HAPPY MEMORIAL DAY TO VETERANS, ACTIVE MILITARY AND MEDICAL PERSONNEL

HAPPY MEMORIAL DAY TO All VETERANS, ACTIVE MILITARY AND MEDICAL PERSONNEL WHO HAVE SO VALIANTLY SERVED AND SACRIFICED DURING PEACETIME, CONFLICT AND WAR.

This particular Memorial Day weekend, in addition, I want to especially recognize our U.S. Army and other military medical and surgical forces, who accomplished so many difficult interventions and medical miracles during the Vietnam War.

Many University of Kentucky Football teammates entering our UK Fall 1961 class served, afterwards, in the Vietnam War. Many of their experiences and accounts in football and war are included in The Thin Thirty by Shannon Ragland published in 2007.

“The Vietnam War, also known as the Second Indochina War, and known in Vietnam as Resistance War Against America or simply the American War, was a war that occurred in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975. It was the second of the Indochina Wars and was officially fought between North Vietnam and the government of South Vietnam. The North Vietnamese army was supported by the Soviet Union, China and other communist allies and the South Vietnamese army was supported by the United States, South Korea, Australia, Thailand and other anti-communist allies.”

[Factasy. “The Vietnam War or Second Indochina War”. PRLog. Retrieved 29 June 2013] [“Vietnam War”. Encyclopædia Britannica. Retrieved 5 March 2008. Meanwhile, the United States, its military demoralized and its civilian electorate deeply divided, began a process of coming to terms with defeat in its longest and most controversial war] [Lind, Michael (1999). “Vietnam, The Necessary War: A Reinterpretation of America’s Most Disastrous Military Conflict] [Moïse, Edwin E. (1996). Tonkin Gulf and the Escalation of the Vietnam War. Chapel Hill, North Carolina: University of North Carolina Press. ISBN 978-0-807-82300-2.]

Dignified, ethical and patriotic behavior was typical of athletes, veterans and citizens at that time in history, during and before the Vietnam War. Most U.S. citizens were extremely respectful of our military troops. This Memorial Day thank each and every soldier and family for their service and sacrifice.

In addition, I thank and congratulate all doctors, my colleagues in the 810th Hospital Unit, nurses and medical personnel for their medical organizational and readiness skills and medical expertise during all military wars, conflicts and convalescence, especially those during the Vietnam War, home and overseas.

When a youngster, we were taught to visit and decorate family and veterans’ graves, respect and thank our veterans. However, now in 2017, behaviors appear to have deteriorated in the U.S. Everyone should re-evaluate their behavior, dignity, conduct, respect and patriotism across the board. Everyone should take time to consider ancestors hardships and veterans and their families’ ultimate sacrifices this Memorial Day.

For citizens who have forgotten history or for some other reason, lack patriotism, lack loyalty and devotion to our United States of America, let us together consider the morbidity and mortality, the ‘Scope of Disease’ (see below) and soldier distress and the burden on the U.S. military departments during the Vietnam War. Think about it. Did you have a family member in that war? On return, most veterans didn’t talk about the war, but did he or she tell you about the atrocities and horrors of that war?

Historically it was said after the First Battle of Bull Run 21 July 1861 that “diseases destroy more soldiers than do powder and the sword.”

“When the appeal and excitement of war fades and the mists of war have cleared, the keen eye of history again affirms the huge impact of disease on the success or failure of military campaigns.”

Diseases, during war historically kills more than injuries and wounds. U.S. military stands in readiness for the onslaught of diseases as well as injuries and wounds. Immense preparation is necessitated in war and readiness.

An example was the scope of casualties and diseases in the Vietnam War during the 1965-1970 time frame, which will now be examined.

The Vietnam conflict was no exception to the rule: “Disease was listed as the cause of 56% to 74% percent of admissions to various hospitals in Vietnam, 1965-70 (PAD), depending on the hospital location.”

“It is essential to understand that internal medicine in Vietnam involved not only such “hallmarks” as tropical illnesses, esoteric disorders, and unusual, unfamiliar, overseas infections, but also the usual comprehensive lists of diseases afflicting military populations of the size found in South Vietnam.

The continuous presence of common medical diseases in large troop populations is often forgotten but, nonetheless, is a constant challenge to hospital medical services and the evacuation system.

The following statistical disease breakdown of the 85th Vietnam U.S. Military Evacuation Hospital in 1967* supports the observation that medical admissions exceeded surgical admissions and combat casualties in almost every month of that year. When the reader analyzes the following diseases which inflicted our troops, evaluate how many of the diseases are foreign to you and then imagine the U.S. Military Medical ingenuity required to get up to speed on the diseases’ clinical and laboratory diagnosis and most efficacious treatment:

Malaria: Falciparum Malaria 276, Vivax Malaria 211, mixed Malaria 18, Fever of Unkonwn Origin 318, Hypertension 24, Myocardial Infarction 2, Cardiac Arrhythmia 3, Rheumatic Heart Disease – Acute Pericarditis 1, Myocarditis 1, syncope 19, Acute Thrombophlebitis 6, Convulsions 16, Chronic Venous Insufficiency 5, Viral Meningitis 13, Brain bleed, Brain Tumor 1, Bells’ Palsy 1, TB 8, Peripheral Neuropathy 1, Upper Respiratory Infection 120, chronic Obstructive Pulmonary Disease (COPD) 5, Kidney Stones 4, Acute Nephritis 1, Chronic Nephritis 2, Prostatitis 13, Lymphogranuloma 3, Penicillin-resistant” gonococcal urethritis (Clap), Chancroid- 1, Pyodermas cellulitis 74, Stevens-Johnson syndrome 1, Erythema multiforme 2, Herpes Zoster 2, Gastroenteritis (unclassified) – 175 Reiter’s syndrome – 2 Infectious hepatitis – 99 Post traumatic arthritis – 3 Peptic ulcer disease 29 Ostroarthritis – 2 Shigellosis 1 Salmonella typhosa -1 Amebiasis -16 Hookworm 6 Infectious mononucleosis – 19 Strongyloidiasis – 5 Hemolytic anemia and G6PD deficiency – 9 Giardiasis – 1 Idiopathis thrombocytopenia purpura Ascariasis, Schistosomiasis (mansoni) – 1 Endocrinologic: Hiatus hernia 1 Throtoxicosis Cholecystitis -1 Diabetes – 8 Pancreatitis-1 Hypoglycemia – Ulcerative colitis – 1 Hemorrhoids – 8 Acute diverticulitis – 1 Steven-Johnson syndrome – 1 Mumps orchitis – 1 Renal glycosuria – 1 Asthma – 22 Clotting abnormality (unclassified Serum sickness – 3 Carcinoma of the bowel – 1 Urticaria – 8 Snake bite – 1 Penicillin allergy – 2 Scorpion bite -1 Drug overdose – 2 Acute Ethanolism (Alcholism),- 4 Gout – 5 [*Maj. Robert E. Blount, MC, Chief of Medicine, 85th Evacuation Hospital, 1966-67: Personal communication and report]

The average of 18 daily admissions at the 85th Evacuation Hospital, imposed on three or four physicians devoting an extended working day to direct patient care, was above the USARV (US Army Vietnam) hospital average of four admissions per internist per day (Ognibene 1969b).

Little time was left for outpatient care. However, because the workday was prolonged, one physician could often accomplish the work of two.
Unlike surgical admissions, medical admissions were constant and did not parallel combat activity. Breaks in the patient flow were rare and coverage could be planned with some certainty.

The mass casualty situations which all too often faced the surgical staff were not characteristic of internal medicine practice in Vietnam.

At the peak of troop strength, 13 medical services, each with three to five internists, provided care to the 5,000 patients admitted per month (Ognibene 1969b).

The diagnostic and therapeutic efforts directed at these patients in USARV hospitals were responsible for preventing a disastrous repeat of the French experience.

A major requirement for diagnosis and treatment of such a challenging array of patients was laboratory support of medical facilities. The trained physician realizes that many of the exotic diseases above mentioned require very sophisticated laboratory tests and experienced laboratory personnel. This accomplishment in and of itself was amazing.

Because certain conditions, especially those seen by the internist, must be diagnosed before any decision to treat or evacuate the patient can be made, a fully staffed and equipped laboratory must be functional with the opening of any hospital and clinic facility.

Imagine first erecting the outside structure under which to treat patients in a day or two, a Military Mobile Field Hospital and Mobile Army Surgical Hospital (MASH), hospitals on wheels, which were wide tent-like structures. These structures were later inflatable. Then imagine equipping and staffing the inside with the most up-to-date equipment and up-to-date, competent Doctors and Health Care Personnel. This remarkable organization was U.S. Military Medical ingenuity at its best.

Continuing the U.S. Military Medical Ingenuity line of thinking, “in 1954, a prominent thoracic surgeon and Harvard graduate, Dr. Frank Berry, was appointed as the second Assistant Secretary of Defense (Health Affairs). Upon assuming office one of his first acts was to propose a plan to enhance military service for doctors, since a doctor shortage frequently revisited the military, and a plan for young military physicians to follow one of 3 pathways after completing their internship:
1. Enter the armed services immediately and return to their residencies after fulfilling their obligated service;
2. Enter the armed services two years after medical school and complete their residencies after service;
3. Enter the service after the completion of residency training.

“The ‘Berry Plan’ deferred doctors who were taking their residency, so that the Army would get the benefit of their advanced education. Eventually, the plan became both a recruiting and a retention tool for doctors in the military, and board-certified specialists were attracted in steady numbers. Soon there was a glut rather than a shortfall in the military as occurred in 1966. [Officially, the Armed Forces Physicians’ Appointment And Residency Consideration Program]

“From 1940 until 1973, during both peacetime and periods of conflict, men were drafted to fill vacancies in the United States Armed Forces that could not be filled through voluntary means. The draft was ended when the United States Armed Forces moved to an all-volunteer military force.” [“Who Must Register”. sss.gov. May 7, 2009]

The Berry Plan complicated matters for some of us, because there soon became NO military Doctor shortage. I was not able to join the military because there were no vacancies and residency programs did not want a resident Doctor drafted out of the residency program and deplete the department’s staff and on-call-coverage. Therefore, Doctors who pursued specialty training at that time were required to have there military obligation fulfilled before residency training began, because the draft was in effect until 1973.

After my internship in 1969, in order to fulfill my obligation, I tried to join the military, but there were no openings for doctors at that time. I called the Pentagon and spoke with every branch to no avail, from the Marines, Army, Coast guard to Public Health Service and all military branches in between, if you can imagine that!

Therefore, I began the general practice of medicine until both a military doctor slot and UK ophthalmology residency slot were concurrently available. Both slots opened in 1970 and 1972, respectively, in Lexington, KY. Historically speaking, by the mid-1990s, the strength of the Army’s Medical Corps had risen to about 5,400 active duty officers. Again they were saturated with doctors. The pendulum swung. Then doctor cutbacks soon ensued.

September 10, 1970 I joined the U.S. Army Reserves, 810th Convalescent Hospital, Lexington, KY, during the Vietnam War, and was commissioned Captain with duties of a General Medical Officer; later commissioned as an ophthalmologist, when my ophthalmology residency was completed in June 1975. The tour of duty was 6 years until 1976. Our unit met 1 weekend, Saturday and Sunday 8:00 am to 5:00 pm, every month and 2 weeks every summer at designated U.S. Army posts.

Intensive didactic and clinical military medicine training were offered during week-end monthly duty and summer camp, when our 810th unit worked at
• Brooke Army Medical Center and Burn Center, San Antonio, Texas,
• Hospitals in Fort Leonard Wood Hospital, Missouri
• Ireland Community Hospital and Clinic, Fort Knox, Kentucky, twice
• 1st Medical Brigade, Darnall Hospital, Combat Support Hospital at Fort Hood, Killeen, Texas. Fort Hood is the largest military installation in the world by area, 215,000 acres and the most populous military installation in the world,

U.S. Military Medical education, training and organization were detailed and rewarding studies for us doctors stateside. I performed induction physical examinations during weekend service, but performed general medical and ophthalmological examinations, eye surgery and hospital duties during summer camp tours.

Recruits were brought to the reserve center in bus loads, literally. I positioned myself in a room in a chair, the recruits lined-up outside in the hallway, were ushered in and, seemingly, performed vital signs, rectal exams, hernia checks, and the remainder induction examination on every recruit in Kentucky, during his 6 year service. I was extremely busy, to say the least.

I enjoyed the military education provided by the U.S. Army Reserve and was provided educational manuals and literature for study concerning battle field medicine, surgery, blood volume replacement after injury and current burn treatments. The educational experiences in the military clinics and on the military hospital wards were vast and preparative for possible combat field hospital deployment. Some of this information is from military communications and didactics.

We and our colleagues in the field hospitals were well trained, but often their intense, diligent work was distressing, depressing and saddening. The abilities for everyone involved in the field hospitals to establish a modern functioning medical community, created upon a foreign, desolate uninhabitable terrain with no electricity, safe water, no air-conditioning at times and no other modern conveniences to begin-with and Doctors and other personnel’s ability and training to keep their ‘fingers on the pulse’ of modern medicine and surgery were amazing accomplishments by the U.S. military and doctor medical corps.

Midway my 6 year term of service the 810th began transformation from a convalescent hospital to a field hospital, which was understood among the administrative officers. More hospital professionals were recruited. The unit expanded with every type hospital service: Dentists, Doctors in all specialties, hospital administrators, nurses, laboratory technicians, x-ray technicians, orderlies, cooks, transportation specialists and so on.

Rumor was the 810th was gearing-up for deployment, because of the increase in health care personnel. It never happened. The unit was never deployed to active duty in Vietnam, because the Vietnam War was over in 1975. The unit was later disbanded.

During my 6 year tour of duty, many former athletes were examined and treated.
Occasionally conversations about sport participation broke-out during the history taking part of the examination. Remarkably, it seemed athletes were very comfortable with their anticipated or established military roles and appeared to be well suited for combat.

In the epic story of army life in the calm before Pearl Harbor, with reliable sources, at the Pearl Harbor army base in 1941, Colonel Delbert said, “good soldiers are born wild and wooly…… “Good athletes make the best soldiers and the best leaders……”Good leaders make good organizations and without good leaders nothing is ever accomplished.” [From Here to Eternity: The Restored Edition by James Jones, Open Road Media, May 10, 2011 821 pages]

When former athletes joined our 810th Hospital Unit or we received former athletes for examination and placement elsewhere, we were pleased and content about the prospects for their future in the military and potential accomplishments. Many of my former UK football teammates became respected military officers and some made the military a successful career.

I continue to be proud of my teammates and thank my teammates, all veterans, active duty soldiers, Doctors and all medical personnel for their military service and encourage our citizens to exhibit and demonstrate dignity, ethical conduct and patriotism.

Concluding on a humerus note, when Colonel Hampton was asked why our 810th was serving state side rather in Vietnam, paraphrasing, Melvin said, many of us have served overseas before, and for those that haven’t they likely will get their chance, but for now someone must do this work in the states, because not many induction physicals can be done in Vietnam. He continued, “you see, this army is a big organization, but not many new recruits for the U.S. Army live in Vietnam.”

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