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Preface

Table of Contents

Preface

The account of dermatologic activities in the Vietnam conflict represents a major contribution to the effort to record, in historical perspective, the internal medicine effort in Southeast Asia. The ability to characterize skin diseases and the importance of their impact on combat activities provide the basis for this publication as a separate compendium. Lt. Col. Alfred M. Allen has provided a perceptive analysis of the far-reaching implications of skin disorders on military operations in tropical areas. Historically, diseases of the skin have not been accorded the concern they deserve. This possibly relates to the low mortality generally associated with skin disorders. The high morbidity rates and the noneffectiveness rates, however, demand critical attention to the skin in the planning of any tropical military operation. Data from World War II clarified the incom­plete and inaccurate picture of hospital admission rates in the evaluation of the impact of skin disease on combat efficiency. The noneffectiveneSs rates must be calculated at the dispensary and sick call level where non-duty days caused by dermatologic disorders are a considerable source of manpower loss. Colonel Allen has carefully cataloged the various skin conditions to be expected in tropical operations and faithfully recorded their impact in Vietnam. He has extracted innumerable "lessons to be learned" from application of principles (wise and unwise) used in the Vietnam theater.

As medical consultant to USARV (U.S. Army, Vietnam) during 1969, I can fully endorse Colonel Allen's concern for the recognition of the critical importance of skilled dermatologic expertise as an available commodity in tropical operations. His detailed analysis of the impact of "paddy foot" on the mission of the 9th Infantry Division is a classic example of this requirement.

Lessons of history occasionally are buried in time, but fortunately some of importance surface appropriately. Experiences recorded following World War II pointed out the gross staffing failure in large hospitals without a single medical officer equipped with even a cursory knowledge of skin disease. The assignment of a designated dermatologist in each corps area in Vietnam represented a significant advance. The condemnation of history had been clearly detailed in chapter XX, page 546, of volume III of "Internal Medicine in World War II": "The tables of organization for these units [hospitals] originally had no provision for a dermatologist, and the Personnel Division, OTSG (Office of The Surgeon General), apparently saw no need for providing one." While indifference did not apply to the


Vietnam war, the total appreciation of the magnitude of the impact of dermatologic disorders on the soldier was not always appreciated. Those areas which were inadequately addressed are appropriately analyzed by Colonel Allen and permit the reader an opportunity to consider the future with necessary foresight. The historical value of this treatise cannot be overemphasized. It heralds the dawning of a full appreciation of increased combat effectiveness in tropical operations by simple but critical attention to the skin.

I take this opportunity to thank the personnel of the Medical History Division, U.S. Army Center of Military History, for their expert assistance in coordinating this project and for their strong support in the development of a separate dermatologic manuscript.

ANDRE J. OGNIBENE,

Colonel, MC, USA