Two weeks ago Treat, 31, a Reserve major on active duty at the Brooke Army Medical Center in San Antonio, Texas, was sent on a mission of mercy. He was part of a five-member medical team helping survivors of history's worst air disaster—the crash of two jumbo jets at Tenerife airport in the Canary Islands in which 576 died and only 67 survived.
The 14 most severely burned passengers were brought to the Army's burn center at Brooke, widely regarded as the best of its kind in the world. As many as 280 victims a year are treated there. "I was surprised at the good spirits of the patients," Treat reports. "I was surprised, too, that they showed no fear of flying after the tragedy back on Tenerife."
Brooke began to specialize in burn treatment when napalm and nuclear devastation at the end of World War II suggested that there would be many burn cases in any future war—a theory borne out by Korea and Vietnam. During those wars hundreds were treated at Brooke, and new treatments developed: salving of burns to reduce infection; temporary skin grafts, first from human donors (including the dead), then from pigs, to speed healing. These methods resulted in a dramatic improvement in the survival rate of patients with burns on as much as 60 percent of their bodies.
At Brooke 20 doctors ministered to the crash victims. (Ironically, two of Treat's bosses, burn center director Col. Basil A. Pruitt Jr. and Maj. Scott McDougal had to leave for a meeting of the National Burn Association in California shortly after helping check the new patients.) "It's never a one-man show around here," Treat says. "We removed the bandages and assessed the patients for long-range treatment. Each got a thorough physical examination. The burn areas were thoroughly cleansed. Dead skin was removed. The worst burn we found covered 72 percent of the victim's body, but his condition has remained stable and his prognosis hopeful."
By the time the rounds were completed, Treat had been on the job for 42 consecutive hours, but he had one more task. "I went down to talk to the patients' families. They need treatment, too, in cases like these."
Most of the survivors are in for a long stay. "A patient sustaining third-degree burns over 50 percent of his body normally stays 50 days," Treat explains. "The rule—and there are many exceptions based on variations of age and general health—is one day in the burn ward for each percentage point of burn."
Now, more than two weeks after the accident, the victims' unremitting pain continues as a major problem. Treat says, "A skin graft won't take unless a patient is virtually immobile in the grafted area for three days—and that only makes the pain worse. We use morphine and other drugs, but they may have side effects prolonging recovery."
The center has a special bed, a kind of tub filled with tiny silicone beads buoyed by compressed air. According to Treat, "This can relieve a bed-ridden patient somewhat. We even have a psychologist on our staff who tries to quell pain through hypnosis, and this can be helpful."
A native of Wooster, Ohio, the slight, soft-spoken Treat was an honor graduate of Ohio State University Medical School. He volunteered for the burn unit even though it meant extending his hitch in the Army by an additional year—to three years.
Treat does not regret his choice. "Burn victims concentrate many medical challenges into a single case," he explains. "All physical functions are affected. I have a special interest in caring for critically ill patients, and what I'm learning here will help me do it better."
I've never seen anybody die of pain," says U.S. Army Dr. Richard C. Treat, "but it's probably the toughest thing we treat in burns. It is a difficult business."