colonel Sheehy's continued participation in the series, and the burden fell to Colonel Wells. Because the 629th Medical Detachment (Renal) obviously contributed significantly to troop care, Maj. (later Lt. Col.) James H. Knepshield, MC, was appointed to assemble data on renal diseases. In 1975, Col. John Castellot, MC, and Lt. Col. (later Col.) Norman W. Ream, MC, were asked to develop Volume III, "Drug Abuse in Vietnam," to complete the series. When Colonel Verdon left the Army and Colonel Wells resigned from the committee in 1976, Colonel Barrett and Colonel Ognibene assumed broader responsibility for direct input to Volume II and concurrently served as co-chairmen and principal authors from that time forward.

When medical care of American troops in Vietnam is finally assessed, several aspects will deserve special emphasis. The immediate helicopter evacuation of seriously wounded troops to definitive treatment centers is cited in this volume. No less important is the establishment, for the first time in U.S. Army Medical Department history, of a renal unit in a combat area capable of providing immediate and appropriate treatment of acute renal insufficiency; the success of that effort is documented in the section on renal care.

Finally, there is the story of malaria and its ultimate control in the combat zone. This disease, known from antiquity, has affected many military campaigns as dramatically as has combat itself. In the late fifties and early sixties, malaria was looked upon condescendingly as a condition for which there was adequate epidemiological control and individual treatment and thus no longer a threat to world health. Then, almost predictably, history began to repeat itself. First came isolated case reports of drug-resistant falciparum malaria from several areas around the world; next, the unheeded warnings from visionaries like Brig. Gen. William D. Tigertt. This was followed by the first case of drug resistance in falciparum disease in an American officer in Vietnam and, finally, the complete unfolding of the seriousness of drug-resistant disease and the remarkable effort required to control it in Vietnam. A postscript to the story in Vietnam was the problem of imported and induced malaria in the United States, mostly the consequences of poor prophylaxis compliance by returning troops. The task of telling the malaria story was assigned first to Colonel Conte and Colonel Blohm. Recognition of the vastness of the project led to the addition of Colonel Ognibene to the group. Finally, Colonel Barrett also became a member after the death in September 1977 of our colleague and friend, Colonel Blohm, to whom the section on malaria is respectfully dedicated. This section, therefore, represents the collaborative efforts of four members of the Advisory Editorial Committee, all of whom served in Vietnam and all of whom had extensive experience with the disease, both in Vietnam and in the United States.

Obviously the efforts of many people were required to bring this volume to successful fruition. Those of the personnel of the former Medical History Division, U.S. Army Center of Military History (previously The Historical Unit, U.S. Army Medical Department), were continuously superb despite interruptions caused by moves of the activity first from Forest Glen to Fort Detrick (Frederick), Md., then to the Forrestal Building in Washington, D.C., and then to its present location in the Pulaski Building in Washington, D.C. The driving force in that continuing effort was Mr. Charles J. Simpson, Director of the Clinical History Program, who provided the perspective, organization, and encouragement necessary to develop a valuable historical treatise. The editors are personally indebted for his counsel, memory, and gracious support. We would also like to thank Mrs. Martha R. Stephens for her editorial suggestions, Miss Mary C. Efdimis for her administrative support, and the archivists at Fort Detrick and the Center of Military History for their assistance in obtaining documents and records. Special thanks are due Mrs. Linda A. Kincaid, the first prepublications editor, Ms. Ann Rhodes Conley, who completed the prepublications editing, and Mrs. Mary Nelson, who shepherded galley and page proof through the publication stages. They painstakingly reviewed the manuscript, plagued the editors with questions, and assured publication quality. We also appreciate the assistance of secretarial personnel at the many institutions who typed textual material and that of Mr. Howell C. Brewer and Mr. Roger D. Clinton, who prepared the charts and the maps, respectively.

The manuscript could not have been completed without the statistical data which were supplied by the Office of Patient Administration, Office of the Surgeon General, and by the biostatistical agency of the U.S. Army Health Services Command; Mr. H. F. Ewert fulfilled the many requests which we placed upon these two agencies.

Finally, we must recognize all those who generously contributed material to the authors of this work. To them and all physicians who participated in the care of the U.S. soldier in Vietnam, this text is dedicated; it stands as a tribute to their efforts. They provided an abundance of data, both published and unpublished, which enriched the treatise and broadened our understanding of the medical activities of the period.

ANDRE J. OGNIBENE,
Brigadier General, MC, USA.

O'NEILL BARRETT, Jr.,
Colonel, MC, USA (Ret.).