Remembering Vietnam—Dale Smith

The National Library of Medicine (NLM) is pleased to collaborate with the National Archives and Records Administration (NARA) to present the panel discussion “Remembering Vietnam: Medics, Corpsmen, and Nurses” on April 26, 2018 at the McGowan Theater in Washington, DC, livestreamed and archived on YouTube, in association with the National Archives exhibition Remembering Vietnam. Panel members include Major General (Retired) Donna Barbisch, Colonel (Retired) Merle Snyder, Colonel (Retired) Don Hall, and Tom Berger, PhD. The discussion will be moderated by Dale Smith, PhD, Professor of History at the Uniformed Services University of the Health Sciences and a member of NLM Board of Regents. Today Dr. Smith kicks off a related series of posts with a historical overview of the U.S. military medical environment during the Vietnam War.

The time: The 1960s. The “baby boomers” come of age, and are asked to consider what they can do for their country. The dream of redeeming the promises of equity regardless of race or sexuality inspires a vision of a Great Society—dreams ultimately overshadowed by “war.” The place: Vietnam. No one really wanted a war in Vietnam, a place few people could find on a map until their sons and daughters and neighbors were going there in uniform.

In observation of the semicentennial of the war in Vietnam NLM and NARA are honored to provide a public forum, “Remembering Vietnam: Medics, Corpsmen, and Nurses,” with reflections by a historian and veterans who served in various medical roles, field medic, helicopter evacuation pilot, and nurse. Their personal and professional experiences, along with those of thousands of other patients and providers, were part of the Department of Defense’s ongoing commitment to care for those who go in harm’s way on behalf of the rest of us.

That commitment had always been to provide the best medical care America had to offer, and American medicine was both the best in the world and undergoing profound change.  Medicine in America had committed to specialty care, almost as a public policy accident.  By 1960, the lesson of World War II, for both the public and the medical profession, that science-based specialized care was “best,” had assured that virtually every new medical graduate went to post-MD specialty training called residency; TV shows like “Dr. Kildare” and “Ben Casey” were reinforcing the lesson weekly to the public.  Even general practitioners were working to become specialists in primary care or family practice.  In civilian life, the addition of outpatient insurance coverage, often under the name “Blue Shield,” even if not part of the Blue Cross Blue Shield network of plans, made specialized care available to most working families. Congress and the Profession reached an agreement under which medical research and parts of medical education could receive public support through the National Institutes of Health without producing fear of socialism, and NIH Directors, like James Shannon, MD, and Robert Q. Marston, MD, regularly testified that breakthroughs on various diseases were close. And it worked: The Veterans Administration taught us to treat hypertension, cortical steroids battled inflammation, new antibiotics and vaccines were bringing infectious diseases to heel, the possibilities seemed endless and affordable.

Military personnel in the Army, Navy, and Air Force also had insurance for their families, which combined some access to civilian care with care in military hospitals.  To staff the military hospitals doctors were drafted; every fit male MD owed two years of public service, or as residency became more common they could defer their obligation until after residency and serve for three or four years. The military had its own residency programs to attract regular, career-oriented officers, but the great bulk of care was given by the drafted doctors. The percentage of those who were called to serve grew as the war in Vietnam expanded in the late 1960s, and a drafted army was cared for by drafted doctors. But the care remained exceptionally good. Stunningly, the hazards of military service were dramatically reduced as the disease and non-battle injury rates dropped to the lowest in history, and the died-of-wounds rates reached unimagined lows of 1.7 or 1.8%. Still, as the classic TV series M*A*S*H (based on the 1970 anti-war film of the same name) eloquently noted, “There are certain rules about a war, and rule number one is: Young men die. Rule number two is: Doctors can’t change rule number one.”

Along with the science-based, specialized, and often drafted doctors were volunteer nurses and associated medical personnel, officer and enlisted. They accompanied the soldier, sailor and Marine in harm’s way, provided the first dressings, and got them to field hospitals as good as any in America. They worked in those hospitals to care for those wounded and sick, and with remarkable success, sent more home alive than anyone had dared to predict.  Once home, the nation discovered that there were hazards we had not appreciated, both physical and psychological, that we have spent much of the last fifty years struggling to address; but what was not known cannot take away from what was done. “Remembering Vietnam: Medics, Corpsmen, and Nurses” is the story of a representative sample of those that did the unimagined: they salvaged more of our young men from mortal wounds than anyone had before.

Watch the panel discussion “Remembering Vietnam: Medics, Corpsmen, and Nurses” on April 26, 2018 live on YouTube.