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Chapter IV

Table of Contents

CHAPTER IV

Education and Training

With the exception of dermatologists the medical personnel who were called upon to diagnose treat, and prevent skin disease in Vietnam had little if any training in dermatology. Until the publication of a field manual entitled "Management of Skin Diseases by Company Aidmen in the Tropics" in August 1969,1 there were no educational materials available to medical aidmen or to nonspecialist physicians that provided basic information about the management of skin diseases in soldiers. In many respects this situation was no different than that which existed in the civilian community, where diseases of the skin tended to receive a low priority in both medical and paramedical education.

Even fully trained dermatologists were not optimally educated to meet the Army's needs for control and management of skin diseases in Vietnam. Dermatologists entering or already on active duty in the Army were oriented toward providing dermatologic care to patients in clinics located in a medical center or general hospital environment. They were accustomed to a referral practice where the emphasis was on diagnosis and treatment of diseases which, because of their rarity or severity, could not be managed properly by physicians with less specialized knowledge. The hospital-based training system produced physicians who were fully capable of handling similar situations in any part of the world, but it did not prepare them to design and implement programs for prevention and primary care of common skin diseases in troop populations living under field conditions in the Tropics.

The lack of emphasis on education and training in dermatology was undoubtedly responsible for a large proportion of the morbidity caused by skin diseases. This lack of emphasis was not apparent in other medical fields of importance in tropical warfare, such as malaria and enteric diseases, but seemed to be attributable to a general lack of appreciation for the enormous losses of manpower that can result from cutaneous diseases.

Until the appearance of the field manual on skin diseases in 1969, there was little educational material that dealt with the kinds of skin diseases which were prevalent in Vietnam. On the professional level, there were no TB MED's (Medical Technical Bulletins) which directly addressed the

1Field Manual (FM) 8-40, Headquarters, Department of the Army, 22 Aug. 1969, subject: Management of Skin Diseases by Company Aidmen in the Tropics.


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problems of fungal disease, bacterial infections, miliaria, or any other cutaneous affliction. The USARV (U.S. Army, Vietnam) Medical Bulletin, published in 1969 as part of a compendium in internal medicine, contained a chapter on dermatologic disease designed to guide the newly arrived physician in the essentials of dermatologic diagnosis and care. Although distributed to all medical officers, it provided only sketchy information useful as a basic primer. Two TB MED's dealt with the common problems, but only in a peripheral manner. They were TB MED 259, "Treatment and Prevention of Streptococcal Disease and Its Sequelae,"2 dated 20 December 1965, and TB MED 81, "Cold Injury," dated 20 October 1964.3 In the former, there was no specific mention of streptococcal skin infections, streptococcal disease being considered only in terms of pharyngeal infection; in the latter, that cold injuries could occur with prolonged exposures to water at temperatures greater than 70 F was stated probably erroneously.

Information for enlisted personnel also was extremely limited. For corpsmen, TM (Technical Manual) 8-230, "Medical Corpsman and Medical Specialist," published in May 1961,4 contained brief descriptions of the common fungal and bacterial infections of the skin (such as furuncle, carbuncle, athlete's foot). FM (Field Manual) 21-10, "Military Sanitation," published in May 1957,5 contained passing mention of dermatophytosis and scabies. In control of dermatophytosis, the manual recommended good personal hygiene (for example, keeping the feet clean and dry, and frequent application of foot powder) plus the institution of environmental control measures, including the use of duckboards and the disinfection of shower stalls. Thus, the environmental control measures which had been demonstrated to be of no real value during World War II6 were still being officially recommended until well into the 1960's.

The provision of appropriate educational materials was met best by nonmedical elements of the Army. In FM 31-30, "Jungle Training and Operations," published in September 19657 and designed primarily for use by field troops, the threat that skin diseases can pose to troops in tropical jungles was clearly stated. The following excerpts illustrate the point:

Prevalence: Various types of fungi produce the most widespread

2Medical Technical Bulletin (TB MED) 259, Department of the Army, 20 Dec. 1965, subject: Treatment and Prevention of Streptococcal Disease and Its Sequelae.

3Medical Technical Bulletin (TB MED) 81, Department of the Army, 20 Oct. 1964, subject: Cold Injury.

4Technical Manual (TM) 8-230, Department of the Army, 8 May 1961, subject: Medical Corpsman and Medical Specialist.

5Field Manual (FM) 21-10, Headquarters, Department of the Army, 6 May 1957, subject: Military Sanitation.
6Grauer, Franklin H., Helms, Samuel T., and Ingalls, Theodore H.: Skin Infections. In Medical Department, United States Army. Preventive Medicine in World War II. Volume V. Communicable Diseases Transmitted Through Contact or by Unknown Means. Washington: U.S. Government Printing Office, 1960, pp. 86-90, 94-95, and 106-107.

7Field Manual (FM) 31-30, Headquarters, Department of the Army, 23 Sept. 1965, subject: Jungle Training and Operations.


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infections. Constant exposure to high heat and humidity causes most troops to harbor fungus. These organisms grow at an extremely rapid rate unless a constant effort is made to keep the body dry. Foot care is most important, although fungus infection also occurs quite commonly in the ears and on the hands.

Seriousness: Fungus infections, probably the most common of all disorders, generally are more annoying and painful than incapacitating.

Fungus Diseases of Skin: "The seriousness of these diseases, especially those of the ears and feet, is seldom realized except by men with long jungle experience."

Remedial Action: "Fungus diseases, if neglected, will incapacitate many men, regardless of personal cleanliness and the use of foot powder."

Although not couched in precise medical terms, these excerpts indicate that the combat arms element of the Army had a clearer concept of the importance of common diseases in the Tropics than did the Medical Department.