U.S. Army Medical Department, Office of Medical History
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    It is a lamentable but nonetheless incontrovertible fact that most of the serious losses which occurred from cold injury among United States Army troops in World War II should not have occurred. It would be less than candid not to acknowledge this painful truth.
    These losses occurred, as is repeatedly pointed out in this volume on cold injury, because the lessons of the past were not learned. The British experience in World War I was not recollected by the United States Army in World War II. The experience of the Aleutians, where the losses from cold injury were numerically small but proportionately large, was not transferred to the Mediterranean theater, in which the losses were both numerically and proportionately significant. The lessons of the Mediterranean theater were not transferred to the European theater, in which the preliminary figure of approximately 46,000 cases reported as cause of admission in the fall and winter of 1944-45 accounted for about 5 percent of all admissions to medical treatment. The more complete figures now available, which include cases of cold injuries associated with wounds and other conditions, bring the total number of cold injuries for the European theater to approximately 71,000, most of which occurred in the 1944-45 winter. The total number of cold injury cases in all theaters for the entire war period was 91,000.
    The bitter experiences of the Aleutians campaign and the Mediterranean and European theaters were finally appreciated, and there seems little doubt, had invasion of Japan been necessary, that casualties from cold injury would have been reduced to the irreducible minimum because the planning had been so careful and so farsighted. In both the Mediterranean and the European theaters, it is true, efficient plans of prevention and control of cold trauma were eventually set up. They produced excellent results in the Mediterranean theater in the second winter of fighting, but they were set up in the European theater almost too late to prove their efficiency. The individual ingenuity of the American soldier was a factor in preventing a worse disaster than actually occurred.
    There are no absolute excuses for the epidemics of cold injury which occurred on the Continent of Europe during World War II. There are, however, a number of explanations for them. The first, as just pointed out, was failure to learn the lessons of the past. For that matter, the European theater failed to profit from its own early experience. It was not realized that the high-altitude cold injuries which had originally beset the Eighth Air Force in Europe in 1942 and 1943 were of the same general etiology as the ground type of cold injury which was to occur later and that they were susceptible to the same general principles of prevention and control.

    Cold, wet, or cold and wet in combination are, of course, the basic causes of cold injury, but this statement does not tell the whole story. Predisposing factors are also of great importance. In World II, these factors included (1) the intensity of combat; (2) the inadequacy of clothing and footgear; (3) the pressure of events which required that new troops be taught so much in such a limited period of time that they were not taught the essential facts of cold injury; and (4), as General Bradley himself has acknowledged, the taking of a calculated risk, for which a price had to be paid, when, in the summer and early fall of 1944, it was decided that gasoline and ammunition should take precedence in transportation over supplies of winter clothing.

    No single person and no single branch of service can be blamed for what happened. The prevention of cold injury is primarily a function of command from the highest to the lowest echelon. It requires the assumption of responsibility by all personnel, including the Medical Corps, which, though its role is purely advisory, must nonetheless assume the responsibility for making its advice forceful as well as correct.
    Cold injury is a condition for which no satisfactory treatment existed in World War I or World War II and for which no fully satisfactory method of treatment has yet been found. Its prevention is therefore doubly imperative. Although, in the circumstances of warfare, the necessities of combat take precedence of every other consideration, it is still perfectly possible to prevent most cases.
    The historical chapters of this volume set forth the important details of what happened concerning cold injury in all recorded wars of history as well as in World War I and World War II. Its possible causes and predisposing factors are set forth from every angle in the very complete chapter on epidemiology, in which the presentation is based on the concept that the same epidemiologic principles can be applied to trauma due to cold as are applied to infectious diseases and that the same general principles of control are operative. The clinical chapters clearly indicate the inadequacy of our basic knowledge of cold injury and the unsatisfactory results of present methods of treatment; they also point up the necessity for continued studies in these fields. The urgent necessity for preventing a repetition of past experiences is apparent in the chapter on costs.
    I think it no exaggeration to say that this is the most comprehensive volume on the ground type of cold injury that has ever been published. I think it equally fair to say that, if it is carefully studied and if the lessons of the experience of the United States Army in World War II are properly read, marked, learned, and inwardly digested, there should be no similar experience in any future war.

Major General,
The Surgeon General.