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Chapter V

Table of Contents

CHAPTER V

Command Policies

The maintenance of the health of troops is a command function, encompassing two major areas of responsibility: care of the sick and wounded and prevention of disease and injury. Direct responsibility for provision of medical care falls wholly upon the Medical Department, whereas implementation of preventive medicine programs depends to a great extent on a cooperative effort between the Medical Department and the command.1 Without full command support, most preventive medicine efforts will not succeed, including those designed to prevent disabling skin diseases in troops at high risk.

Efforts to prevent skin diseases among troops in Vietnam were not notably successful for a number of reasons. First, and in many ways most important, communication failed between commanders and their medical staffs concerning the problem. Commanders could not be kept adequately informed about skin diseases because (1) the medical statistical system was not capable of reporting the true combat noneffectiveness resulting from skin disease2 (see also chapter on medical statistics); (2) serious misconceptions existed among the medical staffs concerning the causes, contributing factors, and means of control of the common disabling skin diseases; and (3) there was no specific, well-coordinated preventive medicine program, such as existed for malaria, directed toward the control of cutaneous diseases.

The second reason for lack of success in preventing skin disease was the combination of inconsistencies, irrelevancies, and impracticability of many of the measures recommended to commanders by their surgeons. There were many examples: (1) frequent changes to dry socks were recommended for men whose next steps would be into knee-deep water; (2) a change from wet boots to shower clogs or thong sandals was recommended for infantrymen in base camp but clogs and sandals were not available from the supply system; (3) lightweight mesh socks were recommended, although the only socks supplied were thick cotton-wool hose originally designed for use in northern Europe during World War II.

A third contributing factor to lack of success in preventing skin dis-

1Gordon, John E.: The Strategic and Tactical Influence of Disease in World War II. Am. J. M. Sc. 215: 311-326, March 1948.

2Allen, Alfred M., Taplin, David, Lowy, James A., and Twigg, Lewis: Skin Infections in Vietnam. Mil. Med. 137: 295-301. August 1972.


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ease was that the regulation entitled "Prevention of Skin Disease Among Troops Operating in Inundated Areas" (app. A) was a medical and not a command regulation. The practical effect of this distinction was such that it did not carry the full weight of the theater commander's authority and could therefore be ignored with relative impunity by subordinate commanders. The failure of this regulation to influence command policy was proved in the many instances when commanders refused to allow their troops to wear abbreviated clothing while in base camp. Without specific authorization coming down through command channels, subordinate commanders feared that the unmilitary appearance created by wearing abbreviated clothing would be interpreted by superior officers as a breach of discipline or as a reflection of poor leadership.

Of the notable exceptions to the general lack of effective command policies concerning prevention of skin diseases, one of the most effective was that promulgated by the Commanding General of the U.S. 9th Infantry Division in October 1968. A command letter directed that all subordinate commanders would limit combat operations in inundated terrain to a maximum of 48 hours and that this period of exposure would be followed by a minimum 24-hour standdown period in a dry area (app. B). The dramatic effect which this policy had on rates of cutaneous disability can be seen in chart 12.