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Chapter VII

Table of Contents

CHAPTER VII

Treatment Facilities

Skin diseases were treated at every echelon of the medical care system in Vietnam, ranging from battalion aid stations at unit level to field and evacuation hospitals at theater level. The nature of treatment and the character of the facilities designated to provide treatment varied according to echelon: field medical care was given at battalion aid stations; primary hospital care was made available by clearing companies; and definitive hospital care and consultant services were provided at selected field and evacuation hospitals.

Outpatient services were rendered at all of these facilities. Therefore, the pattern described applied only in a general sense. Local conditions and the availability of resources usually dictated the type of facility at which a soldier with a dermatological condition would first be seen.

The kind of staff that provided care was standard in each class of treatment facility.1 Battalion aid stations were manned by a general medical officer and a handful of enlisted corpsmen designated as clinical specialists. Neither the physicians nor the corpsmen had more than the barest minimum of training and experience in the diagnosis and treatment of skin diseases before their assignment to Vietnam. A few received a brief indoctrination in the management of patients with common dermatoses upon arrival in Vietnam. This occurred in units that were experiencing high rates of disabling afflictions of the skin.2

Clearing companies differed from battalion aid stations principally in numbers rather than in types of personnel assigned. While more physicians and corpsmen were available to provide treatment in clearing companies, their level of competence in the management of skin diseases was no greater than that in aid stations.

The vast majority of dermatologic patients were seen and treated in either aid stations or clearing companies.

Field and evacuation hospitals usually had partially or fully trained dermatologists on their staffs. They, therefore, were able to provide high quality diagnostic and treatment services to their dermatologic patients.

1Army Regulation (AR) No. 40-4, 1 July 1967, subject: Army Medical Department Facilities.

2Blackwell, Travis L., Duca, Peter R., Hickey, Timothy F., and Ellerin, Philip S.: Operation Safestep: An Approach to the Problem of Dermatological Diseases in a Riverine Environment. USARV Med. Bull. (USARV Pam 40-11) September-October 1968, pp. 20-22.


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FIGURE 66.-Enlisted corpsmen tending pyoderma in infantrymen at a battalion aid station in Vietnam. Aid stations were sandbagged to prevent injury from enemy mortar attacks.

This was especially significant in the diagnosis and management of rare or very serious dermatoses and in selection of patients for evacuation.

The physical facilities in which dermatologic services were provided to soldiers in Vietnam ranged from tents and sheds surrounded by sand­bags (fig. 66) to air-conditioned wards in permanent hospital structures.

Battalion aid stations were located in the tents and sheds; the interiors were hot, humid, dirty, and poorly lighted. They had no beds and no diagnostic instruments. Medical supplies of value in the treatment of skin diseases were limited to dressings, a few topical antibiotics and steroid ointments, and such commonly used systemic antibiotics as penicillin, erythromycin, and tetracycline.

Clearing company facilities differed from aid stations primarily in their size and in their provision of 8 to 12 beds for "inpatient" treatment lasting up to 72 hours.

Hospital wards, on the other hand, were comparatively clean and well stocked with drugs and other materials. Hospitals could provide treatment for a patient with a serious dermatosis for a number of  weeks, if necessary. Because of these factors and the air-conditioning found on some wards, inpatient dermatologic services in Vietnam often rivaled the best in military hospitals in the United States.


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Clinic facilities that were attached to hospitals varied markedly in the adequacy of the supplies, equipment, and space provided. However, at least one enterprising dermatologist was able to obtain an entire air-conditioned building for his exclusive use as a clinic. He installed a suite of examining rooms that was the envy of every physician who saw it.3

A serious problem in all of the Army medical facilities in Vietnam was a lack of diagnostic instruments that were appropriate for dermatologic patients. Not even microscopes were supplied to aid stations.4 Therefore, it was impossible for the physicians staffing these facilities to confirm their diagnostic impressions concerning such diseases as dermatophytosis, candidiasis, and gonorrhea.

Obtaining cultures and antibiotic sensitivity studies from hospital or area support laboratories was difficult, if not impossible, for physicians not assigned to a hospital. Thus virtually all of their diagnoses rested purely on history taking and physical examination.

Although physicians assigned to hospitals had excellent laboratory support compared to their colleagues in clearing companies and aid sta­tions, the dermatologists assigned to these hospitals complained frequently about the lack of even the simplest diagnostic tools for use in their clinics.5 Their requests for microscopes, Wood's lamps, and other instruments met so often with frustration that they sometimes were forced to ask that these items be sent to them by friends and family in the United States.

There was little evidence that the need for providing diagnostic aids was fully realized at higher medical and command levels. The furnishing of adequate means for the proper classification of skin disease remained an unsolved problem throughout the war.

3Ognibene, Andre J. [Unpublished account of Lieutenant Colonel Ognibene's professional experiences as USARV Medical Consultant, 1968-69]

4Table of Organization and Equipment 7-46H, Headquarters and Headquarters Company, Infantry Battalion, 30 Nov. 1970.

5(1) Jacobs, Stanley E.: Dermatology in Vietnam. [Unpublished account of Captain Jacobs' professional experiences in Vietnam, 1966-67.] (2) Hennessy, W. J.: Dermatology in Vietnam. [Unpublished account of Lieutenant Colonel Hennessy's professional experiences in Vietnam, 1969-70.]