Foreword
In medicine, as in life, there is usually small profit in attempting toassign full praise or full blame for a success or a failure to any single actionor circumstance. On the other hand, if any single medical program can becredited with the saving of countless lives in World War II and in the KoreanWar, it was the prompt and liberal use of whole blood.
The development of the concept of the liberal use of whole blood and the-regrettably delayed-implementation of the concept represent one ofthe great pioneering achievements of World War II. The same concept was appliedin the Korean War, fortunately more rapidly, with equally spectacular results.It has been carried over into civilian life, again with brilliant results,though sometimes, one fears, almost too casually, as one sees blood administeredwhen it is not actually needed and apparently without thought of its possibleconsequences.
The story told in this volume of the history of the U.S. Army MedicalDepartment in World War II is one that must be told. When that war broke out inSeptember 1939, a whole-blood service had already been successfully providedduring the 3-year Spanish Civil War, and the British immediately put intooperation the program which they had developed 6 months before. Yet, it was notuntil May 1940 that the United States took the first steps in what later becamethe whole-blood program, and when this country was precipitated into World WarII in December 1941, the plasma program, at least from the standpoint ofcommercial production, was still in its early stages.
The British experience with whole blood in North Africa, before the UnitedStates entered World War II, gave rise to discussions in the United States as tothe need for provision of whole blood for combat casualties, but thesediscussions were not much more than academic until after the Allied invasion ofNorth Africa in November 1942. It was that invasion and the casualties that itproduced which brought the true situation sharply home, both to medical officersoverseas and to the numerous persons and agencies in this country who werestudying shock. Our experience in North Africa made it quite clear that plasma,in spite of its virtues and advantages, could not take the place of whole blood.Plans for its provision were worked out in both the Mediterranean and Europeantheaters, and, by May 1943, the Office of The Surgeon General had formulated aplan, frankly a compromise with the ideal, for supplying whole blood to forwardhospitals from base sections. By November of 1943, however, an entirely workableplan had been prepared in the Transfusion Branch of that Office to fly bloodfrom the Zone of Interior to oversea theaters. The Surgeon General at this timeconsidered the plan both impractical and unnecessary, and it needed thecasualties of the first weeks of the Normandy invasion to demonstrate that thereliance placed upon local supplies of whole blood was completely unrealistic.Then, in August 1944, the same plan and the same airlift that had been rejected in November 1943 were utilized to fly blood to the Europeantheater. A similar airlift to the Pacific Ocean areas was instituted in November1944.
The blood program in World War II was a brilliant success in spite of thedelays and frustrations that attended its inception. After the war, however, theprogram was allowed to lapse, and, when the Korean War broke out, less than 5years after World War II had ended, planning for whole blood in a future war hadonly just been instituted, and the implementation of the planning had to beeffected during the active fighting.
It is hard, in retrospect, to understand why the United States was so slow tograsp the implications of the use of whole blood in World War I, limited thoughthat experience was; why it did not take advantage of the successful bloodprogram used during the Spanish Civil War; and why it did not immediately makeuse of the British experience in the early months of World War II, when thenecessity and value of whole blood for combat casualties were so clearly proved.It is even harder to understand why, between World War II and the Korean War,all plans for a supply of whole blood in possible future wars were allowed tolapse, so that the United States entered the Korean War with a plan, it is true,but with no arrangements for implementing it.
Brig. Gen. Douglas B. Kendrick, the author of this book, carried the chiefresponsibility for the Army blood program during World War II and during much ofthe Korean War. I note that in his preface he is somewhat apologetic for thedetail with which the story is told. He should not be. He is quite correct inemphasizing that behind the drama of transfusion, and its almost miraculousresults in both those wars, lay an elaborate mechanism of procurement, storage,delivery, and other monotonous but highly necessary details. Furthermore, as hehas pointed out, it is only by the strictest and most precise attention to suchdetails that blood is able to achieve its life saving miracles, and, equallyimportant, can be prevented from becoming a lethal agent.
I am also glad that, contrary to the usual practice in this historicalseries, the story of the whole-blood program has been carried over from WorldWar II into the Korean War, even though, as already stated, the story, at leastin the beginning, reflects no credit upon our foresight. Our thoughtlessnegligence makes it the more important to record the facts. Like my predecessorsin the Office of The Surgeon General, I have taken the position that thishistory must be written with complete candor and frankness, not only because ahistory is worthless if it is not honest but also because we must spell out theerrors of the past so clearly that the same mistakes cannot be made again.
I do not believe that these gigantic errors are likely to be repeated. Thereis now in my Office a special transfusion officer whose business it is to seethat they are not. No matter what form future conflicts may take, there is noconceivable kind of injury which will not require blood, plasma, or both. Theseagents, in fact, will be needed even more than in World War II and in the KoreanWar, for future wars will surely involve civilians as well as militarypersonnel, and probably in even greater numbers.
In this book will be found the key to salvation in future wars as far asblood is concerned. Blood is not a commodity that can be collected and stored,at least by present techniques. It must be collected as the need arises, and thepoint of collection is seldom the point of administration. It cannot becollected when the need for it arises, nor can it be taken to the area of need,unless there has been careful advance planning for its procurement andtransportation. A blood program cannot be improvised on the spur of the moment.Some technical details may change as knowledge increases, but the basicprinciples of the World War II blood program and the Korean War blood programare biologic principles and they are unlikely to change materially from thefacts set forth in this book.
Medical officers who, like myself, served overseas in World War II, and whoobserved the management of casualties with and without the use of whole blood,are peculiarly qualified to appreciate the achievements of the whole-bloodprogram. Its results unfolded before our eyes. In forward hospitals, we saw mensaved from death and, sometimes, almost brought back from the dead. In fixedhospitals, we received wounded men who once would have died in forwardhospitals, or even on the battlefield. We received casualties with the mostserious wounds in good condition. With the aid of more blood, we performedradical surgery upon them, and we watched them withstand operation and, withstill more blood, recover promptly from it.
There are more than the usual reasons for the preparation and publication ofthis volume on the whole-blood program. A major reason, of course, is the impactthis therapeutic advance has had upon medical care, civilian as well asmilitary. Another reason is to keep faith with the multiple personnel whoplanned and operated the whole-blood program, and with the millions of Americancitizens whose gifts of their own blood saved the lives of so many Americansoldiers, who otherwise would have died.
As in previous forewords, I desire again to express my thanks to the authorsand editors of all of these volumes and to the personnel of my own office, whoare helping me to carry out this extremely important phase of my mission as TheSurgeon General.
LEONARD D. HEATON,
Lieutenant General,
The Surgeon General.
