Table of Contents

CHAPTER II

Health of the Command

Rates and Trends

In Vietnam, as in Korea and in the Asiatic and Pacific theaters in World WarII, the cumulative effect of disease was the greatest drain on the strength ofthe American combat and support effort. Disease admissions accounted for justover two of every three (69 percent) hospital admissions in Vietnam in theperiod 1965-69; battle injuries and wounds, in contrast, were responsible forapproximately one of six admissions during this period. (Table 1) But theaverage hospital stay and thus the time lost from duty resulting from combatinjury was considerably longer than that resulting from disease. In 1970,however, as a result of the diminution of the American combat role, disease andnonbattle injury accounted for more than half the man-days lost to the Army inthat theater. (Table 2)

While indicative of the theater's single greatest cause of morbidity, diseaserates for Vietnam revealed encouraging trends when compared to rates forprevious conflicts. The average annual disease admission rate for Vietnam (351per 1,000 per year) was approximately one-third of that for theChina-Burma-India and Southwest Pacific theaters in World War II (844 per 1,000per year and 890 per 1,000 per year, respectively), and more than 40 percentless than the rate for the Korean War (611 per 1,000 per year). (See Table 1.)*

One of the most striking achievements of military medicine in Vietnam wasthe rapid and effective establishment of a preventive medicine program thatblunted the impact of disease on combat operations. In World War II, preventivemedicine programs in the Far East did not begin to make inroads upon diseaseincidence until 1945, a year of transition from war to peace. In Korea thedelay was less, but still considerable. In Vietnam, however, effective diseasecontrol programs were introduced in 1965, and these were successfully maintainedthroughout the stress of the troop buildup. (See Table 1.)

In addition to minimizing the incidence of disease in American troops, themedical effort in Vietnam had the ancillary benefit in the late 1960's

*Rates are expressed as cases per annum per 1,000 average strength, throughout this chapter.

33

TABLE 1.-HOSPITAL ADMISSIONS FOR ALL CAUSES, U.S. ARMY,IN THREE WARS: WORLD WAR II, KOREA, AND VIETNAM, BY YEAR
[Rate expressed as number of admissions per annum per 1,000 average strength]

¹July-December only.
Sources: (1) World War II: Morbidity and Mortality in the United StatesArmy, 1940-1945. Preliminary Tables Based on Periodic Summary Reports, Office ofthe Surgeon General, U.S. Army. (2) Korea: Korea, A Summary of MedicalExperience, July 1950-December 1952. Reprinted from Health of the Army, January,February, and March 1953, Office of the Surgeon General, U.S. Army. (3) Vietnam:Health of the Army, May 1966, May 1967, May 1968, May 1969, May 1970, Office ofthe Surgeon General, U.S. Army.

of making predictable the parameters of various disease problems atparticular points in time. The curves depicting the monthly rates per 1,000 peryear of those diseases having greatest impact on military operations revealthat, as the Medical Department effort became established and routinized, theannual rates fell, month by month, very closely together. Thus, the 1968 and1969 curves for malaria, for example, were almost superimposed upon each other.(Chart 6) Not only was disease being controlled but, if preventivemeasures were properly implemented, its incidence could be forecast withincreasing accuracy, and it therefore became a variable for which the fieldcommander could account in planning combat operations.

34

TABLE 2.-APPROXIMATE NUMBER OF MAN-DAYS LOST FROM DUTY, BYCAUSE, AMONG U.S. ARMY PERSONNEL IN VIETNAM, 1967-70
[Preliminary estimates based on sample tabulations of individual medicalrecords]

¹ CRO: Carded for record only.
Source: Health of the Command, report submitted to the Deputy SurgeonGeneral, March 1971.

Concentration upon prevention did not preclude the aggressive development ofnew treatment regimens for old and known problems. In 1965, the average timelost from duty for a patient ill with Plasmodium vivax malaria was 21days, and for the Plasmodium falciparum malaria patient, 5 weeks. By1969, P. vivax patients were being returned to duty in 5 to 8 days, and P.falciparum patients in 17 to 19 days. Similarly, in 1966, average time lostfrom duty for the patient with infectious hepatitis was 49 days; in 1970, it was35 days.

Diseases of major military import for which the incidence in Vietnam exceededthe incidence in the Army as a whole include malaria, viral hepatitis, diarrhealdiseases, diseases of the skin, FUO (fever of undetermined origin), and venerealdisease. Venereal disease in Vietnam was most often gonorrhea or otherinfections of the urinary canal reported under this rubric on clinical groundsalone. It was treated on an outpatient basis and was not a major cause of lostduty time.

The other diseases can be divided into two rather general groups: those, suchas hepatitis, which affected relatively few men but incapacitated them for longperiods; and those, like most diarrheal and skin diseases endemic to Vietnam,which incapacitated large numbers of men,

35

CHART 6-ADMISSIONS, BY YEAR, TOHOSPITAL AND QUARTERS FOR MALARIA IN THREE WARS: WORLD WAR II, KOREA, ANDVIETNAM
[Rate expressed as number of admissions per annum per 1,000 average strength]

36

but for relatively short periods. Malaria, and especially the drug-resistant P.falciparum strain, widespread and incapacitating for relatively longperiods, combined the least desirable features of each of these categories andwas consequently the greatest medicomilitary disease problem in Vietnam. (Table3)

TABLE 3.-SELECTED CAUSES OF ADMISSIONS TO HOSPITAL ANDQUARTERS AMONG ACTIVE-DUTY U.S. ARMY PERSONNEL IN VIETNAM, 1965-70
[Rate expressed as number of admissions per annum per 1,000 average strength]

 ¹ CRO: Carded forrecord only.
Source: Health of the Army, May 1966, May 1967, May 1968, May 1969, May1970, Office of the Surgeon General, U.S. Army.

Other diseases were of grave concern to the Medical Department because oftheir widespread presence in the civilian population with the concomitant threatto American troops or because of their relatively exotic nature. In the first ofthese categories fell such conditions as plague, tuberculosis, cholera, andrabies. In the second were found such disease problems as melioidosis, JapaneseB encephalitis, and amebiasis. These diseases, although constantly monitored forpreventive purposes, had no material effect on U.S. fighting strength.

Statistics on hospital admissions are not an accurate guide to the extent ofhigh-incidence, short-duration diseases, for often these conditions were treatedon an outpatient basis. In 1968, for example, the Ninth Infantry Divisionsurgeon reported that, after 5 days in the rice paddies of the Mekong Deltaregion, a battalion's strength was at one time reduced as much as a third byskin disease; though not fully fit for duty, most of these men were treatedas outpatients. Similarly, statistics on diarrheal disease are commonlyconsidered to reflect a small but unknown fraction of noneffectiveness caused bythat problem.

37

A parallel problem is posed by FUO because of the tendency in the field toreport such miscellaneous nonfebrile conditions as headache and backache withinthis category. One informed observer contends that between one-quarter andone-third of the disease reported as FUO was not in fact febrile illness.Statistics on malaria and infectious hepatitis are firmer because of the moreprecise nature of the categories and because of the long-term impact of thedisease upon the individual patient, although studies reveal that some malariahas been reported as FUO.

Experience showed that the acclimatization process had a significant effecton the impact of the high-incidence, short-duration disease problems inVietnam. Speaking at the 1970 Pacific Command Conference on War Surgery,Brigadier General George J. Hayes, MC, stated:

. . . [t]here is a time reference with respect to diarrheal and upper respiratorydisease and fevers of unknown origin. . . . The combination of change incircadian rhythm, climate, and early acquired diarrhea, most certainly of viralorigin, lead to about a six week acclimatization period for the troops. Afterthis time the incidence of such disorders in acclimatized troops decreases to anegligible level.

Because of the 12-month rotation policy, unacclimatized troops continuallyarriving in Vietnam tended to keep the rates for these diseases high.

Acclimatization was not only a physical problem but a psychological andcultural one as well, as indicated by the substantial rates of neuropsychiatricineffectiveness in the theater, especially during the latter part of the 1965-70period. Not all replacements, upon entering Vietnam and being assigned to aunit, were able to negotiate the period of psychological adjustmentsuccessfully, despite the salutary effect of the 1-year rotation policy. Inaddition, for the individual soldier, adjustment to the Vietnam environmentalso involved coming to grips with the use of illicit drugs among his peers. Theextent of this problem, the result of which is partially reflected in risingneuropsychiatric rates, is only now being explored.

Major Problems

Malaria.

In Vietnam, the average annual rate of admission to hospital and quartersfor malaria (26.7 per 1,000 per year) was about one-third of that for theSouthwest Pacific theater (70.3 per 1,000 per year) and one-quarter of that forthe China-Burma-India theater (101 per 1,000 per year) in World War II. (SeeChart 6, Table 1.) Vietnam rates, however, were higher than those for theKorean War (11.2 per 1,000 per year), principally because P. falciparummalaria was encountered infrequently during 1950-53, and because primaquine,having just been

38

introduced into general use, had not yet induced the development of adrug-resistant strain of the parasite.

Over-all rates do not reflect the crippling effect of malaria on Americanstrength at the outset of the Vietnam effort. In December 1965, the over-allArmy rate in Vietnam reached a peak of 98.4 per 1,000 per year; during thatperiod, rates for certain units operating in the Ia Drang valley were as highas 600 per 1,000 per year, and at least two maneuver battalions were renderedineffective by malaria.

Malaria rates among military personnel in Vietnam were cyclical, reachingtheir low in February or March and their high in October or November. Ratescorrelate with climatic conditions, region of operation, and degree of contactwith the enemy. (Chart 7) Studies done from 1965 to mid-1967 showed that,in the central highlands, enemy soldiers provided a reservoir for infection bythe malaria parasite, especially the P. falciparum strain.

The progressive gains of the antimalaria program can be measured by thedifference between the peak and bottom monthly rates in each year of theAmerican presence. The smaller the difference, the more effective the programhas been in curbing malaria. In 1965, the differ-

CHART 7-ADMISSIONS TO HOSPITAL ANDQUARTERS FOR MALARIA AMONG U.S. ARMY PERSONNEL IN VIETNAM, 1965-69
[Rate expressed as number of admissions per annum per 1,000 average strength]

39

ence between these two rates was 97.1; in 1969, it was 20.7. Success was alsoindicated by the down trend, since 1967, in the absolute number of malariacases, and by the low level at which deaths from malaria have been held:

Year	Cases	Deaths
1965	1,972	16
1966	6,662	14
1967	9,124	11
1968	8,616	15
1969	7,322	10
1970	6,718	12

Much of the success in the fight against malaria was the result of theongoing preventive medicine program and of findings of Army researchers in thefield and the laboratory. Advances also were made in the treatment of thedisease once it had been incurred, advances which lowered the relapse rate andreturned the soldier to duty more quickly.

In mid-1966, a multiple treatment regimen consisting of quinine,pyrimethamine, and dapsone was instituted for the initial attack of P.falciparum. Before the addition of dapsone to this regimen, relapse ratesaveraged 7 to 8 percent; after the change, they were lowered to 2 to 3 percent.Studies done in 1969 and 1970 at the 6th Convalescent Center, however, indicatedthat, among patients who received this regimen orally, the relapse rate hadincreased to about 10 percent. For those re-treated with quinine orally, therelapse rate was 67 percent; with intravenous quinine, 11 percent. Theseobservations suggest that the P. falciparum malaria parasite acquiressubstantial resistance to quinine, a phenomenon that demands further study.

Plasmodium vivax malaria was experienced very rarely in Americantroops until mid-1967. Since then, largely because of breakdowns in malariadiscipline, it has become an increasingly large factor in the problem with thisdisease in Vietnam. P. vivax infection has been easily treated with ashort course of chloroquine followed by primaquine. A further problem with thisstrain, however, arose with its increasing appearance in the United States inVietnam returnees, an experience which paralleled that of the American forces inKorea.

In 1965, 62 cases of malaria were treated in Army facilities in the UnitedStates. In 1970, 2,222 such cases were treated, and this figure is a minimum,neglecting cases that arose in returnees after separation from the service.Eighty percent of these stateside cases of malaria were of the P. vivaxvariety. This graphically pointed to a failure in the terminal

---

40

prophylaxis program, which, as a result, has received further commandemphasis during 1970:

Year	Cases
1965	62
1966	303
1967	2,021
1968	1,598
1969	1,969
1970	2,222

Hepatitis

As with malaria, the average annual infectious hepatitis rate in Vietnam (6.9per 1,000 per year) was lower than comparable rates for World War II (SWPA, 27.1per 1,000 per year; CBI, 9.8 per 1,000 per year), but unlike malaria, Vietnamrates for infectious hepatitis were also lower than those for Korea (7.9 per1,000 per year) . (See Table 1; Chart 8). The hepatitis rate in Vietnamreached a peak in August 1968;

CHART 8-ADMISSIONS, BY YEAR, TOHOSPITAL AND QUARTERS FOR HEPATITIS IN THREE WARS: WORLD WAR II, KOREA, ANDVIETNAM
[Rate expressed as number of admissions per annum per 1,000 average strength]

---

41

CHART 9-ADMISSIONS TO HOSPITAL ANDQUARTERS FOR HEPATITIS AMONG U.S. ARMY PERSONNEL IN VIETNAM, 1965-69
[Rate expressed as number of admissions per annum per 1,000 average strength]

the low rate for the theater, achieved in July 1965, has not been approachedsince that time. (Chart 9) Unlike statistics for most other disease entities inVietnam, hepatitis incidence has not shown a downward and stabilizing trendover a period of time. Largely caused by failures in mess and field sanitationand by consumption of nonpotable water and ice available through the localeconomy, this disease was most commonly acquired by soldiers in their fourththrough ninth month in Vietnam. The incidence of hepatitis co-varied with theoccurrence of combat operations and with the degree of troop interaction withthe civilian populace. Although no specific treatment was available, mostpatients recovered completely from viral hepatitis with adequate rest and diet.A study at the 6th Convalescent Center reconfirmed Korean War findings that bedrest was not essential after the patient had recovered from the acute phase ofthis illness.

Recently, added attention has been paid to the serum hepatitis problem. Itstrue extent among American soldiers is unknown because it is masked by over-allhepatitis statistics, but those who ran the greatest risk were men receivingmultiple transfusions after battle injury, and those injecting illicit drugsintravenously.

Diarrheal Diseases

The incidence of that fraction of diarrheal disease severe enough to requirehospitalization or assignment to quarters showed a steady downward trend between1965 and 1970. In 1965, the average theater-wide annual rate for this type ofdisease was 69 per 1,000 per year; in 1969, it was 35 per 1,000 per year. Alsoduring this period, the difference

---

42

between the annual high and low rates was significantly reduced, indicatingan improvement in control during periods of peak disease incidence. In 1965,this difference was 55.4; in 1969, it was 18.7.

A comparison with World War II experience gives Vietnam diarrheal diseaserates added significance. With respect to the China-Burma-India theater, it wasreported that ". . . except for an occasional winter month, monthly ratesfor diarrheas and dysenteries were never under 100 per 1,000 per year until thefall of 1945." For both the China-Burma-India and Southwest Pacifictheaters, average annual rates, when viewed over a period of time, did notreveal a downward trend as did those for Vietnam; furthermore, the Vietnam ratewas a fraction of the rates for these areas. (Table 4) Accuratecomparisons with the Korean experience cannot be made because of differences inthe bases for statistics in the two conflicts.

Incidence of diarrheal disease peaked in May or June, corresponding with themonsoon season, and sometimes reached a secondary peak in October. (Chart 10)Affected most severely were unacclimatized troops and troops under combatconditions. For the latter, disease often stemmed from feces-laden soil beingwashed into inadequately protected water supplies in the field.

Any one of a host of viral, bacterial, or parasitic agents caused diarrhea inVietnam; an exact etiology could not be identified in most instances. Whenspecific agents were identified, excellent therapy was readily available. Theaverage hospital stay for a patient with a diarrheal problem was 5? days.

TABLE 4.-INCIDENCE RATE OF DIARRHEAL DISEASE AMONG U.S.ARMY PERSONNEL IN WORLD WAR II AND IN VIETNAM, BY YEAR
[Rate expressed as number of cases per annum per 1,000 average strength]

World War II			Vietnam
Year	China-Burma-India	Southwest Pacific	Year	Rate
	Rate	Rate
1942	123	59	1965	69
1943	146	70	1966	48
1944	181	55	1967	49
1945	93	74	1968	43
			1969	35

 Sources: (1) World War II: Morbidity andMortality in the United States Army, 1940-45. Preliminary Table Based onPeriodic Summary Reports, Office of the Surgeon General, U.S. Army. (2) Vietnam: Health of the Army, May 1966, May 1967, May 1968, May 1969, May 1970, Officeof the Surgeon General, U.S. Army.

---

43

CHART 10-ADMISSIONS TO HOSPITAL ANDQUARTERS FOR DIARRHEAL DISEASE AMONG U.S. ARMY PERSONNEL IN VIETNAM, 1965-69
[Rate expressed as number of admissions per annum per 1,000 average strength]

It is notable that cholera, the most feared of diarrheal diseases, has notbeen a military problem in Vietnam, though it is endemic in the civilianpopulation. Immunization against typhoid fever, however, has not been soeffective; 25 Army cases have occurred in the theater, 13 of these in 1970.

Diseases of the Skin

Rates of incidence of skin disease severe enough to require hospitalizationor admission to quarters in Vietnam varied around the 30 per 1,000 per yearlevel until 1968, when the institution of a prophylactic program resulted in adramatic drop to the 20 per 1,000 per year level. (See Table 3.) Figuresfor 1970, however, indicate a resurgence of this problem to heights comparableto those of 1965. This rise is, as yet, unexplained.

No adequate statistics exist for the comparison of dermatological problems inVietnam with those of World War II and Korea. As previously noted, hospitalstatistics provide minimum figures only in this

---

44

area of disease; dermatological problems have been severely debilitating inunits operating in flooded areas of Vietnam.

The three major skin disease problems in Vietnam have been superficial fungalinfection (dermatophytosis), bacterial infection, and immersion foot. Disease isprobably due to the interaction of four factors: changes brought about in theresistance of the skin to infection because of prolonged exposure tocontaminated water; damage to the skin by trauma and friction generated bywearing boots and socks; presence of the etiological organisms in the wateryenvironment; and increased temperature of the tropical environment.Susceptibility to dermatological diseases increased with time in combat, peakingat the 10th month, although some individuals had inherent immunity. Black troopsproved to be less susceptible than white troops.

The keynote in dealing with the militarily important dermatological diseasesin Vietnam was prevention. Immersion foot was treated through the use of adrying-out period, and the others through the therapeutic use of griseofulvin-V,broadscope antibiotics, and a variety of topical treatments.

Melioidosis

Melioidosis, one of the more exotic medical problems encountered by U.S.troops in Vietnam, is an infectious disease caused by Pseudomonas pseudomalli,a common bacterium of Southeast Asia that has been cultured from soil, marketfruits and vegetables, well water, and surface water. The source of theinfection is not fully known, nor has man-to-man transference been observed.

In humans, melioidosis is manifest in one of three ways: by acute lunginfection, by overwhelming systemic infection, or by localized abscess. Theunfamiliarity of American physicians with this disease and their concomitantfailure to diagnose and treat it properly in all but the most severe cases areshown in the low rate and high fatality incidence in 1966:

Year	Cases	Deaths
1965	6	0
1966	29	8
1967	50	3
1968	56	1
1969	46	1
1970	43	1

Although multiple antibiotics were initially used to treat melioidosis, ithas become clear over time that tetracycline alone was the drug of choice. Since1967, most patients have been treated and returned to duty in Vietnam. Patientsevacuated from Vietnam or found to have

---

45

the disease after departing were referred to Valley Forge General Hospital,Phoenixville, Pa., or Fitzsimons General Hospital, Denver, Colo., bothdesignated by The Surgeon General as melioidosis treatment centers.

Neuropsychiatric Problems

Psychosis and neurosis. Until 1968, the neuropsychiatric disease rate inVietnam remained roughly stable and parallel with that for the rest of the Army.In that year, however, Army-wide rates began to increase, and rates in Vietnamincreased more precipitously than in any other location where substantialnumbers of American troops were serving. (Table 5, Chart 11) Rising ratesshowed increases in all areas of psychiatric illness: psychosis, psychoneurosis,character and behavior disorders, for example.

CHART 11-ADMISSIONS TO HOSPITALAND QUARTERS FOR NEUROPSYCHIATRIC CONDITIONS (PSYCHOTIC, PSYCHONEUROTIC, ANDCHARACTER AND BEHAVIOR DISORDERS) AMONG U.S. ARMY PERSONNEL IN VIETNAM, 1965-69
[Rate expressed as number of admissions per annum per 1,000 average strength]

The extent of the problem is evident from several statistical indices. Ratesfor admission to hospital and quarters for neuropsychiatric cases in Vietnammore than doubled between 1965 (11.7 per 1,000 per year) and 1970 (25.1 per1,000 per year). (See Table 3.) In terms of estimated man-days lost,neuropsychiatric conditions were the second leading disease problem in thetheater in 1970; the 175,510 figure for that year is more than twice as high asthe estimate for 1967 (70,000), reflecting a steady increase over the 1967-70period. (See Table 2.)

Statistics in this area are not comparable with those for World War II andKorea because of differences in diagnostic standards and categories, but it isnotable that, unlike the case for World War II, in Viet-

---

46

TABLE 5.-INCIDENCE RATE OF PSYCHIATRIC CONDITIONS,ARMY-WIDE, 1965-70
[Rate expressed as numbers of cases per annum per 1,000 average strength]

Year	Total psychiatric conditions					Psychosis						Psychoneurosis
	Army-wide	CONUS		USAREUR	RVN	Army-wide		CONUS	USAREUR	RVN		Army-wide	CONUS		USAREUR		RVN
1965	9.1	9.1		7.7	10.8	1.4		1.6	0.7	1.6		1.6	1.5		1.0		2.3
1966	10.3	10.8		7.3	11.6	1.7		2.1	0.8	1.4		1.9	2.0		1.0		2.5
1967	9.7	9.5		8.2	9.8	1.6		1.8	0.9	1.7		1.7	1.9		1.0		1.3
1968	10.3	9.9		7.9	12.7	1.8		1.9	0.9	1.8		1.9	1.9		1.2		2.2
1969	11.3	10.4		7.8	15.1	2.6		2.4	1.6	3.4		1.7	1.6		1.5		1.9
19701	15.4	12.5		9.7	24.0	3.3		3.2	2.4	3.8		2.3	1.9		1.8		3.3
Year	Character and behavior disorders								Other psychiatric conditions
	Army-wide		CONUS		USAREUR		RVN		Army-wide		CONUS			USAREUR		RVN
1965	2.3		2.0		2.2		3.1		3.8		4.0			3.8		3.8
1966	2.5		2.4		2.2		2.8		4.2		4.3			3.3		4.9
1967	2.4		2.1		2.2		2.9		4.0		3.7			4.1		3.9
1968	2.3		1.8		1.8		3.7		4.3		4.3			4.0		5.0
1969	2.4		1.8		1.6		4.2		4.6		4.6			3.1		5.6
19701	3.7		1.7		1.9		8.4		6.1		5.7			3.6		8.5

¹January-September only.
Source: Morbidity Report, RCS MED-78.

---

47

nam the incidence of neuropsychiatric admissions did not co-vary with theincidence of combat injury. Rather, neuropsychiatric rates rose despite thediminishing combat role in that country in 1969 and 1970.

Several hypotheses have been offered to explain these rising rates in theArmy in general and in Vietnam in particular. It has been suggested, forexample, that increased drug abuse has been reflected in increased rates ofpsychosis, rates which include toxic (drug-induced) psychosis. For Vietnam, ithas also been suggested that identity with another peer group, such as one basedupon race, political affiliation, or drug use, at the unit level has threatenedthe integrity of the squad as the sole reference point for the soldier incombat. This tendency in turn resulted in rising neuropsychiatric rates amongindividuals who, presented with alternatives, lack the certainty in the stressof combat that confidence in the squad gave the World War II infantryman. Theseand other hypotheses are currently under study.

In providing psychiatric support for combat troops, the practice in Vietnamwas to offer aid as close to the unit as possible, relying upon the socialworker and enlisted clinical specialist, and upon three basic tools: rest,sedation, and supportive psychotherapy. Guidelines indicated thathospitalization was to be avoided except when the patient was dangerous tohimself or others or mentally ill. Hospitalization for simple drunkenness, forsociopathological individuals, or for administrative convenience was forbiddenby regulation. This adds significance to the rising statistics cited previously.

Drug abuse. One of the unique problems that faced the MedicalDepartment in Vietnam was the drug milieu into which the American soldier wasimmersed, both on and off duty, upon arrival in the theater. The growth ofillicit drug use within the Army kept pace with that in the larger society, butthe ready availability of marijuana, barbiturates, amphetamines, heroin, opium,and other substances in Vietnam, at a lower price for a less adulterated productthan that available in the United States, exacerbated the problem.

Comprehensive statistics are not available, but preliminary work based uponsample surveys of soldiers entering and leaving the combat zone indicates thatillegal drug use is widespread, especially among younger, lower ranking enlistedmen, and that many individuals started using drugs while in Vietnam. One study,done in 1969 at the Cam Ranh Bay replacement depot by Captain Morris Stanton,MC, reported that, of a population of 994 outgoing enlisted men, 53.2 percenthad tried marijuana sometime in their lives, 21.5 percent for the first time inVietnam. The same study reported that the use of opium among the soldierssampled nearly tripled during their stay in Vietnam, rising from 6.3 percent to17.4 percent.

---

48

Growing command awareness of the nature and extent of the drug problem inVietnam led to a search for a flexible, nonpunitive response that wouldencourage drug users to seek professional help in solving their problems, thusaiding them and, at the same time, serve the Army's interest in conserving thefighting strength. This search resulted in a two-fold program in Vietnam. At thefirst level the program was educational, bringing information about the problemto key commissioned and non-commissioned officers so that they could dealintelligently with it, and provide believable advice about drug abuse to thetroops in Vietnam. The latter task was the more difficult because conflictinginformation available in all sectors of American society about the dangers ofmarijuana and the, linking of its use with other drug problems led to a state ofincredulity among American troops. This credibility gap was partially overcomethrough the use of ex-addicts in information programs, through the realisticredirection of the efforts of the Armed Forces Radio, and through an attempt todispense factual data personally through medical channels.

But informational activities were directed at men who had not yet becomedeeply involved with drugs. For others less fortunate, the experimentalinstitution of an amnesty program in the 4th Infantry Division in 1968 attractedwide attention as a promising attempt to deal with the problem. The programprovided that a soldier who voluntarily presented himself as a drug user to hiscommanding officer, chaplain, or unit surgeon, would not be punished merely foradmitting to the use of drugs, if this use had not previously come to theattention of the command. The drug user who voluntarily sought assistance wasaided through limited hospitalization to determine the nature and extent of hisaddiction; through extensive, psychiatric and other counseling, including grouptherapy when possible; and through assignment of a "buddy" to give himpositive reinforcement in his effort to give up drugs. During the period ofcounseling and rehabilitation, the patient continued, as much as possible, toperform full military duties. The 4th Infantry Division's program was adoptedthroughout the Army in December 1970.