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Foreword

Contents

Foreword

In medicine, as in life, there is usually small profit in attempting to assign full praise or full blame for a success or a failure to any single action or circumstance. On the other hand, if any single medical program can be credited with the saving of countless lives in World War II and in the Korean War, it was the prompt and liberal use of whole blood.

The development of the concept of the liberal use of whole blood and the-regrettably delayed-implementation of the concept represent one of the great pioneering achievements of World War II. The same concept was applied in the Korean War, fortunately more rapidly, with equally spectacular results. It has been carried over into civilian life, again with brilliant results, though sometimes, one fears, almost too casually, as one sees blood administered when it is not actually needed and apparently without thought of its possible consequences.

The story told in this volume of the history of the U.S. Army Medical Department in World War II is one that must be told. When that war broke out in September 1939, a whole-blood service had already been successfully provided during the 3-year Spanish Civil War, and the British immediately put into operation the program which they had developed 6 months before. Yet, it was not until May 1940 that the United States took the first steps in what later became the whole-blood program, and when this country was precipitated into World War II in December 1941, the plasma program, at least from the standpoint of commercial production, was still in its early stages.

The British experience with whole blood in North Africa, before the United States entered World War II, gave rise to discussions in the United States as to the need for provision of whole blood for combat casualties, but these discussions were not much more than academic until after the Allied invasion of North Africa in November 1942. It was that invasion and the casualties that it produced which brought the true situation sharply home, both to medical officers overseas and to the numerous persons and agencies in this country who were studying shock. Our experience in North Africa made it quite clear that plasma, in spite of its virtues and advantages, could not take the place of whole blood. Plans for its provision were worked out in both the Mediterranean and European theaters, and, by May 1943, the Office of The Surgeon General had formulated a plan, frankly a compromise with the ideal, for supplying whole blood to forward hospitals from base sections. By November of 1943, however, an entirely workable plan had been prepared in the Transfusion Branch of that Office to fly blood from the Zone of Interior to oversea theaters. The Surgeon General at this time considered the plan both impractical and unnecessary, and it needed the casualties of the first weeks of the Normandy invasion to demonstrate that the reliance placed upon local supplies of whole blood was completely unrealistic. Then, in August 1944, the same plan and the same airlift that had been rejected in November 1943 were utilized to fly blood to the European theater. A similar airlift to the Pacific Ocean areas was instituted in November 1944.

The blood program in World War II was a brilliant success in spite of the delays and frustrations that attended its inception. After the war, however, the program was allowed to lapse, and, when the Korean War broke out, less than 5 years after World War II had ended, planning for whole blood in a future war had only just been instituted, and the implementation of the planning had to be effected during the active fighting.

It is hard, in retrospect, to understand why the United States was so slow to grasp the implications of the use of whole blood in World War I, limited though that experience was; why it did not take advantage of the successful blood program used during the Spanish Civil War; and why it did not immediately make use of the British experience in the early months of World War II, when the necessity and value of whole blood for combat casualties were so clearly proved. It is even harder to understand why, between World War II and the Korean War, all plans for a supply of whole blood in possible future wars were allowed to lapse, so that the United States entered the Korean War with a plan, it is true, but with no arrangements for implementing it.

Brig. Gen. Douglas B. Kendrick, the author of this book, carried the chief responsibility for the Army blood program during World War II and during much of the Korean War. I note that in his preface he is somewhat apologetic for the detail with which the story is told. He should not be. He is quite correct in emphasizing that behind the drama of transfusion, and its almost miraculous results in both those wars, lay an elaborate mechanism of procurement, storage, delivery, and other monotonous but highly necessary details. Furthermore, as he has pointed out, it is only by the strictest and most precise attention to such details that blood is able to achieve its life saving miracles, and, equally important, can be prevented from becoming a lethal agent.

I am also glad that, contrary to the usual practice in this historical series, the story of the whole-blood program has been carried over from World War II into the Korean War, even though, as already stated, the story, at least in the beginning, reflects no credit upon our foresight. Our thoughtless negligence makes it the more important to record the facts. Like my predecessors in the Office of The Surgeon General, I have taken the position that this history must be written with complete candor and frankness, not only because a history is worthless if it is not honest but also because we must spell out the errors of the past so clearly that the same mistakes cannot be made again.

I do not believe that these gigantic errors are likely to be repeated. There is now in my Office a special transfusion officer whose business it is to see that they are not. No matter what form future conflicts may take, there is no conceivable kind of injury which will not require blood, plasma, or both. These agents, in fact, will be needed even more than in World War II and in the Korean War, for future wars will surely involve civilians as well as military personnel, and probably in even greater numbers.

In this book will be found the key to salvation in future wars as far as blood is concerned. Blood is not a commodity that can be collected and stored, at least by present techniques. It must be collected as the need arises, and the point of collection is seldom the point of administration. It cannot be collected when the need for it arises, nor can it be taken to the area of need, unless there has been careful advance planning for its procurement and transportation. A blood program cannot be improvised on the spur of the moment. Some technical details may change as knowledge increases, but the basic principles of the World War II blood program and the Korean War blood program are biologic principles and they are unlikely to change materially from the facts set forth in this book.

Medical officers who, like myself, served overseas in World War II, and who observed the management of casualties with and without the use of whole blood, are peculiarly qualified to appreciate the achievements of the whole-blood program. Its results unfolded before our eyes. In forward hospitals, we saw men saved from death and, sometimes, almost brought back from the dead. In fixed hospitals, we received wounded men who once would have died in forward hospitals, or even on the battlefield. We received casualties with the most serious wounds in good condition. With the aid of more blood, we performed radical surgery upon them, and we watched them withstand operation and, with still more blood, recover promptly from it.

There are more than the usual reasons for the preparation and publication of this volume on the whole-blood program. A major reason, of course, is the impact this therapeutic advance has had upon medical care, civilian as well as military. Another reason is to keep faith with the multiple personnel who planned and operated the whole-blood program, and with the millions of American citizens whose gifts of their own blood saved the lives of so many American soldiers, who otherwise would have died.

As in previous forewords, I desire again to express my thanks to the authors and editors of all of these volumes and to the personnel of my own office, who are helping me to carry out this extremely important phase of my mission as The Surgeon General.

LEONARD D. HEATON,
Lieutenant General,
The Surgeon General.

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