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Table of Contents

Books and Documents

Contents

FRONT MATTER

FOREWORD

PREFACE 

INTRODUCTORY NOTE

Chapter

I. Introduction

Historical Background

Geography and Military Operations

II. Consultants

Deployment of Dermatologists
MEDCON Concept 
Armed Forces Epidemiological Board Consultants
Consultation for Operation SAFESTEP

III. Statistics

Hospital Statistics

Medical Evacuations

Outpatient Statistics

Statistics From Surveys

Theater Statistics

Morbidity Statistics and Environmental Data

Field Medical Statistics

IV. Education and Training

V. Command Policies

VI. Diseases

Fungal Infections

Bacterial Infections

Immersion Injuries of the Feet

Diseases of the Sweat Glands, Sebaceous Glands, and Hair Follicles

Parasite Infestations and Infections

Contact Dermatitis

VII. Treatment Facilities

VIII. Summary and Conclusions

APPENDIX

A. USARV Regulation No. 40-29, Prevention of Skin Disease Among Troops Operating in Inundated Areas

B. Letter, Prevention of Skin Disease, 9th Infantry Division

Illustrations

1.  American infantryman crossing flooded paddy in Vietnam

2.  Foot soldier taking time out from patrol to examine his feet

3.  Walter Reed Army Institute of Research Field Dermatology Research Team in Vietnam

4.  Captain Allen examining infantrymen in Mekong Delta

5.  Inflammatory tinea corporis and tinea cruris

6.  Vietnamese boy holding rats trapped for food

7.  Trichophyton rubrum infection on waist of Vietnamese infantryman

8.  Vietnamese rice farmer in Mekong Delta

9.  Vietnamese boy with granular T. mentagrophytes infection of orbit

10. Inflammatory T. mentagrophytes infection of legs and feet

11. T. mentagrophytes infection on buttocks

12. Tinea cruris due to T. mentagrophytes

13. T. mentagrophytes infection in area covered by canteen belt

14. Early mycotic folliculitis caused by T. mentagrophytes

15. Inflammatory T. mentagrophytes infection showing confluence of lesions

16. Tinea cruris caused by T. mentagrophytes in a black soldier

17. Psoriasiform appearance of tinea cruris in a black soldier

18. Severe T. mentagrophytes infection and water immersion injury

19. Closeup view of the infection shown in figure 18

20. Granuloma of the bearded region caused by granular T. mentagrophytes

21. Tinea pedis in an American soldier in Vietnam

22. Tinea pedis localized to the fourth toeweb

23. Typical patch of dermatophytosis on glabrous skin

24. Dermatophyte (ringworm) infection; extensive psoriaticlike lesions

25. Inflammatory T. mentagrophytes infection of dorsum of foot secondarily infected

26. Prototype boots and socks developed by U.S. Army Natick Laboratories

27. Groin candidiasis in soldier who worked in hot, humid environment

28. Candidiasis of the toeweb; candidiasis of interdigital spaces of hand

29. Candidiasis of the axilla

30. Candidiasis of the glans penis

31. Tinea versicolor in a black soldier

31. Tinea versicolor in a black soldier (cont.)

32. Infantrymen with severe streptococcal pyoderma of ankles and feet

33. Trigonosoma decorum flies feeding on seropurulent exudate from streptococcal skin infections

34. Streptococcal impetigo of upper lip

35. Streptococcal ecthyma on legs on infantrymen

36. Multiple streptococcal pyodermas on dorsum of foot

37. Indolent streptococcal infections on hand of a soldier

38. Soaking pyoderma in a soap solution containing hexachlorophene

39. Furunculosis (multiple boils) in an American soldier

40. Bullous (staphylococcal) impetigo; cluster of ruptured bullae

41. Vietnamese child with bullous impetigo; closeup view of bullae

42. U.S. infantrymen traversing a swampy area of the Mekong Delta

43. A U.S. infantry patrol crossing a paddy in the Mekong Delta

44. Section of skin from dorsum of foot showing typical histopathologic changes of tropical immersion foot

45. Dermal pathology in tropical immersion foot

46. An early, mild case of tropical immersion foot

47. Tropical immersion foot in a Vietnamese marine

48. Tropical immersion foot in a Vietnamese marine

49. Tropical immersion foot 4 days posthospitalization

50. Tropical immersion foot in an American soldier

51. Warm water immersion foot

52. Erosion injury (wet sock abrasions) of dorsum of foot and ankle

53. Erosion injury of the foot 

54. Pitted keratolysis

55. Miliaria of the buttock

56. Cystic "tropical" acne on back of soldier; chest of same man

57. Extensive tropical acne, posthealing

58. Severe tropical acne undergoing involution

59. Pseudofolliculitis barbae

60. Leech bite on leg of infantryman

61. Engorged buffalo leeches feeding on a volunteer

62. Blister beetle "burn" showing characteristic linear configuration

63. Blisters on forearm of a volunteer to which DEET had been applied

64. Purulonecrotic lesion in antecubital fossa of a volunteer after application of DEET

65. Scarring resulting from application of DEET to antecubital fossa

66. Enlisted corpsmen tending pyoderma at battalion aid station

Charts

1. Hospital and quarters admissions for skin diseases, for all diseases combined, and for all medical and surgical conditions: U.S. Army personnel in Vietnam, 1965-72

2. Annual incidence of skin disease (hospitalized cases) among U.S. Army personnel in Vietnam, Korea, and the continental United States: 1965-72

3. Hospital admissions for skin diseases in comparison to admissions for other diseases: U.S. Army personnel in Vietnam, 1965-72

4. Annual incidence of skin, respiratory, malarial, and diarrheal diseases (hospitalized cases): U.S. Army personnel in Vietnam, 1965-72

5. Incidence of skin disease (hospitalized cases): U.S. Army personnel in Vietnam, 1965-72

6. Outpatient visits for skin diseases in comparison to visits for other causes: U.S. Army personnel in Vietnam, 1965-72

7. Hospitalization and outpatient visits for skin diseases in relation to troop strength: U.S. Army personnel in Vietnam, 1965-72

8. Rate of outpatient visits for skin diseases: U.S. Army personnel in Vietnam, 1965-72

9. Outpatient visits for skin diseases in relation to mean monthly rainfall and relative humidity indexes: U.S. Army personnel in Vietnam, 1967-70

10. Outpatient visits for skin diseases in relation to mean monthly temperature index: U. S. Army personnel in Vietnam, 1967-70

11. Hospitalization for skin diseases in relation to mean monthly rainfall index: U.S. Army personnel in Vietnam, 1967-70

12. Combat man-days lost from maneuver battalions: U.S. 9th Infantry Division, 1968-69

Map

1. Major geographic features of South Vietnam

 Tables

1. Admissions for skin diseases during a 1-year period, 17th Field Hospital, Saigon, 1966-67                                            

2. Disposition by primary diagnosis of selected dermatologic conditions of active-duty Army personnel, Vietnam origin, 1965-70

3. Distribution of dermatologic causes of medical evacuation from Vietnam, 1965-70                                                   

4. Most common diagnoses in new patients seen at the dermatology clinic, 17th Field Hospital, Saigon, July 1967

5. Proportionate distribution of skin diseases seen in U.S. Army dermatology clinic, 95th Evacuation Hospital, Da Nang, Vietnam, 15 May 1970 to 31 July 1971                                               

6. Proportionate distribution of skin diseases seen in U.S. Army dermatology clinic, William Beaumont General Hospital, El Paso, Tex., 1 Jan. 1970 to 30 June 1971
7. Proportionate distribution of skin diseases in Vietnamese patients seen at the 95th Evacuation Hospital, Da Nang, I Corps, July-October 1970

8. Number of patient visits for skin diseases and for other diseases in an infantry battalion, U.S. 9th Infantry Division, Mekong Delta, 1968

9. Number of patient visits to battalion aid stations during a 4-week period in November 1968, U.S. 9th Infantry Division, Mekong Delta

10. Sick call statistics of a 350-man Mobile Riverine Force unit following a 4-day combat operation, Mekong Delta, 3 Oct. 1968

11. Combat man-days lost due to skin diseases as related to those lost to all medical and surgical conditions, infantry maneuver battalions, U.S. 9th Infantry Division, Mekong Delta, 1968-69

12. Number of man-days lost from three U.S. infantry battalions due to skin diseases and to other medical causes during a 1-week period in March 1969, U.S. 9th Infantry Division, Mekong Delta

13. Skin disease survey of mechanized infantry company, I Corps, July 1970

14. Disability due to skin diseases in the 10 maneuver battalions of the U.S. 9th Infantry Division, Mekong Delta, February 1969

15. Fungal species in culture-positive cases of dermatophytosis in U.S. troops and Vietnamese

16. Prevalence of clinically diagnosed tinea corporis and tinea cruris in U.S. troops and Vietnamese, 1968-69

17. Site-specific prevalence of clinical dermatophytosis in U.S. troops and Vietnamese

18. Distibution of dermatophytic pathogens in U.S. troops in the Mekong Delta, 1968-69

19. Prevalence of pyoderma in four population groups in the Mekong Delta

20. Prevalence of pyoderma by race in American soldiers in Vietnam

21. Results of bacteriologic studies in 50 cases of tropical pyoderma in U.S. marines and Navy hospital corpsmen, Quang Tri Combat Base, 1968

22. Results of culture in 36 men requiring treatment for pyoderma in the Mekong Delta

23. Distribution of lesions in 50 cases of tropical pyoderma in U.S. marines and Navy hospital corpsmen, Quang Tri Combat Base, 1968

24. Antibiotic resistance of beta-hemolytic Streptococcus group A cultured from pyoderma lesions of U.S. troops in Vietnam and of Vietnamese

25. Antibiotic resistance of Staphylococcus aureus cultured from pyoderma lesions of U.S. troops in Vietnam and of Vietnamese

26. Distinguishing features of tropical immersion foot and warm water immersion foot