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Foreword

Contents

Foreword

Orthopedic surgery in the Mediterranean (originally the North African) Theater of Operations developed by a process of evolution. One would almost be justified in saying that the surgery which was first performed was pioneering in character. Certainly, one is justified in saying that the early endeavors culminated in superb treatment of combat-incurred injuries of the extremities. The Mediterranean theater thus served as a testing ground for the principles and techniques which were applied with such success in the later campaigns in this theater and by which these injuries were treated in the European Theater of Operations in 1944 and 1945.

When United States Army troops invaded North Africa in the fall of 1942, almost no medical officers with previous experience of combat-incurred injuries of the bones and joints were on active duty in the theater, and no official, definitive policies had been established for the management of these wounds. It was inevitable, therefore, that these combat-incurred injuries should be managed by the principles and techniques then employed in peacetime practice and that they should be managed, also, by individual variations of these principles and techniques.

A brief experience showed that the methods employed, however satisfactory they might have been in the circumstances of peacetime practice, were not satisfactory in time of war for a variety of reasons; namely, (1) the logistic situation in North Africa; (2) the timelag, which was frequently quite prolonged; and (3) the nature of most combat-incurred wounds, which were devastating to a degree entirely unknown in peacetime.

The new policies of management, which were based on the staged treatment of battle-incurred wounds, were first applied to soft-tissue wounds. By the end of 1943, a year after the beginning of combat in this theater, the practice was well established of managing this type of wound by initial and reparative surgery overseas, with reconstructive procedures reserved for Zone of Interior hospitals. By the spring of 1944, it had become accepted practice to use the same methods in the management of compound (open) fractures. Before the war ended, they were also applied to wounds of the joints.

The most important consideration in the management of compound fractures and wounds of the joints was that of sound surgery. The sulfa drugs were useful until penicillin became available. Penicillin proved extremely valuable in the prevention and control of invasive infection. Both chemotherapy and antibiotic therapy, however, were always regarded as adjunct measures. They were never considered as substitutes for indicated surgical procedures.

Dr. Hampton's comprehensive coverage of orthopedic surgery in the Mediterranean theater during World War II is the result of careful planning. Through the foresight of Col. Edward D. Churchill, MC, chief consultant in surgery to the theater surgeon, surveys of special types of combat-incurred injuries and other lesions of the bones and joints were planned and carried out while the war was still in progress. The analyses of these surveys and the conclusions drawn from them add materially to the value of this record.

It is fortunate that the subject of wartime orthopedic surgery is so thoroughly covered in this volume. The errors made early in the war in the management of combat-incurred injuries of the bones and joints are frankly recorded, as they should be, to prevent the making of the same errors in the event of another war. The validity of the principles of management which were established in the Mediterranean theater was proved in actual combat. They are still valid. These are the principles which must govern the management of mass casualties should total war ensue in the future. Details of management may change. Principles of management are permanent.

The story that is told in this volume is a record of hard experience. It is a story that should be generally known. For this reason, I hope that this book will find its way into the libraries of medical schools and that tile principles which it sets forth will be incorporated in the curricula of these schools. The medical students and young physicians who are our future medical officers will find the history of orthopedic surgery in the Mediterranean theater a helpful introduction to the management of combat-incurred injuries of the bones and joints.

S. B. HAYS, 
Major General, United States Army, 
The Surgeon General.