Between Flesh and Steel

by Richard A. Gabriel

  The medical regulating officer controlled helicopter evacuation by designating assignments of medevac flights within his area of coverage. The call for a helicopter initially came from the combat unit’s medic. Helicopters already in flight were diverted depending upon the seriousness of the wound. In planned battle operations, helicopters hovered near the site of the action, ready to land at a moment’s notice. If no helicopter was in flight, machines of the aeromedical evacuation ambulances stood by on the ramp and upon receiving a call took to the air. Once on the landing zone (LZ), it took less than a minute to load the casualties and for the machine to become airborne again.

  The medic aboard the helicopter contacted the radio controller, who had a direct “hot line” to the MRO. The MRO then designated the hospital destination depending upon the seriousness of the wound, the availability of expertise in a given hospital to treat the specific injury, and the time to transport the casualty to the hospital. Distance was always less important than time. If the helicopter commander questioned the decision to divert to a specific hospital, a physician was consulted by radio. The inbound helicopter then informed the receiving hospital of the number of patients aboard and their respective wounds; this information allowed the hospital to make any special necessary preparations. Usually within minutes of arrival, the patient was on the operating table.163

  The medevac crews’ heroism in landing their machines on “hot LZs” is testified to by the fact that in a two-year period 39 crew members were killed and 210 wounded while flying medical evacuation missions. They flew 13,004 missions in 1965, and they increased to 76,910 in 1966, to 85,804 in 1967, and peaked in 1969 at 206,229.164 In addition to evacuating casualties, the medical helicopters also transported blood, supplies, and medical personnel throughout the medical evacuation system.

  The Vietnam War saw the repair of vascular injuries become routine, and vascular surgeons were present at every major medical installation. The overall success rate of vascular surgery approached 75 percent by war’s end. During World War II, division-level medical facilities used almost no whole blood, relying instead on stored plasma as the primary agent to prevent shock. In Vietnam, 14 percent of all blood transfusions were done at division level, mostly with whole blood that could be stored safely in a new Styrofoam blood box.165 The forward units’ liberal use of whole blood was a major factor in reducing death by shock. Further, medical personnel found that the blood types stamped on the soldiers’ dog tags were incorrect in approximately10 percent of the cases, so blood typing became routine practice in surgical hospitals.166 To reduce blood transfusion reactions, a decision was made in 1965 to send only type O universal donor blood to the war zone. Between 1967 and 1969, 364,900 blood transfusions were accomplished with less than a thousand reactions of all kinds.167 For the first time in U.S. military history, military personnel, their dependents, and civilian employees at military installations donated free of charge every unit of whole blood used for casualties.168

  The military introduced disease control programs early in the war, and these prevention programs did much to reduce troops lost to sickness. The major diseases affecting U.S. troops were malaria, viral hepatitis, diarrheal diseases, skin infections, fevers of undetermined origin, and venereal diseases. The average annual disease admission rate in Vietnam was 351 per 1,000 men compared with 611 per 1,000 in Korea and 844 per 1,000 in the Pacific theater in World War II.169 The encounter with a resistant strain of malaria resulted in a malaria rate of 26.7 percent, more than double the rate of 11.2 percent for Korea.170

  NOTES

  1. An excellent overview of the major contributions of military physicians in the early twentieth century is found in William H. Crosby, “The Golden Age of the Army Medical Corps: A Perspective from 1901,” Military Medicine 148, no. 9 (September 1983): 707–11.

  2. The racial theorists of this period argued that the slaughter of war was actually beneficial to the genetic health of the population because it weeded out “the unfit.”

  3. Rayne Kroger, Good-bye Dolly Gray (London: Cassell, 1960), 167.

  4. Rice, “Evolution of the Military Medical Service,” 149.

  5. Peter Lovegrove, Not Least in the Crusade: A Short History of the Royal Army Medical Corps (Aldershot, UK: Gale and Polden, 1951), 26.

  6. Redmond McLaughlin, The Royal Army Medical Corps (London: Leo Cooper, 1972), 22.

  7. Lovegrove, Not Least in the Crusade, 27.

  8. Ibid.

  9. McLaughlin, Royal Army Medical Corps, 22.

  10. Edward H. Benton, “British Surgery in the South African War: The Work of Major Frederick Porter,” Medical History 21 (July 1977): 277.

  11. Garrison, Notes on the History, 192.

  12. Benton, “British Surgery,” 277.

  13. Fraser, “Doctor’s Debt to the Soldier,” 66.

  14. Theodore James, “Gunshot Wounds of the South African War,” South African Medical Journal 45 (October 1971): 1089.

  15. Ibid., 1092.

  16. Benton, “British Surgery,” 280.

  17. Lovegrove, Not Least in the Crusade, 26.

  18. Ibid., 23.

  19. McLaughlin, Royal Army Medical Corps, 23.

  20. W. Charles Cockburn, “The Early History of Typhoid Vaccination,” Journal of the Royal Army Medical Corps 101, no. 3 (July 1955): 174.

  21. Stephen A. Pagaard, “Disease in the British Army in South Africa, 1899–1900,” Military Affairs (April 1986): 74.

  22. Ibid.

  23. McLaughlin, Royal Army Medical Corps, 24.

  24. Benenson, “Immunization and Military Medicine,” 2.

  25. Denis Warner and Peggy Warner, The Tide at Sunrise: A History of the Russo-Japanese War, 1904–1905 (New York: Charterhouse, 1974), x.

  26. Gurdjian, “Treatment of Penetrating Wounds,” 164.

  27. McGrew, Encyclopedia of Medical History, 104.

  28. Gilbert W. Beebe, Battle Casualties: Incidence, Mortality, and Logistic Considerations (Springfield, IL: Charles C. Thomas, 1946), 77.

  29. Warner and Warner, Tide at Sunrise, 351.

  30. Ibid., 447–48.

  31. McCord, “Scurvy as an Occupation Disease,” 591.

  32. McGrew, Encyclopedia of Medical History, 104.

  33. Louis L. Seaman, The Real Triumph of Japan, The Conquest of the Silent Foe (New York: D. Appleton, 1906), 103. Seaman’s report is that of an American military physician serving as an observer with the Japanese Army during the war. It represents the best and most complete work on the subject of Japanese military medicine during the Russo-Japanese War available in English. See also Jan K. Herman, “Dr. Rixey and the Medical Observations of the Russo-Japanese War,” The Grog: A Journal of Navy Medical History and Culture 4 (Winter 2011): 4–10.

  34. The Japanese military preventive medicine programs were so effective that during the war the Japanese Army suffered only 362 cases of smallpox with 35 deaths from the disease in an army of almost three-quarters of a million men, even though smallpox was endemic to Japan at this time. See Grissinger, “Development of Military Medicine,” 347.

  35. Seaman, Real Triumph of Japan, 223–25.

  36. Ibid., 106–7. The surgeon general of the Japanese Navy believed that beriberi was caused by a nutritional deficiency and experimented with reducing the amount of rice in the sailor’s diet while increasing the amount of other foods. His observations proved correct, and two years before the war the Japanese Navy had all but eliminated beriberi in its ranks. The Japanese Army, however, refused to accept the navy’s success and stubbornly continued to feed its troops mostly on rice. The result was that 24 percent of the army’s total disease casualties during the war were caused by beriberi. See Alan Hawk, “The Great Disease Enemy: Kak’ke (Beriberi), and the Imperial Japanese Army,” Military Medicine 171, no. 4 (April 2006): 333–39.

  37. Ibid., 336.

  38. Ibid., 334.

  39. Ibid.

  40. For an interesting description of medical care in Japanese hospital
s and hospital ships during this period, see Teresa Eden Richardson, In Japanese Hospitals during Wartime: Fifteen Months with the Red Cross Society of Japan, April 1904–July 1905 (London: William Blackwood and Sons, 1905), 259–62. This work is one of the few accounts of Japanese military medicine available in English and was written by a nurse who served in Japanese military hospitals. The basic information source for many works on the Japanese Army in the war is British War Office Staff Study, The Russo-Japanese War, 6 vols. (London: His Majesty’s Stationery Office, 1906–1908).

  41. Seaman, Real Triumph of Japan, 123.

  42. For an evaluation of British surgical doctrine as a consequence of the Boer War, see James, “Gunshot Wounds of the South African War,” 1089–1094.

  43. In General Kuroki’s army at the battle of the Yalu River, 7,967 men were wounded: 6,753 by small arms fire, 1,073 by shellfire and hand grenades, and another 141 from bayonets. See Seaman, Real Triumph of Japan, 112.

  44. Ibid., 125.

  45. Garrison, Notes on the History, 193.

  46. Ibid.

  47. Seaman, Real Triumph of Japan, 125.

  48. Ibid., 7.

  49. Garrison, Notes on the History, 193.

  50. Warner and Warner, Tide at Sunrise, 353.

  51. Ibid., 365.

  52. In collecting their dead for cremation, special medical teams cut the corpse’s Adam’s apple so that a small bone, the nodobotoke, or “little Buddha,” could be retrieved from the body and sent home to relatives. According to Japanese tradition, the shape of the bone determined the future fate of the dead. If the bone was shaped in the image of a small Buddha, it meant that the person’s next life would be one of happiness. If the bone was misshapen or shapeless, it indicated that the person’s next life would be one of pain. The relatives deposited these bones at the temple of Tennoji in Osaka, where they were placed in a vault. After years of collection, the bones were retrieved, ground, and mixed into a paste, and a statue of Buddha was sculptured from the material.

  53. Richardson, In Japanese Hospitals, 48.

  54. Seaman, Real Triumph of Japan, 32.

  55. Ibid., 60.

  56. Ibid., 261.

  57. Warner and Warner, Tide at Sunrise, 387.

  58. Garrison, Notes on the History, 193.

  59. Seaman, Real Triumph of Japan, 177.

  60. Warner and Warner, Tide at Sunrise, 421.

  61. Ibid., 390.

  62. McCord, “Scurvy as an Occupational Disease,” 591.

  63. As a general rule, indirect fire is the greatest objective generator of psychiatric casualties. During the Crimean War, tremendous bombardments were common. It is likely that hundreds of psychiatric casualties resulted on all sides, but the lack of diagnostic tools to define psychiatric conditions meant that they were neither recorded nor treated outside the normal medical evacuation chain.

  64. Gabriel, Soviet Military Psychiatry, 35–36. This work remains the only complete work on the history and development of Russian military psychiatry published in English.

  65. This section on Russian military psychiatry is taken largely from Richard A. Gabriel’s works No More Heroes and The Painful Field.

  66. Aldea and Shaw, “Evolution of the Surgical Management,” 561.

  67. Ibid.

  68. Anthony Bowlby, “The Hunterian Oration: On British Military Surgery in the Time of Hunter and the Great War,” Lancet 1 (February 22, 1919): 288.

  69. Aldea and Shaw, “Evolution of the Surgical Management,” 561.

  70. London, “An Example to Us All,” 86.

  71. Aldea and Shaw, “Evolution of the Surgical Management,” 563.

  72. Ibid.

  73. McGrew, Encyclopedia of Medical History, 34.

  74. Fraser, “Doctor’s Debt to the Soldier,” 71.

  75. Aker et al., “Causes and Prevention,” 923.

  76. Stark, “Plastic Surgery in Wartime,” 511.

  77. Ibid.

  78. Fulton, “Medicine, Warfare, and History,” 483.

  79. Grissinger, “Development of Military Medicine,” 346.

  80. Fulton, “Medicine, Warfare, and History,” 483.

  81. Grissinger, “Development of Military Medicine,” 345.

  82. Fraser, “Doctor’s Debt to the Soldier,” 72.

  83. Garrison, Notes on the History, 196.

  84. Ibid., 200.

  85. Stanislas Kohn, The Cost of The War to Russia: The Vital Statistics of European Russia during the World War, 1914–1917 (New Haven, CT: Yale University Press, 1932), 137.

  86. McCord, “Scurvy as an Occupational Disease,” 591.

  87. Kohn, Cost of the War to Russia, 137.

  88. P. M. Ashburn, A History of the Medical Department of the United States Army (New York: Houghton Mifflin, 1929), 334.

  89. Sieur, “Tribulations of the Medical Corps,” 224.

  90. Ibid., 226.

  91. Ibid., 225.

  92. Ibid., 226.

  93. Ibid.

  94. Lovegrove, Not Least in the Crusade, 36.

  95. Ibid.

  96. McLaughlin, Royal Army Medical Corps, 38.

  97. Bowlby, “On British Military Surgery,” 289.

  98. London, “An Example to Us All,” 85.

  99. Bowlby, “On British Military Surgery,” 289.

  100. McLaughlin, Royal Army Medical Corps, 54.

  101. The field hospitals behind the lines at Ypres, for example, were struck by artillery fire with horrendous casualties. One of these hospitals was located in a place the soldiers called “Sanctuary Wood.” The Germans deployed long-range guns and, probably by accident, shelled the hospital, causing high casualties among the already wounded.

  102. Ashburn, History of the Medical Department,” 347.

  103. Garrison, Notes on the History, 200.

  104. Ibid.

  105. Ibid., 196.

  106. Ashburn, History of the Medical Department, 215.

  107. Garrison, Notes on the History, 197.

  108. Ibid.

  109. Ashburn, History of the Medical Department, 215.

  110. The American rates of psychiatric casualties were no lower after psychiatric screening was introduced than they were before. Moreover, even though psychiatric testing was regularly used during the induction process in World War II, American psychiatric casualty rates during the war were actually higher than they had been in World War I.

  111. Ashburn, History of the Medical Department, 306.

  112. Ibid., 342.

  113. Garrison, Notes on the History, 200.

  114. Ashburn, History of the Medical Department, 325.

  115. Ibid.

  116. Ibid.

  117. Rose C. Engelman and Robert J. T. Joy, Two Hundred Years of Military Medicine (Fort Dietrich, MD: Historical Section, U.S. Army Medical Department, 1975), 17.

  118. Edward A. Strecker, “Military Psychiatry in World War I, 1917–1918,” in Hall et al., One Hundred Years of American Psychiatry, 386.

  119. Fraser, “Doctor’s Debt to the Soldier,” 68–70.

  120. Ibid., 70.

  121. Lovegrove, Not Least in the Crusade, 56.

  122. Ibid., 57–58.

  123. McLaughlin, Royal Army Medical Corps, 67.

  124. Derby, “The Military Surgeon,” 184.

  125. McLaughlin, Royal Army Medical Corps, 64.

  126. Ibid., 67.

  127. McGrew, Encyclopedia of Medical History, 318.

  128. Ibid., 249.

  129. Fulton, “Medicine, Warfare, and History,” 484.

  130. Aldea and Shaw, “Evolution of the Surgical Management,” 563.

  131. McLaughlin, Royal Army Medical Corps, 87.

  132. Beebe, Battle Casualties, 93.

  133. Ibid., 22.

  134. Ibid., 75.

  135. Aldea and Shaw, “Evolution of the Surgical Management,” 563.

  136. See Charles M. Wiltse, The U.S. Army in World War II (Washington, DC: Military History Section, Department of the Army, 1963), appen
dix C, 602, for a description of the German military medical service.

  137. Ibid., 603.

  138. Ibid., 606.

  139. Ibid., 607.

  140. Ibid.

  141. Ibid.

  142. Frank A. Reister, Battle Casualties and Medical Statistics: U.S. Army Experience in the Korean War (Washington, DC: Office of the Surgeon General, 1973), 3.

  143. Ibid., 16.

  144. Ibid., 8.

  145. Fulton, “Medicine, Warfare, and History,” 484.

  146. Reister, Battle Casualties and Medical Statistics, 83.

  147. Albert E. Cowdrey, The Medic’s War (Washington, DC: Center for Military History, Department of the Army, 1987), 151. See also Warner F. Bowers, “Evacuating the Wounded from Korea,” Army Information Digest 5 (December 1950): 50.

  148. Cowdrey, The Medic’s War, 150.

  149. Reister, Battle Casualties and Medical Statistics, 79–80.

  150. Ibid.

  151. Aldea and Shaw, “Evolution of the Surgical Management,” 566.

  152. Ibid., 565.

  153. Ibid., 566.

  154. Ibid.

  155. Derby, “The Military Surgeon,” 184.

  156. Spurgeon Neel, Medical Support of the U.S. Army in Vietnam, 1965–1970 (Washington, DC: Department of the Army, 1973), 50–51.

  157. Aldea and Shaw, “Evolution of the Surgical Management,” 566.

  158. Neel, Medical Support, 56.

  159. Ibid., 50–51.

  160. Leonard D. Heaton et al., “Military Surgical Practices of the U.S. Army in Vietnam,” Current Problems in Surgery 3, no. 1 (November 1966): 3–4.

  161. Medical evacuation helicopters were often called “medevacs.” The term was derived from the radio call sign of one of the first evacuation helicopters used in the war. Its pilot, Maj. Charles L. Kelly, MSC, was killed on July 1, 1964, while trying to rescue casualties from a firefight.