FOREWORD
Many in our society, todayand in the past,have found it difficult to reconcile theprofessions of medicine and the military, on the thesis that one existsto maintain life and theother to take it. Nothing could be further from the truth. The ultimategoals of each are preciselythe same: preservation of life, society, and the dignity of man.
When deterrence fails and war does come,these professionsbecome even furtherintertwined. Medicine must keep the force fit, prevent or treatdisease, and repair the injured. Farmore is at stake than just the moral obligation to care for ourwounded. The successfulprosecution of warfare demands that we treat and return the wounded tobattle as quickly aspossible. If we do our job well, we become the principal source ofexperienced replacements inwartime.
Surgeons must not forget the lessons sobitterly learned inprevious wars. It is time toremember what we did in the Vietnam conflict. We did many things rightin Vietnam. Perhapsbetter than in any previous war, we remembered the lessons of the past.We managed woundsproperly and uniformly, even though there was turbulence in thesurgical ranks, as would beexpected in a one-year combat zone tour. We practiced delayed woundclosure from the start andquickly relearned that closure by secondary intention is the preferredcourse in many wounds.We took advantage of the helicopter to change the entire system ofmedical care from one ofmoving treatment facilities to patients to one of moving patients totreatment facilities. Thisallowed us to create the most sophisticated medical facilities everseen in a combat theater. Wehad ample blood, fluids, and adjunctive antibiotics. Our logisticalsupply line, thoughextraordinarily long, was effective and essentially unthreatened. Weused the continuum of careinherent in our system well, evacuating the patients via stages fromthe combat zone to thecontinental United States (CONUS).
Since the Vietnam era anew generation ofsurgeons has been trained. Medicine and surgery haveadvanced technologically, and there has been sufficient time to forgetthe basics of war surgery.To prevent this loss of knowledge, the authors of this volume undertooktheir task. The group oforthopedic surgeons who came together in 1972 to write this historyknew it would be difficultto combine the historical record with a volume useful for orthopedicsurgeons in their day-to-daypractice. To be credible, their statements and conclusions needed to besupported by scientificdata which had been difficult to collect in a wartime situation. Thewide dispersion of orthopedicpatients throughout CONUS made comprehensive data especially difficultto retrieve. Therefore,most of the clinical data in the chapters came not from a centralretrieval system but fromrecords collected by the individual contributors. Had centers for hand,peripheral nerve,amputee, and other medical problems been established, as would havebeen ideal, data couldhave been collected and treatment modalities altered on the basis ofthis experience even duringthe war.
The authors of thisvolume, alreadydistinguished military surgeons and educators whenthe book was started in 1972, have each achieved additional honors insubsequent years. TheArmy Medical Department is fortunate that these leaders in Americanorthopedic surgerycompleted full careers in Army medicine prior to their presentimportant roles in nationalmedicine.
Professor William E. Burkhalter (Colonel, Medical Corps, retired), the coordinating author/editor, exercised noteworthy leadership in compiling this text. The other authors are busy men who have given their time and effort out of loyalty to Army medicine and to society. These men were my heroes when I was a young surgeon in Vietnam. They remain my heroes today.
I must commend our medical editor, Lottie Applewhite, formerly of the Letterman Army Institute of Research, who volunteered hundreds of hours of work on this volume. Finally, the authors and I thank Dr. Mary Gillett, director of the clinical history program at the Center of Military History, for placing this work “at the head of the queue.”
FRANK F. LEDFORD, Jr.
Lieutenant General, USA
The Surgeon General
