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Chapter 9

A Decade of Progress - Contents

Meeting the Challenge in War and Peace

We must be ready to dare all for our country. For history does not long entrust the care of freedom to the weak or the timid.-DWIGHT D. EISENHOWER.


The Army Medical Department prepares in peace for service in war. Preparedness involves many tasks and functions, none of which is independent of the others-mobilization and contingency planning to ensure that the right unit is at the right place at the right time; stockpiling of essential medical supplies at carefully selected sites to fill the gap until routine supply procedures become possible; development of lightweight, durable field equipment for mobility on the battlefield; intelligence operations to gather information on medical conditions in any area of the world where U.S. combat forces might be committed; and modification of the organization and structure of medical field units in response to changing strategic concepts and tactical requirements. Demanding, challenging, and necessary work, but at best, an estimate of needs and requirements. Combat, and combat alone, is the test of combat readiness.


Apart from combat support operations in South Vietnam, the ability of the Army Medical Department to


react quickly in an emergency was significantly tested on three occasions in the past decade. The first of these tests, the Lebanon Operation, was completed before General Heaton became The Surgeon General. Because the evaluation of medical support activities was completed after he assumed office, and because he directed that the lessons learned in Lebanon be used as a basis for improving and strengthening such support operations, a discussion of the operation has been included in this account.

Lebanon Operation, July 1958

The dispatch of U.S. Armed Forces to Lebanon early in July 1958 provided the first real test since the Korean War of how well the Army Medical Department was accomplishing one of its basic missions-combat readiness. The number of participating troops ashore was approximately 13,000, including marines, and the operation lasted slightly more than 3 months (July-October 1958). No combat was involved; instead a "semigarrison" situation was encountered, with most of the medical problems being in the field of preventive medicine. Nevertheless, the incident did provide a test of the capability of the Army Medical Department to deal with a sudden, unexpected situation in an overseas area.

The Army medical units that participated in this operation were dispatched by air or water from Europe to Lebanon. The 58th Evacuation Hospital was the largest medical treatment unit committed. Units deployed to Lebanon in addition to the 58th Evacuation Hospital included the 4th Surgical Hospital (Mobile Army); the 1st Clearing Platoon, 24th Airborne Brigade; Medical Platoon, 187th Airborne Battle Group; medical detachments of the 3d Tank Battalion and the 299th Engineer Battalion; 100th Veterinary Food Inspection Detachment; and the 485th Preventive Medicine Company. U.S. Army, Europe, also supplied the medical personnel for the Headquarters, American Land Forces (Provisional).


To provide a focal point for compiling data, for developing emergency requirements, and for analyzing and disseminating information, an Emergency Operations Center was established in the Office of The Surgeon General. The center was abolished in October 1958 when the emergency ended.

A study conducted in the Office of The Surgeon General at the request of the Assistant Secretary of Defense (Health and Medical) found that several published accounts which were critical of the medical support in the initial phase of the operation were nevertheless reasonably accurate and constructive in nature. Subsequent detailed analysis established that Army Medical Department personnel performed their basic mission in a creditable manner. Early deficiencies were resolved, and the effectiveness of the Medical Department increased as the operation progressed.

On the basis of The Surgeon General's study, and similar studies conducted in the offices of the Surgeons General of the Navy and the Air Force, the Secretary of Defense, on 14 March 1960, requested the Joint Chiefs of Staff to include a permanent medical staff in the headquarters of each established unified and specified command. He also asked that a medical staff section be included in the headquarters of any specified commands set up for an operation in which the use of a significant number of troops was anticipated. On 17 June 1960, the Joint Chiefs of Staff directed the commanders of unified and specified commands to establish the medical elements required by this new policy.

Insofar as the Medical Department was concerned, a number of important lessons were learned in the course of the Lebanon Operation which were later incorporated in operational plans. One was that medical support, particularly preventive medicine support, must accompany the first contingent of troops, since medical problems are greatest at the onset of a campaign. A second was that sanitary orders must be prepared for issue before troops are committed. These orders should be sufficiently


comprehensive and detailed to assure maximum protection from disease. Third, preventive medicine units included in the task force must have balanced and complementing organic elements reflecting all their capabilities when they are committed. Survey and control sections should be committed simultaneously to be effective. A fourth was that, in planning phased shipment of organizational equipment, adequate insect and rodent control materiel must be included in the first or second phase. A fifth was that The Surgeon General must be provided with timely and comprehensive statistical and sanitary reports from any joint commands in which Army troops are involved. Sixth, in planning for operations of this type, an appropriate medical staff must be assigned to assure preparation of adequate medical plans and to coordinate, control, and supervise the execution of these plans. A seventh was that planning for any task force operation must provide for sufficient surgical capability concurrent with the arrival of troops in the area. An eighth was that plans should be developed whereby individuals are not only designated for deployable units but are also indoctrinated and trained with the unit for their assigned mission. A ninth was that careful study must be made to ascertain that the troop lists and the equipment lists will satisfy anticipated requirements. Finally, automatic supply shipments must be augmented with adequate quantities of any unusual items that might be required because of the nature of the country in which the task force is to operate.

The Cuban Crisis, October 1962

The heaviest emergency demands upon the Army during 1962 were made because of the forces deployed to South Vietnam. Closer to home than the challenge in Vietnam was the Communist threat in Cuba that developed during October of that year. When the crisis over the U.S.S.R. buildup of missiles in Cuba arose in October 1962, the Army moved swiftly to prepare for


an outbreak of hostilities. On 16 October, it designated the Commanding General, U.S. Continental Army Command, as Commanding General, U.S. Army Forces, Atlantic, to assist the Commander in Chief, Atlantic, in contingency planning for an assault on Cuba.

War rooms and operational headquarters went on a wartime footing in mid-October, and the Army sent alerts to its forces around the world. After President John F. Kennedy's speech on the Cuban crisis on 22 October, the Army began to move combat and support units to assembly areas. The 1st Armored Division moved on 23 October from Fort Hood, Tex., to Fort Stewart, Ga., where it would be more accessible to port facilities. Signal units came from Fort Gordon, Ga., Fort Carson, Colo., and Fort Bragg, N.C.; artillery batteries and replacement companies from Fort Lewis, Wash.; ordnance units from Fort Meade, Md.; transportation companies from Fort Eustis, Va.; hospital trains from Ogden, Utah; field hospitals from Fort Leonard Wood, Mo., Fort Sam Houston, Tex., and Fort Bragg; and quartermaster units from Fort Lee, Virginia.

Nearly 200,000 troops and more than 100,000 tons of equipment were moved during the crisis. Troop units were located near outloading ports so that they might reach the objective area quickly, should the need arise.

The Army established forward headquarters of U.S. Army Forces, Atlantic, at Homestead Air Force Base, Fla., to coordinate Army activities in the base areas, and set up the Peninsular Base Command at Opa-Locka Air Force Base, Fla., to provide logistic and administrative support of all Army troops in the Florida area.

In the meantime, the Third U.S. Army executed plans for the defense of the southeastern United States and the Florida Keys. NIKE-HERCULES missile units were deployed to provide area defense against medium- and high-altitude targets, and HAWK missile units guarded against low-level attacks.

The Army force remained ready until the crisis passed. Redeployment began on 29 November when the first


Army unit, a signal battalion, departed for Fort Bragg. By 20 December, all major Army combat units had returned to home stations, with the exception of the air defense units still defending against the existent Cuban air threat.

The support mission assigned to the Army Medical Department fully tested the capability of medical personnel to implement plans for such contingencies. Within a week, a medical force of a medical group, four field hospitals, a clearing platoon, several motor ambulance platoons, a mobile laboratory and blood bank, and a medical depot were in a state of operational readiness in Florida. Commenting on The Surgeon General's role in the Cuban crisis, Major General Conn L. Milburn, Jr., then Chief Surgeon, U.S. Army Peninsular Base Command, said:

General Heaton's capacity of leadership was never more evident than the prompt and effective manner in which he met the Army Medical Department's challenge in the Cuban Affair in the fall of 1962. * * * As Surgeon of the Logistical Command assigned in Florida to support the operation, I had the opportunity of seeing at first hand the manner in which General Heaton met a condition of crisis. He immediately grasped all of the facts concerned with the operation, analyzed them perfectly, and formulated a successful plan of execution. * * * As the Chief Surgeon on the spot in Florida, I was amazed at the split-second efficiency of General Heaton and his staff in meeting this crisis of such national importance.

The Dominican Republic Crisis, April 1965

The ability of the Army Medical Department to react quickly in an international emergency was significantly tested a second time in late April 1965. At that time, an abortive military coup in the Dominican Republic set off a chain of events which led to the partial collapse of governmental authority, leaving sections of the capital city of Santo Domingo in the hands of Communist-infiltrated armed mobs. This necessitated the direct employment of U.S. combat forces to evac-


uate U.S. citizens and other foreign nationals, to prevent Communist elements from seizing control of the government, and to allow time for the Organization of American States to effect a cease-fire and prepare the way for free elections.

The dispatch of U.S. Armed Forces to the Dominican Republic provided a realistic test of Army Medical Department combat readiness. During the first week of this operation, 39,000 pounds of medical supplies for civil relief and 2,800 pounds of medical supplies for U.S. military use were airlifted to Santo Domingo. In addition to their normal mission of providing medical support to U.S. Army troops, Army Medical Department units assisted the civil population and treated casualties of both sides, loyalist and rebel (fig. 13).

The 15th Field Hospital, the largest medical treatment unit committed (fig. 14), received an average of 86 admissions a week. Units deployed to the Dominican Republic in addition to the 15th Field Hospital included the 584th Ambulance Company, the 53d Surgical Team, the 714th Preventive Medicine Team, the 54th Helicopter Ambulance Detachment, the 545th Supply Detachment, the 139th Orthopedic Team, and the 307th Medical Battalion.


Chile Disaster Relief Operations

After the devastating earthquakes and quake-generated tidal waves in Chile late in May 1960, the Chilean Government appealed to the U.S. State Department for assistance. Acting quickly in response to this appeal, the Joint Chiefs of Staff, on 25 May, authorized the U.S. Army to airlift two fully staffed and completely equipped field hospitals to the disaster area to assist in the evacuation and care of the injured and to help prevent outbreaks of epidemic diseases.


FIGURE 13.-A civil aid team dentist administers an anesthetic preparatory to extracting a tooth, Dominican Republic, 1965.

The hospitals selected for this mission were the 15th Field Hospital from Fort Bragg, N.C., and the 7th Field Hospital from Fort Belvoir, Va. The former was staged out of Pope Air Force Base, Fort Bragg, and the latter out of Andrews Air Force Base, Washington, D.C. Each hospital was augmented by an Engineer Corps water


FIGURE 14.-Part of the 15th Field Hospital, located on an abandoned airstrip near Santo Domingo, Dominican Republic, early June 1965.


purification unit, a Quartermaster Corps laundry detachment, and a Signal Corps communications team. The airlift, which involved about 1,230,000 pounds of Army supplies and equipment and 550 Army personnel, required the use of 59 giant transport aircraft of the Military Transport Service (C-124 Globemasters and C-118's). It was the Army's largest emergency airlift since the Lebanon Operation in 1958.

The first aircraft to leave on the 6,000-mile flight to Chile departed from Pope Air Force Base at 0509 hours and the second from Andrews Air Force Base at 0549 hours on 26 May. These flights were the beginning of an airstream which continued at the rate of approximately one plane per hour until the last of the huge planes was airborne. The principal limiting factor in the airlift was the lack of capability of the intermediate and destination airfields to service the large transport aircraft.

To support the operations of the Army units, rations for 15,000 patients, 225 aid station supplement packs, and two medical maintenance units (medical resupply packs) were also included in the initial military airlift. Later, in response to an appeal from the Chilean National Health Director, the Louisville Medical Depot shipped 1,400 bottles of tetanus vaccine and gas gangrene antitoxin by commercial aircraft.

During the afternoon of 26 May 1960, the Joint Chiefs of Staff requested that the Army send 10 helicopters to Chile to assist in the disaster relief operations. Two medical helicopter ambulance detachments, the 56th from Fort Bragg, N.C., and the 57th from Fort Meade, Md., equipped with the new Iroquois (Bell HU-1A) helicopter, were loaded into the maws of C-124 aircraft and placed into the airstream to Chile. A small (12-man) Transportation Corps detachment accompanied the helicopter units to provide maintenance support.

These Medical Department helicopters, piloted by Medical Service Corps officers, played an important role in


the relief activities by surveying the disaster areas and by evacuating the injured and rescuing the homeless from outlying and isolated regions, some of which were virtually inaccessible except by helicopter. The helicopters also flew food, blankets, clothing, medical supplies, and medical personnel to regions where the people were in distress. Many of the missions flown were in support of the extensive program that was carried on to suppress epidemics by flying Chilean physicians to administer mass inoculations.

Upon arrival in Chile, the planes carrying the 15th Field Hospital were refueled at Santiago before continuing about 500 miles south to Puerto Montt, where the hospital was unloaded and its tents set up in a stadium. The 7th Field Hospital had to be unloaded at Santiago and then moved by rail and truck to its site in Valdivia, which did not have adequate facilities for handling the C-124 aircraft. The hospitals began operations on 29 May and 1 June, respectively.

It soon became evident that the medical assistance required by Chilean physicians in caring for disaster victims was not so great as had been anticipated (figs. 15 and 16). In some instances, the tent wards of the field hospitals were pressed into service as temporary housing for refugees.

The 7th and the 15th Field Hospitals were the two largest medical treatment facilities sent to Chile. Units deployed to Chile in addition to these field hospitals were the 56th and 57th Medical Helicopter Ambulance Detachments, two laundry detachments from the 496th Quartermaster Company, two water purification units from the 19th Engineer Battalion, two Signal Corps teams from the 50th Signal Battalion, and a detachment from the 25th Transportation Company (Maintenance).

All personnel of the Army units sent to Chile, except for small rear detachments, had accomplished their missions and had returned to their home stations by 30 June. Meanwhile, the U.S. Government announced its


FIGURE 15.-The 15th Field Hospital at Puerto Montt, Chile, May 1960. The unit was flown from Fort Bragg, N.C., to assist victims of the earthquake disaster. (U. S. Army photograph by Lt. Cecil W. Stoughton.)


FIGURE 16.-Personnel of the 15th Field Hospital assist earthquake victims in Puerto Montt, Chile, May 1960. (U.S. Army photograph by Lt. Cecil W. Stoughton.)


decision to donate all the equipment of the two field hospitals to the Chilean Government. This transfer was completed by mid-July.

Apart from the humanitarian aspects of the mission to Chile, the airlift demonstrated that a fully staffed and completely equipped field hospital could be assembled, transported, and set up for operation within a relatively few hours, regardless of the distances involved. The 56th and 57th Medical Helicopter Ambulance Detachments were selected by the American Helicopter Society as recipients of the William J. Krossler Award for 1960 because of their outstanding performance during the Chilean disaster.

Earthquake Disaster Skopje, Yugoslavia

The readiness of the Army Medical Department to react to an emergency situation was demonstrated when the United States assisted the disaster victims in the Skopje, Yugoslavia, earthquake. On 27 July 1963, a 120-bed unit, reinforced, of the 8th Evacuation Hospital (fig. 17) at Landstuhl, Germany, was airlifted from Ramstein Air Force Base at 2245 hours. The next morning, the unit arrived at Belgrade at 0730 hours, and departed an hour later for a 270-mile overland move to Kumanovo, some 20 miles from Skopje. It became operational at 0200 hours on the 29th, some 27 hours after takeoff, which included a 12-hour road movement.

Earthquake and Flood Disasters, Alaska

On 27 March 1964, a severe earthquake caused widespread damage in Alaska. Anchorage was hard hit. Seward, 130 miles southeast of Anchorage, was damaged by the earthquake, seismic sea waves, and fire. Valdez, Whittier, and Kodiak were also heavily damaged by earth tremors and seismic sea waves.

The Army Medical Department responded promptly. In a matter of a few hours, a medical team of five doctors, 12 nurses, and 20 enlisted technicians from Mad-


FIGURE 17.-Members of the 8th Evacuation Hospital in Skopje, Yugoslavia, following the earthquake in 1963. The unit was flown to the disaster site to provide medical care to the victims. (U.S. Army photograph.)

igan General Hospital and Fort Lewis, Wash., was dispatched to the scene to assist the 64th Field Hospital in Alaska. Alerted and ready to respond also were the 27th Surgical Hospital and the 47th Field Hospital.

Alaska experienced a second major disaster in the summer of 1967. On 14 August, the Chena and Tanana Rivers near Fairbanks overflowed their banks, causing widespread damage to Fairbanks and Fort Wainwright. The rising floodwaters made further operation of St. Joseph's Hospital, the only civilian hospital in Fairbanks, impossible. At the request of the Mayor of Fairbanks, the 68 patients at St. Joseph's Hospital were evacuated to Bassett Army Hospital. Thereafter, Basset Army Hospital provided emergency hospitalization for the civilian population until St. Joseph's was reopened on 6 September 1967.

Apart from these major missions, the Army Medical


Department has assisted in a number of minor operations such as the relief of flood victims in Italy, earthquake disaster victims in Morocco, and the drought and famine stricken populace of the Somali Republic. In carrying out these mercy missions, it has served, in General Heaton's words, "as an instrument of peace in a war-torn world."


Field Medicine

President Lyndon B. Johnson's decision in July 1965 to commit substantial U.S. forces to Southeast Asia placed the Army on the threshold of one of its most challenging periods since World War II. The urgent need for rapid deployment of sizeable Army forces and resources to South Vietnam, while maintaining a state of readiness to meet contingencies elsewhere in the world, created demands that were felt by every member and activity of the Army. The Army Medical Department was thus faced once again with the challenge of maintaining and restoring the health of American soldiers fighting for the principles of freedom on foreign soil. As so many times before in the 194-year history of the Medical Department, the story is one of highly trained and dedicated men and women working heroically to provide the American fighting men the finest possible medical care.

There are many individuals who could be singled out for praise-the aidmen who, with no thought for their own safety, render emergency medical care before and during evacuation; the helicopter crews who brave enemy fire to rescue the wounded and fly them quickly from the scene of battle to hospitals (fig. 18); the talented and dedicated doctors, nurses, and technicians working long hours, both to save the lives of wounded brought in from battle and to provide everyday medical care so vital to maintaining the health of military and civilian person-


FIGURE 18.-South Vietnamese and American soldiers load a casualty into an HU-1B helicopter ambulance. (U.S. Army photograph by Pfc. John R. Sanford.)

nel engaged in the struggle in Southeast Asia. Working behind the scenes are countless others, such as the administrators who keep the medical facilities operating smoothly and the researchers who work constantly to master the problems which arise to develop new equipment to provide better treatment.

In January 1965, the Army Medical Department had 110 hospital beds operational in South Vietnam. By June 1969, there were more than 4,750 beds in 21 installations which provided hospital service to the largest forces the United States has fielded since World War II. Concomitant with this buildup of facilities and units was the development of an effective organizational structure to coordinate and direct the activities of the Army Medical Department in Vietnam.

The 44th Medical Brigade was responsible for all non-divisional medical service in support of Army forces in


South Vietnam. Initially a subordinate unit of the 1st Logistical Command, command control of this unit was transferred to the U.S. Army, Vietnam, on 10 August 1967. The Commanding General, 44th Medical Brigade, thus also functioned as Surgeon, U.S. Army, Vietnam.

While the 44th Medical Brigade was the principal medical operating agency of the U.S. Army, Vietnam, not to be overlooked were the divisional medical elements, the aviation dispensaries of the 1st Aviation Brigade, the floating medical stations of the 9th Infantry Division, and the "dustoffs" of the airmobile 1st Cavalry and 101st Airborne Divisions, as well as others. These "medics" constituted about one-third of the medical troops with the U.S. Army, Vietnam. They were the people who manned the vital facilities which kept a wounded man alive until the hospitals could take over the task. Five of these heroic corpsmen (fig. 19) were awarded the Nation's highest decoration, the Medal of Honor, for bravery in action, three posthumously.

All Army hospitals in South Vietnam, including the MUST units, were fixed installations (fig. 20) with area support missions. The peculiar nature of counterinsurgency operations in South Vietnam and the tropical environment there required modification of the usual concepts of hospital usage in a combat area. Since there was no secure road network in the combat areas of Vietnam, surface evacuation of the wounded was both impracticable and almost impossible. Therefore, air evacuation of the injured became routine. The importance of getting the casualty and the doctor together as soon as possible was an axiom of Medical Department philosophy. The helicopter was achieving this goal as never before. Of equal importance was the fact that the Medical Department was getting them together in a hospital environment equipped to meet almost any situation. The degree of sophistication of medical equipment and facilities everywhere in South Vietnam permitted Army physicians to make full use of their training and capability. As a result, the care that was available in Army hospi-


FIGURE 19.-Specialist Lawrence Joel, first medical aidman to be awarded the Medal of Honor for service in Vietnam. (U.S. Army photograph by Oscar E. Porter.)

tals in South Vietnam was far better than has ever been generally available for combat support previously. All hospitals had facilities for determining blood pH. Many, including all the evacuation hospitals, had facilities for doing blood gas determinations. Whole blood was consistently available in sufficient quantities. Many patients survived because means were available to render massive transfusion. Procedures such as repair of arterial injuries by anastomosis or vein grafting, which were


FIGURE 20.-8th Field Hospital, Nha Trang, South Vietnam, 17 March 1966. (U.S. Army photograph by SP5 Verner W. Cain.)


done by only a few selected surgeons in the Korean War, were performed routinely. For example, about 2,000 vascular repairs were performed in South Vietnam. Partial hepatectomy for certain liver injuries kept alive some patients who would undoubtedly have succumbed to older methods of treatment. 

The backbone of this life-saving system was the helicopter ambulance company (fig. 21), which greatly shortened the critical time from wound to operating table. Several scores of flying "medics" whirled their unarmed helicopters into hostile areas, risking their own lives to save those of others. "Dustoff," so known from their radio call signal, medical evacuation flights averaged only about 35 minutes each, a feat which often meant the difference between life and death for hundreds of patients. Of the wounded who reached medical facilities, about 97.5 percent survived.

The helicopter air ambulances assigned to Vietnam evacuated approximately 8,000 casualties each month during the Vietcong offensive in early 1968. Of these, approximately 27 percent were Vietnamese and another 5 percent were casualties from other free-world nations. Army air ambulances completed more than 94,000 aeromedical evacuation missions while flying approximately 47,000 combat hours.

Helicopters were aided by new equipment designed especially for use in jungle terrain. The forest penetrator was a spring-loaded device which may be attached to the end of a hoist cable and used to retrieve patients from areas too dense for a helicopter to land. The device was used extensively and to great advantage in Vietnam. Highly mobile and widely deployed forces must have a highly mobile and flexible medical evacuation system immediately responsive to their needs. The Army Medical Department developed such a system. Aeromedical support was provided by almost 140 air ambulances. These helicopters could transport six to nine patients at a time, depending upon the number of litter cases, and were particularly effective. The more seriously wounded usu-


FIGURE 21.-General Heaton during a visit to South Vietnam in November 1967. (Walter Reed Army Institute of Research photograph.)


ally reached a hospital within 1 to 2 hours of the time of their wounding.

The helicopter brought modern medical capabilities closer to the frontline than ever before. Furthermore, combined with a medical radio network, the helicopter provided greater flexibility in regulating patients. Preliminary evaluation of the injury and the condition of the patient was made while in flight, and the use of the radio network permitted redirecting the patient to the nearest hospital suited to his needs (fig. 22). Also, some hospitals may develop surgical backloads, and the combination of helicopter and radio facilitated regulating patients according to the immediate availability of operating facilities, rather than available beds. This combination was the core of the Army medical support system in Vietnam.

The patient evacuation policy for South Vietnam was established as a 15-day minimum or a 30-day optimum. Under this policy, it was possible to return to duty in South Vietnam nearly 40 percent of those injured through hostile action and 70 percent of other surgical patients.

Initially, out-of-country medical regulating was controlled at the Far East Medical Regulating Office in Japan through a representative functioning at the Office of the Surgeon, U.S. Army, Vietnam. Out-of-country evacuation was by aircraft to Clark Air Force Base in the Philippines, following which evacuees were subsequently routed either to the continental United States; to Tripler General Hospital in Hawaii; to the U.S. Army Hospital, Ryukyu Islands; or to Japan. Since the summer of 1966, however, direct evacuation of patients from South Vietnam to the continental United States via one stop in Japan by means of jet aircraft has been in operation.

Patients received in the continental United States were largely accommodated in general hospitals nearest their homes, but some were regulated to class I hospitals even nearer their homes when these hospitals had


FIGURE 22.-Aerial view of the 45th Surgical Hospital, South Vietnam. The 45th Surgical Hospital was the first unit to use MUST (Medical Unit, Self-contained, Transportable) equipment in support of combat operations.

beds available and the professional capability of managing their injuries.

As the entire Republic of Vietnam had been designated a combat zone, fixed hospitals that give long-term care to patients and that are normally found in the


Communications Zone were not present. If all the injured or sick who could not be returned to duty in South Vietnam within the established 15- to 30-day evacuation policy had been evacuated to the continental United States, it would have created a great drain of experienced manpower from the combat zone. To give this fixed-bed capability, the equivalent of about three and one-half general hospitals were established in Japan to receive and care for patients who could be expected to return to duty within a period of 60 days.

Since substantial U. S. forces were committed to Southeast Asia in 1965, the relative continuity of combat was as much a factor in building up patient leads as was the severity of fighting. Further, under such conditions, patient evacuation was accelerated to improve theater capability for contingencies All these factors combined to increase the flow of patients to the continental United States, directly and through Japan, and resulted in a rapid buildup of workloads in Army hospitals. During the first 9 months of 1968, for example, more than 21,000 evacuees originating from Army troops in South Vietnam were received in the continental United States. Because of General Heaton's foresight in expanding the continental United States hospital system, physical facilities were available, and the patient flow presented no major problem.

Since 1965, General Heaton traveled more than a quarter of a million miles by air and made at least one extensive tour of the Far East each year to inspect medical facilities and to inspire Medical Department personnel supporting the combat soldier in South Vietnam. "Patient care in Vietnam can be described only in the most glowing terms," General Heaton said. Troops engaged in combat against aggression in Vietnam were supported by teams of highly trained, exceptionally skilled, and well-motivated medical personnel (fig. 23). "I have had the opportunity to observe these teams in action in Vietnam," he added, "and based upon my personal observation and the comments of field commanders at all eche-


FIGURE 23.-General Heaton observed patient care at an Army hospital in South Vietnam during a visit in November 1967. (Walter Reed Army Institute of Research photograph.)


lons, I can say without reservation that our fighting men are receiving medical care which is far superior to that available to any army in any previous conflict. Never before in the history of warfare have the wounded received such complete medical service so quickly."

Since 1965, disease has continued to be the biggest cause of hospital admissions in South Vietnam. Malaria was one of the chief afflictions. Time lost due to illness caused by vivax malaria was about 12.5 days; the time lost from falciparum malaria has been reduced from 24 to 19 days, an outstanding example of medical advances that have been made in Vietnam.

Fevers of undetermined origin were a second major cause of hospitalization in Vietnam, but the duration of such hospitalization was usually less than 7 days. Studies were underway in Vietnam to define the cause of these conditions.

Diarrheas of various types also contributed to temporary disability, including hospitalization. These conditions were usually short lived. Amebic dysentery, which normally causes a longer lasting illness, was not common among American troops.

Hepatitis occurred at a low rate, and most patients with this condition returned to duty within 30 to 40 days.

Although plague and cholera were endemic in South Vietnam and there had been sporadic outbreaks among the native population, there had been no cases among U.S. servicemen. Other conditions which had occurred, but which created no serious problem, were dengue fever, scrub typhus, Japanese B encephalitis, and leptospirosis.

The U.S. Army Medical Department in Vietnam was staffed with specialists in all the surgical skills, and the care furnished casualties was superior. With the arrival of the specialty consultants in late 1965, an effective system of supervision and control of surgical care was initiated. Injuries from hostile action constituted about 25 percent of hospital admissions. Because of the use of air evacuation of patients, Army hospitals in South Viet-


nam received more critically and mortally wounded patients than they had in any previous conflict. Since many of these patients could not be saved, it tended to result in higher case fatality rates. However, the survival rate for the wounded reaching medical treatment facilities was no lower in Vietnam than in the Korean War. Data from Vietnam indicated that of all patients with battle injuries who were treated in medical treatment facilities, 975 per 1,000 survived.

It is noteworthy that the resuscitation of the injured in Vietnam was accomplished largely through the use of blood, plus other fluids, with relatively little usage of plasma substitutes such as albumin, dextran, and Plasmanate, although these were available in the theater and were used in emergencies. There was never any lack of an adequate supply of blood in South Vietnam. Until the summer of 1966, this blood supply was collected exclusively in the Far East theater by the 406th Medical Laboratory in Japan from troops and other blood donors in other facilities in that theater. In the summer of 1966, this supply was supplemented by the regular shipment to the Far East of small amounts of blood collected from military installations in the United States.

The rate of psychiatric illness in Vietnam was favorably low. Comparative statistics revealed that from a high of 101 admissions per 1,000 from one American army in the European Theater of Operations during World War II, and an average rate of 37 per 1,000 per year, in the period from July 1950 to December 1952, during the Korean War, the average admission rate for psychiatric disorders in Vietnam fell to about 12 per 1,000 per year.

Among the factors that contributed to the low incidence of emotional breakdown in American troops in Vietnam were better training, freedom from intense and prolonged artillery barrages or extended periods of combat, relatively frequent opportunities for rest and recuperation, the definite period of time of 1 year in the


combat zone, and refinements in the principles of combat psychiatry such as the availability of mental health workers at the combat level, where crisis and stress take place.

The American fighting men received medical care which was far superior to that available to any army in any previous conflict, but the Medical Department continued its search for ways and means to improve further patient care capability in Vietnam. Although the malaria rate decreased significantly in 1968, it remained the most serious disease in South Vietnam, and a significant problem in maintaining combat forces at peak strength. An experimental antimalarial drug, which was expected to be more effective than the one in use, was field tested in Vietnam. Another recent advance in the fight against malaria was the development of a highly specific and extremely sensitive new test to detect malarial antibodies. Plans were underway to automate this test so that it can be used in routine blood bank operations to confirm the acceptability of the donor.

Since 1966, a surgical research team from the Walter Reed Army Institute of Research has been in South Vietnam conducting intensive studies of wound bacteriology, blood coagulation, blood volumes, blood gases, and pH and enzyme determinations. Use of the supraclavicular central venous catheter, as popularized by the team, was widely utilized clinically to monitor circulatory changes during resuscitation. The frequent use of blood gas determination emphasized the syndrome of occult arterial hypokalemia in the severely wounded. Advanced research techniques were employed within minutes of wounding, and the information obtained contributed significantly to the clinical care of these patients. A similar team began studies at the 24th General Hospital in Japan.

Pulmonary insufficiency was found to be one of the major problems in the treatment of both thermal and mechanical trauma. A unique and promising capillary oxygenator was undergoing testing. This oxygenator,


coupled with the Army pulsatile blood pump, which has already been used successfully in man, offered a new approach to circulatory support and oxygenation during the acute period of respiratory insufficiency.

Civic Action

The Vietnamese conflict has been described as two wars-the military effort against the enemy and the day-to-day struggle to win the minds and hearts of the people. In addition to medical support for the military effort, the Army Medical Department was deeply engaged in this second effort. Medical personnel served ably and with dedication in the Military Advisory Assistance, the Medical Civic Action, and the Military Provincial Hospital Assistance Programs. They shared their medical knowledge and instructed their South Vietnamese military and civilian counterparts in the most recent medical advances. In their spare time, Army Medical Department personnel also worked voluntarily with the South Vietnamese orphanages and sought out opportunities for expanding their help to such agencies. As General Heaton so aptly said:

The practice of medicine knows no language barrier and hence is one of the most effective forms of civic action. By treating the sick and injured Vietnamese, we demonstrate our concern for the welfare of the individual and our true interest in the well-being of mankind. By training and advising South Vietnamese personnel, we increase both the confidence of the native population in their government and their ability and desire to establish democratic institutions.