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Foreword

Table of Contents

FOREWORD

Many in our society, today and in the past, have found it difficult to reconcile the professions of medicine and the military, on the thesis that one exists to maintain life and the other to take it. Nothing could be further from the truth. The ultimate goals of each are precisely the same: preservation of life, society, and the dignity of man.

When deterrence fails and war does come, these professions become even further intertwined. Medicine must keep the force fit, prevent or treat disease, and repair the injured. Far more is at stake than just the moral obligation to care for our wounded. The successful prosecution of warfare demands that we treat and return the wounded to battle as quickly as possible. If we do our job well, we become the principal source of experienced replacements in wartime.

Surgeons must not forget the lessons so bitterly learned in previous wars. It is time to remember what we did in the Vietnam conflict. We did many things right in Vietnam. Perhaps better than in any previous war, we remembered the lessons of the past. We managed wounds properly and uniformly, even though there was turbulence in the surgical ranks, as would be expected in a one-year combat zone tour. We practiced delayed wound closure from the start and quickly relearned that closure by secondary intention is the preferred course in many wounds. We took advantage of the helicopter to change the entire system of medical care from one of moving treatment facilities to patients to one of moving patients to treatment facilities. This allowed us to create the most sophisticated medical facilities ever seen in a combat theater. We had ample blood, fluids, and adjunctive antibiotics. Our logistical supply line, though extraordinarily long, was effective and essentially unthreatened. We used the continuum of care inherent in our system well, evacuating the patients via stages from the combat zone to the continental United States (CONUS).

Since the Vietnam era a new generation of surgeons has been trained. Medicine and surgery have advanced technologically, and there has been sufficient time to forget the basics of war surgery. To prevent this loss of knowledge, the authors of this volume undertook their task. The group of orthopedic surgeons who came together in 1972 to write this history knew it would be difficult to combine the historical record with a volume useful for orthopedic surgeons in their day-to-day practice. To be credible, their statements and conclusions needed to be supported by scientific data which had been difficult to collect in a wartime situation. The wide dispersion of orthopedic patients throughout CONUS made comprehensive data especially difficult to retrieve. Therefore, most of the clinical data in the chapters came not from a central retrieval system but from records collected by the individual contributors. Had centers for hand, peripheral nerve, amputee, and other medical problems been established, as would have been ideal, data could have been collected and treatment modalities altered on the basis of this experience even during the war.

The authors of this volume, already distinguished military surgeons and educators when the book was started in 1972, have each achieved additional honors in subsequent years. The Army Medical Department is fortunate that these leaders in American orthopedic surgery completed full careers in Army medicine prior to their present important roles in national medicine.

Professor William E. Burkhalter (Colonel, Medical Corps, retired), the coordinating author/editor, exercised noteworthy leadership in compiling this text. The other authors are busy men who have given their time and effort out of loyalty to Army medicine and to society. These men were my heroes when I was a young surgeon in Vietnam. They remain my heroes today.

I must commend our medical editor, Lottie Applewhite, formerly of the Letterman Army Institute of Research, who volunteered hundreds of hours of work on this volume. Finally, the authors and I thank Dr. Mary Gillett, director of the clinical history program at the Center of Military History, for placing this work “at the head of the queue.”

FRANK F. LEDFORD, Jr.

Lieutenant General, USA

The Surgeon General