U.S. Army Medical Department, Office of Medical History
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History of medical experience looks in two directions: in surveying and reporting on the past it suggests, by inference and implication, the impact that past experience will have on future practice.

This observation is dramatically illustrated by the many volumes now published in which are recorded the activities of the Medical Department, U.S. Army, in World War II. The stresses of global war impose extraordinary responsibilities on the physicians and surgeons charged with maintaining the combat capabilities of the Nation's fighting men. Meeting and discharging these responsibilities often means compressing into months or even weeks the formulation and testing of new medical concepts involving unfamiliar or obscure medical conditions-tasks that under normal circumstances might take years. It means, too, the opportunity to evaluate results under unified direction and under controlled circumstances to the ultimate benefit of all mankind; and on a scale that finds no counterpart in civilian medical practice.

This volume is the third and last in that medical series reporting on the experience of the U.S. Army Medical Department with internal medicine in World War II. The first of the internal medicine volumes, published in 1962, dealt with the activities of consultants in medicine in all parts of the world. The second volume (1963) contained an account of the infectious diseases encountered in a global war. This final volume continues the account of infectious diseases and considers various aspects of other internal medicine problems. It continues, also, the impressive account of the expansion of our knowledge of the etiology, clinical picture, control, and management of a wide variety of infectious diseases, including some about which little or nothing was known before the war. Such a disease is "Bullis Fever," a tickborne illness which is described in chapter VI. The account of the discovery of this new disease entity, and of the clarification of its epidemiology within a very short period of time, is a tribute to the Army medical officers who participated in its clinical and laboratory investigation.

In the broad field of internal medicine, military medical practitioners were provided an unparalleled opportunity to study disease and to acquire new knowledge in a variety of climes and circumstances. In hot climates, we had to rediscover that man has remarkable heat adaptation mechanisms and that adherence to sound physiological principles permits him to work hard, efficiently, and effectively in any naturally occurring hot environment. The problem of living and working under these adverse climatic conditions was solved at the expense of a considerable number of casualties and with some loss of life, but the basic principles, once learned, should not be for-

gotten and should form the basis for the proper handling of troops in hot climates in future years.

During the Second World War, to the fevers and fluxes of previous wars were added the hazards of exposure to high altitudes and the devastating effects of blast and bombs. It was, therefore, inevitable that the diseases and disorders, which affect the stability of the circulatory system, should have attracted particular attention and detailed study. Thus, the special attention given to the heart and vascular system in the process of selection of persons for military service provided an insight into the strength as well as the weakness of our eligible population. Although this effort proved disturbing in certain respects, it stimulated the thoughtful planning of special studies in the fields of hypertension and of latent coronary disease.

An outstanding example of medical effort in World War II which had significance both in the spheres of infectious disease and cardiovascular physiology was the new and detailed information gained about tsutsugamushi fever (scrub typhus). This acute and serious disease was widely encountered by the Army in the Southwest Pacific Area and in Burma, where more than 5,000 cases were reported. Three major epidemics occurred in northern Burma and in Netherlands New Guinea in 1944, and as a direct result of the Army experience, several concepts of the nature of this rickettsial disease were changed. It was discovered that there were no typical scrub typhus areas, a wider geographic distribution of the disease was established, the etiology was confirmed, vector species were proved, strains were isolated, a new complement fixation test was developed, and the clinical pattern and pathological features were described.

War, with its characteristic situation changes, dramatically brings to the forefront the environmental aspects of man's struggle for existence. The chapter on nutritional diseases presents a vivid description of the progressive states of starvation following improper or inadequate food intake, as seen in the unfortunate inmates of prisoner-of-war and concentration camps during World War II. The findings, initial, intermediate, and terminal, provided clinicians with a clear portrayal of the pathognomonic symptoms of the various vitamin nutritional deficiencies, which they could utilize in predicting the effects of various restricted diets.

Dermatological diseases, although seldom severe enough to cause death, nevertheless are among the most common and chronic medical conditions with which an army in the field must cope. Particularly is this true in semitropical and tropical climates where heat and humidity favor such diseases. Under these circumstances, crippling results requiring prolonged hospitalization are not unusual. We are fortunate, indeed, in having a splendid description of our experience in this regard based on the report and recommendations of Dr. J. Gardner Hopkins, following his tremendously helpful consultant visit to the Southwest Pacific Area for The Surgeon General during World War II.

In addition to a better understanding of symptoms and complaints referable to bodily dysfunction or defect, military physicians in World War II learned to appreciate psychological and sociological influences upon disease and adjustment. This experience in military medicine fostered the growth of the psychosomatic viewpoint, so well recognized today. Although psychosomatic concepts had some vogue before World War II, they received a major impetus during the war years, for here was a vast laboratory of stress where physicians could observe firsthand the effects of mind-body interrelationships upon symptoms, treatment, and disposition in a wide variety of diseases and injuries.

The evolution of military medical practice, as related in this third volume of the internal medicine series, is interesting and professionally highly informative reading. Much of the experience was gained in remote and unfamiliar areas of the world. It is, also, a record of achievement and progress which is a testament to the devotion to duty and the diligence of medical personnel, and especially to the many experienced physicians and investigators, both military and civilian, who pursued their studies under circumstances which were always difficult and frequently dangerous.

As with the other volumes in the history of the Medical Department, I take great pleasure in expressing my gratitude to the many authors whose contributions made possible this additional volume; to its editor, Dr. W. Paul Havens, Jr.; to the Advisory Editorial Board on the History of Internal Medicine of which Dr. Garfield G. Duncan is chairman; and to the Director and his staff of The Historical Unit who are doing the prodigious work of producing these volumes.

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