CHAPTER XIV
Summary and Conclusions
The thirteen preceding chapters in this monograph present a review of themajor areas of Medical Department activity in support of the U.S. Army inVietnam, as derived from a variety of official documents. This final chapter, onthe other hand, includes value judgments related to these activities, theirsuccesses and weaknesses, and highlights some of the more significant lessonslearned. These opinions are based upon extensive review of official records andreports as well as on my own experience and observations during two tours ofduty as a senior medical officer in Vietnam, interspersed with two tours of dutyin the Office of The Surgeon General.
Medical Command and Control System
The preferred organization for employing and controlling military medicalresources is the vertical medical command and control system which reached itsepitome in Vietnam. Medical service is an integrated system with its treatment,evacuation, hospitalization, supply, service, and communications components. Itis not a subsystem of logistics, nor is it a subsystem of personnel.
To achieve maximum effectiveness and efficiency in medical service support,with the utmost economy in the utilization of scarce health care resources,there must be strong professional medical control from the most forward to themost rearward echelon. The commander of the medical command, regardless ofechelon, should function as the staff surgeon to the responsible supportedcommander. Medical capability must not be fragmented among subordinate elementsbut rather centrally directed and controlled by the senior medical commander. Nononmedical commanders should be interposed between the medical commander and theline commander actually responsible for the health of the command. Specifically,logistical commanders, with their broad materiel-related functions, should notbe made responsible for a task so critical and so uniquely professional as theprovision of health services. The well-being and care of the individual soldiermust not be submerged in, or subordinated to, the system responsible for thesupply and maintenance of his equipment. The issues involved are too great torisk failure or marginal accomplishment.
170
Health of the Command
The health of the U.S. Army in Vietnam has been excellent. A majorconsideration in the decision to commit U.S. forces in Southeast Asia was theconcern that disease in that area would decimate our troops, and that activecombat operations would be impossible. This was not the case. A majorcontributing factor to the well-being of U.S. troops was the recognition that a6-week period of adjustment and acclimatization was needed. This "precommitment"period provided, most definitely, one of the lessons learned in Vietnam.
Empirically, it has been observed that it takes about 5 days to adjust to thesignificant time zone changes and to develop a new diurnal cycle. It also takes2 to 3 weeks to acclimatize to the heat and humidity of the Tropics, if troopstresses are gradually increased. A total of approximately 6 weeks is requiredto develop a "relative biological acclimatization" to the types ofinfectious organisms encountered in the new environment. This 6-week period ofadjustment and acclimatization was a necessity; command recognized it as aphysiological and biological reality, and senior commanders in Vietnam postponedcommitment to major combat operations accordingly.
During this 6-week period, troops spent their time profitably. They learnedagain to live in the field, mess personnel became more efficient in fieldsanitation, and all the new arrivals developed a keen awareness of the problemof health and a greater appreciation of the necessity for a vigorous preventivemedicine program-both by command and by the individual.
The diseases encountered in Vietnam were those which have plagued all armiesthrough the years: fever of undetermined origin, diarrhea, upper respiratoryinfections, dermatological conditions, and malaria. Although disease accountedfor more than two-thirds of all hospital admissions, the average annual diseaseadmission rate for Vietnam (351 per 1,000 per year) was approximately one-thirdof that for the China-Burma-India and Southwest Pacific theaters in World WarII, and more than 40 percent less than the rate for the Korean War.
Malaria was the most significant medical problem in Vietnam, but it was onewhich the Army Medical Department had anticipated. Studies undertaken in SouthAmerica and elsewhere in Southeast Asia after World War II showed thatchloroquine-resistant malaria would emerge as a problem in Vietnam. This provedto be the case in 1965, when U.S. troops began operating in the CentralHighlands where there had been no real malaria eradication program because ofVietcong domination.
The precipitous rise in the incidence of P. falciparum malaria amongcombat troops in contact with the Vietcong indicated that the standardchloroquine-primaquine prophylaxis was not completely effective against
171
this strain of plasmodium. It became apparent that another antimalarial wasneeded. Medical researchers concluded that DDS (4,-4?-diaminodiphenylsulfone),a drug long used in the treatment of leprosy, seemed to be the most promisingof many drugs under evaluation. Following intensive field tests on a prioritybasis in-country, it was found that the daily use of 25 milligrams of DDS, inaddition to the standard chloroquine-primaquine weekly tablet, reduced theincidence of malaria by approximately one-half. This, therefore, became theoperational regimen, and is now followed in tactical units operating in malariarisk areas in Vietnam.
Not only did the use of DDS, in conjunction with other antimalarials, reducethe incidence of malaria, but it also assisted greatly in lowering the incidenceof relapse from a former high of almost 40 percent to a low of only 3 percent.Of equal importance, DDS aided in reducing the period of hospitalization byone-half, thus making it feasible to hold virtually all malaria patientsin-country until fully recovered.
Infectious hepatitis did not pose a major problem. The incidence of thisdisease had been relatively low, and the disease in Vietnam was milder than inprevious military experience. When the use of ISG (immune serum globulin) toprovide passive immunity was instituted in mid-1964, the incidence of thedisease had already begun to decline from the 1962-63 experience.
In 1964, when there were relatively few U.S. troops in Vietnam, ISG wasadministered to all incoming troops as a precautionary measure. For botheconomic and medical reasons, the dose of ISG was reduced in early 1966, and inMarch of that year the program was further changed to administer ISG selectivelyto personnel on high-risk assignments or in key positions. No major problemsdeveloped from this change in policy and procedure. The lesson here is, ofcourse, that all decisions must be evaluated constantly and changed withboldness and courage if the situation so dictates.
The exotic tropical diseases, endemic and epidemic in Southeast Asia, did notpose a problem in U.S. troops. Plague in the Vietnamese civilian populationpointed up, however, the shifting of disease patterns when the normal way oflife of any peoples whose structure, economically or environmentally, isaltered. Vietnam is a rice-producing and rice-exporting country. Normally, thegrain flowed from the rice bowls of the interior to the few major ports of thecountry. The rodents which infest the areas followed the path of the rice to theports. There they were controlled; thus, the danger of a serious outbreak ofplague was averted. During the war when, for economic reasons, the SouthVietnamese began to import grain, a reverse situation was created. The rice wasshipped from the ports into the countryside; the rodents followed the flow ofthe grain inland and created havoc in the form of increased incidence of
172
plague among the native population in areas which had heretofore beenrelatively free of the disease.
Contrary to experience in recent wars, neuropsychiatric illness did notconstitute a significant problem. Until 1970, the rate and types ofneuropsychiatric illness approximated those in the continental United States.This relatively low incidence may be attributed to the type of tacticaloperations being conducted; the high caliber and morale of the soldiers manningcombat units; the 1-year tour; magnificent leadership; and an aggressive andeffective preventive medicine program with strong command support.
However, during the wind-down in 1970, the incidence of neuropsychiatricdisorders among troops increased and has remained at a disconcerting level. Thisincrease also parallels the incidence in the United States, and has beensomewhat compounded by the allegations so frequently voiced in the news mediathat the citizens of this country are dissatisfied with the war and the U.S.involvement therein. As the United States continues to disengage, this problemwill continue, although it is known that the command, at every level, recognizesthe problem and is exercising vigorous leadership to overcome it.
Combat Casualties
The wounded soldier in Vietnam received better care more quickly than in anyprevious conflict. This was possible because, early in the war, it was foundthat relatively small numbers of helicopters with an exclusive medical missioncould evacuate large numbers of patients to centrally located medicalfacilities. As the years went by, equipment was updated, more powerfulhelicopters were used as air ambulances, radio communications were refined toassure more rapid response to requests for casualty evacuation, and airambulance crews were given sufficient basic medical training to enable them toevaluate a patient's condition, to recommend the most suitable destination, andto provide resuscitative care en route. Thus, the care given to combatcasualties was the finest furnished by any army to date, despite the seriousnessof the wounds and the impediments to evacuation and surgical treatment.
Regardless of the criteria used-survival rates, case fatality rates,return-to-duty rates, length of hospital stay, and so forth-the Vietnamexperience compares favorably with all military medical experience to date.Important factors which contributed to this record are: rapid, reliablehelicopter evacuation, as noted above; well-equipped stable forward hospitals;well-trained, dedicated surgical and support teams; improved management; andcontinuous availability of whole blood. The availability of whole blood, whichhad been a problem early in each major war to date, was not a problem inVietnam. An efficient blood
173
distribution system kept pace with the increasing requirements for wholeblood; in no instance was blood unavailable when, where, and in the types andamounts needed. The Military Blood Program Agency must be retained duringpeacetime and must be prepared for activation in war.
Two circumstances make this record even more remarkable. While thedistribution between high velocity and fragment wounds in Vietnam approximatedthat of World War II and Korea, the incidence of mine and boobytrap wounds wasmore than triple that in the other two wars. These injuries, often multiple,always devastating, pose the most formidable threat to life and the greatestchallenge to the surgeon. The helicopter contributed to survivability bydelivering to hospitals greater numbers of more seriously wounded than in anywar to date. These casualties included many with wounds that in past wars provedfatal before the casualty could be evacuated to a treatment facility. Despitethese two factors, the survival rate remained high.
Hospitalization
Hospital support was ample for the task, both quantitatively andqualitatively. Semipermanent hospitals, located in base areas, with the mostsophisticated equipment, with air-conditioned surgical and recovery suites andintensive care wards, permitted the application of the latest techniques ofmodern medicine in the forward battle area. Procedures that were rarelyperformed in the combat zone in previous wars were done on a routine daily basisin all hospitals in Vietnam.
Longer term care for patients suffering from malaria and hepatitis, orrecuperating from surgery, was also provided in-country. The convalescentcenter at Cam Ranh Bay was used to oversee the reconditioning of the longer termpatients. Availability of this convalescent center, as well as the excellentArmy Medical Department facilities in Japan for those patients who could not beaccommodated in Vietnam-not because facilities were not available, but ratherbecause it was always necessary to maintain a fairly substantial number of emptybeds for possible peak influx of patients-assured the command as a whole, andthus the American people, that casualties of all types who did not requireonward evacuation to the continental United States, could receive all of thecare necessary. Upon recovery, these men could be expeditiously returned totheir units, in-country, to carry on with their assigned duties, thus conservingmanpower in the theater of operations.
Environmental control within the hospital was clearly demonstrated asessential to proper military medical practice. The MUST (Medical Unit,Self-contained, Transportable) was a practical answer to control in a mobilesituation. The MUST is a good concept, and Vietnam was
174
the right war for its employment; however, there were some managementdeficiencies in its utilization. The MUST should have been used to establish animmediate treatment facility in new areas of operations, then replaced by lessexpensive semipermanent hospitals when the continuing need became apparent andconstruction support became available. This was not done, and the "T"(transportability) capability was not exploited.
The adequacy of hospitalization, in-country and offshore, was evidenced bythe favorable survival and return-to-duty rates in both areas. The efficiency ofhospitalization was greatly enhanced by effective Army and Air Force aeromedicalevacuation and by a smoothly functioning medical regulating system.
Many people and many elements were responsible for the excellent recordachieved in the care and treatment of the soldiers in Vietnam. The judicious andbold use of hospital facilities was certainly a major facet in thissuccess-"bold," since hospitals in Vietnam were actually assignedmissions beyond their normal TOE capabilities. Evacuation and field hospitalsreally functioned as 400-bed general hospitals. The 30-day evacuation policyplus the relative stability of hospitals, made possible in large measure by theoutstanding in-country evacuation system, combined to permit sophisticatedprocedures and contributed to a high return-to-duty rate in-country.
In essence, hospitalization in Vietnam combined that normally found in thecommunications zone in a classic theater of operations with that found in thecombat zone.
Helicopter Evacuation
Army Medical Department helicopter evacuation, in addition to movingcasualties swiftly and comfortably from the battlefield to supporting hospitals,proved to be an important tool of modern military medical management. Adequateand reliable medical helicopter evacuation, with a medical radio network and anefficient medical regulating system, permitted more efficient and moreeconomical use of medical resources.
With helicopter evacuation, hospitals can be stabilized for more efficientoperation, without losing responsiveness to changing tactical situations.Hospitals need not be moved so often, with expensive "downtime" andloss of continuous support. The flexibility and versatility of helicopterevacuation under medical regulation and control permits the utilization of allthe hospitals all of the time. Surgical lags are reduced. It is no longernecessary to staff every hospital with every specialty, because the casualty canbe directed to that hospital best suited for the special attention he needs. Atthe same time, a specialty surgical capability
175
is placed in direct support of every forward medical activity. Fewerhospitals and fewer professional personnel are required for a given operation,owing to the medical management inherent in such evacuation system as thatdeveloped in Vietnam. Despite the cost of helicopter procurement, operation, andmaintenance, a medical system which includes helicopters is just as economicalas one without helicopters, when the total costs in national resources areconsidered.
Tactical and strategic aeromedical evacuation support of the Army by the AirForce was magnificent and contributed in large measure to the effectiveness ofthe Army medical operations. The enthusiastic responsiveness of the Air Forceand its ability to move large numbers of patients rapidly, on short notice, madeit possible for in-country hospitals to maintain a higher bed occupancy rate inthe interest of conservation of strength, without sacrificing the capacity toaccommodate waves of casualties. Generally, the Air Force moved patients betweenlarger hospitals along the coast and offshore; however, it also evacuatedcasualties directly from forward brigade and division bases, when requested todo so.
Similarly, there was enthusiastic cross-service support among Air Force,Navy, and Army medical facilities, in-country and offshore, as promulgated inJoint Chiefs of Staff Publication No. 3. U.S. Navy hospital ships providedinvaluable augmentation to shore-based medical facilities, especially in the ICorps Tactical Zone. Interservice medical co-operation was outstanding.
Medical Supply
Medical supply support for the U.S. Army in Vietnam was superb, consideringthe many problems and impediments encountered. Early in the war, there was muchcriticism of medical supply, and a major reorganization of the existing systemwas required to provide adequate support. (See Chapter V.) It was againdemonstrated, and most forcibly, that medical supply is part of the over-allmedical support system, and that it must remain in that system, underprofessional medical control, if it is to be effective.
In addition to the existence of an unsatisfactory medical materiel managementsystem in 1965-66, certain medical supply problems were iatrogenic ("causedby the physician").
For example, early in the buildup, it was decided to upgrade the capabilitiesof all hospitals in-country, because of the stability that was available and theremoteness of the objective area from the nearest offshore support. Essentially,the evacuation and field hospitals functioned as small general hospitals, andthe surgical hospitals were similarly
176
upgraded. The TOE's of these hospitals were inadequate for the expandedmissions. Specialty oriented physicians immediately required different and moresophisticated types of surgical, X-ray, laboratory, and recovery and wardequipment. The impact of these requirements on medical supply and maintenancesupport is obvious. Also, in late 1965, medical authorities decided to add thedaily DDS tablet to the weekly chloroquine-primaquine tablet in thechemoprophylaxis against falciparum malaria. That decision immediatelycreated "a serious medical supply shortage" that was felt throughoutthe system including the manufacturer.
The wisdom of these and other operational decisions in improving the medicalcare in Vietnam is documented in this monograph. Medical supply was neveraccepted as a constraint to medical capabilities planning, and the systemresponded in a commendable manner.
Outpatients
All the hospitals in Vietnam were inundated with outpatients referred forspecialized consultation by physicians in troop dispensaries and divisionalmedical activities. These hospitals were not staffed or equipped to accommodatethis unprogrammed workload. Adequate facilities to house and feed the referralswere usually not available; and significant discipline, control, andtransportation problems arose.
The thrust of modern medical education contributed significantly to thedifficulty. Many of the physicians on duty in Vietnam had come directly fromcivilian practice or training. Modern medical school curricula place increasedemphasis on specialization and the use of specialist consultants. Thesophistication of modern medicine, the desire of the physician to provide thevery best care for his patient, and the increasing awareness of malpracticesuits added further to the problem.
A twofold approach to resolving this problem is underway. The new modularcombat support hospital, which is intended to replace the surgical andevacuation hospitals, will have a realistic outpatient capability. Of moreimportance, in restructuring the medical service support within the division,consideration is being given to including certain specialists in the medicalbattalion. Thus, outpatient consultant capability in such specialties asinternal medicine, dermatology, ophthalmology, and orthopedic surgery will beavailable in the division base, preventing the unnecessary evacuation of manypatients and keeping the troops under division control. These specialists willconsult freely with other division medical officers and will also teach andvisit dispensaries. In the interest of economy and mobility, division medicalfacilities for inpatient specialist care will not be augmented.
177
Battalion Surgeons
Vietnam, and other recent experience in division and brigade medical support,has shown that it is no longer necessary nor desirable to assign medicalofficers to combat battalions. The impact of helicopter evacuation, frequentlyoverflying battalion aid stations and going directly to supporting medicalfacilities, is only one of the considerations. Equally important is the natureof modern medical education and modern medicine, and the orientation of today'syoung physician, who depends heavily on laboratory and X-ray facilities, and onconsultations with other physicians. This is the best way to practice medicineand field medical organization is being modified to accommodate this reality.
The battalion surgeon is being removed from the combat battalion. Hisclinical replacement will be a well-qualified technician, probably in the gradeof warrant officer, and modeled after the "physician's assistant" incivilian practice. The technician will work under the direction of physicians inthe brigade base and will provide initial resuscitation to wounded and doscreening at sick call. The general practice of medicine will be moved from thebattalion to the brigade base.
Impact of Policies
The 1-year tour of duty, unique to the Vietnam experience, had a definiteimpact on the medical support system. The favorable effect of the 1-year tour onmorale and the reduction of neuropsychiatric illness has been described. A moresubtle effect has been on the traditional emphasis placed by the medics, and theline, on "conserving the fighting strength." Contrary to U.S.experience in conventional "open ended," or "duration plus sixmonths" wars, this emphasis seems to have diminished in Vietnam. Thepolitical and military wisdom of certain personnel policies on evacuation andreturn to duty implemented in Vietnam is obvious, and the medical service mustbe prepared to modify its approach accordingly.
Patients medically qualified for return to duty from offshore hospitals, butwith less than 60 days remaining on their Vietnam tour, were not sent back toVietnam. Those received in offshore hospitals with less than 60 days to DEROS(date eligible for return from overseas) were further evacuated to thecontinental United States when the medical condition permitted. This practicelowered the return-to-duty rates and the workloads of the various hospitals inthe chain of evacuation. Approximately one-sixth of the patients evacuatedoffshore were administratively ineligible to return to duty in Vietnam,regardless of the medical condition or the degree of recovery. This reason,among others, contributed to the
178
decision to have a 60-day offshore evacuation policy, rather than thetraditional 120-day holding policy.
This "60 days remaining on DEROS" policy was also one of thefactors responsible for the increase of the in-country holding policy from 15 to30 days. (There are other more cogent ones.) The increased capability andholding capacity of in-country hospitals led to more selective evacuation ofcomplicated cases, largely surgical, to the offshore hospitals in Japan andelsewhere. Patients with simple surgical, medical, and neuropsychiatric ailments were treated in-country and returned to duty there. The imbalancebetween the types of patients received offshore, and the balanced staff preparedto receive them, created a management problem. Repeatedly, the Army waschallenged on "under utilization" of offshore capability by"managers" who could not understand why a 1,000-bed general hospitalwas "full" with only 650 patients. In fact, a 1,000-bed generalhospital, staffed for a 40-40-20 percent mix of medical, surgical, andneuropsychiatric patients, was inundated with 650 patients, most of whomrequired complicated surgery, often orthopedic.
A more insidious policy, which troubled me as a physician and staff officer,was the provision that patients evacuated to the continental United States, orhome of record, would be given tour-completion credit and would not be requiredto return to Vietnam. Originally the policy applied to battle wounded only, butlater it also included disease and nonbattle injury cases. This expansion of thepolicy gave me the most concern, because it damaged the safety and preventivemedicine programs by giving a bonus to the careless or disaffected manipulator.There was a time, in the fall of 1965, when the best way for a soldier to insurebeing home with his family on Christmas was to contract malaria in theHighlands, or to be seriously injured in a Honda accident in Saigon, or toreceive a bad "accidental" burn in Nha Trang. At the subconsciouslevel, where a soldier is really motivated, such a bonus in illness or injurycan have a most negative effect.
In late 1968, USARV made extraordinary efforts to meet in-country strengthceilings imposed by higher authority. Although the so-called "patientaccount" portion of the USARV troop strength was established at 3,500, thesurgeon was directed to reduce the number of patients occupying beds to no morethan 3,000, to provide spaces to cover accesses in in-country temporary dutypersonnel. Also, some 5,000 hospital beds were available during that period.There seemed to be little command concern about the overevacuation offshore toaccomplish the reduction. In fact, when informed that certain patients who wouldbe fit for return to duty within, say, 5 days, were being evacuated to Japan onesenior commander said that he sent troops to Japan for only 5 days on arecurrent basis-the R&R (rest and recuperation) Program. In short, thereseemed
179
to be less command concern in retaining experienced combat troops in-country,because of the ready availability of replacements.
These observations are not intended to be critical, but they should beconsidered when developing future policy related to eligibility to return tocombat zones after illness or injury. Modifications of Medical Department policyand procedure, and the allocation of resources among successive medicaltreatment echelons, most also be done in light of these realities.
Lack of Responsiveness of The Army Authorization Document System
A major problem encountered in the buildup phase was the lack ofresponsiveness to TAADS (The Army Authorization Document System) in the combatsituation. When the decision was made in 1965 to upgrade the capabilities ofin-country hospitals, their TOE's were grossly inadequate for the expandedmissions. Authorizations for the additional personnel and equipment requiredwere hopelessly delayed, first by the moratorium in effect on TAADS, then by theinertia of the system. The most frustrating part of the problem was securingauthorizations against which to requisition nonmedical equipment and enlistedpersonnel (including medical).
Through the use of effective technical channels, The Surgeon General mostexpeditiously provided the Medical Department officers and the medical equipmentneeded for the expanded hospital missions. Enlisted personnel and the nonmedicalequipment, however, had to be processed through nonmedical channels, involvingmonths of delay.
While TAADS may be an effective way to manage force structure in peacetime,it should be waived in the combat situation to permit timely implementation ofdecisions necessary to support operations.
Research
Clinical research, surgical and medical, in forward combat hospitals,essential to the finest practice of medicine and to the improvement of techniqueand materiel procedures, was done most effectively in Vietnam. Adequatephotographic as well as written documentation of combat medical experience wasalso furnished for review and evaluation in the refinement of procedures.
Vietnamese Civilian Care
While providing the best in medical care for U.S. forces, the MedicalDepartment made significant contributions to the care of sick and injuredVietnamese civilians from the earliest days of U.S. involvement. These
180
efforts, of considerable magnitude and scope, were well integrated with otherUnited States and Vietnamese efforts and contributed to the improvement ofVietnamese medical practices.
Despite frequent and continuing political allegations to the contrary, U.S.troops were compassionate and did provide full assistance to the disruptedVietnamese nation. Apart from the humanitarian aspects of the various civilianmedical assistance programs, this involvement provided U.S. medical personnelgainful and rewarding activity during lulls between peak military medicalsupport requirements. This, in turn, contributed to the high morale of committedU.S. "medics."
Civilian Implications
In every major war, medical advances are made which have a strong positiveinfluence on the over-all practice of medicine in civilian society. Vietnam wasno exception. Skilled surgical and research teams developed improved techniquesfor managing trauma in individuals and in groups. Examples of specific advancesare contained in the body of this monograph. Less obvious is the tremendouscontribution that physicians and surgeons are making to American medicine as aresult of their in-depth experience in Vietnam. Throughout the Nation, there areyoung surgeons completely competent to handle the most complicated and seriousof injuries, whether due to accident, natural disaster, or war. Similarly,physicians returning to their civilian practices bring with them diagnostic andtherapeutic capability to manage the most baffling and complicated medicalconditions. No other country in the world is so blessed.
Improved medical management, developed on the field of battle, has directapplication in civilian practice. Regionalization of medical care delivery andincreased utilization of ancillary health care personnel under the team concept,now receiving so much attention at national and local levels, are patterned onthe military model that has been used for many years. The medical controlconcept, medical radio network and helicopter evacuation-the systems approachwhich proved so successful in Vietnam-is now being used for efficient,effective regionalized health care delivery in the United States.
The highly successful MAST (Military Assistance to Safety in Traffic) Programis but one prime example of the adaptation of the military model to the civilianrequirement. This demonstration project cannot help but expand, and the hope isthat before too long the civilian community, rural and metropolitan, may achievea real emergency medical care system approaching the effectiveness of thatprovided in Vietnam. The Vietnam veteran, having seen what can be done half wayaround the world, is now demanding that the same capability be provided here athome.
181
As in previous wars, the medical experience gained in Vietnam is likely tocontribute to the saving of more lives in the future than were lost during theconflict.
This, then, is the story of the medical support of the U.S. Army in Vietnam.The challenge was met with vigor and enthusiasm, and the mission wasaccomplished in the highest tradition of the U.S. Army and its MedicalDepartment.
