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Foreword

Contents

Foreword

The first volume on thoracic surgery in the history of the U.S. Army Medical Department in World War II was published in 1963. This is the second and final volume of that special series.

In addition to administrative considerations, the first volume set forth the routine of management of chest injuries from emergency care on the battle field to final rehabilitation in a chest center. It dealt with special types of wounds and with complications only incidentally. This second volume deals in detail with both of those subjects, both of which deserve most careful attention, for many of the concepts set forth were unknown in World War I and in civilian thoracic surgery and were recognized for the first time in World War II.

The syndrome of the wet lung, for instance, undoubtedly existed in World War I, but it went unrecognized and untreated, and its sequelae-often its lethal sequelae-were massive atelectasis and pneumonitis. Yet, once the existence of the syndrome was recognized and its pathophysiology elucidated, its prevention became a relatively simple matter and its management almost equally simple.

Similarly, hemothorax undoubtedly existed in World War I, but again its importance in military surgery was not realized, and such concepts as were developed about it were later proved to be fallacious. Correct management-that is, simple aspiration of the chest-did not always prevent organization of the retained blood and did not always prevent infection of the organizing clot, or even hemothoracic empyema, but it usually aborted most of these pathologic processes. If organization of the clot did occur, decortication was the solution of the problem of infection and hemothoracic empyema. The chest cripples after World War I were happily absent after World War II.

The results achieved in these potentially dangerous complications 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, in which there appears the record of a really unique endeavor, the followup, in 1960-61, of a small group of casualties who sustained their chest injuries in 1943-45. The series is small, it is true, but there seems every reason to assume that 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 similarly critical.

Once again, as in the first volume of the series, I would express my thanks to the authors and editors whose devoted work has made possible 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 particular tribute to the fine work of Dr. Frank B. Berry, Editor for Thoracic Surgery, whose enthusiasm, patience, and wise guidance carried this project past its initial difficulties and discouragements to a highly successful conclusion.

LEONARD D. HEATON,
Lieutenant General,
The Surgeon General.

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