The men and women of the ANC (Army Nurse Corps) have provided nursing care of the highest quality to U.S. troops in Vietnam since mid-1962. Thirteen nurses were included on the staff of the 5th Field Hospital which arrived at Nha Trang in March 1962. Thereafter the number of nurses sent to Vietnam increased gradually as the troop buildup continued. The number reached a peak strength of 900 in January 1969, after which it fell rapidly to about 650 by July 1970 as the withdrawal of US troops gained momentum.

Administration

From 1962 through 1964, when the 8th Field Hospital was the only Army hospital operating in Vietnam, the nursing service did not require the assignment of a chief nurse as a special staff adviser to the surgeon at Army component headquarters in order to function efficiently. In anticipation of the imminent buildup of Army combat and support forces, a decision was made to place a chief nurse on the staff of the USASCV surgeon early in 1965. On 3 February, Lieutenant Colonel Margaret G. Clarke, ANC, senior nurse at the 8th Field Hospital, was assigned that position as an additional duty.

Just as was true for all other Medical Department officers who wore two hats during that period, the physical separation of the 8th Field Hospital from Headquarters, USASCV, in Saigon, hindered Colonel Clarke in the accomplishment of her staff responsibilities. Consequently, when USASCV was redesignated Headquarters, USARV, on 20 July 1965, a primary duty space was authorized in the surgeon's office for a staff nurse. However, not until 15 September, when Colonel Clarke was transferred from the 8th Field Hospital to Headquarters, USARV, to assume the duties of chief nurse, was that position filled.

As chief nurse on the staff of the USARV surgeon, Colonel Clarke and her successors acted as advisers on all nursing activities, and as nursing consultants for the medical service structure in Vietnam. The scope of her responsibilities included initial assignments for incoming ANC officers and recommendations on personnel actions. That Colonel

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Clarke, as the first full-time chief nurse in Vietnam, did her job well is reflected in her winning the award of "US Army Nurse of the Year" in 1965.

The arrival of the 44th Medical Brigade in 1966 had no appreciable effect on the staff structure for nursing service in Vietnam. The USARV chief nurse simply assumed a second staff position as staff nurse at Headquarters, 44th Medical Brigade. By 9 March 1967, however, increases in ANC personnel and expanded nursing activities in the theater of operations warranted the assignment of a full-time nursing adviser to the staff of the commanding officer of the brigade. Consequently, Lieutenant Colonel (later Colonel) Rose V. Straley, ANC, was appointed chief nurse with responsibility for assigning and managing all ANC personnel within the brigade.

On 10 August 1967, the 44th Medical Brigade became a major subordinate command of USARV headquarters. As a result of that reorganization of the medical service structure, a position for a staff nurse in the brigade headquarters was deleted. Colonel Straley was reassigned to the 24th Evacuation Hospital with duty assignment as assistant chief nurse in the USARV surgeon's office. Once again, the USARV chief nurse donned a second hat as chief nurse of the 44th Medical Brigade.

The final reorganization of the US Army medical service structure in Vietnam occurred on 1 March 1970, when Headquarters, 44th Medical Brigade, was consolidated with the USARV surgeon's office. The unified USAMEDCOMV retained a chief nurse as a staff adviser to the USARV surgeon and the USAMEDCOMV commanding general, and as nursing consultant for all US Army medical facilities in Vietnam.

Assignments. The tour of duty was 1 year and this caused a problem of staff rotation in hospitals. Most hospitals arrived with a full complement of nurses whose tours ended simultaneously, necessitating complete restaffing at the end of the year. While waiting for the hospital to become operational, the original nurses were permanently assigned to units already in operation. As the hospital began to receive patients, nurses were assigned to the staff so that their eligibility for return to the United States would be staggered, thus solving the problem of mass rotation to some extent.

Assignments were often based on unit needs rather than on TOE (table of organization and equipment) authorization. Owing to rapidly changing needs, new assignments were made to a specific unit after the nurse's arrival in-country. Some factors used to meet hospital staffing requirements were the type and rapidity of admissions and dispositions, the status of enlisted staffing, and the strength or weakness, of the individual officer assigned. Most nurses were assigned to hospitals and to the 6th Convalescent Center at Cam Ranh Bay. Nurses were authorized

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by TOE for thoracic, orthopedic, neurosurgical, maxillofacial, neuropsychiatric, renal, and other specialized teams.

The difficulty of assigning nurses was further complicated by the fact that 60 percent of the nurses assigned had less than 6 months' active duty and lacked experience in combat nursing. Vietnam became a training ground for a large number of inexperienced officers. This problem was solved by the institution of intensive training programs in each unit and continuous counseling and guidance by more experienced nurses. Army nurses also participated in professional conferences sponsored by the, Allied Nations medical personnel in-country.

There was a crucial need for nurses trained in certain specialized skills. The critical need for operating-room nurses was lessened by cross training and by lending trained nurses to other hospitals in emergencies such as increases in casualties. To meet Vietnam needs, the length of the operating room course (in the United States) was decreased from 22 to 16 weeks and offered at eight Army hospitals. The rise in the number of medical units caused by the troop buildup and high casualty rates increased the need for nurse anesthetists. Because replacements sent to Vietnam were often inexperienced, the policy of utilizing senior nurse anesthetists as instructors and traveling consultants was initiated in 1970. Ward, patient care was adversely affected by the lack of field grade medical-surgical nurse supervisors; however, this shortage was alleviated by using experienced captains in supervisory positions.

Utilization of male nurses. Since 1955 men have received commissions in the Amy Nurse Corps. Male nurses were assigned to organic medical units of major combat elements as well as to hospitals in Vietnam. Male nurse anesthetists were assigned to the 173d Airborne Brigade, the 101st Airborne Division, and the 1st Cavalry Division (Airmobile). They gave direct patient care, supervised nursing activities, and administered anesthesia to patients during emergency surgical procedures. One-half of all male nurses were in the clinical nursing specialties of anesthesia, operating room, and neuropsychiatry. Male nurses were used in special situations as in November 1967 when the nursing service of the 18th Surgical Hospital (MUST) was reorganized as an all-male unit in anticipation of increased enemy activity.

Combat Nursing

The highest quality of nursing care was given despite the constant threat of attack. All hospitals from the northern highlands at Pleiku, to the Delta town of Vung Tau were vulnerable to enemy mortar, rocket, and small arms fire. Several, such as the 45th Surgical Hospital at Tay Ninh, the 3d Field Hospital at Saigon, and the 12th Evacuation Hospital at Cu Chi, for example, were hit one or more times. First Lieutenant

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Sharon Anne Lane, ANC, was killed by hostile fire on 8 June 1969, while on duty at the 312th Evacuation Hospital at Chu Lai. On 11 November, 1969, an intensive care, ward at Fitzsimons General Hospital, Denver, Colo., was formally dedicated as the Lane Recovery Suite in memory of her service, at that hospital.

The principles of good nursing remained unchanged in Vietnam but ingenuity was required to maintain high standards of nursing care. The nurses used their resourcefulness to overcome a lack of certain equipment. Stones in a Red Cross ditty bag made weights for traction, a piece of Levin's tube could be used as a drinking straw, plastic dressing wrappers served as colostomy bags, soap and intravenous bottles were, used as chest drainage bottles, and items of equipment not authorized by hospital TOE were designed and constructed from scrap lumber and other materials. Improvements were constantly needed, and some were made in methods of sewage disposal and in bathing and laundry facilities. During seasonal offensives, heavier-than-normal workloads were placed on medical units, and all nurses went on 12-hour work schedules in order to maintain high standards of nursing.

Army nurses voluntarily gave medical assistance to the Vietnamese during their off-duty hours. Clinics were established and staffed by nurs-

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ing personnel who gave basic care, including immunizations, to the civilians. Sick calls were conducted at various orphanages and courses in child care were given to the natives. Vietnamese nationals were hired as nurses' aides and were given intensive on-the-job training in English and basic nursing procedures. Nurses taught in Vietnamese Armed Forces hospitals, and USMACV nurses helped the Vietnamese Army train its own nurses.

Background

The Vietnam conflict generated new approaches for conducting warfare which extended to all phases of combat, combat support, and combat service support activities. In the latter area, changes in US, Army military dentistry ranged from those caused by the Vietnamese environment to others adaptable to any combat environment.

Treatment problems of the Dental Corps differ from those faced by other specialty services of the Army Medical Department, whose programs and policies are designed to cope with acute, episodic diseases and injuries. Generally, persons entering active duty are healthy young people. However, from the perspective of the Dental Corps, many of these individuals are already afflicted with chronic oral diseases. Since early in World War II, when dental standards for entry on active duty were all but eliminated, the Army has inherited from civilian life vast accumulated needs for dental care. The result was that the Army had too few dentists to remedy the results of years of neglect.

From a military perspective, the major effect of oral disease occurs when an acute, painful lesion develops. A soldier with a toothache is not a casualty in the same sense as one with a combat wound. However, if he must be absent for several days for emergency dental treatment, this absence is just as much a drain on the fighting force as is any other disability. To improve the oral health status of the military population during times of hostilities, the dental service designed programs not only to treat but also to prevent such dental emergencies.

The goal of the program during World War II and the Korean War was to treat all dental problems before the soldiers left CONUS for overseas assignments. Much of the needed treatment was accomplished, but over-all results were unsatisfactory because there were not enough dentists to perform all the necessary work, because training schedules interfered with treatment, and because, new and more effective controls were needed.

In the early period of American involvement in Vietnam, dental preparation of men for duty was similar to that used in previous years. As long as the number of, men involved was small, complete corrective care for all on a one-time basis was possible. But when troop strength started escalating in 1965, dental problems in preparing soldiers for

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combat duty also escalated. In response, new approaches were developed to support the combat missions.

Mission Concept

The major development in the concept of mission support of combat arms was the Dental Effectiveness program. This development began after Major General Robert B. Shira, chief of the Dental Corps, visited Vietnam in the spring of 1968. He was disturbed by reports from field commanders that combat effectiveness was being disrupted by dental emergencies which incapacitated key men for as long as 7 days. General Shira's onsite evaluation resulted in the authorization of a 20-percent increase in dental officer strength to 278 officers in-country by June 1968, in the promotion of programs of mass application of preventive agents, and in the appointment of a task force to collect data on types and treatments of dental emergencies.

Preventive services, an added step in dental service activities since the Korean War, were limited because professional personnel had to perform the services. In the fall of 1968, a stannous fluoride phosphate paste, which the patient could apply himself, was developed. Semiannual applications of this paste reduced the incidence of new caries from as much as 60 percent.

The task force recommended that a dental combat effectiveness program be established at all CONUS posts conducting advanced individual training. The objectives of the program were to select individuals with critical military occupational specialties, identifying their dental needs and treating them with the least possible interference to combat training, and to develop an intermediate restorative material for fast effective scaling of deep caries.

The survey of dental emergencies disclosed an annual rate exceeding 142 per 1,000 men, which corroborated the field commanders' impressions. Since about three-fourths of the emergencies were caused by advanced caries, treatment was centered on caries likely to need attention within 12 to 18 months.

Two additional phases of dental care were started in Vietnam: in replacement centers of combat units, dental screening became part of the in-processing; and any previously overlooked dental conditions were treated immediately. In the field, dental forward area support teams provided both screening and needed dental care.

Within 9 months after the program began, the annual dental emergency rate had been reduced to 73 per 1,000 men, or by about 50 percent.

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Distribution of Personnel

A new, concept in the Vietnam conflict was the provision of most dental services through cellular dental units, not organic to the combat division but serving in an area support role. Team KJ, Dental Service Detachment, the first such unit, was made up of 15 dental officers, an administrative officer (Medical Service Corps), and 21 enlisted men; this team provided routine dental care. The four dental officers still assigned to the medical battalion of each division (compared to the previous 15) treated emergency conditions. Medical units, such as hospitals and dispensaries, also had organic dental officers: officers assigned to hospitals treated the hospital staff; those assigned to dispensaries treated individuals located in their immediate area.

Command and Control

At the beginning of 1965, the seven dental officers in Vietnam were assigned to the 36th Medical Detachment (kJ). Lieutenant Colonel George F. Mayer, DC, was commanding officer of the 36th; he was also dental surgeon to the 1st Logistical Command. In July 1965, the 36th was assigned officially to the 1st Logistical Command, as were other kJ

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teams when they arrived in-country. In December 1965, the 932d Medical Detachment (AI) assumed command over kJ teams and dental personnel organic to other medical units.

Concurrently with the arrival of the 932d in Vietnam, the position of dental surgeon was created in. the Office of the Surgeon, USARV. Colonel Ralph B, Snead, DC, was assigned to this position and was also to supervise dental personnel assigned to combat divisions.

No further changes in command and control setup occurred until October 1967, when Colonel Jack P. Pollock, DC, was assigned additional duty as 44th Medical Brigade dental surgeon and technical supervisor over dental personnel in medical units as well as divisions.

Early in 1970, the USARV surgeon's office and the 44th Medical Brigade were combined to form the Medical Command, USARV. At this time, the positions previously listed as USARV dental surgeon, 44th Medical Brigade dental surgeon, and commanding officer of the 932d Medical Detachment were, combined to integrate more effectively the efforts of dental personnel in kJ teams with those in nondental units.

Equipment

Among the improvements in field dental equipment were the lightweight automatic dental film processor, portable ultrasonic prophylaxis, field dental equipment set for the hygienist, more powerful air compressor, water-jet devices, and lighter and more compact field dental sets. The superior Encore portable speed dental engine was issued to more units; the power difficulties created by this engine were finally solved with the availability of additional electric power.

Dental treatment clinics were widely dispersed and ranged in size from one chair to 14 chairs; almost half of the clinics were air conditioned. They were located in tents, tropical shelters, wooden frame or concrete buildings, warehouses, quonset huts, bunkers, and mobile vans. The initial airmobile dental clinic, used by the 39th Medical Detachment (kJ) in the Pleiku area and transported by a Flying Crane helicopter was an immediate success.

Automated records reduced the work required to maintain and gather data.

Oral Surgery

For the first time in US military history, the Army Dental Corps had available both a large cadre of trained oral surgeons to provide skilled specialized surgical support, and helicopter ambulances to provide evacuation for early definitive treatment of maxillofacial injuries. New and important research contributions of the Army Institute of Dental Research to oral surgery included an improved type of surgical

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dressing, pulsating water-jet devices for lavage, a cold curing resin material for rapid splinting of jaw fractures, preformed silicone mandibles, and an intermediate restorative material and the ultrasonic Cavitron for peridontal disease.

The US Army Veterinary Corps shares in the responsibility of safe guarding the health of the Army. In South Vietnam, during 1965-70, the Veterinary Corps performed its traditional activities under conditions which were often unlike any previously encountered by American troops. It also participated in civic action programs, and furnished advisory support to the ARVN veterinary service in an effort to improve its animal care and, veterinary personnel training. Above all, however, the Veterinary Corps, in its food inspection activities and annual medicine care, met a variety of challenges and resolved difficult and complex problems posed by conditions peculiar to the Vietnamese conflict.

Food Inspection

Veterinary food inspection in Vietnam encompassed a variety of activities. The objective of these activities was to protect the health of the soldier. To achieve that objective, veterinary food inspectors carried on surveillance inspection of depot food stocks, receipt inspection of foods delivered to port facilities, and procurement inspection of indigenous ice, bread, and fresh fruits and vegetables.

Initially, all veterinary activities were carried out by the 4th Medical Detachment in Saigon. With the increase in US troop strength in 1965, additional depots and ports were established throughout Vietnam, from Da Nang in the north to Vinh Long in the Delta. Only one or two food inspectors from the 4th Medical Detachment were permanently assigned to the larger of the new depots, such as that at Cam Ranh Bay, with mobile teams organized for dispatch to the smaller ones to resolve special problems. Thus, veterinary food inspection was concentrated on those major food depots which received food directly from refrigerated ships or by secondary LST shipment. Finally, in 1968, a sufficient number of veterinary food inspectors were authorized to permit total coverage for each food distribution activity.

Depot stocks. Although veterinary inspectors were primarily concerned with protecting the health of troops by preventing the consumption of unsafe foods, they were also interested in food conservation.

As more refrigerated storage facilities became available, it was possible to replace the field ration diet with one which included more dairy products as well as fresh and frozen foods. The refrigerated storage

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facilities available for such foods ranged from a few cold-storage warehouses remaining from French colonial days, to the self-contained, portable, walk-in boxes which became a part of each food distribution point, and to refrigerated Navy barges anchored offshore. Despite this variety, refrigerated storage was seldom of adequate capacity or temperature, and never caught up with demand. Lack of refrigerated storage frequently caused significant losses. To keep such losses to a minimum, produce on the verge of spoiling was inspected daily to determine which items to salvage and which to condemn, including items that would spoil if shipped.

Losses also occurred because depots and supply points bulged with stocks far in excess of amounts that could be consumed before deterioration. Nonperishables were stored in the open, canned goods corroded, and flour soured. With these stockpiles far greater than requirements, depot personnel were indifferent to waste. The saving factor in this subsistence supply chaos was simply the overabundance of foods which continued to flow into the country.

To bring some order out of this chaos, the 1st Logistical Command, in 1967, directed the Veterinary Corps to inspect nonperishable food stocks every 60 days. Although the Veterinary Corps favored regular, routine checks, such a workload was too great for the food inspection forces available. Surveillance inspection continued to be limited to "spot check" at irregular intervals.

Indigenous food. The purchase of indigenous foods soared after the activation of the US Army Procurement Agency in May 1965. By the fall of 1966, more than $900,000 worth of produce, was being purchased monthly. The amount of locally produced foods examined by veterinary inspectors rose from 50 million pounds in 1965 to 430 million in 1966. (Table 10) By 1967, 39 Vietnamese stores and plants bad been approved as a source for the purchase of commodities, ranging from baked goods to ice.

Representatives of the Veterinary Corps and the Army Procurement Agency worked together to develop standards to govern the production of locally grown fruits and vegetables and the preparation of bread and ice. Though not as high in Vietnam as in the United States, the sanitary standards were as realistic as possible. The yardstick was: Does it endanger the health of the soldier? The manner in which the sanitary standards of the two cultures were reconciled is perhaps best illustrated in regulations governing the production of ice.

Ice was in enormous demand because of the hot, muggy climate. If ice from an approved source was not available, the soldier purchased it from the nearest Vietnamese vendor, even when it was yellow with sediment and made from water pumped from a drainage ditch. There

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¹ Quantities shown represent condemnation of Government-owned foods.
² January-June only.
Source: Veterinary Activities Reports, 1965-70.

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was evidence that contaminated ice contributed to an outbreak of viral hepatitis and that it posed a significant health hazard. To solve this problem, the Army approved purchase from Vietnamese icemaking plants which chlorinated the water to have at least 5.0 parts per million free available chlorine. Also, because attempts to sell nonpotable ice continued, all iceblocks were tested upon delivery.

Inspection of Vietnamese bakeries posed another problem. Since baking was done at night, observation during production was unsafe, even in Saigon. (Vietnamese managers claimed that Vietcong "tax collectors" chose the hours of darkness to make their rounds.) The alternative was to section samples of bread and rolls upon receipt, and examine them for insects, other extraneous matter, and "ropey dough" caused by bacterial contamination during processing of the dough. The organism involved, although nonpathogenic, caused bread to sour within 36 hours, which was often less than the time needed to distribute the bread to units. Contaminated bakeries were suspended until cleanup procedures had eliminated the problem and the bread kept, for 96 hours at ambient temperatures.

Perishable food at resupply points. No single factor so profoundly affected the fresh food supply and distribution procedures as did the Sea-Land van deliveries that began in December 1967. These vans, loaded at west coast ports on ships modified for them, were self-contained refrigerators which could maintain optimum temperatures for the items transported. Wheels, bolted in place upon arrival, made the vans mobile. Van refrigeration units operated on bottled gas or from an outside source of electric power. The advantages of the vans were obvious, better temperature control, less handling of product, and faster loading and off-loading, with issue made directly from vans to ration trucks. This revolutionary procedure made possible, volume delivery of such highly perishable items as lettuce, pears, tomatoes, and melons.

Food inspectors made daily checks of the vans parked in Sea-Land yards, recording temperatures and noting product condition. This information, supplied to the 1st Logistical Command, permitted immediate response and centralized control of perishable items. In addition, veterinary out-turn reports forwarded directly to CONUS provided procuring activities with feedback data. As road security improved, vans made direct delivery to the supply points of all but the more remote combat units.

With increased utilization of Sea-Land vans and the advent of palletized shipping containers, the veterinary food inspection specialists authorized for Transportation Terminal Commands in Vietnam could not be fully utilized at the ports, for to dismantle palletized and weatherproofed packaged items at dockside would compromise the protection

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provided against the elements and against pilferage. Furthermore, because port operations were either "feast or famine," food inspection resources could be better utilized in nearby depots. Accordingly, an informal agreement was made with Transportation Terminal commanders, making food inspection personnel organic to these commands available to the major veterinary food inspection unit in that area. This move materially aided the over-all inspection effort.

Animal Medicine

Routine care. Initially, in 1965, routine professional veterinary care for military dogs, in Vietnam was provided by three small veterinary food inspection detachments then in-country. Each of these units was authorized one veterinary animal specialist, in addition to its food inspection specialists. At that time, approximately 350 Army and Marine Corps sentry dogs were assigned to some 10 locations throughout the country.

With the buildup of US, forces and the accompanying increased use of dogs in field operations, the dog population rose from the 350 in 1965, to more than 1,200 in 1968, dispersed widely throughout Vietnam.

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With more veterinary support required in the forward areas, additional veterinary detachments arrived in Vietnam, but without a comparable increase in the numbers of animal specialists. Veterinary food inspectors from the forward detachments were used to augment the small number of these specialists. Utilizing the services of these additional veterinary enlisted men was, at first, hampered by their inexperience in animal medicine and by the lack of veterinary medical equipment sets in the food inspection units. This situation was remedied by training food inspectors locally in certain animal specialist skills, and by obtaining equipment from the veterinary hospital and dispensary detachments.

The need for fewer food inspectors and for more animal specialists and animal medical equipment sets in Vietnam constituted a significant change in the operation of veterinary service detachments. To reflect this need, appropriate changes were subsequently made in the veterinary service tables of organization and equipment.

Hospitalization and evacuation. The 4th Medical Detachment maintained a small-animal clinic in Saigon for the emergency care and treatment of military dogs and for mascots and animals privately owned by US Army troops and other authorized personnel. All animals requiring extensive treatment were evacuated to Saigon, except Marine Corps dogs which were evacuated to DA Nang.

In January 1966, the 936th Veterinary Detachment (ID), a veterinary small-animal hospital, arrived at the Tan Son Nhut Airbase to provide definitive medical care and hospitalization for all military dogs in the II, III, and IV CTZ. Additionally, it provided a consultation service to the field, monitoring all dog medical records, requisitioning and issuing all veterinary drugs to area veterinarians, and collecting and evaluating veterinary military dog statistics. On 19 October 1966, a small-animal dispensary detachment, the 504th Medical Detachment (IE), arrived in DA Nang. Although organized as a dispensary, this unit provided complete veterinary service for scout and sentry dogs in the entire I CTZ. In 1966, also, the veterinary department of the 9th Medical Laboratory became operational, making available comprehensive veterinary laboratory diagnostic services and investigations of animal diseases of military and economic interest.

In 1968, with the arrival of additional small-animal dispensary detachments, the three echelons of veterinary care and treatment of military dogs- unit, dispensary, and hospital,--became clearly established. Particular emphasis was placed on improving administrative procedures to provide more definitive data on the health of military dogs. An expanded monthly morbidity and mortality reporting system was developed, and

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completion of detailed admission reports for hospitalized dogs, was stressed.

Deployment of scout dogs in 1966 resulted in casualties suffered in action. To insure prompt treatment, dogs were evacuated by air to the 936th Veterinary Detachment (ID). Handlers were evacuated with their dogs, and remained with them until treatment was completed.

During 1969, difficulties were encountered in evacuating military dogs from dog units and veterinary dispensaries to veterinary hospital facilities. Accordingly, a firm evacuation policy was established. All dogs requiring treatment for more than 7 days, were evacuated. In addition, a veterinary medical regulator was designated to direct the flow of dogs to the hospital facilities. Evacuation of military dogs was coordinated with the Air Force and with medical units utilizing ground and air ambulances.

In 1969, also, the high incidence and prolonged course of Tropical Canine Pancytopenia left some military dog units unable to perform adequately. The remedy was establishment of dog-holding detachments at the two veterinary hospitals. Dogs to be hospitalized for 15 days or longer were transferred to the, dog-holding detachment, thereby enabling the dog unit to requisition replacement dogs.

Medical problems. Canine disabilities most frequently seen, in addition to wounds from hostile action, were heat exhaustion, ectoparasites and endoparasites, myiasis, nasal leeches, and dermatoses of varying etiology. Heartworms posed a potentially severe canine disease problem. Cases of microfilaria were as high as 40 percent in some scout dog platoons, although few animals exhibited clinical signs of disease. The incidence of hookworms was comparable to that of heartworms, and was frequently manifested by clinical signs. Outbreaks of disease resembling leptospirosis occurred; one incident involved 55 dogs, but laboratory examinations did not confirm the clinical diagnosis. Ticks, a persistent problem throughout Vietnam, required equally persistent control measures.

Tropical Canine Pancytopenia, an unusual disease, characterized by hemorrhage, severe emaciation, pancytopenia, and high mortality, broke out in 1968, in US military dogs in Vietnam. Know first as IHS (Idiopathic Hemorrhagic Syndrome) and ultimately as TCP (Tropical Canine Pancytopenia), the disease seriously jeopardized the operational efficiency of combat units dependent on military dogs. Between, July 1968 and December 1970, about 220 US military dogs, primarily German Shepherds, died of the disease, and it was the contributing reason for the euthanasia of many others. Near the end of 1969, a program of tetra-

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cycline and supportive therapy for 14 days, based on recommendations from the WRAIR laboratories in Saigon, was initiated for all TCP cases. This therapy returned to duty approximately 50 percent of the dogs treated for the disease.

Beginning in May 1969, "red tongue," a nonfatal, nonsuppurative glossitis, occurred in a significant number of military dogs. The glossitis was often accompanied by excessive, salivation, gingivitis and edema of the gums, and, at times, a serious conjunctivitis. The condition is extremely painful, and affected dogs could eat and drink only with difficulty. In most instances, the signs regressed and the dogs returned to normal in 3 to 7 days. The etiology of the condition has not been established.

Acute glossitis in scout dogs spread throughout Vietnam during 1970. Morbidity rates as high as 100 percent in some platoons made these units noneffective for periods up to 2 weeks.

Up to 1966, the Army veterinary rabies control program was primarily restricted to vaccination of military dogs, pets, and mascots. In August of that year a coordinated rabies program was put in operation. Vaccination clinics were held, often as far forward as medical clearing stations. Three major difficulties were recognized, the enormous number of pets acquired by Americans, the large number of small units throughout the country, and the absence of meaningful civilian rabies control programs.

In September 1967, standard procedures were established for the control of pets and the program was widely publicized by radio and television, stressing the dangers of rabies. More than 7,000 animal vaccinations were reported for 1967, the majority being rabies immunizations. Nevertheless, in that year only half of the animals owned by U.S. soldiers were vaccinated. The significant problem here was that many men were located in small detachments scattered among the Vietnamese communities, where pet control was essentially nonexistent. One countermeasure was to vaccinate Vietnamese dogs around US, military installations, thereby lessening the chance of dogs on these bases coming into contact with rabid animals. Where possible, dogs were vaccinated on Vietnamese military installations. Also, with the requirement that soldiers pay for having their pets vaccinated, many were reluctant to immunize or identify their animals.

The Vietnam experience showed the need for free rabies vaccinations for animals privately owned by US personnel, to assure an unhampered, comprehensive disease control program. Toward this end, with the existing active combat conditions in Vietnam, the Army waived the provisions of the regulation which required payment to the Government for immunization and quarantine of such privately owned animals.

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Three AMSC (Army Medical Specialist Corps) officers (two dietitians and one physical therapist) were assigned to Vietnam in the spring of 1966. There was no authorization for these officers in existing TOE's (tables of organization and equipment) for field and evacuation hospitals, but because hospitals in Vietnam operated as fixed installations, providing essentially the same services as station and general hospitals in the continental United States, the need for dietitians and physical therapists was recognized. The relatively short periods for which patients were hospitalized in Vietnam precluded the long-range rehabilitation programs provided by occupational therapists; however, occupational therapy was used extensively in caring for patients evacuated to Japan. During the buildup of medical, support in Vietnam in fiscal year 1966, 30 AMSC officers- 13 dietitians, 10 physical therapists, and seven occupational therapists- were assigned to hospitals in Japan.

The two dietitians assigned to Vietnam in 1966 acted as consultants to hospitals in establishing food service programs. Major (later Lieutenant Colonel) Patricia Accountius, dietitian, was originally assigned to the 3d Field Hospital in Saigon, but was soon given the additional post of dietary consultant for the 44th Medical Brigade, 1st Logistical Command. Captain James Stuhmuller was assigned at the medical group level. Major (later Lieutenant Colonel) Barbara Gray, physical therapist, was assigned to the 17th Field Hospital, Saigon, but also acted as consultant to hospitals throughout the command. Because of the contributions made by these officers to the improvement of hospital food service and to the in-country rehabilitation of patients, requests: were received for the assignment of additional AMSC personnel.

In the spring of 1967, four dietitians and 10 physical therapists were assigned. The senior dietitian continued to act as dietary consultant to the 44th Medical Brigade and dietitians were assigned to headquarters staff of medical groups. Physical therapists were utilized in evacuation and field hospitals, with the senior therapist having the additional duty as consultant at the brigade level.

The utilization of physical therapists remained essentially unchanged. In August 1967, the dietary staff adviser of the 44th Medical Brigade was given the additional duty as consultant to the USARV surgeon. With the formation of USAMEDCOMV (provisional) in March 1970, the dietary staff adviser was assigned to the office of the USARV surgeon. Another major organizational change affecting dietitians occurred in July 1968, when food service sections were made separate elements within each medical group headquarters. Staff dietitians, designated as primary staff officers, food service warrant officers (food advisers) and hospital food service noncommissioned officers (food service supervisors) con-

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stituted the section staffs. Concurrent transfer of all food service functions and personnel from the S-4 Section to the newly created food service section increased the effectiveness of dietitians as consultants at the group level. The maximum authorization for AMSC officers in Vietnam was 17, which included 12 physical therapists and five dietitians. The largest number of AMSC officers serving in Vietnam at any one time was 21.

Dietitians

Because a shortage of dietitians precluded their assignment at the hospital level, the concept of the group or "shared" dietitian provided the best utilization of these specialists. Dietetic supervision of several hospitals was easily accomplished because of the proximity of hospitals, within each group and the availability of air travel. The use of the Army Master Cycle Menu (Field Ration Menu) in all medical facilities, coupled with the necessity for centralizing food requirements for modified diet food items to assure logistical support, lent itself to the concept of centralized planning and control.

A major accomplishment of dietitians in Vietnam was in menu planning and the procurement of adequate subsistence supplies for hospitals. At the request of the 1st Logistical Command and in cooperation with the Defense Supply Agency, the 44th Medical Brigade dietitian, in 1966 developed a 28-day cycle master menu which was used by both field and hospital messes in Vietnam. A hospital master menu was also developed which provided meal plans for the approximately 14 types of modified diets commonly served in hospitals. These menus were updated as a wider variety of food and equipment became available. With the excellent support of the subsistence section of the 1st Logistical Command, early problems in availability of subsistence items were largely resolved, and hospitals were given first priority for food issues when shortages did occur.

Staff dietitians reviewed, analyzed, and evaluated space design and layouts to upgrade medical food service facilities. By personal visits, to various supply depots, they were able to locate and arrange for delivery of garrison-type mess equipment to hospital messes. By the end of 1968, TOE food service equipment in all hospitals within the 44th Medical Brigade, with the exception of the I Corps Tactical Zone, had beer replaced by garrison-type equipment.

Improvements in assigning, utilizing, and training enlisted men and civilians resulted in high-quality food service to hospitalized patients. Originally, hospital tables of organization and equipment did not authorize hospital food service enlisted personnel (MOS 94F40 and 94B30), and as a result, many military cooks, and mess stewards assigned to hospitals were, without previous experience in this specialized type of feeding. Many food service warrant officers (MOs 941A), who were

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directly in charge of food service at individual medical facilities, also lacked experience in this type of food service. Conversely, hospital-trained food service personnel were often assigned to troop-feeding facilities. Through personal screening of food service personnel arriving in-country, this situation was partially alleviated, and in 1967, modified tables of organization and equipment reflected the need for hospital-trained enlisted men in food service sections. The accomplishments of many of these, men in upgrading the quality of food service to patients deserve special recognition.

Food service to bed patients remained a problem. Electric carts used to deliver bulk food to the wards were not suitable for use in hospitals which did not have covered ramps and cement walkways. Many hospitals continued to use insulated containers to hand-carry food to ward areas. There was no provision in tables of organization and equipment for ward tray service attendants, and overtaxed nursing staffs often had the responsibility for assembling trays on wards and delivering food to patients. In 1969, authorization was received to employ Vietnamese for this purpose.

Dietitians provided assistance to Allied personnel serving in Vietnam. The USARV dietary consultant, working with the 1st Logistical Command II Field Force food service consultant and the G-4 of the Royal Thai Army Volunteer Forces, developed a more acceptable ration for the Thai Army and assisted in training programs for Thai food service personnel. At the request of the US Army Engineer Command, Vietnam, dietitians assisted Free World forces from Korea and Australia with their cantonment mess programs in procuring equipment and in training personnel in the use of the equipment in food preparation.

Physical Therapists

The work performed by the first physical therapist assigned to Vietnam in 1966 demonstrated the value of this type of treatment for certain injuries, particularly soft-tissue injuries to extremities. The need for additional physical therapists was evident from the many requests for their services from physicians throughout the country. After evaluation of the numbers and types of patients who could benefit from physical therapy in USARV medical facilities, the decision was made in 1967 to assign physical therapists to field and evacuation hospitals and to the 6th Convalescent Center. The senior therapist, in the capacity as Brigade consultant, had the responsibility for constantly assessing facilities and workloads and for assigning incoming officers and enlisted men to hospitals most in need of their services.

Malassignments often occurred with physical therapy specialists (MOs 91J20). Since no authorizations existed, trained specialists arriv-

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ing in-country were often assigned in their secondary military occupational specialty. Until this deficiency was corrected, records of incoming personnel were carefully screened and qualified individuals were diverted to medical facilities where their specialized training and experience could be better utilized.

The primary treatment goal of physical therapy was the rehabilitation of patients who were capable of being returned to duty. For patients requiring evacuation, treatment was aimed toward starting basic rehabilitation, procedures which could be continued throughout the evacuation, process. Because of the relatively short periods of hospitalization of patients in Vietnam, physical therapy during the initial years, was largely limited to ward-treatment programs, although a number of outpatients were treated in some hospitals. Because, commanding officers were so pleased to have the services of physical therapists, they were most cooperative in providing space for clinics and helping to procure equipment. As facilities and equipment were improved, the types of treatment available in physical therapy clinics were also expanded. More long-term treatment programs, particularly for Vietnamese patients, were initiated, and a great deal of emphasis was placed on training Vietnamese technicians in physical therapy techniques and procedures. Physical therapists volunteered their services to civilian hospitals and rehabilitation centers to assist in treatment of civilian casualties. In May 1970, at the request of the US Military Assistance Command, Vietnam, a physical therapist was assigned to that command to participate in rehabilitation programs being established in ARVN hospitals. Her primary responsibility was training Vietnamese to conduct these programs.