U.S. Army Medical Department, Office of Medical History
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It is well known from histories of wars that diseases caused by infectious and parasitic agents-the communicable diseases of men and animals-have inflicted great losses upon armies and related groups essential to a military effort. At times, these diseases have impeded campaigns or have contributed to the defeat of armed forces. At other times, they have been milder deterrents. In all instances, however, either as threats or as actual attackers, they, have presented large and difficult problems. Military leaders and their medical supporters have always been aware of the handicaps imposed by diseases among troops and of the need to protect troops against disability of sickness, or possibly loss by death, resulting from infectious diseases. These lessons from the past, with almost appalling projections into the imminent future, imparted both urgency and comprehensiveness to the Medical Department's program for the prevention and control of communicable diseases in the Army during World War II. Through its actions in this field, the Medical Department functioned as a part of the administration of the whole Army.

During World War II, the problems of the prevention and control of communicable diseases in the Army, and in the populations with which the Army was in contact, were. of unprecedented complexity and magnitude. A story of the activities of the Medical Department in dealing with these problems, together with some account of deficiencies and successes, will occupy at least three volumes in the preventive medicine series of the history of the Medical Department in World War II. This foreword to volume IV is, therefore, the prologue to the presentation that will fill several volumes.

The prevention and control of communicable diseases constituted the major segment of the general mission of the Medical Department in securing and maintaining the health of the, Army. The understanding of why this was so is readily grasped from apprehending that the segment included a myriad of diseases caused by bacteria, spirochetes, rickettsiae, viruses, fungi, protozoa, helminths, ectoparasites, and toxins, transmitted from man to man and from animals to man by a large variety of means and vectors, under such variations of global epidemiology as made some familiar diseases seem almost as exotic as the newly encountered diseases of foreign lands.

The mission was carried out through many organizations and devices. Among these were the Preventive -Medicine Service in the Office of the Surgeon General; the Preventive, Medicine Divisions in the Offices of the Chief Surgeons of theaters of operations; the medical components of combat units in the theaters; units of civil affairs and military government; and appropriate units in the Zone of Interior in the continental United States and in the overseas Departments. Governmental agencies, particularly the United States Public


Health Service and the entomological divisions of the Department of Agriculture, numerous civilian foundations and organizations in the health field, and research advisory bodies such as the National Research Council's Division of Medical Sciences and the Committee on Medical Research of the Office of Scientific Research and Development, and hundreds of individual civilian consultants were drawn into a concerted attack on these problems. In addition, two new organizations were created within the Army and War Department to reinforce this attack; namely, the Army Epidemiological Board and the United States of America Typhus Commission. The power thus assembled was equal to the national, international, and global task of operating military preventive medicine in an army spread over the world.

The work was done in the tradition established by Surgeon General George M. Sternberg, "father of American bacteriology," who, during his long term of office from 1893 to 1902, initiated the modern extensive program of military preventive medicine that was so effectively applied to the prevention and control of communicable diseases in World War II. This program included research, the application of the latest scientific methods for disease control based on knowledge of the infectious agents, modes of transmission, biology of vectors, susceptibility of human and animal hosts, epidemiological data, environmental factors, and collaboration between the Army Medical Department and all appropriate governmental and civilian agencies.

The success achieved during World War II is indicated by the reduction of deaths from disease to a number below that of deaths from battle. In the Spanish-American War, approximately 5 American soldiers died of disease to 1 killed in battle. In World War I, the ratio was about even-1:1. In World War II, the ratio was 0.07:1.

The prevention and control of malaria and typhus by the use of the new insecticides developed during the war deserve to be ranked among the greatest scientific achievements of the time. Demonstrations in important military and civilian situations showed bow these scourges may be eradicated.

The results of operational military preventive medicine in the control of communicable diseases in the Army during World War II, set forth in this and subsequent volumes, confirm the conviction that "a strong program of preventive medicine is a basic requirement for the successful conduct of modern war." They inure, also to the benefit of civil public health.

S. B. HAYS, Major General, The Surgeon General.