War syndromes & their evaluation: from the U.S. Civil War to the Persian Gulf War

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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