War syndromes & their evaluation: from the U.S. Civil War to the Persian Gulf War
September 20, 1996
PURPOSE: To better understand the health problems of veterans of the
Persian Gulf War by analyzing previous war-related illnesses
and identifying possible unifying factors.
English-language articles and books on war-related illnesses
published since 1863 that were located primarily through a
manual search of bibliographies.
Publications were assessed for information on the clinical
characteristics of war-related illnesses and the research
methods used to evaluate such illnesses.
Poorly understood war syndromes have been associated with
armed conflicts at least since the U.S. Civil War. Although
these syndromes have been characterized by similar symptoms
(fatigue, shortness of breath, headache, sleep disturbance,
forgetfulness, and impaired concentration), no single
recurring illness that is unrelated to psychological stress
is apparent. However, many types of illness were found among
evaluated veterans, including well-defined medical and
psychiatric conditions, acute combat stress reaction,
post-traumatic stress disorder, and possibly the chronic
fatigue syndrome. No single disease is apparent, but one
unifying factor stands out: A unique population was intensely
scrutinized after experiencing an exceptional,
life-threatening set of exposures. As a result, research
efforts to date have been unable to conclusively show
causality, have been subject to reporting bias, and have
lacked similar control populations. In addition to research
limitations, war syndromes have involved fundamental,
unanswered questions about the importance of chronic somatic
symptoms and the factors that create a personal sense of ill
CONCLUSION: Until we can better understand what
constitutes health and illness in all adult populations, we
risk repeated occurrences of unexplained symptoms among
veterans after each war.
MCM: Brief review of war-related syndromes (DaCosta S or
irritable heart in Civil War, Effort S/Neurocirculatory
asthenia and Shell Shock in WWI, Battle Fatigue and Effort S
in WWI and Korean War, Agent orange/dioxin exposure and
Post-Traumatic Stress Disorder in Vietnam, and Gulf War S. and
PTSD in Gulf War). Describes similarities of symptoms,
including in many cases fatigue, difficulty with
concentration, SOB, palpitations, precordial pain, headache,
muscle or joint pain, diarrhea, sweating, dizziness, sleep
disturbance, forgetfulness. Notes problems with poorly
defined syndromes, lack of controls, secondary gains for
illness, effects of diagnostic labelling, and lack of
objective findings. Describes similarities with CFS.
Hyams KC, Wignall FS, Roswell R
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