Letters to the Editor

Military Medicine, Apr 2006 by DiNicola, A F, Rivera, R R, Vargas-Tobon, H H, Benefield, B, Et al

To the Editor

"Regional Detention Facility Weight Fluctuations of Detainees in Iraq

At one Regional Detention Facility (RDF) in Iraq, we retrospectively reviewed the medical records of 149 healthy Iraqi detainees with the intent of comparing the weight differences on the day of admission and the day of release/transfer. Detainee medical records noting the use of daily medication, chronic illness, obesity, or significant acute illness during detainment were excluded from the review. All detainees are offered three culturally appropriate prepackaged meals per day with a minimum of approximately 2500 calories per day along with unrestricted water intake. Records reviewed were of detainees incarcerated from July through early November.

Of the 149 detainee records reviewed, all detainees were male with ages ranging from 15 to 68 years of age (average age 26.9 years) and with duration of stays at the RDF ranging from 9 to 27 days (average detainee stay 17.2 days). One hundred and two (102) detainees (68%) had an average weight loss of 4.9 lbs (range 1 to 13 lbs weight loss). Thirty-one (31) detainees (20%) gained an average of 3.2 lbs (range 1 to 8 lbs weight gain); and, 16 detainees (11%) had no weight fluctuation.

Caloric intake, physical activity as well as environmental and emotional stress are probably important factors affecting the weight fluctuations. Understanding weight fluctuations in detainees will help in assessing the adequacy and appropriateness of meals provided as well as other aspects of detainee care. Guidelines for the detention and medical care of the detainees in Iraq are of the highest standard.

CDR A.F. DiNicola MC, USNR

HM1 (FMF) R.R. Rivera USNR

HM2 (FMF/AW) H.H. Vargas-Tobon USN

HM1 (FMF) B. Benefield USN

We wish to acknowledge the courage and sacrifice of the 5th BN 14th MAR DIV as well as attached Corpsmen and other medical personnel in Iraq.

To the Editor

We read with interest the April 2005 supplement on the History of U.S. Military Contributions to the Understanding, Prevention, and Treatment of Infectious Diseases, especially the article by Artenstein, et.al. titled "History of U.S. Military Contributions to the Study of Vaccines against Infectious Diseases." This article has a section of about 1000 words dedicated to "Yellow Fever Control and Vaccine Development." Because of our interest in yellow fever we read this section with anticipation and care. We were surprised to find a number of misconceptions and factual errors.

"The U.S. Military's involvement in yellow fever control began with the establishment by President McKinley of a scientific commission to study its causes."

The U.S. military's involvement in yellow fever control had been ongoing for many years. Surgeon General George Miller Sternberg had been the Army's leading medical expert on yellow fever for over two decades. He had published on it as early as 1875 and had served as secretary of the Havana Yellow Fever Commission of the National Board of Health in 1879. In 1890 he published "Report on Etiology and Prevention of Yellow Fever: a U.S. Marine Hospital Service public health bulletin. The number of different groups studying yellow fever may have confused the authors. The 1897 commission detailed by the President and the Secretary of the Treasury assigned two Marine Hospital Service Officers, Eugene Wasdin and H.D. Geddings, to investigate the cause of yellow fever. Their report published in 18999 supported the claims of Giuseppe Sanarelli that he had discovered the agent of yellow fever.

"Surgeon Generals George Sternberg appointed a young officer in the Army Medical Corps. MAJ Walter Reed, to head the commission."

This sentence appears in the same paragraph that opens with the statement on the Presidential commission appointed in 1897 implies that Reed headed the 1897 study. Sternberg did appoint Walter Reed to head a board to study yellow fever in Cuba but not until May 1900. Over the years, the terms board and commission have been used interchangeably; however, the Army does not use the term commission. All service members are familiar with the terms promotion board, medical board, board of inquiry, etc. The Reed board ended up at significant odds with the Wasdin and Geddings report creating several years of hard feelings between the Army and the U.S. Marine Hospital Service. The assertion that reed was a "young officer in the Army Medical Corps" is open for discussion; young is relative but Walter Reed was 48 when appointed to head this board.

"Yellow Fever Commission correctly focused its attention on the mechanisms of disease transmission, rather than its etiology."

The Reed board studied and discovered the secrets of yellow fever transmission but only after spending its first month looking of its etiology. In their first published paper on the work of the board, Reed, et. al. detailed the blood cultures and autopsies done in an attempt to isolate an etiologic agent. A second purpose of these bacteriologic studies as to negate the claim of Giuseppe Sanarelli, an antagonist of both Sternberg and Reed, that he has isolated the bacterial cause of yellow fever.