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War Syndromes and Their Evaluation: From the U.S. Civil War to the Persian Gulf War

Kenneth C. Hyams, MD, MPH; F. Stephen Wignall, MD; and Robert Roswell, MD
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From the U.S. Naval Medical Research Institute, Rockville, Maryland; U.S. Naval Medical Research Unit No. 2, Jakarta, Indonesia; and the Department of Veterans Affairs, Bay Pines, Florida. Disclaimer: The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Navy, Department of Defense, or Department of Veterans Affairs. Requests for Reprints: Kenneth C. Hyams, MD, MPH, U.S. Naval Medical Research Institute, 12300 Washington Avenue, Rockville, MD 20852. Current Author Addresses: Dr. Hyams: U.S. Naval Medical Research Institute, 12300 Washington Avenue, Rockville, MD 20852.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;125(5):398-405. doi:10.7326/0003-4819-125-5-199609010-00007
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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.

Data Source: English-language articles and books on war-related illnesses published since 1863 that were located primarily through a manual search of bibliographies.

Data Extraction: Publications were assessed for information on the clinical characteristics of war-related illnesses and the research methods used to evaluate such illnesses.

Data Synthesis: 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 health.

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.

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