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FOREWORD by Ben Felson (1981)

Tropical radiology has been a stepchild of our specialty. It encompasses some of the most common diseases in the world, yet we seldom find them discussed in our literature. One reason for this paradox is that the affluent society of the temperate zones seldom suffers from tropical diseases, whereas the underprivileged tropical society has not had the luxury of adequate radiology or of a sufficiency of radiologists.

But the political and economic worlds are changing and with them the medical world. The underprivileged are demanding - and receiving - privileges, among which is the privilege of reasonable health care. Health organizations in the United States and United Nations, among others, are striving to control and prevent diseases in the Third World with some measure of success. A big and a little country, China and Israel, have managed to largely control their own parasitic diseases, setting an example for other nations to emulate. At the same time, certain tropical countries, specifically those in the Middle East, have prospered and can now afford, and hopefully will provide, better medical care. For these reasons, the incidence of tropical diseases in some parts of the tropics may be on the wane. Modern preventive medicine has come a long way, but there is still a long, arduous journey ahead.

Meanwhile, countless Arabs, Orientals, Caucasians and Blacks are traveling, and their microorganisms are traveling with them. As an example, I recently saw, in Cincinnati, a Vietnamese suffering from chronic smallpox osteomyelitis. (Incidentally, the roentgenograms were diagnostic.) At the same time, poverty, crowding, disease and drug addiction have made segments of our own privileged nontropical domain less privileged and ripe for attack by opportunistic foreign organisms that are lurking about looking for new bodies to inhabit. There is indication that the incidence of tropical disease is on the rise in the United States and Europe, as yet only slightly.

Great advances in the diagnosis, treatment, and prevention of tropical diseases have been made in recent years. These measures are now so effective that it is a needless tragedy for a child to be ravaged by chronic malnutrition from an unrecognized helminthic infestation, or for a patient to die of undiagnosed amebic liver abscess. It is essential today that every physician knows something about the tropical diseases that he or she may occasionally encounter, and where to quickly find appropriate detailed information. Apart from all this, the roentgenology of tropical diseases is stimulating from an intellectual standpoint; it offers fascinating visual images of advanced disease, and an exciting challenge to decipher unfamiliar shadows and reconstruct their pathogenesis. It is (and should be) a matter of great satisfaction to the radiologist to be the first to recognize the presence of a serious tropical disease, such as amebiasis, and then to have the diagnosis verified and the patient cured.

My own tenuous role in the production of this book has been that of a catalyst. More than 15 years ago I heard a most fascinating lecture on African tropical diseases by a British colonial radiologist named Philip Palmer. A few years later, I was planning an issue of the journal Seminars in Roentgenology on diffuse diseases of the colon. In scouting about for authors of the various sections, I encountered a problem: Who would do "Tropical Diseases"? Palmer was still in Africa and, since communication and deadlines would be too difficult, I couldn't enlist him. So I looked about for an American expert on the subject, to no avail. It occurred to me that the Armed Forces Institute of Pathology (AFIP) must have considerable material on parasitic diseases. So, on my next consultant visit to the Radiology Section there, I recruited Maurice Reeder, a staff member, who knew only a little more about the subject than I, to write the article. Overriding his protests, I predicted that much of the material he would need was in the AFIP files. Reeder did his homework and found my prediction false. He then went on a collector's hunt, scrounging for material and begging for cases from colleagues all over the world. He also reviewed the literature, perusing many exotic journals and books. Eventually he came up with a first class article on tropical intestinal diseases. I used him again for an article on tropical diseases of bone and soft tissues with similar results. In this gathering process, much more material came in than he needed, so, perforce, Reeder became a specialist in tropical radiology.

One of Reeder's many donors was Palmer, who subsequently moved to the United States. The two men finally met and continued their work together. This book is a culmination of that collaboration, and incorporates Palmer's 15-year experience in Africa and subsequent return visits, together with Reeder's experience in the U.S. Army, including 5 years in the Far East and Hawaii and 13 years at the Walter Reed Army Hospital and the Armed Forces Institute of Pathology in Washington, D.C., seeing patients and their diseases from around the world. Joining them in this endeavor are Herman Zaiman, a renowned parasitologist recently turned radiologist, and A. C. Johnson, once Chairman of Radiology at Christian Medical College in Vellore, India, and now residing in the United States. "Johnny" Johnson is not only an expert on tropical diseases, but also on snake swallowers. He has a spectacular roentgen movie of snakes swimming about in the stomach of a Hindu fakir that will make us both wealthy if he will only let me be the distributing agent.

The Radiology of Tropical Diseases contains carefully selected material culled from the extensive personal collections amassed by its authors, and from the literature. The book caps a long, arduous, and, I might add, successful effort to create an inclusive treatise on the subject. It will serve as a quick, reliable, unobtrusive consultant, not only for the radiologist, but also for other physicians. It is a veritable encyclopedia of parasitology and the clinical, roentgenologic, and pathologic aspects of tropical diseases. It is extremely well illustrated. If "a picture says a thousand words," this book speaks millions.

BENJAMIN FELSON, MD

Professor of Radiology

University of Cincinnati School of Medicine

Cincinnati, Ohio

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Copyright: Palmer and Reeder