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Preface

Contents

Preface

As was pointed out in the first of the two volumes which make up the thoracic surgery series in the history of the U.S. Army Medical Department in World War II, the fact that the story could not be told in one volume is a reflection of how this specialty came of age in the Second World War.

The first of the thoracic surgery volumes includes a historical note; the general, including the statistical, background of thoracic injuries; administrative considerations in the Mediterranean and European theaters and in the Zone of Interior; and the routine of management of war wounds of the chest from emergency care on the battlefield to rehabilitation in a thoracic surgery center.

This second volume deals with the special types of thoracic wounds caused by the missiles of modern warfare and with the management of their complications. As noted in volume I, the Pacific experience will be related in the volume dealing with surgery in the Asiatic-Pacific theater.

Special attention is devoted in volume II to certain complications of these injuries whose significance was realized, or fully realized, for the first time in World War II.

Retained foreign bodies have always constituted a fascinating phase of military chest surgery, though their management has not always been as discriminating, and therefore as successful, as it eventually became in this war. The series of 134 operations performed by Lt. Col. Dwight E. Harken, MC, in which foreign bodies were removed from the heart and great vessels, constitutes a remarkable achievement. There were no deaths in the series, and all of the patients left the chest centers with normally functioning hearts. The cardiac and cardiovascular operations performed at this and other chest centers during the war helped to lay the foundations for the almost miraculous advances in this field since the war.

The concept of wet lung was developed in World War II by Maj. Thomas H. Burford, MC. The methods devised to combat it prevented graver subsequent complications of chest wounds. As a result, the huge morbidity that had attended these injuries in World War I was eliminated, and many lives were undoubtedly saved.

Hemothorax was recognized in World War II as one of the important complications of chest wounds and as an antecedent of the more serious complications of organizing and infected hemothorax and hemothoracic empyema. Prompt and adequate aspiration of the chest was a simple and uniformly applicable measure of management that eventually came into general use.

Decortication proved the solution in patients with hemothorax which went on to organization and infection because of bad management, or in spite of sound management. The operation had been employed earlier for the type


of empyema usual in civilian life, but not for complications of wounds of the chest. Its bold and imaginative application to organized hemothorax and hemothoracic empyema by Major Burford was attended with such good results that the operation promptly came into general use throughout the theater.

It is a tribute to the excellent quality of the chest surgery done overseas that, after the first months of the war, relatively little active treatment was required by the thoracic casualties evacuated to Zone of Interior hospitals. The thoracic cripples who thronged these hospitals after World War I were almost never observed in World War II.

By tradition, a history of military medicine in any particular war has ended with the end of the fighting. There have been almost no attempts to determine the postwar results of special methods of treatment. Particular attention is therefore directed to the final chapter in this volume, which deals with the clinical and roentgenologic followup, in 1960 and 1961, of 167 casualties who sustained chest wounds in the 1943-45 period. The recorded data represent an incredible amount of time and effort on the part of many persons and agencies, but the followup was entirely the inspiration, and chiefly the work, of Dr. Lyman A. Brewer III, formerly Maj., MC. It was a practical effort because the groundwork for it had been laid during the war: While Dr. Brewer was serving as a thoracic surgeon with the 2d Auxiliary Surgical Group in the Mediterranean theater, he kept an individual record for each casualty he cared for personally. The selection of the patients whom it was considered practical to followup in 1960 and 1961 was made from this material.

This long-term followup study is a unique and praiseworthy endeavor. It is unfortunate that more such attempts have not been made. The excellent clinical and roentgenologic status of these casualties and their active engagement in the normal activities of civilian life give testimony, as Dr. Brewer concludes, to the management of critical thoracic wounds during World War II by the policies and practices described in these two volumes.

As was pointed out in the preface to the first of these two volumes, it would be impossible to produce books of the range of these volumes on thoracic surgery without the painstaking and devoted assistance of a great many persons and agencies. In the end, for a variety of reasons, the chief responsibility for the preparation of this material fell upon a relatively small number of authors. It is a pleasure again to make acknowledgment to them:

Dr. Brian Blades (formerly Col., MC), Consultant in Thoracic Surgery to The Surgeon General and Chief, Thoracic Surgery Section, Walter Reed General Hospital, Washington, D.C., during World War II.

Dr. Brewer, who served with Team No. 2, 2d Auxiliary Surgical Group, in the Mediterranean theater and later in the European theater.

Dr. Burford, who served with Team No. 3, 2d Auxiliary Surgical Group, in the Mediterranean theater.

Dr. B. Noland Carter (formerly Col., MC), Assistant Director, Surgical Consultants Division, Office of The Surgeon General. Dr. Carter, in addition


to preparing the chapters which carry his name, reviewed the entire manuscript and made many helpful suggestions.

Dr. Michael E. DeBakey (formerly Col., MC), Chief, General Surgery Branch, Surgical Consultants Division, Office of The Surgeon General, and now Chairman of the Advisory Editorial Board for Surgery.

Dr. Harken, Regional Consultant in Thoracic Surgery to the Senior Consultant in Surgery, European theater. Dr. Harken also directed the chest center at the 160th General Hospital, Stowell Park, Gloucestershire.

A large part of the artwork was Dr. Brewer's original conception, and he directed the preparation of all of it from beginning to end.

Mr. Milton C. Rossoff, formerly Assistant Chief, Statistical Analysis Branch, Medical Statistics Division, Office of The Surgeon General, collected and tabulated the official statistics for the thoracic surgery volumes.

My grateful appreciation is due to Mrs. Ethel Bauer Ramond, who served as assistant to the Associate Editor and who typed the entire original manuscript with notable speed, accuracy, and real medical intelligence.

Grateful acknowledgment is also due to a number of the personnel of The Historical Unit, U.S. Army Medical Service:

Maj. Albert C. Riggs, MSC, formerly Chief, General Reference and Research Branch, and Mrs. Esther E. Rohlader, Assistant Chief, provided much of the basic data for these volumes and patiently and efficiently answered endless queries and tracked down numerous obscurities to their final solution.

Mrs. Pauline B. Vivette, Assistant Chief, Editorial Branch, prepared both volumes for publication and, with the assistance of Mrs. Martha R. Stephens, Editor (Printed Media), prepared the artwork and its layouts in editorial style for the printer.

Mrs. Hazel G. Hine, Chief, Administrative Branch, handled the multiple details connected with the preparation of volumes issued under Government auspices and also supervised the final typing of the manuscript.

Finally, a special word of appreciation is due to two other persons who worked on these volumes:

Miss Elizabeth M. McFetridge, Associate Editor for the surgical series of volumes, who, after many discouragements, was able to bring together the material prepared by the group of thoracic surgeons who worked in the Mediterranean and European theaters and to prepare it for publication.

Col. John Boyd Coates, Jr., MC, former Director, The Historical Unit, U.S. Army Medical Service, and Editor in Chief of the history of the U.S. Army Medical Department in World War II. Colonel Coates, who served in World War II as Executive Officer, Medical Division, Third U.S. Army, saw the unfolding of the story of thoracic surgery in the European theater and, during the campaign, was in frequent contact with the Consulting Surgeon, Sixth U.S. Army Group. His firsthand knowledge has been useful, and his cooperation in all the work on these two volumes has been most helpful.

FRANK B. BERRY, M.D.

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