## The medics' war

-  The medics' war 
-  Table of Contents 

# The medics' war

Cowdrey, Albert E

Center of Military History

This book was produced in EPUB format by the Internet Archive.

The book pages were scanned and converted to EPUB format automatically. This process relies on optical character recognition, and is somewhat susceptible to errors. The book may not offer the correct reading sequence, and there may be weird characters, non-words, and incorrect guesses at structure. Some page numbers and headers or footers may remain from the scanned page. The process which identifies images might have found stray marks on the page which are not actually images from the book. The hidden page numbering which may be available to your ereader corresponds to the numbered pages in the print edition, but is not an exact match;  page numbers will increment at the same rate as the corresponding print edition, but we may have started numbering before the print book's visible page numbers.  The Internet Archive is working to improve the scanning process and resulting books, but in the meantime, we hope that this book will be useful to you.

The Internet Archive was founded in 1996 to build an Internet library and to promote universal access to all knowledge. The Archive's purposes include offering permanent access for researchers, historians, scholars, people with disabilities, and the general public to historical collections that exist in digital format. The Internet Archive includes texts, audio, moving images, and software as well as archived web pages, and provides specialized services for information access for the blind and other persons with disabilities.

Created with abbyy2epub (v.1.6.7)

THE MEDICS’ WAR

Library of Congress Cataloging in Publication Data

Cowdrey, Albert E.

The medics’ war.

(United States Army in the Korean War; 4th v.)

“CHM pub 20-5”—T.p. verso.

Bibliography: p.

Includes index.

1. Korean war, 1950-1953—Medical care—UnitedStates. 2. United States. Army—Medical care—History.I. Center of Military History. II. Title. III. Series.

[DNLM: 1. Military Medicine—history—Korea. 2. MilitaryPersonnel—history—Korea. DS 921.3 C874m]DS918.U5246 [DS921.25] 951.9’042 s 86-25950

[951.9’042]

First Printing—CMH Pub 20-5

For sale by the Superintendent of Documents, U.S. Government Printing OfficeWashington, D.C. 20402

UNITED STATES ARMY IN THEKOREAN WAR

David F. Trask, General EditorAdvisory Committee

(As of 1 August 1985)

| Charles P. Roland                                          | Archer Jones                                                                    |
|------------------------------------------------------------|---------------------------------------------------------------------------------|
| University of Kentucky                                     | North Dakota State University                                                   |
| Roger A. BeaumontTexas A&M University                  | Lt. Col. Robert A. DoughtyU.S. Military Academy                                 |
| Jamie W. MooreThe Citadel                                  | John H. HatcherOffice of the Assistant Chief ofStaff for Information Management |
| Donald W. Smythe, S J.John Carroll University              | Col. Louis D. G. FrascheU.S. Army Command and General                           |
| Brig. Gen. Richard L. ReynardU.S. Army War College         | Staff CollegeL. Eugene Hedberg                                                  |
| Maj. Gen. Edward J. HuyckeDeputy Surgeon General, U.S.A.   | American Enterprise Institutefor Public Research                                |
| James O’NeillNational Archives andRecords Administration   | Maj. Gen. Carl H. McNair, Jr.U.S. Army Training andDoctrine Command             |

U.S. Army Center of Military HistoryBrig. Gen. William A. Stofft, Chief of Military History

| Chief Historian                          | David F. Trask                           |
|------------------------------------------|------------------------------------------|
| Chief, Histories DivisionEditor in Chief | Lt. Col. Richard O. PerryJohn W. Elsberg |

V

to Those Who Served

Foreword

This is the fourth volume published by the U.S. Army Center of MilitaryHistory in its United States Army in the Korean War series. Once termed apolice action, the Korean War was fought by massed armies on a constrictedfield of operations. Its battles were as intense as those of any other war thiscentury.

The Medics’ War views this conflict from an uncommon angle. It documentsthe efforts of American Army doctors, nurses, and enlisted medics to save lifeand repair the damages wrought by wounds and disease. Though the charges ofbiological warfare made at the time are shown to have no foundation, thedisease-ridden environment of wartime Korea aided the side with the bestmedical care. The real MASH clearly emerges in this study, along with thevariety of technical innovations produced by the conflict that have advancedmedical science.

The perspective of The Medics’ War is an enlightening one, showing that thecompassionate treatment of both United Nations and enemy wounded pre-served human values in the midst of bitter, unforgiving strife. Civilian andmilitary readers alike will gain from it a deeper understanding of the processes,destructive and reconstructive, that together made up the human experience ofthe Korean War.

Washington, D.C.

24 March 1986

WILLIAM A. STOFFTBrigadier General, USAChief of Military History

IX

The Author

Albert E. Cowdrey was born in New Orleans, Louisiana, and received hiseducation from the schools of that city and from Tulane and Johns HopkinsUniversities. He served in the Army as an enlisted man during the years1957-59. After teaching at Tulane University and at Louisiana State Universityin New Orleans he entered the government historical programs, working for theCorps of Engineers historical office and, since 1978, for the U.S. Army Center ofMilitary History. His continuing interest in southern history brought him theHerbert Feis Award of the American Historical Association, in 1984, for hisbook This Land, This South. He has written widely on medical and militaryhistory, in American and British journals. The Medics’ War was written while hewas chief of the Medical History Branch at the Center of Military History.

X

Preface

The medical history of war casts light not only upon the suffering of thosewho fight but upon the dedication of those who save. Though the associationbetween slaying and saving is paradoxical, it exists and helps to shape the natureof modern warfare—and of modern medicine as well.

Often the effort to forestall or to repair war’s damages by preventing diseaseand managing trauma has served to advance medical science. During the pastcentury, conquest of the ancient camp diseases has changed the definition ofwhat is militarily possible. The kind of struggle fought on the Western Frontduring World War I would have been impossible in times past, when largeimmobile bodies of troops would have spawned devastating epidemics. InWorld War II Americans, aided by further medical progress, were able to fightfor years in the most varied disease environments. In turn, that struggle intro-duced to the world a variety of innovations, including the mass production anduse of penicillin and DDT. During the same period, improvements in surgeryand the introduction of a systematic program to supply whole blood steadilyreduced the death rate among the wounded in military hospitals.

In the roster of wars that have contributed to medical progress, the Koreanconflict holds a place of importance. Major innovations included the MASH(mobile army surgical hospital); widespread use of the helicopter for medicalevacuation; improved forward vascular surgery; and advances in the handlingand treatment of neurosurgical injuries. Indeed, modern emergency medicinewould be hard to imagine without the pioneer work done on the Korean battle-fields. By their courage and skill American medics in Korea were able to saveand restore the lives of many soldiers and marines who otherwise would havesuccumbed to the fighting, the omnipresent diseases, and the harsh fieldconditions.

While researching and writing The Medics' War, I benefited from the sup-port and expertise of many people. The bibliographical essay gives credit to thewriters of earlier published works. My thanks are due especially to the archivistsand librarians of the Washington area, notably to Hannah M. Zeidlick, CharlesEllsworth, Geraldine K. Judkins, and Mary J. Sawyer of the U.S. Army Centerof Military History; to Norman M. Covert at Fort Detrick; to Dorothy Hanks atthe National Library of Medicine; and to Victoria S. Washington and Fred W.Pemell at the National Archives and Records Administration. Mr. Pernell, inparticular, deserves a campaign ribbon for his unwearied help to myself andlater to my editor.

Fellow historians displayed their usual professional generosity, providingperceptive comments on my efforts and constructive suggestions for improve-

XI

ment. John Duffy, now professor emeritus at the University of Maryland, of-fered valuable guidance in many phases of the writing—notably by allowing meto audit his course in medical history when I first began to study this difficultspecialty—and also critically reviewed the manuscript. J. Kenneth MacDonald,historian of the Central Intelligence Agency, made materials available to mefrom his agency’s files. Richard J. Sommers of the U.S. Army Military HistoryInstitute, Carlisle Barracks, was most helpful. Robert J. T. Joy, M.D., of theUniformed Services University of the Health Sciences played a special role inthe making of the book. He was a mine of information on the history of militarymedicine; encouraged me to assemble my notes on germ warfare for an article inthe Journal of the History of Medicine and Allied Sciences, which he edits; and,as a member of the panel on this book, provided a lengthy and useful critique.

My colleagues at the Center of Military History contributed beyond myability to offer adequate thanks. Mary C. Gillett placed her formidable scholarlyknowledge of medico-military topics at my disposal. The ongoing works ofGraham A. Cosmas and Mary Ellen Condon-Rall on the medical history ofWorld War II yielded valuable insights into the immediate background of theKorean struggle. Young Gil Chang—since tragically deceased—saved me fromerrors not only by his historical insight but also by his grasp of the language andculture of his native land. Billy G. Mossman read the manuscript with a criticaleye and offered constructive suggestions. Unfailing encouragement and supportcame from two successive chiefs of the Histories Division, Col. James W. Dunnand Lt. Col. Richard O. Perry, and from Chief Historian David F. Trask.Stephen E. Everett reviewed for accuracy the material on Army units. Linda M.Cajka skillfully designed the maps, charts, and paperback cover, and also pre-pared the photographs. Finally, my editor, Joanne M. Brignolo, was extraordi-narily diligent both in clearing the knotty language from the text and in amplify-ing the footnotes to provide maximum information to the critical reader. It is,however, due to all these valued associates and mentors to say that any errorsremaining in the book are entirely my own.

War and healing meet in many places, in the field and prison camp, in thehospital and laboratory. I hope that those who study either, or merely enjoyreading about them, will find some matters of interest in the contribution thatfollows.

xii

Washington, D.C.24 March 1986

ALBERT E. COWDREY

Contents

Page

PROLOGUE: THE UNEXPECTED WAR  3

Chapter

1. BETWEEN THE WARS  7

The Great Unraveling  8

TheASTPs  11

The Drive To Professionalize   14

Reorganizing the Department   16

The Unification Drive  22

The Personnel Problem Revisited  28

2. JAPAN AND KOREA AFTER V-J DAY  36

Public Health and Welfare  38

Care of the Troops  44

The Occupation of Korea   50

American Policy and Korean Ills   51

Americans in Korea  58

Japan Under the Later Occupation   63

3. THE MEDICAL SERVICE IN RETREAT  69

Medics in Retreat   71

The Pusan Perimeter  79

The Other Side of the Line  86

The Medical System Takes Form  88

Enter the Helicopter  93

4. THE MEDICAL SERVICE IN THE ATTACK  98

Medical Support for the Invasion  98

Medics in the Breakout  105

The Advance to the Yalu  112

The Forces of General Winter  116

“An Entirely New War'’  119

The New Shape of Army Medicine  127

5. BEHIND THE LINES  132

Sources of Supply   133

Getting Supplies to the Troops  135

Water, Blankets, and Litters  137

Personnel  139

Preven ti ve Medicine  145

Xlll

Chapter

Page

Hospitalization and Evacuation  149

The Blood Program  154

The Growth of Psychiatric Support  155

Dental Care  156

Professional Services  158

6. FIELD AND BUNKER  160

On the Battlefield  161

The Third Horseman  173

Into the Bunkers  177

Life on the Line  182

How Good Was the Field Medical Service?  187

7. STATIC WARFARE  197

From Battle Line to Hospital  200

Life on the Line  207

Men in Armor  210

Back to the Battle  213

Germ Warfare  217

The Opening Barrage  222

Charge and Countercharge  224

8. MEDICAL SUPPORT BEHIND A STABLE FRONT  228

Organization of the Rear Areas  228

A New Army   229

Training  234

Supply  238

The Blood Program  243

Preventive Medicine  245

Dental Care  250

Of Professional Interest  253

The Flow of the Wounded  257

9. DEFINITIVE CARE  261

Evacuation: The First Leg  262

The Hospitals of Japan  270

On the Wards  276

The Way Home  289

Zone-of Interior Hospitals  291

Selected Hospitals  294

10. VICTIMS OF WAR  299

U.N. Prisoners: The First Phase  300

Communist Prisoners: The First Phase  306

The Riots and After  314

XIV

Chapter Page

The Refugee Problem  321

Korean Soldiers and Laborers  329

11. THE END OF THE FIGHTING  335

The Medical Picture  335

On the Line  340

Operation LITTLE SWITCH  345

Operation BIG SWITCH  351

After the Battle  355

Civil Assistance Revisited  359

The Korean Experience  362

BIBLIOGRAPHICAL NOTE  365

LIST OF ABBREVIATIONS   375

INDEX  379

Tables

No.

1. Medical Department Officer Strength, December 1947   13

2. Distribution of Army Nurses, June 1948   19

3. Results of the Moral Suasion Campaign, June 1949   32

4. Board-Certified Regular Army Medical Officers, March 1950 ... 34

5. Comparative Case Rates of Major Diseases During the Occupation . 41

6. Anticipated Deficit in Medical Officers, Eighth Army, 1949 .... 67

7. Medical Personnel in Japan, June 1950   68

8. Nondivisional Medical Units in Korea, August 1950   99

9. Battle Casualty Data, April 1951  195

Charts

1. Medical Evacuation, September 1950   151

2. Organization of the Korean Civil Assistance Program, June 1952 . . 324

3. Organization of the United Nations Civil Assistance Command,

Korea, November 1952   324

4. Organization of the Medical Section, United States Army Forces,

Far East, December 1953   334

Maps

1. The Enemy Advances, June-July 1950   72

2. The Pusan Perimeter, August 1950   80

XV

No. Page

3. The U.N. Advances, September-November 1950   110

4. Land Lost and Regained, January-May 1951  169

5. The Central Korean Battleground, September 1951-July 1953 ... 212

6. Japan and Korea   265

7. The Pusan-Koje Area  313

8. Refugee Movements, June 1950-July 1951   322

9. Korea Redivided, July 1953   352

Illustrations

American Evacuees From Korea Arriving in Japan  5

Maj. Gen. Raymond W. Bliss  17

Draftees Undergoing Physicals  31

Brig. Gen. Crawford F. Sams  37

Brig. Gen. Guy B. Denit   45

Sanitary Inspector Taking Water Samples  46

Korean Civilians Welcoming U.S. Occupation Troops  52

Smallpox Ward in the Seoul Communicable Disease Hospital .... 55

American Nurse Instructing Korean Nurses   57

South Korean Casualties Awaiting Evacuation to the Rear   71

Tagging an American Casualty at a Forward Aid Station  73

Ambulance Driver Covering the Red Cross With Mud  76

Unloading Wounded Soldiers at a Battalion Aid Station   78

Col. Chauncey E. Dovell and the Eighth Army Medical Staff  81

South Korean Casualties Receiving Medical Attention  89

Surgeons at Work in Taegu  91

Field Psychiatry  92

Loading a Casualty on a Marine Corps Helicopter  94

Korean Civilian Hospital at Inchon  103

4th Field Hospital in Ascom City  104

A Medic in the Breakout  105

Unloading Casualties From a DUKW  107

Enemy Soldier Receiving First Aid  109

Corpsman Treating Daughter of a North Korean Officer  113

The Effects of Frostbite  117

Hospital Train Evacuation From Pyongyang  125

Maj. Gen. Silas B. Hays  134

Winter Supplies  138

Army Nurses of the 121 st Evacuation Hospital  144

Battalion Aidman Vaccinating South Korean Troops  147

U.N. Patients in a Pusan Hospital Ward  152

Facilities at the 3d Station Hospital in Pusan  153

Loading Blood in a Helicopter Pod  155

XVI

Page

Dental Prosthetic Section Making Dentures   157

Medic Treating Wounded Chinese Soldier  162

Litterbearer Coming to the Aid of a Casualty  164

Capt. Hubert D. Gaddis Piloting a Helicopter  166

Norwegian MASH Surgeon Amputating an Arm  171

Neurosurgical Team at the 121 st Evacuation Hospital  172

Primitive Stretchers Used by Chinese Medics  174

Bunker-Type Forward Aid Station  178

Evacuation by Tank During the October 1951 Fighting  180

Road-Rail Bus   181

Quartermaster Shower Point  184

Maj. Gen. George E. Armstrong  188

Aidmen Helping Casualties of a Patrol Mission  198

Forward Aid Station Near Old Baldy  199

Evacuation by Litter Toboggan  201

Nurse at the Italian Red Cross Hospital  204

Artificial Kidney Machine  206

Typical MASH Operating Room  209

Infantry Soldiers in Armored Vests  211

Holding Ward in a Regimental Collecting Station  214

Armored Personnel Carrier Evacuation  216

Preparing a Casualty for Evacuation by Tramway  217

Communist Charge of Germ Warfare  223

Maj. Gen. William E. Shambora  225

A Contingent of Medical Officers  232

Medical Equipment Maintenance Technicians at Work  236

Checking the 6th Army Medical Depot Narcotics Supply  241

Medics Administering Blood Plasma  244

Dusting for Mosquitoes  246

Forward Dentistry  251

Interior of a Jamesway Tent  252

Military and Civilian Consultants   253

Men at Work in a Surgical Research Team Laboratory  255

Litterbearers Carrying Casualties to a Hospital Train  256

Casualties on a Hospital Train Headed South  258

Caring for Casualties on Board the USS Consolation  260

USSRe^^o^^ at Inchon  264

Air Force Flight Nurse Aiding Evacuee   266

Unloading an Ambulance Bus at Tokyo Army Hospital  267

Tokyo Army Hospital   271

Osaka Army Hospital  273

Joe DiMaggio and Lefty O’Doul  280

Fracture Ward at Tokyo Army Hospital  281

Turning a Paraplegic in a Stryker Frame  283

xvii

Page

Off-loading a MATS Plane at Hickman Air Force Base  291

Ambulance Buses En Route to Tripler Army Hospital   292

Comforts of Home at Tripler   293

American Atrocity Victim  301

Dusting a Chinese Captive   306

Maj. Gen. Edgar Erskine Hume and Surgeon General Bliss  307

Operating on a Chinese Patient at the 64th Field Hospital  309

Medic Administering Blood to Chinese Patient on Koje  311

Raiding a Prisoner-of-War Compound on Koje  315

Removing Wounded POWs After the Koje Riots  319

Korean Refugees Near Chunju  324

War Orphan Suffering From Malnutrition  328

Care of the Feet  338

Medics at the 47th Surgical Hospital Fitting a Cast  343

Ward 236 at Tokyo Army Hospital Annex  346

Leaving Freedom Village on an H-19 Helicopter  347

Another Change of Clothes  349

Greeting a Little Switch Returnee at Tachikawa Air Base  350

Enemy Captives Going Home  351

Big Switch Returnees Arriving at Freedom Village  353

Repatriated Army Doctors Sharing Their Experience  363

The illustration on p. 223 is from the photo collection of the Library ofCongress. All other illustrations are from the files of the Department of Defenseand the Department of the Army. The author’s article, “‘Germ Warfare’ andPublic Health in the Korean Conflict,” Journal of the History of Medicine andAllied Sciences 39 (April 1984), was used in Chapter 7 with permission of theeditor, Robert J. T. Joy, M.D.

xviii

THE MEDICS’ WAR

mm

PROLOGUE

The Unexpected War

In the rain-soaked predawn darkness of 25 June 1950 the armed forces ofCommunist North Korea crossed the 38th Parallel, aiming at a quick conquestof the ill-armed and ill-prepared Republic of Korea (ROK). Within three daysthe capital city of Seoul fell, and refugees thronged the roads leading south. Inthe United States, which had helped to create and sponsor the South Koreangovernment, news of the attack arrived on the evening of the twenty-fourth(Washington time). For many high officials the first reaction was utter surprise.Maj. Gen. Raymond W. Bliss, the quiet, gentlemanly Yankee then serving assurgeon general of the Army, remarked to his staff that “just a week or so agoG-2 made the statement that we would be alerted perhaps 6 months before any[Communist] invasion and at least 10 days. We had not a moment’s noticeregarding Korea.

Since World War II the American military had looked to a general conflictwith the Communist powers as the only alternative to peace. No plan existed fora limited war or for partial mobilization. Yet American leaders discovered onthe morrow of the invasion that the strategic significance of Korea was as greatas when, a generation earlier, Japan, China, and Russia had struggled over theunhappy nation. Its moral significance in a world divided by the Cold War intotwo armed camps was incalculable. In the week that followed, President HarryS. Truman and his advisers improvised a national policy to resist armed aggres-sion and sought the support of the United Nations (U.N.) for the effort. Withoutawaiting U.N. action, Washington committed air, naval, and then ground forcesto the conflict.^

'Quoted words from Surgeon General Early Morning Conference Notes (hereinafter cited as SGConference Notes), 26 Jun 50, Medical Collection, HRB. All manuscript sources given withoutrecord group (RG) numbers, unless otherwise stated, are in the U.S. Army Center of MilitaryHistory (CMH), Washington, D.C.; location within CMH is specified by the following codes: HRB(Historical Records Branch), CHA (Clinical History Activity), SSB (Staff Support Branch), LIB(Library), and HSF (Historian’s source file). Those sources with RG numbers are in the NationalArchives and Records Administration (NARA), Washington, D.C.; location within NARA is speci-fied by the following codes: MMHB (Modern Military Headquarters Branch); MMFB (ModernMilitary Field Branch), PAB (Printed Archives Branch), and WNRC (Washington National RecordsCenter).

^Walter G. Hermes, “Survey of Planning for the Mobilization and Deployment of Army Divi-sions, 1944-1968,” CMH Historical Study, rev. (Washington, D.C., 1968), pp. 1-11, project file 74,SSB; Joseph C. Goulden, Korea: The Untold Story of the War (New York: Times Books, 1982), pp.84-105.

THE MEDICS’ WAR

For the Army medics stationed in Japan/ the first experience of the new warcame as they helped to move supplies into Korea and provided medical care forAmerican refugees—diplomats, military advisers, and their families. South Ko-rea’s first pleas for assistance on 25 June included many medicalitems—bandages, iodine, penicillin, and sulfa crystals, among other things.Committed to provide logistical support, the Far East Command (FEC) inTokyo dispatched on the twenty-seventh the Advance Command and LiaisonGroup, which consisted of fifteen officers and two enlisted men.

Among the officers was Lt. Col. Everett W. Partin of the Medical ServiceCorps (MSC) who headed the FEC surgeon’s Supply and Fiscal Division. AtSuwon, a road junction south of Seoul, Partin met the surgeon general of theROK Army, who informed him that the enemy had seized all the medicalsupplies stored in the capital. Partin hastily scribbled the first medical requisi-tion of the war to Capt. Richard M. Stacey, MSC, of the Medical Section, FarEast Command:

Dear Stacey:

Rush the items listed by first available air transportation. Ship to TAEJON, mark for‘U.S. DISPENSARY’. We are getting casualties and need the stuff now.

(signed) Everett

P.S. Tell my wife I got the package. Please rush raincoat.^

The requisition, in pencil on thin paper, included requests for splints, ther-mometers, pajamas, cotton, and bandages.

Meanwhile, the surgeon of the 24th Infantry Division, Maj. Wade F. Heri-tage, a Medical Corps officer, and the men of the 24th Medical Battalionprovided aid to the fifteen hundred Americans evacuated from Korea by air andsea. An officer with the 155th Station Hospital found the dependents “dazedand bewildered, with nothing but the clothes on their backs.” At the OsakaArmy Hospital a young doctor, newly arrived from the United States, “had hishands full taking care of hysterical mothers, and cranky, weeping babies; andgetting together all the baby bottles, diapers and cribs he could fmd.”^

The term medics is used in the text as shorthand for “the men and women of the U.S. ArmyMedical Service.” Enlisted medics are identified either by this term or as corpsmen.

■"Quoted words from Note, Lt Col Everett W. Partin, MSC, Medical Section, USAFIK, to CaptRichard M. Stacey, MSC, Medical Section, FEC, received 28 Jun 50, HSF (Partin-1950), HRB. Seealso Far East Command (hereinafter cited as FEC), Annual Report of Medical Service Activities,1950, pp. 8, 12, file 319.1-2 (FEC) Far East-1950, HRB.

Tirst quotation from Interv, Samuel Milner with Lt Col Harry L. Cans, MSC (hereinafter citedas Cans Interv), 29 May 66, p. 2. Second quotation from Interv, Samuel Milner with Col Frank A.Neuman, MC (hereinafter cited as Neuman Interv), 28 May 66, p. 2. Both in AMEDD Oral Historyfiles (Cans) and (Neuman), HRB. See also United States Army Forces, Far East, and Eighth UnitedStates Army, Rear (hereinafter cited as USAFFE and EUSAR), “Logistics in the Korean Opera-tions,” vol. 1, p. 4, Ms no. 8-5.1 A AZ, RG 319, MMHB; Surgeon’s Section, 24th Infantry Division,Journal, 29-30 Jun 50, 24th Infantry Division War Diary, file 324 (Surg’s Journal, 24th Inf Div, 25Jun-22 Jul 50), Box 3479 (24th Inf Div, Surg, Sig, and Chem Journals, Books 31-33, 25 Jun-22 Jul50), Entry 429, RG 407, MMFB; 1st End, Maj F. M. Cowman, Assistant Adjutant General,USAFFE, to Chief of Military History, DA, 16 Nov 53, sub: Transmittal of Revised Draft Manu-script . . . , attached to 8086th Army Unit, Military History Detachment, “Evacuation of Refugees

THE UNEXPECTED WAR

5

American Evacuees From Korea Arriving in Japan

Other Americans appeared among the streams of refugees afoot in Korea. Bynoon of the twenty-eighth about one hundred had straggled into Suwon, withoutequipment other than their clothes. A medical officer, 1st Lt. Robert B. Giffin,Jr., had saved his doctor’s kit. He set up a dispensary in a small room of a localhouse and began to treat the injured. The next day airlift planes started toarrive, but the activity at the airstrip provoked strafing and bombing attacks byNorth Koreans and Americans unloading the planes took several casualties.After the supplies were turned over to the South Koreans for distribution, theplanes began to evacuate the wounded.

The invaders were drawing close. On the evening of the thirtieth, with theencirclement of Suwon imminent, the Americans made their way by motorvehicle to Taejon, an important road and rail junction about 75 miles to thesouth. The South Koreans, having saved the medical supplies that originallywere reported lost, moved them to Taejon. Here the Advance Command andLiaison Group remained for the time.^

In Washington and Tokyo medical planners began to look over the resourcesthat were available to fight this unexpected war. What they found was a shortage

and Civilians from Seoul, June 1950 and December 1950 to January 1951Ms no. 8-5.1A AT, RG319, MMHB.

Tar East Command (hereinafter cited as EEC), Report of Essential Technical Medical Data(hereinafter cited as ETMD), July 1950, pp. 19-20, file 350.05 (EEC) 1950, HRB.

THE MEDICS’ WAR

of trained men and women, large masses of supplies and a substantial body ofexperience deriving from World War II, and a group of newly trained physicianspecialists whose performance in combat had yet to be assessed. The ArmyMedical Service itself was in many ways a new organization, drastically reorga-nized and reformed in the five years since the defeat of the Axis. With broadexperience in the Far East gained from the occupation of Japan and Korea, themedics faced a new kind of war, one that soon would demand surprising impro-visations. But in the early days of the fighting, and indeed throughout thestruggle, the experience of World War II and the changes brought by the briefyears of peace would affect the Medical Service profoundly, both for good andfor ill.

CHAPTER 1

Between the Wars

For the Army Medical Department, the sudden collapse of Japan in August1945 brought not only peace after four years of fighting but also new andperplexing problems. During the struggle the department had grown to unprece-dented size and had achieved extraordinary successes. Yet even before thesurrender key personnel had begun to return to civilian life, and in the postwaryears the loss of doctors, nurses, scientists, medical administrators, and trainedenlisted men became a near hemorrhage that nothing seemed able to stanch.Laboring to fill their depleted ranks, the surgeon general, Maj. Gen. Norman T.Kirk, and his advisers began to reorganize—and indeed rethink—the basicstructure and character of their organization.*

Early plans for the release of personnel envisioned a complex, leisurelyprocess. The War Department demobilization policy rested upon the concept offairness to all who had borne the battle. Aiming at a partial demobilization afterthe surrender of Germany in May 1945, the Army discharged those among itsenlisted people who had a high Adjusted Service Rating—a numerical score thattook into account each individual’s length of service, time overseas, combatexperience, decorations, and number of dependents. To the degree possible,similar standards governed the discharge of officers. Inevitably, long delaysresulted. Desks grew weighty with orders for transfers of high-score units fromEurope to the United States and of low-score organizations from Europe to thePacific or the zone of interior to the fighting fronts.

In the early summer of 1945, facing a rising chorus of complaints, the Officeof the Surgeon General (OSG) sought to justify itself. “Equity in separations,”declared a memorandum, “means delay in separations of between five andseven months.” Pleading that the whole complex process was essentially “soundand just,” the planners anticipated in July that the strength of the Medical Corpscould be reduced only by some seven thousand over the next ten months.

'The wartime experiences of the Army Medical Department—the official designation of theArmy Medical Service prior to June 1950—are detailed in two volumes of the Center of MilitaryHistory’s United States Army in World War II series, The Medical Department: Hospitalization andEvacuation, Zone of Interior (1956) by Clarence McKittrick Smith and The Medical Department:Medical Service in the Mediterranean and Minor Theaters (1965) by Charles M. Wiltse. Completingthe Army’s account are two forthcoming works, The Medical Department: Medical Service in theWar Against Japan by Mary Ellen Condon-Rall and Albert E. Cowdrey, and The Medical Depart-ment: Medical Service in the European Theater of Operations by Graham A. Cosmas and Albert E.Cowdrey. The Office of the Surgeon General also published its own World War II series, TheMedical Department, United States Army, consisting of some forty clinical volumes.

THE MEDICS’ WAR

Ironically, on 6 August, the day the first atomic bomb destroyed Hiroshima, theOSG reaffirmed a policy that considered neither the possibility of a quick end tothe Pacific war nor the imminent unleashing of a force scarcely less explosive:the demand of the citizen soldier to go home.^

The Great Unraveling

“Since the termination of hostilities,” wrote a medical officer awaiting dis-charge in December 1945, “the change in attitude has been unbelievably abrupt.The uppermost question is the probable or possible date of return to civilianlife. . . . Complaints which during the war were voiced but not used as a meansfor the avoidance of duty, became foremost in conversation.”^

The problem went beyond the Medical Department, and indeed beyond theArmy. Though aware of Soviet ambitions and power, and reluctant to demobil-ize quickly, the War Department had little choice but to bow to the publicdemand that already was causing Congress and President Truman to genuflect.Yet no return to the small garrison Army of pre-World War II days was possible.By leading the Western Alliance during the war, by incurring occupation duties,and by emerging into the postwar world as the greatest power on the globe, theUnited States had achieved a position from which it was not free to back away.During the five years between June 1945 and June 1950 the Army would lose 86percent of its wartime officer strength and 91 percent of its enlisted strength.Yet even at the low point it still would be nearly three times as great as in June1940. Because American servicemen remained posted throughout the world, thenation’s military leaders faced problems not only of declining strength but alsoof large and fundamentally irreducible commitments. From the standpoint ofthe Medical Department, the shrinking postwar Army remained persistently toolarge to support in view of the medics’ special problems of recruitment.^'

The full dimensions of the problem, however, would emerge only with time.For the moment what mattered was the almost frenzied demand of the citizensoldier to return to civil life as soon as possible. All the pent-up resentment ofArmy duties and Army ways, the hurry-up-and-wait of Everyman’s militaryexperience, contributed to the drive; so did the confused and turbulent mood ofthe autumn of 1945, when half the world seemed waiting to go home. Soon OSGofficers were complaining of “continued pressure from Congress, the public, theadjutant general, the WDGS [War Department General Staff]” for the release ofpersonnel. At the same time, they were obliged to concede the continuing prob-lems of delay, uncertainty, and confusion that attended a process now aimed at

^Copy of Policy Statement, Office of the Surgeon General, USA, 31 Jul 45, sub: Medical Depart-ment: Redeployment and Separation Policy, pp. 13-14, HSF (OSG Policy-1945), HRB.

^Copy of Ltr, Lt Col Paul N. Mutschmann, MC, AAF Regional Station Hospital, to Maj GenPaul R. Hawley; MC, c/o Surgeon General’s Office, USA, 3 Dec 45, HSF (Mutschmann-1945),HRB. Hawley was the former chief surgeon of the European Theater of Operations.

^U.S. Department of Defense, Selected Manpower Statistics, May 1978, pp. 20, 25-26, file 050(Statistics), HRB; Russell F. Weigley, History of the United States Army, The Wars of the UnitedStates (New York: Macmillan, 1967), p. 436.

9

discharging men and women from service rather than transferring them to thePacific.®

Pressed by the lawmakers, General Bliss, then assistant surgeon general,assured a Senate subcommittee in October 1945 that “separations are now oneof our important missions.” Physicians, he pointed out, were going faster thanother men in uniform, for the 7,213 released since V-E Day represented about16 percent of the Medical Corps’ strength, while total separations representedonly 15 percent of the Army as a whole. Bliss promised that, except for RegularArmy personnel, men wishing to remain, and graduates of special trainingprograms with military obligations to fulfill, “every doctor now in the Army willbe returned to civilian life by the end of next summer.” For the meantime, herequested their understanding of the fact that—with a force of more than 7million men, a patient load of almost four hundred thousand, and monthlyseparations of about 1 million to process—“the Army still needs doctors.”^

Here, in fact, was the crux of the matter: Medical personnel were wantedeverywhere—in civilian life, in hospitals where wartime casualties still demand-ed care, in the forming occupation forces, among the multitudes of refugeesthreatened by epidemics, and in the separation centers where millions of physi-cals had to be given. Medical personnel were not just a part of the process ofdemobilization; they were a key to its success.

Yet whatever difficulties the Army as a whole had to face in retaining keyworkers, those before the Medical Department were greater. This was the penal-ty the medics paid for having so great a proportion of educated, eminentlyemployable people. From the brain surgeon to the medical technician, civilianlife usually promised greater rewards in money, freedom, and professional op-portunity. This was especially true in regard to doctors. Members at one time ofan ill-paid, inept, overcrowded profession, American physicians by the end ofWorld War II had become expert, organized, restrictive, and, on average, quiteprosperous. A postwar study showed civilian doctors in the “top three percentnational income bracket.”^ Most were entrepreneurs as well as professionals, ill-adapted by training and habit to military ways.

No single factor—not even income—told the whole story behind the Army’sinability to retain its medical personnel. Studies carried out with doctors indi-

®Quoted words from extract of Memo, Lt Col E. R. Whitehurst, MAC, Chief, Enlisted Branch,OSG, to Chief, Personnel Division, OSG, 21 Dec 45, HSF (Whitehurst-1945), HRB. See alsoStatement of Brig Gen Raymond W. Bliss, Assistant Surgeon General, USA, 17 Oct 45, in U.S.Congress, Senate, Committee on Military Affairs, Demobilization of the Armed Forces: Hearings onS. 1355, 79th Cong., 1st sess., 17-18 October 1945, pt. 2 (Washington, D.C.: Government PrintingOffice, 1945), p. 190.

‘Quoted words from Statement of Bliss in . . . Hearings on S. 1355, pp. lSS-90.

See also MFR, Military Personnel Division, OSG, 28 Aug 45, sub: On Active Duty in the MedicalDepartment, 30 June 1945, HSF (OSG Division-1945), HRB. The War Department instructedcommanding generals to ignore table of organization and equipment requirements in order torelease doctors, dentists, and nurses as soon as decreasing work loads permitted. See War Depart-ment Circular no. 307, 6 Oct 45, p. 2, para. 3.

’Quoted words from Special Plans Branch, Medical Plans and Operations Division, OSG, Reportof Activities, 1 Jan-30 Jun 49, file 319.1-2 (OSG, Annual Reports), HRB. On the social history ofAmerican medicine, see Paul Starr, The Social Transformation of American Medicine (New York:Basic Books, 1982).

THE MEDICS’ WAR

cated that their lack of interest in Army careers was based largely on profession-al grounds, and on the demand for individual freedom. A 1946 poll of 386medical officers who had entered the service through the Army SpecializedTraining Program showed that only one planned to apply for a regular commis-sion, and ''two out of three said they would like to get out of the Army right now,if it were possible.” A similar majority said that they could not be induced toserve an additional two years under any conditions. The men cited many dissat-isfactions—with professional assignments, financial compensation, and livingconditions. But heading the list was a fundamental dislike of the military itself,and its tradition of impersonal mass medicine. “The Army is totalitarian not ademocracy,”said one respondent. “If a doctor practices in the Army, he is notmuch better off than if he were in Germany or Russia.” Another said flatly, “Iwanted to be a doctor and I feel that I cannot be a doctor in the true sense of theword while I’m in the Army.”*

The situation in the other health care professions was somewhat similar. InJune 1946 a group of 210 nurses assigned to one installation in the zone ofinterior were polled on their interest in Army careers. Only 15 indicated a desirefor Regular Army appointments, and of these 6 had such poor efficiency ratingsas to be ineligible. Technical experts of all kinds were similarly hard to keep, aswere trained enlisted people. The surgeon general attempted to retain scarcetechnicians, in some cases awarding additional rank as compensation fordelayed release. But the decline in strength was rapid, and as a result criticalshortages developed, especially in the zone of interior. Sometimes, even whenofficers were available, trained enlisted men were not. The scarcity of X-ray andlaboratory technicians caused continual complaint.’

Meanwhile, changes in policy reduced the whole process of discharge to amuddle. In response to congressional and popular pressures, the scores neces-sary for separation were revised downward repeatedly, but news of the changesdid not always reach those who needed to know. The chief of the OSG’s EnlistedBranch, engaged in a daily struggle for manpower, learned of one such changeonly by reading his newspaper. Some separation centers, he knew, were dis-charging men under one set of criteria, some under another.

One possible source of personnel was deliberately ignored during the demo-bilization. Queries from Congress and the General Staff about blacks in theMedical Department were met firmly by statements that the 4 percent of“colored” strength in the department during World War II was the “maxi-

*Copy of Study, Troop Attitude Research Branch, Information and Education Division, WD, 2Nov 46, sub: Attitudes of A.S.T.P. Medical Officers Toward Service in the Regular Army, HSF(ASTP-1946), HRB.

’Extract from Memo, Eli Ginzberg, Director, Resources Analysis Division, OSG, to AssistantChief of Staff, G-1, 25 Jan 46, sub: Trends in Medical Demobilization Since V-E Day, HSF(Ginzberg-1946), HRB. See also Nursing Consultants Division, OSG, History of Nursing Branch, 1Apr-30 Jun 46, file 319.1-2 (Personnel Service) Military Personnel Division, OSG, FY 1946, HRB.Between V-E Day and July 1946 the number of Army doctors fell from 45,000 to 8,500; of dentists,from 14,500 to 3,500; and of nurses, from 52,000 to 9,000.

'“Extracts from Memos, Lt Col E. R. Whitehurst, MAC, Chief, Enlisted Branch, OSG, to Chief,Personnel Services, OSG, subs: Weekly Diaries Ending 21 Sep, 5 Oct, and 19 Oct 45, HSF (White-hurst-1945), HRB.

11

mum . . . that can be effectively utilized. . . The medical unit best adapt-ed for blacks, in the surgeon general’s opinion, was the Sanitary Company.Experience had “proven that it is neither practicable nor desirable to utilizecolored units for the care and treatment of white personnel.” As the troop basisfor the Army Reserve was revised, sanitary units were lost, and the implicationwas clear that medical posts for black enlisted men in either the Reserve or theRegular Army would be at a minimum.

The picture with officers was similar. Apparently, the first time the MedicalDepartment had any black regular officers was in August 1949: four in theMedical Corps, two in the Women’s Medical Specialist Corps, and three in theArmy Nurse Corps. By the middle of 1950—with the department’s own needsgreat, racial integration under way, and national policy strongly in favor ofincreased opportunities for blacks in the Army—the Medical Service, as it wasthen called, had 142 black officers and 2,057 enlisted men. Of the officers, only14 were Regular Army. While the medics were not completely rigid in theiropposition to black personnel, their record in the postwar years would showthem to be conservative, cautious, and generally wedded to the Army’s traditionof segregation.*^

In other ways the surgeon general moved to counter the personnel problem.In the spring of 1946 a reorganization of the War Department expanded hisauthority and gave him more direct access to the chief of staff In April, inanticipation of the coming abolition of a superior headquarters called the ArmyService Forces (ASF), hospitals formerly under the ASF commanding generalwere transferred to the surgeon general’s control, more than doubling the num-ber of OSG field installations. The inactivation of the Army Service Forces thatfollowed in June simplified the organizational structure and afforded the sur-geon general, as it did other service chiefs, a better opportunity to make himselfheard. Henceforth, he enjoyed greater freedom to meet his many problems thanhis predecessors had had since the early days of the Second World War.*^

Foremost among the surgeon general’s problems, and the key to understand-ing many of his actions in other fields, was his effort to attract and keep theskilled personnel that the Medical Department needed to function. Reform andreorganization were to make the postwar years a major formative period in thehistory of Army medicine.

TheASTPs

In meeting the need for doctors, the surgeon general had a cushion in thegraduates of the Army Specialized Training Program (the ASTPs). Under this

"Extract from Memo, Brig Gen Guy B. Denit, Acting Surgeon General, USA, to Director,Organization and Training, WDGS, 28 Jun 46, sub: Organization of Negro Manpower in PostwarArmy, HSF (Denit-1946), HRB.

"Department of the Army, Strength of the Army, 31 Aug 49 and 30 Jun 50, LIB. It should benoted that some of the early black medical officers—Col. John F. Harris is an example—achieveddistinguished careers in the Medical Department.

"Extract from Civilian Personnel Service, OSG, Quarterly Historical Report, 1 Apr-30 Jun 46,

(Continued)

THE MEDICS’ WAR

and similar World War II programs, the armed services since 1942 had made anunprecedented commitment to help select promising enlisted men, to deferthem, and to finance their professional training in a number of critical fields,including medicine, dentistry, and veterinary medicine.

Early in the war, military demands had alarmed universities and graduateschools, including schools of medicine and its allied sciences, which saw them-selves likely to be deprived of students by drafting en masse. Hence in Septem-ber 1942, over the objections of the assistant chief of staff, G-3, who believedthat “from a strictly mobilization viewpoint, the value of the program was nil,”provision was made for 150,000 selected enlisted men who had completed basictraining to receive technical and professional education in civilian universitiesand colleges at government expense. Launched in December of the same year,the program provided in part for a future supply of trained doctors, dentists,and veterinarians who would help to staff civilian hospitals during their intern-ships and residencies, and later be commissioned into the appropriate corps ofthe Medical Department to serve during the national emergency. In some relat-ed professions, such as sanitary engineering, similar arrangements were madebut no commission was assured. The costs of the program were considerable.The government paid tuition, fees, and living expenses for some young mendestined for medical careers, relieving their families of the burden. When themedical program ended in June 1946, some 13,373 young physicians hademerged from it with military obligations that were fixed in November at threeyears of active service.*^

In the postwar years the experiences of the Medical Department with theASTPs were not, by and large, happy ones. Men who felt they had committedthemselves to serve during the emergency were not always eager to fulfill amilitary obligation during peacetime, for they preferred to begin establishingtheir practices. Many ASTPs displayed considerable energy in obtaining thesupport of their congressmen and professional associations in fighting OSGefforts to compel them to serve at times or under conditions that were inconve-nient to them. Early in the Korean War the surgeon general would make a harshjudgment: “The ASTP’s were the most disgruntled lot of doctors ever encoun-tered by the Army. . . Yet many of the ASTPs served quietly if not enthusi-astically and for years after World War II provided the main, indeed almost theonly sure, source of replacements for the doctors who had left the Army.

Contemporary records clearly reveal the extent of the Army’s dependence onthese often unwilling soldiers. In November 1945 about 4,500 ASTPs were on

(Conlmued)

HSF (OSG Divisions-1946); extract from Memo, Maj Gen Norman T. Kirk, Surgeon General,USA, to Director, Organization and Training, WDGS, 19 Jun 46, sub: Integration of AUS Officersinto the Medical Department, HSF (Kirk-1946). Both in HRB.

*“*A basic document on the Army program is: Col Francis M. Fitts, MC, “Training in Medicine,Dentistry, and Veterinary Medicine . . . Under the Army Specialized Training Program, 1 May1943 to 31 December 1945,” Ms no. 3-4 BA, RG 319, MMHB.

'^Quoted words from Interv with Maj Gen Harry L. Twaddle, n.d., HRB. Twaddle was an experton the draft laws. See also Marvin A. Kreidberg and Merton G. Henry, History of Military Mobiliza-tion in the United States Army, 1775-1945, DA Pamphlet 20-212 (Washington, D.C.: Departmentof the Army, 1955), p. 635.

*‘SG Conference Notes, 26 Jul 50, Medical Collection, HRB.

13

Table 1-Medical Department Officer Strength, December 1947

| Component                          | Total       | Regular Army |
|------------------------------------|-------------|--------------|
| Actual                             | Authorized  |
| Medical Corps                      | .... 7,702  | 1,206        | 3,000 |
| Dental Corps                       | .... 1,652  | 432          | 743 |
| Veterinary Corps                   | .... 399    | 198          | 186 |
| Medical Service Corps              | .... 2,762  | 740          | 1,022 |
| Army Nurse Corps                   | .... 4,960  | 1,148        | 2,258 |
| Women’s Medical Specialist Corps   | .... 512    | 142          | 409 |
| Total                              | .... 17,987 | 3,866        | 7,618 |

Source: Extract, HSF (Officer Strength-1947), HRB.

active duty. In April 1946, 3,654 more came on duty, and in July, another1,465. Taking losses into account, by mid-1946 more than 5,000 new ASTPswere in uniform. Not only the Army but also other agencies needed them.Though the Navy had operated a similar program known as V-12, it wasobliged to call upon the Army for 291 ASTPs, while the Veterans’ Administra-tion took 1,000 and the Army Air Forces 512. So useful were the ASTPs that fora time the manpower situation was reversed. Because the services were shrink-ing rapidly under congressional cutbacks, and the lawmakers failed to enactUniversal Military Training as had seemed likely in 1946, the supply of doctorsbegan to exceed the demand. By summer the consensus was that even a two-yearservice obligation for ASTPs would oversupply the needs of the Army. Thelength of service was reduced accordingly, and the brightening situation resultedin a call for fewer ASTPs during 1947.*’

For a few months in the spring of the year, the Office of the Surgeon Generalenjoyed the prospect of an impending surplus of medical officers. This surplus,however, failed to materialize, and by the end of the year 1,800 regular slotswent unfilled {Table 1). Shortly afterward, new figures painted a more realisticpicture. Massive separations loomed in early 1948, and efforts to freeze theASTPs looked politically unwise. By 1 July, estimated the deputy surgeon gener-al for plans, the ASTPs “will be a majority of the 5,000 Medical Corps officersthen on duty, and the Medical Department will not be able to perform itsmission without them. . . .”**

’’Extracts from MFRs, Capt H. E. Klarman, 24 Nov 45, sub: ASTP Medical Students; IsaacCogan, 7 Mar 46, sub: ASTP’s Coming on Duty; and Lt Col Rice, 9 May 46, sub: Calling of ASTP toActive Duty, HSFs (Klarman-1945), (Cogan-1946), and (Rice-1946), HRB. See also extract fromMemo, [Cogan] to Assistant Chief of Staff, G-1, 10 May 46, sub: Availabilities and Require-ments—Medical Corps, HSF (Cogan-1946); copy of Memo, James Forrestal, Secretary of the Navy,to the President, 17 May 46, sub: Medical and Dental Service of the Armed Forces, HSF (Forres-tal-1946); extract from Assignments Branch, Military Personnel Division, OSG, Quarterly Reportof Activities, 1 Apr-30 Jun 46, HSF (OSG Divisions-1946); extract from Memo, Cogan to Office ofPersonnel, 25 Oct 46, HSF (Cogan-1946); extract from Memo, Lt Col W. N. Piper, Chief, Procure-ment, Separation, and Reserve Branch, Personnel Division, OSG, to Chief of Personnel, 29 Oct 46,HSF (Piper-1946). All in HRB.

’^Quoted words from copy of Memo, Brig Gen Guy B. Denit, Deputy for Plans, OSG, toDirector, Personnel and Administrative Division, WDGS, Attn.: Brig Gen A. G. Trudeau, 1 Jul 47,sub: Retention of ASTP Officers on Duty, HSF (Denit-1947), HRB. See also extract from MFR,Isaac Cogan, Chief, Resources Analysis Division, OSG, 25 Mar 47, sub: AAF Requirements forMedical ASTP Graduates Being Called to Duty, July-December 1947, HSF (Cogan-1947). For

(Continued)

THE MEDICS’ WAR

Despite the friction that sometimes attended the ASTPs’ service, theyproved to be absolutely indispensable. They contributed only a limited numberof professionals to the war, but they markedly eased the bumpy first years oftransition to peace. By and large, they served well, many of them overseas, inposts that included the unpopular ones in Korea and Okinawa. The last of thoseto serve during peacetime in the Far East, their obligation ended, sailed forhome in May 1950, one month before the outbreak of the Korean War.*’

The Drive To Professionalize

Who was to take the place of the ASTPs? Using the breathing space theprogram had gained them. Surgeon General Kirk and his advisers came toconclusions that implied a drastic break with Army medicine’s recent past.

“You wouldn’t believe it,” said a retired general officer at a later time,reflecting on his career, “but in the Thirties, up until I left Walter Reed in 1939,we of the Medical Corps of the Army were not specializing. This was anexaggeration, for military specialties, notably in surgery, had existed beforeWorld War II. But the Army doctor was more commonly a jack-of-all-trades,and often times a soldier as much as he was a physician.

Kirk believed that change was essential. Writing to the chief of staff on 20December 1946, he averred that “much of the unwillingness of the young physi-cian to enter military service is due to his belief that the Army denies tohim . . . opportunities for professional advancement, postgraduate education,for specialization, for certification by professional specialty boards, and forclinical research and self expression.”^* The conclusion was evident. Because theArmy could not match the monetary rewards of a successful private practice, itmust expand the physician’s professional opportunities in the postwar Army. Atthe upper end of the Medical Department’s personnel spectrum, training wasinseparable from procurement.

However, the retention of young officers and the gaining of new ones wasonly one aspect of the program of professionalization. During World War IIRegular Army medical officers had occupied administrative posts, and civiliansand reserve officers, brought in for the duration and awarded Army of theUnited States commissions, had done most of the doctoring. The departure of

(Continued)

personnel estimates, see copy of MFR, Lt Col Rice, 20 Jun 47, sub; Distribution of Incoming ASTP,HSF (Rice-1947). Both in HRB. General Bliss rejected the proposals to freeze ASTPs due for releasein 1948 on grounds of fairness and the impact on civilian medicine. See, for example, SG Confer-ence Notes, 5 May 48, HRB.

'’Copy of Memo, Isaac Cogan, Chief, Resources Analysis Division, OSG, to General Bliss, 24Mar 48, sub: Freezing of ASTP?, HSF (Cogan-1948), HRB; Fitts, “Training . . . Under the ArmySpecialized Training Program,” Supplement to 30 June 1946, p. 3, MMHB.

“Interv, Graham A. Cosmas and Dwight D. Gland with Brig Gen Sam F. Seeley, MC (hereinaftercited as Seeley Interv), 14 Aug 79, sess. 2, cassette 5, p. 36, HSF (Seeley-1979), HRB. Seeley, asurgeon who commanded the 100th General Hospital in the European Theater of Operations,subsequently was chief of Surgical Service at Brooke General Hospital and, as of July 1949, atWalter Reed Army Hospital.

^‘Copy of Memo, Maj Gen Norman T. Kirk, Surgeon General, USA, to Chief of Staff, USA, 20Dec 46, HSF (Kirk-1946), HRB.

15

the latter at war’s end forced upon the Medical Department the massive job ofretraining regulars and advancing at least some of them in clinical specialties.“We have,” noted an OSG officer as late as 1948, “about one-seventh thenumber of highly qualified professional experts we need while at the same timewe have about twice the number of administratively trained officers we need.”^^

The new program was to have a considerable impact on the character of theMedical Corps, and hence upon the Medical Department as a whole. Profession-al skills acquired far greater importance than in the 1930s. In time, credentialsin a clinical specialty became essential to career advancement. Thereby theArmy doctor drew closer to the model already established by his civilian col-leagues. As the Society of United States Medical Consultants in World War IIdeclared, “The concept of the Army medical officer as a general practitioner,capable of doing medicine, surgery, and certain specialities, and trained inmilitary medicine as well ... is wholly against the trend of the times, and ifthe [Medical] Corps set this up as an objective it would be impossible to inducegood men to make Army medicine a career.””

The overall program developed during 1946-49 was complex and aimed at ageneral upgrading of the Medical Department. The training of doctors, however,was clearly foremost in the mind of the surgeon general. Through the promise ofreserve commissions, the department reached out to the student, as medical,dental, pharmacy, and veterinarian ROTC units were reestablished. By 1950these units were in place at forty-nine medical schools, with a total enrollmentof over four thousand cadets. The surgeon general assigned younger officers inthe schools as professors of military science and tactics, allowing them to studyat the institutions where they taught. By bringing higher caliber and moreenthusiastic leaders to the ROTC programs, a traditional source of Army Re-serve officers was revitalized. In the same spirit the practice of affiliation wasrevived in 1947, enabling civilian hospitals and medical schools to sponsor andstaff reserve units. Internships were established in Army hospitals, with the lureof a first lieutenant’s pay for those who were accepted. Such slots were filledconsistently, though often the most desirable candidates declined to serve.”

For those already in the Army, an array of training was provided that rangedfrom Army schools to leading universities. The Medical Field Service School atFort Sam Houston, Texas, the St. Louis Medical Depot, the Army MedicalResearch and Graduate School, and several general hospitals offered a profu-sion of courses for officers and enlisted people. When in-house training was not

^^Raymond E. Duke, “Training Activities of the Army Medical Department,” Military Surgeon102 (May 1948): 339.

^^Quoted words from Resolution, Society of U.S. Medical Consultants in World War II, 4 Jun 49,in Colonel Robinson’s Studies, file 322.051 (Col Robinson’s Studies), Box 31, Accession no.58A-1095, RG 112, WNRC. On career patterns, see War Department Technical Manual 12-425A,Personnel Classification, July 1947, LIB; Department of the Army Technical Manual 20-605,Career Management for Army Officers, June 1948, LIB; Paul I. Robinson, “About the MedicalCorps,” Bulletin of the U.S. Army Medical Department 8 (August 1948): 592-601.

^■“‘Medical Department Training Program,” Statement to the Association of American MedicalColleges, 6 Feb 48, in Military Surgeon 102 (April 1948): 304-05; Office of Deputy for Plans, OSG,Report of Activities, 1 Jul-31 Dec 47, file 319.1-2 (OSG, Annual Reports), HRB; “Medical Depart-ment Affiliation Program,” Bulletin of the U.S. Army Medical Department 9 (August 1949):700-703.

THE MEDICS’ WAR

available, selected members of the Medical Department were sent to civilianinstitutions to study, not only medicine, surgery, and dentistry but also bacteri-ology, business administration, hospital management, chemistry, medical librar-ianship, nursing education, and biochemistry.

The crown of the program was the system of postgraduate medical educationin Army hospitals, which was made available both to officers and to qualifiedcivilians interested in a reserve commission. Residencies were set up in fiveArmy general hospitals, which were designated as teaching hospitals. By mid-1948 a total of 376 residents were in training. Every effort was made to meet themost exacting standards of modern medicine in preparing these future special-ists. During World War II civilian physicians distinguished in their fields hadserved the Medical Department as consultants, providing expert advice andprofessional guidance. In 1946 their status was made permanent. Now such menwere sent into the teaching hospitals part-time to aid the training of the youngresidents—“a practice,” noted the surgeon general, “which incidentally has gonefar to improve relations with the civilian medical profession.” Seemingly, theprogram had something to offer everyone.

Yet the endeavor, though successful in upgrading the Medical Department,failed to provide enough doctors in time to meet the personnel crisis threatenedby the end of the ASTP supply. Lack of top-level support could not be blamed.The year 1947 brought in a new surgeon general, Major General Bliss, whoprovided able and committed leadership to the effort to improve the profession-al quality of Army medicine. In the same year Congress voted a pay raise fornon-ASTP doctors and dentists. In 1948 the Office of the Surgeon Generallaunched an emergency program to enable residents and interns in civilianinstitutions to accept commissions while continuing their studies where theywere. Some regulars also were allowed to train in civilian hospitals. But after allavailable suitable personnel were commissioned, the department still faced ashortage of some twelve hundred medical officers.^^

Reorganizing the Department

At the end of World War II the Medical Department contained sixcorps—Medical, Dental, Veterinary, Army Nurse, Medical Administrative, andPharmacy. A seventh, the Sanitary Corps, was a reserve organization. Eachregular corps provided a vertical organization for officers, based on professionalspecialty, and possessed a mission, history, and collective personality of its own.All but the Army Nurse Corps were comprised exclusively, or overwhelmingly.

“Quoted words from extract of Rpt, Section on Development in the Medical Field, p. 19, Enel toMemo, Col Thomas J. Hartford, MC, Executive Officer, OSG, to Chief, Control Office, LogisticsDivision, DA, 10 Sep 48, sub: Annual Report of Secretary of the Army for Fiscal Year 1948, HSF(Hartford-1948), HRB. See also copy of SGO Circular no. 5, Office of the Surgeon General, DA, 13Jan 48, HSF (SGO Circular-1948), HRB.

“Surgeon’s Circular Letter 5, no. 1, Medical Section, FEC, 1 Jan 50, pp. 4-6, file 300.5 (CircularLetters) FEC, HRB. On the pay raise, see War Department Bulletin no. 21, 28 Aug 47, LIB, andPublic Law no. 80-365, 5 Aug 47.

17

of men; the nurses were all women.

The Medical Corps, composed of phy-sicians, far outweighed the others,both in number and in power.

Throughout, the corps structure re-vealed the duplications and anomaliesof an organization that had “justgrowed,” and to giant size at that, sub-ject to many pressures amid the chang-ing needs of war and peace. To simpli-fy the structure, to establish a measureof parity between its male and femalemembers, and to provide incentives tobring the array of needed talent infrom civil life would be no easy task.

The Medical Administrative Corpswas long the Cinderella of the depart-ment. Organized in 1921, the corpswas limited to a few score officers un-til World War II, because physiciansheld most of the department’s admin-istrative posts and brooked no competition. The war transformed the corps,multiplying its numbers and bringing it new importance and many new duties.Administratively trained Regular Army doctors proved too few to fill the vastnumber of such posts in the Office of the Surgeon General and in variousheadquarters, hospitals, laboratories, and medical field units. Additionally, amelange of specialists entered the Medical Administrative Corps, includingoptometrists, opticians, and experts in supply, in the construction and operationof medical equipment, and the like. The importance of such men was rising asmedicine became more complex and more technical, and the corps emergedfrom the war as a catchall of the allied professions.

The small Pharmacy Corps dated only from 1943, but the political muscle ofthe nation’s pharmacists that created it was in evidence for a longer time. From1936 to 1943 the pharmacists also dominated the Medical AdministrativeCorps, whose regular commissions went only to them. Then a well-organizedlobbying effort won a separate corps from Congress, against the wishes of thesurgeon general. The Pharmacy Corps remained limited in numbers and consid-erably more varied in function than its name implied. The Sanitary Corps wasan organization all of whose officers held either reserve or Army of the UnitedStates commissions. Containing a range of experts from laboratory techniciansto sanitary engineers, the corps duplicated many of the administrative andtechnical features of the Medical Administrative Corps and Pharmacy Corps.

The problems of recruiting nurses were severe enough to underscore the needof greater status for the Army Nurse Corps. Together with a group of femaledieticians and therapists not yet organized as a corps, the nurses since 1944 hadheld Army of the United States commissions in place of the restricted status andprivileges earlier allowed them. By early 1947, however, female officers who

Maj. Gen. Raymond W. Bliss

THE MEDICS’ WAR

wished to remain in the Army were in a dubious position. Impending congres-sional repeal of the law under which their commissions were granted meant thatnurses, unless awarded Regular Army commissions hitherto denied them, wouldlose their hard-earned status in mid-1948.^^

Unable to secure the services of enough women with military experience, theWar Department in January 1947 authorized appointment of 300 nurses with-out such a background. Because the corps had 500 vacancies, and anticipatedthe separation of 1,000 nurses who were then in uniform, a major effort tosecure new officers and persuade veterans to reenlist was clearly in order.Directors of nurses in the various Army areas sent out applications, and OSG’sNursing Division approached 1,068 nurses who had at some time indicated aninterest in an Army career. On the whole, results were discouraging. By the endof March only 101 had replied, and of these 33 had to be rejected, while 4declined appointment.^*

In April Congress authorized Regular Army commissions for Army nurses.At the same time, the lawmakers gave further recognition to the Medical De-partment’s professional women by establishing a Women’s Medical SpecialistCorps for dieticians, physical therapists, and occupational therapists. Theyauthorized a minimum strength of 2,558 for the Army Nurse Corps and 409 forthe Women’s Medical Specialist Corps. In June the first list of Army nursesnominated for the Army Nurse Corps, Regular Army, went to the president. Bythe end of the year 1,201 nurses, therapists, and dieticians received offers ofcommissions and 1,143 accepted. Because a nurse section of the Officers’ Re-serve Corps now existed as well, reserve commissions were offered to nurseswithout previous service. In July Congress abolished Army of the United Statescommissions, effective 1 July 1948; by that time, all Army nurses must becomeeither regulars or reservists. The changeover presented the Army an opportunityto eliminate nurses who had proved unsatisfactory. Others, however, were lostbecause they chose to leave, or because they had young dependents, or becausethey were over 35 years of age.^^

Such doubtful criteria eliminated women who hardly could be spared. Lossesduring 1948 were over a thousand as nurses with Army of the United Statescommissions departed. In the Nurse Corps, as in the Medical Corps and DentalCorps, much time was spent taking head counts that always came up short whenmeasured against need. Counting up the results when the integration program

^’On the early history of therapists and dieticians in the Medical Department, see Harriet S. Leeand Myra L. McDaniel, eds.. Army Medical Specialist Corps (Washington, D.C.: Office of theSurgeon General, Department of the Army, 1968), pp. 1-338. The possibility of employing malenurses was discussed at the Office of the Surgeon General, but with evident disapproval. See SGConference Notes, 31 Mar 49, HRB.

^*Nursing Division, OSG, History of Army Nurse Corps Personnel, 1 Jan-31 Mar 47, file319.1-2 (OSG, Annual Reports), HRB.

^’Public Law no. 80-36, 16 Apr 47. Extract from War Department Personnel News Letter no. 8,10 Jul 47, p. 1, HSF (WD News Ltr-1947); Nursing Division, OSG, Report of Activities, 1 Jul-31Dec 47, file 319.1-2 (OSG, Annual Reports); and Personnel Division, OSG, Report of Activities, 1Jul-31 Dec 47, file 319.1-2 (OSG, Annual Reports). All in HRB. War Department Circular no. 189,22 Jul 47, and Department of the Army Circular no. 79, 29 Dec 47, LIB. “Regular Army Appoint-ments in Women’s Corps,” Military Surgeon 101 (December 1947): 536. On the end of Army of theUnited States commissions, see Public Law no. 80-239, 25 Jul 47.

19

Table 2-Distribution of Army Nurses, June 1948

Major Commands and Other Organizations Strength

Alaska  18

Antilles Department  40

Air Force  546

Brazil   1

China   5

European Command  316

Far East  407

Hawaiian Department  77

Panama  31

Class II Installations  1,730

Transportation Corps  179

Trieste Theater  17

Zone-of-Interior Army Areas“  739

Noneffective  204

Total  4,310"

'Including the Military District of Washington.

"Regular Army nurses numbered 1,470; Reserve Corps nurses, 2,840.

Source: Army Nurse Branch, Nursing Division, OSG, Quarterly Report of Activities, 1 Apr-30 Jun 48, p. 1, file 319.1-2 (OSG,Annual Reports), HRB.

was completed, different OSG divisions arrived at slightly varying conclusions,none satisfactory. A total of 1,756 nurses had been nominated for Regular Armycommissions, while 995 had been disqualified. With the addition of a smallgroup of veterans who had left the Army but now returned, about 1,558 hadtaken the proferred rank. By various estimates, either 3,800 or 5,700 nursesmore would be needed—reservists, civilians, or other—to meet the require-ments of the Army in the year ahead.^”

However calculated, the needs were great and would grow worse. The distri-bution of nurses {Table 2) reflected the worldwide commitments of the UnitedStates. The onset of the Cold War during 1947 and 1948 signaled increasedduties without adequately augmented personnel, for women could not be draft-ed and, under the rigid codes of the time, men, though they could be orderlies,could not be military nurses. Various expedients were tried. Civilian nurseswere employed on contract—supposedly on a temporary basis, until uniformednurses could be obtained. In fact, however, the use of civilian nurses soonbecame a standby in Army hospitals. Reserve nurses became increasingly im-portant, until reservists on extended active duty dominated the corps in num-bers. Far from being phased out, the allotment of civilian nurses increased, anda course of instruction in practical nursing was established for enlisted men atWalter Reed Army Hospital. In many hospitals the eight-hour day for nurseshad to be abandoned, increasing procurement problems because civilian nurseswere accustomed to such a schedule. Despite all efforts, the phrases “criticalshortage” and “matter of grave concern” became refrains in reports and person-nel newsletters.^'

^®Army Nurse Branch, Nursing Division, OSG, Quarterly Report of Activities, 1 Apr-30 Jun 48,pp. 1-3, file 319.1-2 (OSG, Annual Reports), HRB.

^'Quoted words from Department of the Army Personnel News Letter no. 15, 1 Oct 48, p. 7, HSF(DA News Ltr-1948), HRB. See also Nursing Division, OSG, Report of Activities, 1 Jul-31 Dec 47,

(Conlinucd)

THE MEDICS’ WAR

A further blow came in 1949 with the establishment of a separate Air ForceNurse Corps. Army nurses could now choose the service they wished to contin-ue in, and on 26 July 1,199 nurses, including 307 regulars, transferred to the AirForce. Because the Army also was caring for Air Force patients, creation of thenew service reduced its obligations as well as its personnel. Nevertheless, thecorps completed its last full year of peacetime before the onset of the KoreanWar severely depleted in number and dependent upon reserve officers on ex-tended active duty. There was a continuing overall shortage of about 500nurses.^^

Meanwhile, Congress had established another new corps, in large part tocounter the shortage of physicians. Planned since the end of the war, the Medi-cal Service Corps united medical administrators with officers in the allied sci-ences. As a Regular Army component, the corps provided permanent officerslots for personnel whose status, in many cases, had been uncertain. However,the corps faced some opposition within the Medical Department itself, becauseof professional snobbery or genuine doubts about an organization composed ofso many diverse elements. Medical administrators were often former enlistedmen commissioned during the World War II burgeoning of the Medical Admin-istrative Corps, and relations between them and degree-holding experts in scien-tific fields were not always easy. Nevertheless, the importance of the ancillaryfields was such that the surgeon general had his way. The organization set up byCongress on 4 August 1947 was divided into seven sections: Pharmacy, Supply,Administration, Medical Allied Sciences, Sanitary Engineering, and Optometry.Dissatisfaction among the pharmacists was lessened by the appointment of Col.Othmar F. Goriup, a member of that guild, as the first Medical Service Corpschief Three former corps—Medical Administrative, Pharmacy, and Sani-tary—ceased to exist by the same act.^^

The tendency toward professionalism evident in the Medical Corps nowreappeared in the Medical Service Corps. If willing and qualified, officers of thethree abolished corps transferred to the new corps, but provision was made aswell for granting commissions to civilians based solely on their professionalexpertise. “An expert in enzyme chemistry,” explained the Medical Section, FarEast Command, in reviewing the new law, “can be given a regular commis-sion . . . with no more complications than would be involved in commission-ing a brain surgeon in the Medical Corps. . . . The Surgeon General is free touse his discretion as the need arises.”^^

Yet, though the law had multiple uses—recognizing the allied sciences, sim-plifying the organization of the Medical Department, and so forth—there can belittle doubt that its most immediate advantage in the eyes of the surgeon general

(Continued)

1 Jul-31 Dec 48, 1 Jul-31 Dec 49, and Personnel Authorization Unit, Personnel Division, OSG, 1Jul-31 Dec 48, files 319.1-2 (OSG, Annual Reports). Both in HRB.

^^Nursing Division, OSG, Report of Activities, 1 Jul-31 Dec 49, HRB.

“Public Law no. 80-337, 4 Aug 47.

“Quoted words from extract of Surgeon’s Circular Letter 2, no. 10, Medical Section, FEC, 1 Oct47, pp. 3-4, HSF (FEC Circular Ltr-1947), HRB. See, for example. Announcement, “Civilian

21

was the chance it offered to alleviate the shortage of doctors. To expand andstabilize the complement of medical administrators was essential to the effort toprofessionalize the Medical Corps. In hospital units, changes in the tables oforganization and equipment (T/O&Es) now assured that the only doctor in anadministrative post was the commander or, in large units, the commander andhis deputy. The same quickly became true of tactical units and supply depots.Medical Service Corps officers took over much of the supply system; smalldepots and the medical sections of general depots, in the main, functionedwithout a medical officer on duty. In headquarters staff positions Medical Corpsofficers usually appeared only as chiefs of major divisions. The T/O&E revisionsalone produced a decrease of 7.5 percent in the number of medical officersrequired by the department. The whole complexion of the organization began tochange. In World War II the ratio of administrative and allied sciences officersto physicians was about 1 to 2; by 1951, the ratio was approximately 3 to 4.^^

The personnel shortages that developed in the Medical Service Corps were,like the corps itself, a patchwork. In an organization that included such diversepeople as depot supply sergeants who had won commissions, clinical psycholo-gists, psychiatric social workers, industrial hygienists, toxicologists, and gradu-ate engineers, differences were to be expected in the relative appeal of militaryversus civilian life. For former enlisted men, the corps represented an advancein status and earning power. On the other hand, serious recruitment problemsdeveloped and persisted primarily in the Medical Allied Sciences Section and,to lesser extent, in the other professional sections. Overall, the Medical ServiceCorps entered 1948—when, it will be recalled, the surplus of doctors turned intoa serious deficiency—with a shortage of 600 officers.^^

By 1949 the situation of the corps in terms of total numbers resembled thatof the Army Nurse Corps. Among active duty personnel, reservists outnum-bered regulars by about 3 to 1, and four hundred vacancies remained unfilled.In terms of its two basic rationales—to relieve doctors of administrative dutiesand to entice scientists into the Medical Department with regular commis-sions—the Medical Service Corps, though not without achievements to show inboth endeavors, had proven far more successful in the first than in the second.^^

Yet the reorganizations of 1947 proved statesmanlike and durable. Thestructure that developed was comparatively simple and coherent, and gave solidsupport to professionalization. The status of the Medical Department’s femalemembers, on whom it depended and would depend heavily, had markedlyimproved. The personnel problem was another matter. As quality and organiza-tion improved, quantity remained persistently short of need.

Specialists Eligible for Army Reserve Commissions,” Bulletin of the U.S. Army Medical Department8 (October 1948): 769.

^Txtract from General Robinson’s Tour End Report, 1947-1951, HSF (Robinson Report), HRB.

'Txtract from Surgeon’s Circular Letter 3, no. 6, Medical Section, EEC, 1 Jun 48, p. 2, HSF(EEC Circular Ltr-1948); extract from Personnel Action Branch, Personnel Division, OSG, Quar-terly Report of Activities, 1 Jan-30 Mar 48, p.6, file 319.1-2 (OSG, Annual Reports), HRB.

^’Career Management Branch, Personnel Division, OSG, Report of Activities, 1 Jul-31 Dec 48,file 319.1-2 (OSG, Annual Reports), HRB.

The Unification Drive

THE MEDICS’ WAR

The changes within the Medical Department during 1947-49 were overshad-owed by a broader shakeup of the whole defense establishment. The end ofWorld War II compelled basic rethinking of traditional American military dog-mas. The atomic bomb, though no one was yet certain how and under whatcircumstances it could be used, exalted the Air Force, gave new impetus to oldarguments for a separate service, and brought into question the future signifi-cance of the Army and the Navy. Military budgets, as often happens in a time ofpeace, became targets of opportunity both for lawmakers who preferred tospend on domestic programs and for the costive who did not wish to spend atall. Under these circumstances administration officials, members of Congress,and members of the services alike discussed and took sides on proposals to givethe air arm equal status with the Army and the Navy, to achieve greater unityamong the services, and to seek economies through common procurement ofsupplies and enhanced interservice cooperation. Under its chief of staff. Gener-al of the Army Dwight D. Eisenhower, the Army favored maximum unification,especially in the medical field; the Navy, coordination of the services throughjoint committees, culminating in the war-created Joint Chiefs of Staff. Support-ing his chief. Surgeon General Kirk vigorously endorsed a “single, integratedmedical service.”^*

As Congress took up the issue in early 1947, the onset of the Cold Warimparted urgency to the debate. In March 1947 the Truman Doctrine startedaid flowing to Greece and Turkey, both of which were facing Communist pres-sures. The next year brought the Berlin Blockade and a renewed military draft.In 1949 the North Atlantic Treaty was signed. Already operating in China was amilitary medical advisory group headed at first by Col. Howard S. McConkieand then by Col. Floyd L. Wergeland, both Medical Corps officers. In 1949 asimilar mission was established to aid the new Republic of Korea. Supplies,including medical supplies, were sent abroad to friendly and allied nations.^^

During 1947 congressional hearings set the issue of medical organizationfirmly in the context of military unification. Considerations of cost, of a pro-spective shortage of physicians in the event of war, of a duplication of effort bythe Army and the Navy during World War II, and of an underutilization ofdoctors during the conflict all seemed to demand a new approach. For a time,with the outcome of the debate uncertain, almost anything seemed possible. Inhis own testimony, Eisenhower indicated a high-level view of the services’

given in Richard V. N. Ginn, “Of Purple Suits and Other Things; An Army Officer Looks atUnification of the Department of Defense Medical Services,” Military Medicine 143 (January1978): 18.

^’Daniel Yergin, Shattered Peace: The Origins of the Cold War and the National Security State(Boston: Houghton Mifflin, 1977), pp. 275-394; Mae Mills Link and Hubert A. Coleman, A Historyof the Origin of the U.S. Air Force Medical Service, 1907-1949 (Washington, D.C.: Office of theSurgeon General, U.S. Air Force, 1969), pp. 106-44. On the Wergeland mission, see extract fromRpt, Army Advisory Group, Combined Services Division, 6 Oct 47, sub: Surgeon, Army AdvisoryGroup (Senior Medical Officer), pp. 1-3, HSF (Army Advisory Group Report), HRB.

23

medical problem and of some possible solutions. The problem he termed “oneof the hardest ... we have got in the Army,” pointing out to members of theSenate Committee on Armed Services that “we have fewer doctors today in theArmy, in the Regular Service, including the ones who have recently acceptedcommissions, than we did when the war started.” He wished to see a unifiedmedical service for the unified armed forces, and he revealed that he was alsothinking of the possibility of combining the medical services of the Army andthe Veterans’ Administration. Reflecting on the implications of the atomicbomb, he felt that the medical situation demanded “more planning, morebrains, . . . than almost anything I can think of.”"*®

In July, however. Congress passed the National Security Act of 1947, settingup a National Military Establishment of three armed services, each under itsown secretary, with a secretary of defense as the president’s principal assistantin national security matters. This halfway house between separate services andtrue unification was in considerable measure the work of the secretary of theNavy, James Forrestal, representing the views of the second oldest but mosttradition-minded service. On 17 September 1947, however, Forrestal becamethe first secretary of defense. He quickly found his position to be weak andbegan to call for strengthening its powers. The task of being, in effect, a media-tor among three independent services was not attractive when seen from his newperspective. Truman, a strong executive who desired greater control, agreed.The president’s push for reform achieved success after Forrestal’s departure. InAugust 1949 the National Military Establishment became the Department ofDefense, with the three service secretaries subordinate to the second secretary ofdefense, Louis Johnson. A defense secretariat was established to aid in control-ling the huge executive satrapy."*^

The Navy and the proponents of a separate Air Force together ensured thatthe evolution of the National Defense Establishment would be toward coordina-tion of the different services rather than toward unification. There was muchpractical logic in such coordination. In the field of medical supply a usefulmodel already existed in the joint Army-Navy Medical Procurement Office,which dated from December 1945. Because the fledgling Air Force had as yet noseparate medical service, the office purchased for all three departments and theVeterans’ Administration, on the basis of contracts issued by them. A considera-ble amount of nuts-and-bolts work was under way in such areas as developingjoint purchase descriptions and specifications, publishing a joint catalogue,and so forth. In November 1947 the services published joint procurementregulations."*^

'“’Testimony of Chief of Staff General of the Army Dwight D. Eisenhower, 25 Mar 47, in U.S.Congress, Senate, Committee on Armed Services, National Defense Establishment (Unification ofthe Armed Services): Hearings on S. 758, 80th Cong., 1st sess., 18, 20, 25, 26 March and 1-3 April1947, pt. 1 (Washington, D.C.; Government Printing Office, 1947f p. 107. See also Link andColeman, Air Force Medical Service, pp. 166-234.

'"Public Law no. 80-253, 26 Jul 47; Weigley, History of the Army, pp. 493-95.

'‘^Supply Division, OSG, Report of Activities, 1 Jul-31 Dec 47 and 1 Jul-31 Dec 48, files319.1-2 (OSG, Annual Reports), HRB.

THE MEDICS’ WAR

On behalf of the Air Force, the Army Medical Department continued for thetime being to take responsibility for the storage and issue of medical supplies,for obtaining and assigning personnel, and for providing general hospital facili-ties. With the Navy’s Bureau of Medicine and Surgery, cooperation made whatSurgeon General Bliss termed “slow but steady progress.” The services estab-lished similar physical standards, held interservice conferences, standardizedsome medical report forms, and agreed upon joint unification of hospital beds,especially in areas where one service or the other had none of its own available.For a time the two services attempted joint staffing of three naval facilities."*^

As 1947 ended, hospitalization, interservice cooperation, and economy re-mained linked concerns for the secretary of defense. At Forrestal’s behest theservice secretaries agreed on 25 November 1947 to set up a committee of thetwo surgeons general and the air surgeon, with a civilian as chairman, to studytheir hospitalization problems. The secretary’s objective was to achieve greaterefficiency and economy by improved utilization of hospitals and by coordinat-ing medical plans and programs. The “civilian” selected to head the panel wasPaul R. Hawley, a retired major general of the Army Medical Department."*"*

Domineering, astute, and an extremely able administrator, Hawley had orga-nized the medical service of the European Theater of Operations (ETO) duringthe war and later served as medical director of the Veterans’ Administration.However, his work for the Committee on Medical and Hospital Services of theArmed Forces was limited by the demands of his civilian career and by his angerat what he saw as the obstructionism of the three surgeons general. Hawley didnot accompany the committee on its travels and gradually withdrew from itswork. He resigned in January 1949. After Hawley’s departure General Bliss,acting as chairman. Rear Adm. Clifford A. Swanson, the surgeon general of theNavy, and Maj. Gen. Malcolm C. Grow, the air surgeon, carried out much ofthe work with the assistance of Rear Adm. Joel T. Boone, who served as execu-tive secretary. Twenty-two subcommittees, whose members and staffs weredrawn from the medical systems of the Army and the Navy, collected informa-tion and drew up reports."*®

The Hawley committee was diligent, the reforms it proposed limited andwell within established military medical traditions. Members visited about 150

‘‘^Quoted words from extract of Rpt, Section on Developments in the Medical Field, p. 23, Enelto Memo, Hartford to Chief, Control Office, Logistics Division, 10 Sep 48, HRB. See also FourthArmy, Fort Sam Houston, Texas, Annual Report of Medical Department Activities, 1948, p. 3, file319.1-2 (Fourth Army) 1948, Box 4 (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB;extract from Memo, Col Paul I. Robinson, MC, Chairman, Subcommittee on Medical DepartmentPersonnel, to Chief, Joint Plans and Action Division, Office of the Director of Medical Services,OSD, 30 Nov 49, HSF (Robinson-1949), HRB.

‘^Committee on Medical and Hospital Services of the Armed Forces, Office of the Secretary ofDefense, “Report of the Committee on That Part of Its Assignment Relative to Programs forHospitalization in the Armed Forces and for Improvement in the Utilization of Existing HospitalFacilities” (hereinafter cited as Hawley Report), 1949, pp. 1-3, file 337 (Draft Report of Committeeon Medical and Hospital Services of the Armed Forces) Hawley-1949, HRB.

‘‘^Extract from Memo (no. M-212-49), Office of Public Information, National Military Estab-lishment, to the Press, 6 Jul 49, HSF (Public Information-1949), HRB. Hawley’s career is treatedextensively in Cosmas and Cowdrey, The Medical Department: Medical Service in the EuropeanTheater of Operations, forthcoming.

25

armed forces medical installations in the Western Hemisphere—general hospi-tals, naval hospitals, medical depots, laboratories, schools, some of the largerstation hospitals, and even some dispensaries and clinics. One member spent sixweeks covering Europe; another spent time in the Mediterranean and MiddleEast. The surgeons general recommended several improvements in service coop-eration, to include opening joint centers for the diagnosis and treatment ofspecial conditions (for example, neuropsychiatry at the U.S. Naval Hospital,Houston, Texas); conducting experiments in joint staffing; establishing a perma-nent committee to report to the secretary of defense; downgrading some hospi-tals to dispensaries; and closing other hospitals. With few exceptions. SecretaryForrestal accepted their proposals. Whether these changes met the needs of thetime was another question. Organized within the military establishment, thecommittee had no real civilian member and simply assumed many things thatthe civilian profession viewed as disputable. Bliss himself vigorously opposed aunified medical service, which may have reflected the fact that Eisenhower, withhis strong commitment to unification, had now retired to private life. Commit-tee members saw military and civil medicine as radically different, requiring afar higher proportion of doctors in the services than in civilian life. The tradi-tions of providing care to dependents of servicemen and allowing each armedservice its own medical organization were not questioned.'*^

Experience soon showed that even such basic, and to professional militarypeople, axiomatic principles could become matters of public debate. Hawleyspoke out in open forums, declaring his belief that the medical establishmentcould be reduced in numbers without impairing service. Pointing to vacant bedsin military hospitals, he called for greater economy. He believed that the hospi-tals provided an excuse for training specialists, instead of drawing them, in caseof war, from civil life, as was done in the past. (“In the ETO,” he wrote, “I neverhurt for clinical talent but I was constantly hurting for leadership of this talenthalf as good as the talent itself”) He believed and said that the military medicalservices should be unified completely at the general hospital level."*^

Hawley’s attitude toward the work of the committee that bore his name wasscathing. “It did not accomplish one damn thing,” he wrote. “It was a waste oftime and money.” Its only real aim was to make cosmetic changes while seekingto preserve the status quo. “I say to you frankly that, in this Committee which Iheaded, there was a colossal display of bad faith.” The surgeons general hadfollowed a path of “noncooperation” in order to safeguard their own bureaucrat-ic turfs.

“^Hawley Report, pp. 37-75, HRB; copy of Ltr, Hawley to Tracy S. Voorhees, Chairman, Com-mittee on Federal Medical Services, 2 Feb 49, attached to ibid.; extract from Memo, James Forres-tal, Secretary of Defense, to Secretaries of the Army, Navy, and Air Force, 21 Feb 49, sub: Programsfor Hospitalization in the Armed Forces and for Improvement in the Utilization of Existing Hospi-tal Facilities, HSF (Forrestal-1949), HRB; Ginn, “Of Purple Suits,” p. 19; Link and Coleman, AirForce Medical Service, pp. 317-19.

■^’Quoted words in this and following paragraph from copy of Ltr, Paul R. Hawley, Director,American College of Surgeons, to Col Floyd L. Wergeland, MC, 11 Apr 50, and copy of Talk,Hawley, Chief Executive Officer, Blue Cross and Blue Shield Commissions, to Citizens Committeefor the Hoover Report, National Reorganization Conference, 12-13 Dec 49, sub: Better Federal

(Continued)

THE MEDICS’ WAR

Hawley’s views reflected not only an acerbic personal style but also his newstatus in civilian medicine, his political conservatism, and his belief that anyfuture war would be a worldwide struggle resembling those in which he hadserved. Nevertheless, such opinions from a man who had spent much of his lifein uniform gave a taste of what civilians might conclude when they came to takea scalpel to military medicine. Bliss’ own words to his staff suggested that he wasmetaphorically drawing his wagons into a ring. He had hoped, he said, topresent a program for interservice cooperation that would “automatically elimi-nate too many civilians entering into the picture of the unification of the threemedical services.” He emphasized that “our only salvation in keeping this [uni-fication process] ‘medical’ is for the three SG’s to present to the Secretary ofDefense something constructive and sound.”^* But the civilians were not to be soeasily excluded.

From the angle of many physicians—their vision sharpened and sometimesembittered by their experiences during World War II—the established militaryproportion of about 6 doctors to 1,000 troops was grotesque. In civilian life 1doctor to 1,000 or more persons, depending on location, was not uncommon.Believing that their colleagues in uniform should do only professional work,civilian physicians did not always appreciate the fact that a military doctor wasan officer who had other duties to fulfill. The special requirements of theservice—frequent physical examinations in a profession where physical condi-tion was critical; routine hospitalization of men and women who, even forminor illnesses, could not be treated in barracks; treatment of troops scatteredamong many billets and on troopships; and a system of total and compulsorycare, to include preventive medicine—seemed excessive to many civilians.Some American Medical Association members viewed the recruiting efforts ofthe services as a serious drain on a civilian profession already limited in num-bers and, in consequence, judged their demand for more physicians to beunacceptable.^^

In the meantime, further proposals had surfaced through the president’sCommission on Organization of the Executive Branch of the Government. Setup under the general direction of former President Herbert Hoover, the com-mission sought ways to bring greater efficiency and economy to the governmentby eliminating duplication and waste and by increasing centralization. Two ofits task forces took aim at military medicine: the Eberstadt committee on na-tional defense and the Voorhees committee on federal medical services. In theEberstadt committee’s view, “service estimates for their medical and dentalneeds are excessive”—“much higher in proportion to members than in civilianlife.” The committee questioned whether the Army’s emphasis on professional-ism might not lead to neglect of the field service and found the utilization of

(C'onimucd)

Medical Services, Hoover Task Force Report on Hospitalization (Voorhees Report) file, 1949, Box 5(General Green’s Office-Reference File), Accession no. 112-79-5, RG 112, WNRC.

^*SG Conference Notes, 3 Dec 47, HRB.

^’Copy of Memo, Isaac Cogan for The Surgeon General, DA, to Col St. John, Surgeon, FirstArmy, 2 Nov 49, sub: Establishment of a Fixed Ratio of Medical Officers to Troop Strength for theDepartment of the Army, HSF (Cogan-1949), HRB. On physician ratios in civilian life, see MorrisFishbein, ed.. Doctors at tFar (New York: Dutton, 1945), pp. 83-84.

27

doctors to be unsatisfactory. These failings, plus the assistance given the Veter-ans’ Administration to help veterans and the care of dependents, contributed towhat the task force termed “the apparent service shortage” of doctors. TheVoorhees committee, accepting the inevitability of three separate medical ser-vices, recommended that the zone-of-interior hospitals of the armed forces beremoved from military control and placed under a proposed civilian NationalBureau of Health. Other suggestions included the complete unification of medi-cal supply, giving a single service responsibility for hospitalization in eachoverseas area, reduction in dependent care, and curtailment of the armed forcespostgraduate training programs. Specialists in the armed services were to re-ceive residency training in nonmilitary federal hospitals.^*’

Some of the ideas that had reached the commission through the reports ofthe Hawley committee were those of the surgeons general themselves. To othersBliss objected strongly. Control of hospitals was a sore point. In his view theHoover commission in effect was seeking to relegate military medicine to fieldservice, with no suggestion as to how professionals were to be brought into theArmy under such conditions. In a private meeting with Secretary of the ArmyKenneth C. Royall, Bliss protested that “this hospitalization program would socripple the Army Medical Service as to make it completely second-rate—aService of mediocrity. The attitude of Congress, where military control ofhospitals and providing care for dependents were both popular, made it unlikelythat the more extreme proposals would meet with approval. The emergence of adefense secretariat, on the other hand, opened the way for coordination in theinterest of greater unity and economy within the military establishment itself.

Virtually all opponents of a unified medical organization had concurred onthe need for a coordinating body to prepare recommendations on medical policyfor the secretary of defense. As a result, on 9 November 1948, Forrestal set upthe Armed Forces Medical Advisory Committee. The committee, headed byCharles P. Cooper, a New York businessman favored by the Hoover commis-sion, consisted of thirteen civilians and the three surgeons general. But the newgroup soon found itself, like the secretary himself, somewhat stranded withoutan executive agency to carry out its recommendations. The surgeons generaloccupied a position that Gilbert and Sullivan would have loved to satirize. They

^“Quoted words as given in Memo, Col Paul I. Robinson, MC, Chief, Personnel Division, OSG,to Director, P & A Division, General Staff, Attn.: Lt Col E. L. Beauchamp, 3 Feb 49, containingcomments on Summary of Report of the Eberstadt Committee, p. 1, tab 17, Colonel Robinson’sStudies, RG 112, WNRC. See also copy of Memo, Lt Gen H. S. Aurand, GSC, Director of Logistics,to Gen J. Lawton Collins, Chief of Staff, USA, 25 Feb 49, sub: Staff Study on Formulation of ArmyPolicy on Medical Service, HSF (Aurand-1949), HRB, and Committee on Federal Medical Services,United States Commission on Organization of the Executive Branch of the Government, FederalMedical Services [Appendix O]: A Report With Recommendations, January 1949, especially pp.56-58, in Hoover Committee Reports and Appendices nos. 15-18, Law Library, Judge AdvocateGeneral, Department of the Navy. Ferdinand Eberstadt was an investment banker with a longrecord of government service. Tracy Voorhees was formerly a JAG officer assigned to the Office ofthe Surgeon General as a troubleshooter. See Voorhees’ memoir, “A Lawyer Among Doctors,” copyon file in CHA.

^'MFR, Maj Gen Raymond W. Bliss, Surgeon General, DA, 5 Jan 49, sub: Conference WithSecretary Royall, Hoover Task Force Report on Hospitalization (Voorhees Report) file, 1949, Box 5(General Green’s Office-Reference File), Accession no. 112-79-5, RG 112, WNRC.

THE MEDICS’ WAR

gave the secretary of defense advice that, if accepted, each of them—as thesecretary’s technical staff officers—had to review and comment upon. For thisreason, or to eliminate a source of obstruction, Forrestal removed them fromthe committee, making it wholly civilian.^^

In April 1949 the Cooper committee recommended to the new secretary ofdefense, Louis Johnson, that he form an organization with authority to establishpolicies and programs for the military medical services. Johnson created theMedical Services Division under Dr. Raymond B. Allen, a member of both thecommittee and the Hoover commission and president of the University ofWashington in Seattle. The secretary then dissolved the Hawley committee andshifted the hundred or so military and civilian members of its subcommitteesand staff to the new division. An Ohio doctor who had served in the Army AirForces in World War II, Richard L. Meiling, succeeded Allen in October. Amajor general in the Air Force Reserve, he was an influential member of theAmerican Medical Association as well.

Meanwhile, Congress had set up the Department of Defense, and a full-fledged Air Force medical service came into being in September, with its ownsurgeon general. At the end of the same month the Medical Services Divisionbecame the Office of Medical Services. Meiling was appointed director of medi-cal services and assistant to the secretary of defense for medical affairs. Aftermuch bureaucratic turmoil the future of military medicine had taken shape.There were to be three separate medical services, coordinated at Department ofDefense level, with unified procurement of supplies and, to some extent, inte-grated general hospitals.^^

The Personnel Problem Revisited

Throughout the period of unification trial and error (1947-49) the state ofMedical Department personnel continued in its familiar patterns. In all corpssave the Veterinary, substantial numbers of Regular Army officer slots wentunfilled. The Army depended upon reserve officers on extended active duty tobear the greatest part of the burden, but all sources of medical officers togetherwere inadequate to the requirements established by law, regulation, and tradi-tion. The shortage of enlisted personnel also was severe. Budget-cutting de-prived the department of critical numbers of its graded civilians, yet failure bythe Army during 1947 to maintain its authorized strength meant that militarypersonnel were lacking to man the hospitals. Ungraded civilians could not behired to take up the slack, because most of the jobs such low-paid workers couldhandle were in the messes and wards. Skill remained at a premium and oftenwas unobtainable. In mid-1947 some of the enlisted personnel at the Letterman,

should be noted that one of the civilians was Hawley. See Rpt, Elsie LaMantia, 1 Nov 53, sub:Progressive Development of the Office of Assistant Secretary of Defense (Health and Medical)Within the Department of Defense, pp. 1-3, HSF (LaMantia-1953), HRB.

*^Ibid., p. 4; “Dr. Allen To Organize Medical Services Division,” Bulletin of the U.S. ArmyMedical Department 9 (August 1949): 695-96.

McCormack, and William Beaumont General Hospitals worked from sixty toseventy-two hours a week—a situation that did not encourage reenlistment.®''

In the Medical Corps, where skill was highest, conditions were the worst.Two events converged during 1948-49 to intensify all the difficulties of pro-curement: the impending release of most of the ASTPs; and, sparked by theCold War, the revival of the Selective Service System in June, which broughtinto the Army substantial numbers of potential patients while Congress consis-tently declined to draft doctors to care for them. (Doctors might, of course, bedrafted like other young men, but their extended education gave them an unusu-ally good chance, by stringing deferments together with marriage, to avoid beingcalled.) A special draft for doctors and dentists seemed the height of unfairnessto the potential draftees, and the American Medical Association effectivelyopposed it. The attitude of the medical profession was a major disappointmentto the Medical Department. Backing efforts during 1948 to get the doctor draftincluded in the law, the surgeon general declared that “the doctors will volunteerwhen the Draft breathes down their necks. . . .”®®

Defeat of the doctor draft provoked a new Greek chorus of warning andlaments from military medical men and of skepticism from their civilian col-leagues. In July 1948 Brig. Gen. George E. Armstrong, the deputy surgeongeneral, wrote the American Medical Association that “in my opinion the Medi-cal and Dental situation relative to the Armed Forces is more critical than atany time in the last 25 years. All extensive data reveals that the supply ofprofessional personnel ... is deficient in both quality and quantity, and thepresent incentives to attract such personnel into the services are sorely inade-quate.” Efforts to conserve personnel were “small in relation to total shortages,”and unless the procurement of officers could be greatly increased, “the successof supporting the Selective Service Act will be in great jeopardy.”®^

But many in the American Medical Association continued to doubt thatstaffing requirements were as the Army stated them. For its own part, theMedical Department waffled on a third-party inquiry into the question. Col.Paul I. Robinson of the Office of the Surgeon General proposed that the Nation-al Research Council of the National Academy of Sciences conduct an indepen-dent study of Army staffing needs, hoping that it might carry some weight withthe medical profession. The OSG’s Resources Analysis Division rejected thesuggestion on grounds that only the Army could fix its own requirements.However, Isaac Cogan, the division chief, admitted that only legislation could

*Txtract from Ltr, Maj Gen Raymond W. Bliss, Surgeon General, USA, to President, WarDepartment Manpower Board, 30 Jun 47, sub: Personnel Authorizations for 30 June 1947; copy ofLtr, Bliss to Brig Gen George C. Beach, Commander, Army Medical Center, 11 Sep 47. Both in HSF(Bliss-1947), HRB.

^Quoted words from SG Conference Notes, 28 Apr 48, HRB. See also Resources AnalysisDivision, OSG, Report of Activities, 1 Jan-30 Jun 48, file 319.1-2 (OSG, Annual Reports), andextract from Memo, The Surgeon General [Bliss], DA, to Brig Gen George E. Armstrong, DeputySurgeon General, DA, 8 Jul 48, sub: Thoughts on the Medical Implications Resulting From thePresent Draft Bill, HSF (Bliss-1948), both in HRB; and Paul I. Robinson, “About the MedicalDepartment,” Bulletin of the U.S. Army Medical Department 8 (December 1948): 934-35 and 9(February 1949): 104.

**Extract from Ltr, Brig Gen George E. Armstrong, Deputy Surgeon General, DA, to MorrisFishbein, Editor, JAMA, 19 Jul 48, HSF (Armstrong-1948), HRB.

THE MEDICS’ WAR

meet the Army’s needs—that is, a doctor draft—and that “legislation is largelydependent upon the attitude of the civilian profession, specifically [the]A.M.A.” An impasse had been reached.^^

Meanwhile, the general Cold War draft brought about one hundred thousandnew men into the Army during 1948-49. In consequence, thousands of physicalexaminations had to be given, and denunciations of civilian induction stationphysicians, a feature of most drafts, were heard again from the military recep-tion centers. Recruits turned up with “easily diagnosed and patently apparentconditions,” including “valvular heart disease, gross overweight, epilepsy, . . .dislocations of major joints, loss of great toes, active tuberculosis, [and] grossand obvious deformities. ...” Induction station doctors were quoted as havingtold such men: “You’ll be all right,” “When we want information we’ll ask forit,” “Next case,” “The Army will make a man of you,” and so forth. Receptioncenters then had to carry out disability discharge proceedings. The stationhospitals bore the brunt of much of the work, despite severe shortages of man-power, including trained male ward attendants. The draft was not all bad news;medical ROTC enrollments skyrocketed during 1948-49, rising by 100 percentthe first year, with a further jump of 81 percent the next. Overall, however, thework load had increased but the number of the most critical workers had not.®*To its other expedients the Medical Department added the hiring of civiliandoctors and dentists on contract; by the end of 1948, 285 were employed. Butagain, the numbers gained were out of proportion with the impending losses.The personnel problem grew, stretching across the world, like the Army. TheEuropean Command anticipated a loss of 270 out of 376 medical officers bymid-1949, and by the start of the year had “less than ten replacements . . .scheduled definitely.” Faced with a “critical shortage” of doctors, dentists, andnurses, the Far East Command reported that its attempts to recruit “met withsmall success.” By January 1949 the surgeon general had privately given up onthe doctor draft, feeling that his organization would hurt itself with the medicalprofession without any real chance of obtaining such a law. Bliss declared to hisstaff that “anything we could do to aid the draft bill would be of no avail andprove most harmful. It is very, very doubtful as to whether this bill will ever bepassed.” His advisers agreed. “Congress,” wrote Colonel Robinson, “in general.

^^Quoted words from extract of Memo, Isaac Cogan, Chief, Resources Analysis Division, OSG,to Chief, Personnel Division, OSG, 28 Sep 48, sub: Calculation of Medical Department ProfessionalPersonnel Requirements, HSF (Cogan-1948), HRB. See also copies of Memos, Col Paul I. Robin-son, Chief, Personnel Division, OSG, to Chairman, Research and Development Board, OSG, Attn.:Col William S. Stone, 7 Sep 48, and Stone to Robinson, 23 Sep 48, subs: Calculation of . . .Requirements, HSFs (Robinson-1948) and (Stone-1948), HRB.

^^Station Hospital Camp Chaffee, Arkansas, Annual Report of Medical Department Activities,1948, pp. 2 and 8-9 (source of quotations), file 319.1-2 (Station Hospital Camp Chaffee, Ark.),1948, Box 130 (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB. On civilian manning ofinduction stations, see SG Conference Notes, 30 Jun 48, HRB. See also Dental Division, OSG,Report of Activities of the Divisions of the Surgeon General’s Office, 1 Jul-31 Dec 49, file 319.1-2(OSG, Annual Reports), HRB; Station Hospital 6003 Army Service Unit, Fort Ord, California,Annual Report, 1948, p. 32, file 319.1-2 (Station Hospital Fort Ord, Calif) 1948, Box 148 (WWIIAdmin Rees, 1940-49), Entry 54A, RG 112, MMFB; “Annual Reports of Medical DepartmentActivities,” Bulletin of the U.S. Army Medical Department 9 (August 1949): 710-11.

31

Draftees Undergoing Physicals

can be said to be not ‘draft-minded’. . . . Furthermore, the necessity for a draftwould fall on us to prove and it is doubtful that it can be substantiated.”®^

It was under these conditions that the military establishment turned to thecivilian profession in a renewed effort to obtain volunteers. In response theAmerican Medical Association through its journal launched an appeal, but withlittle success. In February 1949 Secretary Forrestal opened a so-called MoralSuasion Campaign at the suggestion of his advisory committee. The committeeargued that “there is a possibility of obtaining sufficient physicians and dentiststo meet the Services’ requirements through an appeal to the professions forvolunteers and that such appeal is a prerequisite to any resort to the compulsoryinduction of such personnel.” This rationale was probably not taken literallyeven by its members, whose main concern was “averting the need for a draft.”An ad hoc committee of the three surgeons general was established, to serve asthe point of contact with the American Medical and the American Dental

^’First quotation from European Command, Annual Report of Medical Department Activities,1948, Professional Services Branch, p. 5, file 319.1-2 (Headquarters, European Command)EUCOM-1948, Box 322 (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB; secondquotation from FEC, Annual Report of Medical Department Activities, 1948, pp. 78-79, file319.1-2 (FEC) 1948, Box 498 (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB; thirdquotation from SG Conference Notes, 10 Jan 49, HRB; fourth quotation from copy of Memo, ColPaul I. Robinson, Chief, Personnel Division, OSG, to The Surgeon General, DA, 29 Mar 49, sub;Recommended Position of The Surgeon General on Vital Subjects Brought to the Front by theImpending Shortage of Medical Officers, HSF (Robinson-1949), HRB.

THE MEDICS’ WAR

Table 3-Results of the Moral Suasion Campaign, June 1949

|                         | Requests for |       |
|-------------------------|--------------|-------|
| Service                 | Active Duty  | Total |
|                         | 1949         | 1950  |  |
| Army                    |              |       |  |
| Medical Corps           | 163          | 17    | 180 |
| Dental Corps

Air Force | 31           |       | 31 |
| Medical Corps           | 39           | 3     | 42 |
| Dental Corps

Navy      | 28           |       | 28 |
| Medical Corps           | 171          | 22    | 193 |
| Dental Corps            | 46           | 2     | 48 |
| Total                   | 478          | 44    | 522 |

Source: Personnel Division, OSG, Report for the Annual Report of the Secretary of the Army, 1 July 48-30 Jun 49, p. 1, file319.1-2 (OSG, Annual Reports), HRB. On 7 March 1949, 10,863 letters signed by the secretary of defense were sent by registeredmail to ASTP- and V-12-trained doctors and dentists, inviting them to apply for commissions in one of the three service depart-ments. Replies numbering 8,762 were received, with the above results.

Associations. It was to report through Cooper to Forrestal. The Office of PublicInformation, Office of the Secretary of Defense, was instructed to mount apublic relations campaign aimed particularly at ASTPs who had escaped ser-vice. Every effort would be made to persuade such men that they owed a periodof military duty to their country and should accept commissions.^"

Simultaneously, a new effort got under way to ensure that the old accusationof inefficient use of medical officers would no longer have substance. Secretaryof Defense Forrestal, Secretary of the Army Royall, and Surgeon General Blisssought for economies wherever they were to be found. The Army reduced bedauthorizations in its hospitals. Because the inspector general had found nomalassignment of medical officers under existing regulations, the regulationswere revised, reducing the number of required physical examinations, limitingdependent care, and cutting back the number of boards and courts that medicalofficers were obliged to attend. The Veterans’ Administration was asked toremove some veterans from Army hospitals and to take more Army patientsinto their own. To expand the manpower pool, the Medical Department re-scinded age-in-grade restrictions on medical officers. Overall, by midyear theArmy had reduced by 37 percent the ratio of doctors to troop strength, from 6 to3.8 per 1,000. Tracy S. Voorhees, now an assistant secretary of the Army, foundthe cuts “so radical . . . that they are not in all respects desirable. Theyare . . . an austerity program necessitated by the present critical shortage ofmedical officers.”"*

“First quotation from copy of Memo, James Forrestal, Secretary of Defense, to Secretaries of theArmy, Navy, and Air Force, 14 Feb 49, sub: Establishment of Ad Hoc Committee for Recruitmentof Medical and Dental Personnel, HSF (Forrestal-1949); second quotation from extract of Memo,Robert M. Beers, Armed Forces Medical Advisory Committee, OSD, to John H. Ohly, Office of theSecretary of Defense, 24 Jun 49, pp. 10-11, HSF (Beers-1949). Both in HRB.

‘"Quoted words from copy of Memo, Tracy S. Voorhees, Assistant Secretary of the Army, toSecretary of Defense, 2 Jun 49, sub: Army Conservation of Doctors, HSF (Voorhees-1949), HRB.See also copies of Memos, James Forrestal, Secretary of Defense, to Secretaries of the Army, Navy,

33

The cuts were real, but the side of the program aimed at recruitment pro-duced no significant effect {Table 3). Few, it would seem, had ever believed itwould. “Under the most optimistic expectations,” wrote Dr. Robert M. Beers, amember of the committee on whose advice Secretary Forrestal had launched theprogram, “it was evident from the beginning that the Moral Suasion Campaigncould not possibly close the gap between the doctors on hand and the Services’stated requirements.” In all likelihood, the objective was to reduce the require-ments rather than to gain new officers in large numbers. Noting that “at firstglance” many of the duties performed by medical officers had appeared tocivilian advisers of the secretary to make no direct contribution to militaryeffectiveness. Beers admitted that “most . . . were specifically authorized bylaw or rooted in tradition.” Pointing with satisfaction to the reduction of servicerequirements from eighty-eight hundred to seventy-five hundred physicians, hetermed the new figure “a minimum estimate . . . adequate to serve the needsof the fighting services under the present conditions.” Those conditions, ofcourse, featured garrison duty in a time of peace.^^

However, the Medical Department, following release of the officers sched-uled for departure, could not meet the new goals any more than the old. The lossof twenty-five hundred ASTPs cut sharply into the supply of company-gradeofficers who would be so important in time of war.

The department resumed its customary search, employing both new and oldexpedients. Congress again voted incentive pay and found money for increasednumbers of contract doctors, dentists, and nurses. The Army gave the surgeongeneral direct access to the chief of staff, and medical officers to their respectivecommanders, raising the priority of the problem, if nothing else. Medical anddental officers were given a variety of perquisites; were favored in the assign-ment of quarters; and, in overseas duty, were authorized to have their depen-dents accompany them. When the surgeon general sought to employ still morecivilian doctors and dentists, however, an Army-level staff study rejected theidea, in part because “further encroachment upon military medicine by civilianmedicine may well threaten the very existence of the Medical Department.

Secretary of Defense Johnson continued to press for greater cooperationamong the services as a means to the end of greater economy. At his insistence,conveyed through Medical Services Director Meiling, and much against the willof Surgeon General Bliss, four of the Army’s general hospitals were closed in the

and Air Force, 1 Mar 49, and Kenneth C. Royall, Secretary of the Army, to Secretary of Defense, 21Mar 49, subs: Reduction of Medical Work Load, HSFs (Forrestal-1949) and (Royall-1949). Ondependent care, see copy of DF, Lt Col C. A. McAllister, MSC, Chief, Operations Branch, MedicalPlans and Operations Division, OSG, to Plans and Projects Office, OSG, Attn.: Lt Col Scheele, 18Feb 49, sub: Hospitalization and Evacuation Policies, HSF (McAllister-1949). All in HRB.

“Extract of Memo, Beers to Ohly, 24 Jun 49, pp. 8-10, HRB.

“Quoted words from Special Plans Branch, Medical Plans;, and Operations Division, OSG,Report of Activities, 1 Jul-31 Dec 49, file 319.1-2 (OSG, Annual Reports), HRB. See also PublicLaw no. 81-351, 12 Oct 49; extract from Surgeon’s Circular Letter 4, no. 10, Medical Section, FEC,1 Oct 49, HSF (FEC Circular Ltr-1949), HRB; Murphy General Hospital, Annual Report ofMedical Department Activities, 1949, p. 45, file 319.1-2 (Murphy General Hospital) ZI-1949, Box87 (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB; Personnel Division, OSG, Reportfor the Annual Report of the Secretary of the Army, 1 Jul 48-30 Jun 49, pp. 7-8, file 319.1-2 (OSG,Annual Reports), HRB.

THE MEDICS’ WAR

Table 4-Board-Certified Regular Army Medical Officers,

March 1950

Specialty Number*

Internal Medicine  52

Radiology  28

Preventive Medicine and Public Health  23

Surgery  23

Orthopedic Surgery  15

Pathologic Anatomy  12

Dermatology and Syphilology  11

Psychiatry  9

Otolaryngology  9

Pathologic Anatomy and Clinical Pathology  8

Urology  7

Psychiatry and Neurology   6

Obstetrics and Gynecology  5

Ophthalmology  5

Pediatrics  3

Physical Medicine  3

Clinical Pathology  3

Anesthesiology  2

“One officer additionally was qualified in each of the following: internal medicine and cardiology; internal medicine and pediat-rics; neurology; preventive medicine, public health, and clinical pathology; ophthalmology and otolaryngology; plastic surgery;surgery and thoracic surgery. There was no board-certified neurosurgeon in the Regular Army component of the Medical Department.

Spring of 1950. Amid many losses and retreats, the surgeon general and thesecretary of the Army looked forward to the time, two years hence, when thepostgraduate programs would begin to bring in their full harvest. Predicting thatthe Army Medical Department would find in its residents the mainstay of itsfuture personnel needs, the secretary foresaw that the shortage of Medical De-partment officers would reach its peak in 1950 and thereafter improve.^^''

But the postgraduate programs were also under pressure as teaching hospi-tals were closed. In May General Bliss announced the “streamlining” of theprogram of medical education, the most expensive aspect of the professionaliza-tion drive in terms of money and manpower. The Medical Department reducedthe number of civilian internships from 300 to 200 and of military internshipsfrom 199 to 150. The number of military residencies was cut by 245, andcivilian residencies were abolished. By this time the department could boast ofspecialists in a variety of fields. However, it still showed disconcerting vacanciesin a few fields and, by cutting back on the program, endangered its effort toappeal to young men of promise {Table 4).^^

As the fifth anniversary of V-E Day passed, a complex and distinctive partof the Medical Department’s history drew insensibly to a close. Obliged to meetthe needs of a greatly expanded peacetime Army without adequate resources,the organization had remade itself in the hope of upgrading the skills of itsofficers and attracting a sufficient number of young physicians into its ranks. In

^■^Special Plans Branch, Medical Plans and Operations Division, OSG, Report of Activities, 1Jul-31 Dec 49, pp. 148-49, HRB.

^^Surgeon’s Circular Letter 5, no. 6, Medical Section, FEC, 1 Jun 50, pp. 3-4, file 300.5 (CircularLetters) FEC, HRB.

BETWEEN THE WARS

35

the process it had become a different organization—more professional, moreexpert, and perhaps less ready for field service. Reorganization expanded therole of medical administrators, made a place in the Regular Army for specialistsin allied fields, and gave the department’s female members more adequaterecognition of their worth. Its relations with the civil profession of medicine alsowere transformed, as it drew closer to the specialist-oriented model popular inthe profession as a whole. In many respects, this evolution benefited its relationswith the rest of the profession. The department had many friends in civilianmedicine. It continued, as it had during the war, to draw upon civilian consult-ants, and it won distinguished advocates near the pinnacle of Americanmedicine.

Yet the profession’s suspicions of the military were not eliminated, and thepractical interests of doctors and dentists were clearly against military servicefor most. The personnel problem, for reasons that went deep into Americansociety, proved fundamentally insoluble. The department lived by expedients.The health of the Army was excellent, the hospitals that remained continued tooperate, and the feeling in the Office of the Surgeon General was that thedepartment could make do until the residents had completed their training. Thetime of most severe depletion, everyone agreed, would come about June 1950.

CHAPTER 2

Japan and Korea After V-J Day

While the surgeon general struggled with the problems of the Medical De-partment at large, medics in the Western Pacific faced challenges of their own.Here 1945 had brought a series of especially drastic changes in fortune. Early inthe year Admiral Chester W. Nimitz’ forces aimed a powerful thrust at the large,heavily defended island of Okinawa, south of the main Japanese islands. Theirobjective was to conquer a staging area for the anticipated assault on Japan.Between April and July, fierce and bloody fighting marked by grim casualtyfigures on both sides ended in an American victory. Meanwhile, V-E Day hadbrought the end of the conflict against Germany, with resulting shifts in person-nel and supplies. In August, as a massive buildup for the invasion got underway, news arrived that indicated that the war would soon be over. Two atomicbombs leveled the Japanese cities of Hiroshima and Nagasaki, the Russiansentered the war, and on 15 August the Japanese government sued for peace. V-JDay was 2 September 1945.*

With stunning suddenness, the armed array gathering in the Western Pacificlost its purpose. In the course of a few months most of its millions of men andwomen headed for home, their military service soon to be ended. The troopswho remained became occupiers of the land they had expected to conquer and,as the custodians of peacetime bases, stored or destroyed the mountains of warmateriel left over from the war. In Japan, the United States emerged as thedominant power of the Occupation, and General of the Army Douglas MacAr-thur, as supreme commander for the Allied Powers, reigned as virtual proconsulin Tokyo. American soldiers gave direction to the civil government and apopulation of about 73 million people.

At the same time, Japan’s former sphere of influence fell to the victors.Korea, for thirty-five years a Japanese colony, hailed as liberators the Russianforces that entered from the north and, later, the American forces that landed inthe south. The two wartime allies divided the country along a line their diplo-mats had previously agreed upon, the 38th Parallel of north latitude. The Unit-ed States had taken on another weighty responsibility. Until mid-1950, how-

'For a history of the Medical Department in the war against Japan, see Condon-Rall andCowdrey, The Medical Department: Medical Service in the War Against Japan, forthcoming. OnOkinawa, see Roy E. Appleman et al., Okinawa: The Last Battle, United States Army in World WarII (Washington, D.C.: Historical Division, Department of the Army, 1948).

37

ever, the true depth of the nation’s in-volvement in Korea was either littleunderstood or seldom admitted. Japanwas another matter. Here the UnitedStates had clear if grandiose aims andundertook them with a will.^

American policy aimed at trans-forming Japan into a democratic andpeaceful nation that would no longerrepresent a military threat to the Unit-ed States or to its allies in the Far East.

From the beginning, however, the de-feated nation required help and redi-rection in many spheres other than thepolitical. For medical authorities, theintimate contacts that the Occupationwould inescapably bring betweentroops and civilians meant that thehealth of the latter was of great impor-tance. Both humanitarian considera-tions and the practical need to preventunrest and promote democratic gov-ernment by demonstrating concern with health and welfare pointed in the samedirection. An occupation policy without a sound medical policy wasmeaningless.

Quickly MacArthur’s rule took a form that divided medical responsibilityinto two spheres, care of the civilian population and care of the troops. Advisinghim on medical matters and establishing medical policy for the occupying forceswas the surgeon who headed the medical staff section of the military command.As military commander in chief, MacArthur gave orders to Americans in theWestern Pacific through the military structure known during 1945-46 as Head-quarters, United States Army Forces, Pacific (USAFPAC), and, after 1 January1947, as General Headquarters, Far East Command (FEC). Two field armieswere in the region, the Sixth and the Eighth, but the disestablishment of theformer left a single major Army command in the Japanese islands. Other organi-zations subordinate to the military command were an air and a naval command,a headquarters and service group, and area commands for the Philippines,Marianas-Bonins, and Ryukyus. Parallel to the military structure was the Gen-eral Headquarters, Supreme Commander for the Allied Powers (SCAP), whoseresponsibility was to guide the Japanese government. SCAP’s medical staff unit

Brig. Gen. Crawford F. Sams{1948 photograph)

Tor background information and general interpretations of the period, see Louis J. Halle, TheCold War as History (New York: Harper & Row, 1967), pp. 1-41, 89-98, 190-201; William Craig,The Fall of Japan (New York: Penguin Books, 1979); George M. McCune, Korea Today (Cambridge,Mass.: Harvard University Press, 1950); Edwin M. Martin, The Allied Occupation of Japan (Stan-ford: Stanford University Press, 1948); Robert A. Fearey, The Occupation of Japan, Second Phase:1948-50 (New York: Macmillan, 1950); D. Clayton James, The Years of MacArthur: Triumph andDisaster, 1945-1964, vol. 3 (Boston: Houghton Mifflin, 1985), pp. 276-79.

THE MEDICS’ WAR

was the Public Health and Welfare Section, headed for six years (1945-51) byCol. Crawford F. Sams.^

Public Health and Welfare

A trim man of aggressive mien, Sams did not lack for work. Japan at war’send was an epidemiologist’s nightmare. In part, the nation’s problems were acarryover from prewar conditions. Japan was a nation with a large populationhoused on constricted islands with meager resources. Until the mid-nineteenthcentury the life of its people was medieval, rich in culture and tradition but poorin scientific knowledge. Western medicine was brought to Japan by Dutchtraders, and once the national policy of isolation had ended, a medical officer ofthe Prussian Army helped to turn Japan toward the German tradition, with itsheavy emphasis on research. As the nation moved at breakneck speed into themodern world, some Japanese researchers contributed brilliantly to the develop-ment of modern medicine. Yet despite such achievements and the strikingmodernity of parts of pre-World War II Tokyo, public health remained for themass of the people a primitive affair. Manuring with human wastes reflected thelack of alternative fertilizers and helped to spread enteric diseases. Malaria,typhus, and encephalitis were endemic. Medical practitioners were ample innumbers but, in great measure, ill-trained; bureaucratic practices that subjectedscientists to administrators ignorant of medicine stifled the public health organi-zation. Reporting of diseases was spotty, and statistics on morbidity—essentialto successful countermeasures—were not collected properly.^

A generation of war had made these conditions incomparably worse. Thedemands of the military had depleted civilian health resources. Merciless bomb-ing destroyed cities, disrupted water mains, and leveled over a thousand hospi-tals. Sams on his first walk through Yokohama saw “only ashes, literally miles ofashes interspersed with tall isolated chimneys and steel safes.”^ Hospitals thathad survived the onslaught were filthy and almost empty of patients, whom

Thomas B. Turner, “Japan and Korea,” in Civil Affairs/Military Government Public HealthActivities, Medical Department, United States Army, ed. Ebbe Curtis Hoff (Washington, D.C.:Office of the Surgeon General, Department of the Army, 1976), pp. 662, 669-71; USAFFE andEUSAR, “Logistics in the Korean Operations,” vol. 1, p. 2, Ms no. 8-5.1 A AZ, RG 319, MMHB. Oncreation of the Far East Command, see United States Army Forces, Pacific (hereinafter cited asUSAFPAC), Annual Report of Medical Department Activities, 1946, p. 2, file 319.1-2 (USAFPAC,Chief Surgeon’s Report, 1946), Box 496 (WWII Admin Rees, 1940-49), Entry 54A, RG 112,MMFB. On the mission of SCAP’s medical section, see Public Health and Welfare Section, GeneralHeadquarters, Supreme Commander for the Allied Powers (hereinafter cited as SCAP), PublicHealth and Welfare in Japan, 1948 (EEC Printing Plant, 1949), pp. 5-6, LIB. Despite the existenceon paper of a headquarters called United States Army Forces, Far East, no actual separate organiza-tion comprehending the various Army commands existed. All commands, regardless of service,reported to the Far East Command.

^Ilza Veith, “On the Mutual Indebtedness of Japanese and Western Medicine,” Bulletin of theHistory of Medicine 52 (Fall 1978): 383-409; Civil Affairs/Military Government Public HealthActivities, pp. 668-69, 673-75, 681; John Z. Bowers, When the Twain Meet: The Rise of WesternMedicine in Japan (Baltimore: Johns Hopkins University Press, 1980).

^Crawford F. Sams, “Medic,” 2 vols, 2:349, LIB. See also ibid., 2:378.

39

hospital personnel had removed fearing that the conquerors would massacrethem.

The lot of the people was grim.^ In Tokyo, Sams picked his way throughsubway tunnels where thousands of the homeless lay in fetid darkness, manydying of smallpox, typhoid, and typhus. Some seventy-eight thousand sick andwounded veterans needed care. Meanwhile, great movements of popula-tion—some 7.3 million either entered or left Japan by the end of1948—threatened the spread of disease. While the war went on, Chinese,Formosans, and Koreans entered Japan for various reasons, hundreds of thou-sands of them as forced laborers. Japanese armies and civilians expanded over-seas, and then, when peace came, their property seized and their lives endan-gered by those they had ruled, returned again to their former homes. Medicsfaced a land filled with tired, hungry and homeless people who were alreadyseeded with diseases, both homegrown and exotic.

SCAP attempted to head off trouble, issuing on 22 September a comprehen-sive directive to the Japanese government demanding surveys of hospital facili-ties and establishing a system of weekly communicable disease reports by pre-fecture. All wholesale civilian and military stocks of medical, dental, veterinary,and sanitation supplies, plus military foodstuffs, were released and distributedthrough the Japanese government wherever needed most. With Navy aid, quar-antine controls were imposed on all ports. The Army granted assistance from itsown supplies, contributing four thousand boxes of medical goods diverted fromthe Philippines in response to an urgent call from SCAP. The supreme com-mander also dispatched 12 tons of supplies to the International Red Cross reliefeffort at Hiroshima. Colonel Sams surveyed the available Japanese profession-als, finding that numbers were satisfactory—some thirty-nine thousand physi-cians plus another twenty thousand with the armed forces, waiting to be demo-bilized. However, he was to write a few months later, “my greatest handicap isnot quantity but lack of quality in the Japanese professional people. . . .”SCAP likewise searched out the available supplies of food, finding that produc-tion of meat was about 10 percent of normal and that of milk at a standstill,except on the northern island of Hokkaido. Rice and seafood, the traditionalmain reliance of the Japanese diet, were available, but in 1946 nutrition surveysshowed, according to Sams, that city dwellers “were near the danger point ofmass starvation. . . .” Caloric intake was low, at 1,034 to 1,325 calories, andthe rations issued by the government did not become entirely adequate until1949.^

‘Unless otherwise indicated, materials on public health are from General Headquarters, SupremeCommander for the Allied Powers, “History of the Nonmilitary Activities of the Occupation ofJapan, 1945 Through December 1950,” vol. 8, “Public Health, September 1945 Through December1945” (hereinafter cited as SCAP, “Occupation of Japan: Public Health”), Ms no. 8-5 AA 7 V 5, RG319, MMHB. On numbers of repatriates, see extract from Ltr, Col Crawford F. Sams, Chief, PublicHealth and Welfare Section, SCAP, to Brig Gen S. Bayne-Jones, Deputy Chief, Preventive MedicineSection, OSG, 4 May 46, HSF (Sams-1946), HRB, and SCAP, Public Health and Welfare in Japan,1948, pp. 66-68, LIB. A useful summary on public health administration is Crawford F. Sams,“American Public Health Administration Meets the Problems of the Orient in Japan,” AmericanJournal of Public Health and the Nation’s Health 42 (May 1952); 557-65.

Tirst quotation from extract of Ltr, Sams to Bayne-Jones, 4 May 46, HRB. Second quotationfrom Sams, “Medic,” 2:428, LIB. See also SCAPIN 48, Memo, Lt Col Harold Fair, Assistant

(C'ontinucd)

THE MEDICS’ WAR

Thrusting aside all other problems were epidemic outbreaks in the fall andwinter of 1945 {Table 5). In October typhus was found to be widespread inHokkaido. The disease had begun among Korean coal miners and other labor-ers. Crossing the Tsugaru Strait to the main island of Honshu as they headedtoward home, these unfortunates spread typhus through the Japanese heartland.Simultaneous outbreaks in other parts of Japan were traced to repatriates arriv-ing from mainland Asia. Osaka was especially hard-hit, and cases were reportedin many major cities, including Tokyo. Caused by organisms called rickettsiae,and carried by lice, epidemic typhus brought high fever, delirium, and prostra-tion often ending in death. The disease is classically associated with famine,overcrowding, and the aftermath of war.

All circumstances favored its spread in Japan, as the onset of winter causedlouse-infested people to huddle together for warmth. Centers of infection devel-oped wherever people mingled—in jails, detention centers, dormitories, thea-ters, orphanages, public baths. Railroad stations were foci of the disease. Here,vagrants sought shelter, living in filth. Because the cities were destroyed in largepart, the government forbade any but essential workers to return to them untilservices had been restored, and in consequence jam-packed trains carried tensof thousands seeking food and work every day. In Sams’ opinion, typhus be-came a contact disease on the trains, spreading like influenza as commutersbreathed in rickettsiae from louse feces in their neighbors’ clothes and hair.®

Essentially, Sams’ response was to combine American medical supplies andknow-how with Japanese manpower, watched over and directed as far as possi-ble by his own personnel. The United States of America Typhus Commissionprovided overall guidance. SCAP ordered the Japanese government to begin anintensive immunization program, using American-supplied vaccine, in thestricken areas. In December 50,000 pounds of DDT arrived by air from theUnited States. Military commanders in Japan, under orders from MacArthur’sheadquarters, kept supplies moving.

Drawing on his professional experience in the Panama Canal Zone and theMiddle East, Sams built up an organization targeted at vector control—that is,destruction of the insect and other carriers of disease. Americans served asprefecture public health officers. U.S. military personnel provided instructionand supervision to Japanese insect control teams. Each team had six men and

(Continued)

Adjutant General, for SCAP to Imperial Japanese Government, 22 Sep 45, sub: Public HealthMeasures, file 300.6 (SCAPINS 1-100), Box 434 (Mail and Records Branch, Operations Division,Adjutant General’s Section, SCAP, 1945-46), RG 331, MMFB; extract from General Headquarters,Supreme Commander for the Allied Powers and the Far East Command, Selected Data on theOccupation of Japan, p. 31, HSF (Occupation of Japan), HRB; extracts from General Headquarters,Supreme Commander for the Allied Powers (hereinafter cited as SCAP), Summation of Non-Military Activities in Japan, no. 1, September-October 1945, pp. 5-11, and no. 2, November 1945,p. 19, HSF (SCAP Summation, 1945-46), HRB. On the problems of getting a hospital going again,see Richard B. Berlin, “Impressions of Japanese Medicine at the End of World War II,” ScientificMonthly 64 (January 1947): 41-49.

*SCAP, “Occupation of Japan: Public Health,” p. 29, RG 319, MMHB; Ltr, Sams to Bayne-Jones, 6 May 46, HRB. On typhus, see Arthur Hurst, with the cooperation of H.W. Barber et al..Medical Diseases of War, 4th ed. (Baltimore: Williams and Wilkins, 1944), pp. 235-60; HansZinsser, Rats, Lice and History: Being a Study . . . Which . . . Deals With the Life of TyphusFever (New York: Blue Ribbon Books, 1935).

41

Table 5-Comparative Case Rates* of Major Diseases During

THE Occupation

| Disease          | 1945  | 1949  | Percent

Decrease |
|------------------|-------|-------|-------------------|
| Diphtheria       | 122.8 | 18.0  | 85.3              |
| Dysentery        | 138.0 | 29.2  | 78.8              |
| Typhoid          | 82.9  | 7.9   | 90.5              |
| Smallpox         | 2.3   | 0.2   | 91.3              |
| Typhus           | 3.5   | 0.1   | 97.1              |
| Tuberculosis'’   |       | 571.2 |                   |
| Death rate       | 280.0 | 168.8 | 39.7              |

*Per 100,000 population.

‘No data prior to 1945.

Source: Extract from General Headquarters, Supreme Commander for the Allied Powers and the Far East Command, SelectedData on the Occupation of Japan, p.31, HSF (Occupation of Japan), HRB.

proved able to oversee twenty-five urban blocks, or about 5,000 people. Demon-stration units spread to health workers exact information on what Sams wanted,while he maintained overall control through the Japanese central government.The residual killing power of DDT made the spraying of ships and railroad carsa long-term solution to a basic source of infection. The control teams alsodisinfected people; in heavily affected areas they might dust and delouse thewhole population of a city block, of several blocks, or even of an entire ward. Inall, about 17 million were dusted and 5.3 million vaccinated against typhus. Bythe end of April the disease was almost wiped out in Osaka, where 40 percent ofthe cases had occurred. In the first half of 1946, 29,939 cases were reported; inthe second, only 1,202. At no time through 1950 did the incidence of typhusexceed 1,000 cases. With every circumstance ripe for a major calamity, thedisease had been contained.’

In large measure, as Sams recognized, the victory over typhus, like theepidemic itself, reflected the conditions of postwar Japan. Knowledgeable physi-cians, working through the military government and the civilian ministry, couldimpose nationwide discipline to fight disease. “We have no comparable minis-try or cabinet [post] in America,” he wrote, “or any program as comprehensivein the United States.” For the time being, the entire Japanese nation wasamenable to the kind of health discipline that at home belonged to the armedservices alone. The work expanded steadily, drawing on the pool of educated oreducable labor in which Japan was rich. By the summer of 1947 nine thousandteams, employing 54,000 people, were at work.*®

Other epidemic outbreaks underlined the necessity for action. One was ty-phoid, always a danger when public sanitation breaks down and, like typhus, an

’SCAPINS 331 and 368, Memos, Col H. W. Allen, Assistant Adjutant General, for SCAP toImperial Japanese Government, 21 and 29 Nov 45, subs: Prevention and Control of Typhus Feverin Japan, file 300.6 (SCAPINS 301-400), Box 434 (Mail and Records Branch, Operations Division,Adjutant General’s Section, SCAP, 1945-46), RG 331, MMFB. See also extracts from Ltrs, Sams toBayne-Jones, 6 May 46, and to Lt Col Stanley J. Leland, Acting Director, Civil Public Health andNutrition Division, OSG, 21 Feb 46, HSF (Sams-1946), HRB.

'“Quoted words from extract of Ltr, Sams to Leland, 21 Feb 46, HRB. See also SCAP, PublicHealth and Welfare in Japan, 1948, p. 63, LIB. On aerial spraying versus ground control, see JosephE, Webb, Jr., “Problems of Insect Control,” United States Armed Forces Medical Journal 3 (April1952): 641-46.

THE MEDICS’ WAR

ailment favored by postwar chaos and disruption. The autumn of 1945 saw thehighest incidence on record in Japan. Urged on by SCAP, the governmentreacted with an environmental cleanup and an immunization program thatreached some 20 million people. Typhoid rates declined by a fourth in 1946 andthereafter fell precipitously to less than a tenth of the 1945 figures. In April 1946another deadly enteric complaint threatened briefly as cholera showed upamong repatriates coming by ship from southern China. Illegal entrants alsocarried the disease into Japan. Again SCAP and the Japanese Ministry of Healthand Welfare launched an inoculation program in the danger areas, reachingmore than 36 million people during the summer and fall. Improved sanitation,however, was more important than the vaccine, which did not prevent transmis-sion of the disease."

For a time, smallpox presented a more serious danger than either typhoid orcholera—in part, ironically, because the government had made a real effort toprevent the disease before the war. When its program of compulsory vaccina-tion lapsed during the conflict, a large part of the population was left in adangerous condition, protected neither by vaccine nor by natural contact withsmallpox. Historically, such virgin populations have suffered terribly from thedisease. Incidence rose throughout the war. In 1946 an epidemic flared, causing17,000 cases before increased production of vaccine and the emergency massimmunization of virtually the entire population—possibly the largest such cam-paign ever undertaken—ended the outbreak.

Far more tenacious was the slow and unspectacular killer tuberculosis. Theleading cause of death in Japan since 1934, tuberculosis gained strength fromthe malnutrition, crowding, exposure, and shortages of fuel and clothingbrought by the war. In 1945 the death rate reached an alarming 280 per 100,000population. In this case, however, the war only reinforced a long-standing per-ception that Japan—compared to her industrial counterparts—was a backwardnation. In late 1946, as soon as the more pressing dangers of the postwarepidemics abated, SCAP moved against the killer disease. The Ministry ofHealth and Welfare launched a nationwide control program. Radio, the press,and posters made tuberculosis a subject for open discussion. Nationwide testingcaused morbidity rates to soar by revealing for the first time the dimensions ofan enormous, unresolved problem. Hospitals and sanitaria expanded and bedsfor patients multiplied. In 1949 a new antibiotic, streptomycin, proved itseffectiveness in many cases. By 1950 the death rate had fallen to 146 per100,000. But despite all efforts, tuberculosis remainded the leading cause ofdeath, and more than half a million victims were undergoing treatment.

Other durable ills were closely entwined with Japanese habits and lifestyle.At the end of the war almost half the population was infested with hookworms,roundworms, or both. Dysentery, diarrhea, and gastroenteritis were likewisecommon, causing about seventeen thousand deaths every year. For obviousreasons, such ills had spread more widely during wartime. In 1945 the dysenterycase rate stood at 138 per 100,000 population compared to a prewar range of 70

"This and the following two paragraphs are based on SCAP, “Occupation of Japan; PublicHealth,” pp. 48-49, 56-6la, and app. 8, RG 319, MMHB.

43

to 105. Using Sams’ system of teams, a vigorous national cleanup began, muchof it carried out at the local and municipal levels. Positive results began toappear as early as 1946, and by 1948 the dysentery rate had fallen to about 18per 100,000. But national habits were not easily changed. Fertilizing with nightsoil continued. In 1947 the Far East Command noted that much of Tokyo wasstill served by the “honey-bucket system,” some of the night soil being shippedback to farm villages for sale. Shortage of other fertilizers made change difficult.Similarly, Japanese dietary habits baffled public health officials, for many foodswere eaten raw, or lightly cooked, and were served in a multitude of smallrestaurants and street stalls. By 1949 disease rates had begun to climb again.Improved treatment reduced fatalities, yet the mortality rate also remainedhigh, and by 1951 the number of cases was three and a half times as great as in1946. As so often happens, public health officials found it easier to halt killerepidemics than to eradicate deeply entrenched endemic ills.*^

Likewise, encephalitis fell in 1949 but rose again thereafter. Malaria re-sponded better, dropping by 1950 to about one-tenth of its 1947 rate, anddiphtheria, in the face of widespread inoculation, declined by over five-sixthsduring 1945-50.*^

Overall, the revolution in health care that SCAP had launched and theJapanese government had carried out showed impressive results. Public healthlegislation set the new policy firmly in the nation’s statute law. Japanese expen-ditures on health and sanitation rose from about 30 million yen in 1945 to 1,167million in 1950. Slower and less visible than the sanitation teams and propagan-da campaigns, but even more important in the long run was a basic reorganiza-tion of the medical and nursing professions. An American education missionaided SCAP and Japanese educators in a thoroughgoing reform of the medicalschools. The health care professions were freed from the control of governmentbureaus and reshaped into professional organizations on the American model.The status of Japanese nurses, who were looked upon as little more than ser-vants before the war, improved markedly. The professional training of nurseswas standardized, and nursing texts were translated from English. Facilities,too, bore the mark of the Occupation. SCAP abolished military hospitals, trans-ferred them to civil management, and encouraged the government to enactcompulsory standards to improve them. Japanese laboratories modernized theirproduction of biologies. Community health centers were set up throughout theislands, as health teaching and care reached out to the whole population.

Medical contributions to the success of the Occupation were substantial inpreventing unrest, in demonstrating the new regime’s practical concern for theJapanese, and not least in improving the health of the people among whom theylived. Japan by the early 1950s was not a promised land of health, but it was onits way to becoming a modern nation in health care and preventive medicine.During the period 1947-50 life expectancy increased from fifty to fifty-eight

*Jbid., pp. 38a-40, RG 319, MMHB. Quoted words from FEC, Annual Report of MedicalDepartment Activities, 1947, app. 1, p. 1, file 319.1-2 (FEC) SWPA-1947, Box 497 (WWII AdminRees, 1940-49), Entry 54A, RG 112, MMFB.

'^SCAP, “Occupation of Japan: Public Health,” pp. 35, 38, 45, RG 319, MMHB.

THE MEDICS’ WAR

years for men and from fifty-four to sixty-two years for women. General Samsleft for home in 1951 and retired in 1955, hailed by the press for ‘‘one of thegreat recent public health achievements,” which he explained as “just a matterof organization.”*''

Care of the Troops

Because armed resistance by the Japanese still seemed a possibility in August1945, large numbers of American troops entered the conquered nation in thefirst few months of peace. With them came nearly all of the field medical unitsoriginally scheduled to accompany the army of invasion. The Sixth Army sur-geon moved with the Army headquarters into Kyoto, while the Eighth Armysurgeon. Brig. Gen. George W. Rice, took up occupation duties in Yokohama.

As medics poured into Japan, they found extraordinarily varied tasks toperform. Tens of thousands of Allied prisoners and internees, many indeplorable physical shape, needed care. American troops celebrated victory inimmemorial fashion. Almost immediately they found means to visit prostitutes,and a lively venereal disease problem began to take shape. Some obtained woodalcohol from Japanese fuel dumps and used it to enhance brandy and saki;fifteen died. Two medical officers of the 1st Cavalry Division had a uniqueexperience shortly after the unit entered Tokyo in September. Former PrimeMinister Hideki Tojo attempted to kill himself, and the officers were called in tosave the aging statesman for later trial and the gallows. Meanwhile, under Brig.Gen. Guy B. Denit, Surgeon, USAFPAC, preparations had begun for a medicalstudy of the aftereffects of the atomic bombings of Hiroshima and Nagasaki.Later the Army team joined forces with Japanese scientists and with a groupsent by the Manhattan District to form the Japan-U.S. Joint Commission forthe Investigation of the Effects of the Atomic Bomb in Japan. The commission’sstudies were to lay the groundwork for all subsequent efforts to comprehend theeffects, including the medical effects, of atomic weapons.*^

‘‘‘Quoted words from “A Good Man Gone,” Newsweek, 8 Aug 55, p. 46. See also SCAP, “Occupa-tion of Japan: Public Health,” pp. 102, 134, 146, 166, RG 319, MMHB; extract from SCAP,Summation of Non-Military Activities in Japan, no. 3, December 1945, HSF (SCAP Summation,1945-46), HRB; Civil Affairs/Military Government Public Health Activities, p. 681.

'^Craig, Fall of Japan, pp. 316-21; United States Army Forces, Pacific (hereinafter cited asUSAFPAC), Report of ETMD, October 1945, pp. 19-21, file 350.05 (USA Forces, Pacific, Oct 45),Box 72 (USA Forces, Pacific, Aug-Dec 45), Entry 54B, RG 112, MMFB; Committee for theCompilation of Materials on Damage Caused by the Atomic Bombs in Hiroshima and Nagasaki,ed., Hiroshima and Nagasaki: The Physical, Medical, and Social Effects of the Atomic Bombings,trans. Eisei Ishikawa and David L. Swain (New York: Basic Books, 1981), pp. 508-09; Ashley W.Oughterson et al.. Medical Effects of Atomic Bombs: The Report of the Joint Commission for theInvestigation of the Effects of the Atomic Bomb in Japan (Oak Ridge: United States Atomic EnergyCommission, 1951); Vincent C. Jones, Manhattan: The Army and the Atomic Bomb, United StatesArmy in World War II (Washington, D.C.: U.S. Army Center of Military History, 1985), pp.543-50. See also Paul Boyer, “Physicians Confront the Apocalyse: The American Medical Profes-sion and the Threat of Nuclear War,” and Barbara Dayand and Howard Waitzkin, “The MedicalProfession and Nuclear War,” both in Journal of the American Medical Association 254 (August1985): 633-43 and 644-51, respectively. Denifs successors as FEC surgeon were Maj. Gen. JamesA. Bethea (August 1946) and Maj. Gen. Edgar Erskine Hume (July 1949).

45

Primary responsibility for thetwenty-four thousand liberated prison-ers of war (POWs) fell first to EighthArmy at Yokohama, then to the 42dGeneral Hospital in Tokyo, which be-gan treating the survivors and process-ing their records. Examination of thePOWs revealed the dismal effects ofprolonged malnutrition and abuse.

More than a third had died in captivi-ty. Treatment had varied from campto camp, but many prison-ers—because of their long periods ofincarceration (three years ormore)—were “a picture of severe star-vation, sunken eyes, high, prominentcheek bones, distended abdomens,

[and] marked atrophy of all mus-cles.”'^ Nutritional edema and beriberiwere common. Virtually all prisonershad intestinal parasites, including As-caris, Necator (hookworm), and Strongyhides. Amoebic dysentery was common.Nearly all had “chronic productive coughs,” and in camps where statistics couldbe obtained, pneumonia ranked as the chief killer, causing almost half of alldeaths. In the years following liberation, tuberculosis would continue to kill.

Yet, in the opinion of the doctors who examined the POWs, the key tounderstanding them was the fact that they were a select group, the survivors of amerciless Darwinian process that had weeded out any who lacked great tough-ness of mind, body, or will. Few psychoneurotic problems were observed, formen who had suffered severe depression or similar symptoms had died early.Army doctors emphasized the essential normality of the survivors, plus thepowerful group bonding that had enabled them to endure. “They regard them-selves as perfectly normal,” said one report, “and do not ask for nor expectpity.”*"

The primary treatment for all save those who were in extremis was food.Dieticians prepared a special ration and three meals were served daily, with nolimit on refills. Canteens and post exchanges stood open twenty-four hours aday for snacks. Vitamins were dispensed with a free hand. Appetites werestupendous. In the three weeks most former prisoners remained under medicalcare in Japan the average weight gain was 20 pounds, and 30 to 40 pounds wasnot uncommon. By the time they left the depots for home, there was little in thephysical appearance of most to suggest to the casual observer the long ordealthey had undergone.**

“USAFPAC, Report of ETMD, October 1945, pp. 106-07, RG 112, MMFB.

'Jbid., p. 108, RG 112, MMFB.

'^Blanche B. Armfield, Organization and Administration in World War II, Medical Department,

(Continued)

Brig. Gen. Guy B. Denit

THE MEDICS’ WAR

As the POWs were processed out,the job of turning an army of invasioninto an army of occupation was al-ready under way. Typical was the ex-perience of the medical personnel inMaj. Gen. Innis P. Swift’s I Corps ofthe Sixth Army. After participating inmany Pacific campaigns, the corpslanded on 25 September 1945 at Wa-kayama, Honshu, and occupied theOsaka-Kobe-Kyoto area. All its unitscame ashore with adequate medicalsupplies for thirty days—a reminderof its original combat mission. Even inthe beginning the drastic dispropor-tion between the medical needs of afighting force and an occupation forcewas evident. Preparations for evacuat-ing large numbers of casualties provedto be needless. Unit dispensaries andcorps collecting and clearing compa-nies were well able to provide care forthe common run of illness and injury. Seriously ill patients, however, werecarried offshore to Navy hospital ships or were flown from Osaka to hospitals inthe Western Pacific. Customary medical discipline, developed during the war,was maintained and adapted to the new conditions. Medics ensured that troopstook their Atabrine tablets if they were quartered in areas endemic for malaria;malaria survey and control detachments continued to operate. Preventivemedicine teams used DDT freely, especially as the corps took over JapaneseArmy barracks infested with fleas. As quickly as possible, Americans introducedthe comforts of home, nearly all of which helped to control influenza and othercomplaints: heated shower rooms, hot water for bathing, heated latrines. ByAmerican standards municipal water supplies proved to be contaminated, anddrinking water for the posts was purified by various means, reducing the risk ofenteric ills.

By early 1946 the I Corps area was heavily oversupplied with medical care,as hospitals intended to handle massive wartime casualties poured in, foundshelter, and set up shop. “At the beginning of the year,” reported the corpssurgeon, “there were no less than eighteen Medical Department units includingevacuation hospitals, portable surgical hospitals, separate, clearing and collect-ing companies plus the medical battalions of five divisions all trying to operate

Sanitary Inspector TakingWater Samples

(Continued)

United States Army (Washington, D.C.: Office of the Surgeon General, Department of the Army,1963), p. 489. Later studies did not confirm these optimistic first assessments. See Bernard M.Cohen and Maurice Z. Cooper, A Follow-up Study of World War II Prisoners of War, Veterans’Administration Medical Monograph (Washington, D.C.: Government Printing Office, 1954), pp.19-23.

47

hospitals of some sort in I Corps zone of responsibility, and in many caseslocated within two blocks of each other.”'*'

Because the health of the command was good, this array had little to treat.Rapid demobilization was desirable, as well as necessary, but brought with it thefamiliar problem of personnel turbulence. Changes in the corps’ Medical Sec-tion, reported Col. Reuel E. Hewitt at the end of 1946, were “too numerous tomention.” He himself was the fourth corps surgeon to serve during the year.Because demobilization was an individual process, governed by the point sys-tem with constantly changing criteria, neither unit coherence nor efficiencystood much of a chance. Though personnel from inactivated units were trans-ferred to active ones, by the end of the year shortages had developed in criticalspecialties. The corps went from having too many medical units to having toofew doctors, dentists, and technicians to care for the troops.^”

Throughout Japan a shrinking medical establishment faced, as its mainproblem, the multiplying contacts between soldiers and civilians. A militarypopulation in rapid flux eagerly sought out Japanese food and scenery—andprostitutes, who were among the least healthy of the nation’s citizens. Non-fraternization, a policy that failed in occupied Germany, was not attempted inJapan. American and Japanese health were interdependent, and the occupationauthorities were obliged to improve the second in order to safeguard the first.

Underlining the danger, the epidemics of the first year took their toll amongthe occupiers as well as among the civilian population. The first case of small-pox in an American serviceman occurred on 29 December 1945. By the end ofJanuary 1946 sixty-one cases, including twenty-one deaths, were recorded.Clearly, some vaccinations had not taken. While the nationwide campaign tovaccinate the Japanese was under way, a vigorous re vaccination drive amongthe military suppressed the outbreak in February. Meanwhile, a growing num-ber of Japanese civilians found work with the occupation forces, including jobsas diverse as ward attendants in the hospitals, laboratory technicians, cooks,depot clerks, bakers, stevedores, carpenters, and charwomen. As personnellosses increased, the dependence of the Americans on such workers could onlygrow. Living with their families and working on American bases, these civilianemployees carried disease from vanquished to victor.^'

Nowhere was the potential health threat more evident than in the case ofvenereal disease (VD). Americans and Japanese brought to sex a commonalityof basic impulse combined with wide divergence in cultural norms and values.Prostitution in prewar Japan was a recognized, if lowly, profession regulated by

”I Corps, Annual Report of Medical Department Activities, 1946, p. 3, file 319.1-2 (I Corps)1946, Box 565 (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB. As of 1 January 1946,the corps had become part of the Eighth Army.

^"Quoted words from ibid., p. 2, RG 112, MMFB. See also I Corps, Quarterly Reports of MedicalActivities, 1 Jul-30 Sep 45 and 1 Oct-31 Dec 45, both p. 3, file 319.1-2 (I Corps) SWPA-1945/3and 1945/4, Box 565, and Eighth United States Army (hereinafter cited as EUSA), Annual Report ofMedical Department Activities, 1946, pt. 1, pp. 10-11, file 319.1-2 (EUSA) SWPA-1946, Box 500.Both (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB.

^'EUSA, Annual Report of Medical Department Activities, 1946, pt. 1, pp. 1-6, 25-26, 38, 41,43, RG 112, MMFB. The general rule in medical units was: the larger the installation, the greater theproportion as well as the number of Japanese employed.

THE MEDICS’ WAR

the police. Poor parents sold girls to brothelkeepers, who in turn gave the girlstheir shelter and a dowry of clothing but took nine-tenths of their earnings. Debtpeonage ensnared prostitutes in a web that few could ever escape. Authoritiesattempted to control venereal disease through a system of regular medicalcheckups for women in red-light districts. Yet, because the disease was associat-ed with the prostitute class, VD cases among the respectable were concealed;physicians did not report them, and no attempt was made to trace a victim’ssexual contacts. Then came the war, and the inspection system, like other formsof public health discipline, broke down. Surveys taken in September and Octo-ber 1945 indicated that about 50 percent of prostitutes had syphilis and about75 percent had gonorrhea. In Osaka a survey by the Army showed near 100-percent incidence of one or more venereal disease. In 1946 the Japanese govern-ment reported about 129,000 cases of gonorrhea and 74,000 of syphilis nation-wide. Because virtually all the recorded victims were prostitutes, however, thetrue incidence in the general population remained unknown.^^

Young soldiers flocked to such women with the pertinacity of lemmings andin similar numbers. “Long queues of soldiers,” wrote two American correspon-dents, “four abreast, could be seen standing, waiting their turn” outside the cribsof Tokyo and Yokosuka. In a higher-class red-light district they recorded thepatter of a pimp: “‘There is the “Beautiful Flower,” Mr. Yank’ . . . ‘only seven-teen yen, Mr. Yank, and very very new’ ... ‘or “Rose Blossom” . . . manylike her, Mr. Yank, only one hundred yen. . . .’” Like some of the brothels ofNew Orleans and San Francisco in an earlier day, the establishments had names.One was “Brother and Sister House,” another “Love House,” and a mahoganysign across the doorway of one sported the simple word “Whorehouse.””

Early efforts at control through prophylactic stations and the wide distribu-tion of condoms were not effective; later decisions to put brothels off limitsapparently enjoyed little greater success. VD rates climbed steadily to a peak of150 cases per 1,000 troops per annum in October 1946—an epidemic rise. Itshould be noted, however, that conditions were worse in postwar Europe, wheresex among the ruins was no less popular than in Japan and disease controlproved to be even more difficult. The Occupation attacked the problem, asusual, from both the civilian and the military side. While US AFP AC cranked upa campaign of information and propaganda for GIs, SCAP ordered the Japanesegovernment to put venereal diseases into the same category as other communi-cable ills. In each prefecture a standard venereal disease control ordinanceprovided weekly examinations of prostitutes, bar girls, and others likely totransmit infection. Penicillin treatment for victims began. The Ministry ofHealth and Welfare set up training courses for laboratory and VD clinic person-nel. By the end of 1945 such clinics were in operation in Tokyo and Yokohama.The military adopted well-proven methods: reminding officers that VD control

“Ibid.,p. 58, RG 112, MMFB.

”Frank Raymond Kelley and Cornelius Ryan, Star-Spangled Mikado (New York: McBride,1947), pp. 150-51. See also USAFPAC, Report of ETMD, November 1945, pp. 23-24, file 350.05(USA Forces, Pacific, Nov 45), Box 72 (USA Forces, Pacific, Aug-Dec 45), Entry 54B, RG 112,MMFB.

was a command responsibility, appointing control officers, and coordinating itscampaign under the Eighth Army’s chief of preventive medicine.

But results were slow in coming. The high incidence in the general popula-tion, the influx of new troops, and the reluctance of the Japanese government toviolate established customs all worked against success. Efforts to suppress broth-els only forced prostitutes, who knew no other means to make a livelihood, intothe streets where they were even less controllable than before. Nevertheless,public awareness and military discipline both counted for something, and ratesamong GIs began to decline in November 1946, reaching 83 cases per 1,000troops per annum in July 1947, after which they rose again to 94 in December.High by comparison with the United States, low by comparison with Europe,VD rates in postwar Japan reflected the usual difficulties of dealing with deeplyentrenched endemic ills under postwar conditions. Traditional attitudes ofshame and concealment, common to both Americans and Japanese, added tothe medical burden.

Throughout the early years of the Occupation all problems were made moredifficult by the influx of raw, untrained replacements. “Readjustment” began inthe Eighth Army on 21 September 1945, when the first group of veteran soldiersmoved into the 4th Replacement Depot near Yokohama. By November thedepot was handling 25,000 men a month. On the anniversary of V-J Day inSeptember 1946 some 272,000 officers and enlisted men already were home andabout 65,000 new replacements on hand. To the possibly jaundiced eyes ofmedical officers the replacements seemed a poor lot, immature and untrained,plagued by psychoneurotic disabilities and boundlessly susceptible to disease.Doctors blamed not only the draft system but also the Army’s inability toprovide adequate training under the conditions of the time. The situation didnot improve during 1946; in the winter of that year 75 to 80 percent of thereplacements had had only four to eight weeks of training. Many had not evenexperienced the childhood diseases. Jammed into troopships to travel the Pacif-ic by a northern route during winter, they endured voyages prolonged by badweather from a normal ten to fourteen days to twenty-one days or more. Depotsin turn were overcrowded. Influenza and scarlet fever broke out. In one ship,bound ultimately for Korea, 336 cases of scarlet fever were counted among2,000 men. Dispersion of the replacements among the scattered occupationunits helped to spread shipboard infections far and wide.^®

Other worries about the health of the troops proved either groundless or ofno great importance in terms of the number of men affected. Ending suppressive

Above paragraphs are based on extracts from SCAP, Summation of Non-Military Activities inJapan, no. 1, September-October 1945, p. 11, no. 2, November 1945, p. 18, and no. 3, December1945, pp. 19-20, HRB; EUSA, Annual Report of Medical Department Activities, 1946, pt. 1, pp.30-32, RG 112, MMFB; EEC, Annual Report of Medical Department Activities, 1947, pp. 23-24,RG 112, MMFB.

^Sources of this paragraph include: I Corps, Quarterly Reports of Medical Activities, 1 Jul-30Sep 45 and 1 Oct-31 Dec 45, RG 112, MMFB; FEC, Annual Report of Medical DepartmentActivities, 1947, pp. 1-5, RG 112, MMFB; extract from Ltr, Brig Gen James A. Bethea, Surgeon,Medical Section, FEC, to The Surgeon General, USA, 26 Aug 47, sub: Outbreak of CommonRespiratory Diseases in Japan and Korea During the Winter of 1946-1947, HSF (Bethea-1947),HRB.

THE MEDICS’ WAR

malaria therapy in nonendemic areas resulted in flareups among veterans infect-ed during the Pacific war. An outbreak of poliomyelitis in the summer of 1947brought the Virus and Rickettsial Commission of the Army EpidemiologicalBoard to Japan. Fortunately, the number of cases—187—was small. For a timein 1947 rheumatic fever similarly caused concern, the disease, with its dangersto the heart, following as a consequence of the scarlet fever outbreak. Incidence,however, never rose above 0.7 cases per 1,000 troops per annum. Cholera andtyphus apparently took no toll among servicemen. The commoner enteric dis-eases were another matter. Outbreaks of dysentery occurred among the troops,and amebiasis was described in 1947 as “prevalent throughout the [Far East]Command,” while roundworm infestation was “not unusual.” Japanese food-handlers, civilian food stalls, and the near impossibility of controlling the spreadof such complaints in a land that fertilized with night soil were the probableculprits. However, the tropical posts of the command in the Philippines andGuam had a higher incidence than either Japan or Korea, and within thesenations American disease rates were enviable by local standards.^^

As the difficult years immediately following the war gave way to moreorderly and normal conditions, both in the Army and in Japan, the medicalpicture brightened accordingly. If medics were few, so were the troops; byNovember 1946, for example, the actual strength of the Eighth Army haddropped to less than 60,000 men as against its authorized strength of more than100,000. Recruits also received more extensive screening and training at home.But above all, the health of the troops improved with that of the Japanesecivilian population. The Medical Department, on the whole, could look backwith satisfaction on the combination of good management, discipline, and luckthat had brought the forces occupying Japan through the early years.

The Occupation of Korea

In Japan, sound and compassionate policy was preparing what in time ofcrisis would prove to be a secure base, if not a second homeland, for Americanforces. Across the Korea Strait, in a little-noticed sideshow, geography, greatpower rivalry, and confused American purposes helped to prepare a historictragedy.

When Americans of the 7th Infantry Division entered Korea at the port ofInchon on 8 September 1945, they encountered a people who were, even for thatturbulent time, troubled and uncertain of their future. Korea was a paradox, aland of independent and long-established culture doomed by geography to for-eign invasion and to strong, contradictory foreign influences. An incompleteland-bridge between China and Japan, Korea from early in the Christian era wasexposed to Chinese cultural influence and occasional invasions from both of itsneighbors. The nation declined during the eighteenth and most of the nine-teenth century in self-imposed isolation from the world. Soon afterward the

^TEC, Annual Report of Medical Department Activities, 1947, secs. 1, 2, and 6, RG 112,MMFB.

51

rivalries of China, Japan, and Russia engulfed it. The Japanese defeated each ofthe others in turn, deposed the Korean emperor, established a colonial regimeunder a governor-general, and annexed Korea in 1910.

In 1945 the Korean people emerged from the colonial state with their nation-alism intact, indeed probably intensified. They had little experience of govern-ment and felt a deep hatred of the Japanese, whose policies had left them acountry in which modern and medieval mingled oddly and jarringly. Complicat-ing a difficult rebirth was a new foreign intrusion. Both Americans and Rus-sians, for their own ends, proceeded to bring about the one thing that allKoreans viewed as intolerable—the division of the country into two zones withvastly different governments. The zones then evolved into two nations. In theNorth, a coherent, repressive, and well-armed Communist state rapidly tookform, drawing some of its strength from native revolutionary impulses. In theSouth, party strife, peasant uprisings, and conflict among potential leadersyielded only gradually and imperfectly to an emerging strongman, former exileDr. Syngman Rhee, and the American military that backed him.

By comparison with Japan, to say nothing of the undestroyed parts of theWestern world, Korea was an undeveloped country. In one way the nation wasmore fortunate than its former rulers, for, spared bombing, Korea was free ofextensive physical destruction. In most ways, however, its condition was worse.The political division of the country separated the industrial and agriculturalnorth from the less industrial rice-growing south, building into the latter’s econ-omy a fundamental, and for the time at least, incurable flaw. In place of anestablished national government through which to work, the Americans whooccupied southern Korea found only the police and the bureaucracy of theJapanese colonial regime. Because the higher-ranking officials, including thosewho had run the public health system, were Japanese, they were anathema to theKoreans. Korean doctors by and large were ill-trained, while practitioners offolk medicine treated patients with herbs and acupuncture. For the Americans,the task before them in Korea was at least as great as that in Japan, but themeans were less and the time—the Occupation would end in mid-1949—wasshorter.^^

American Policy and Korean Ills

Until August 1948, when the Republic of Korea was proclaimed. GeneralMacArthur in his capacity as supreme commander bore responsibility for theoccupation and government of Korea south of the 38th Parallel. The immediatetasks of establishing order fell upon the XXIV Corps, whose troops, after fight-ing in the Philippines and on Okinawa, were diverted from the planned invasionof Honshu to occupation duty in Korea instead. Lt. Gen. John R. Hodge com-manded. For a time the corps carried on military government as a staff function.

^Extract from Department of Public Health and Welfare, United States Army Military Govern-ment in Korea (hereinafter cited as USAMGIK), Historical Summation, September 1945-May

(Continued)

THE MEDICS’ WAR

Korean Civilians Welcoming U.S. Occupation Troops

but in January 1946 a new headquarters, the United States Army MilitaryGovernment in Korea, was set up.

Public health functions, however, predated the military government. On 24September 1945 a Bureau of Public Health was established to replace a police-run bureau that had existed under the Japanese. The following month thename—reflecting a wider range of services—was changed to the Department ofPublic Health and Welfare. By the end of the year the department containedabout fifty American officers, drawn from the Army and the Navy, and thirtyenlisted men. Training programs opened for Koreans, and by the end of the yeartwenty-two students had completed a six-week course in public health at SeoulUniversity. At the request of the military authorities the Rockefeller Founda-tion granted ten fellowships to Korean physicians to study public health. As atrickle of competent Koreans began to enter the program, the Americans shiftedto an advisory role. U.S. civilians from the War Department, too, arrived during1946 to help man the system. At SCAP Colonel Sams selected Col. John K.

(Continued)

1947, p. 3, HSF (USAMGIK Summation, 1945-47), HRB; James P. Pappas, “Civil Assistance tothe Republic of Korea: Public Health, 1950 Through 1954,” Professional Papers, Box 34, Group 3,Medical Historical Unit Collection, Archives, U.S. Army Military History Institute, Carlisle, Penn.A recent and detailed revisionist history of Korea in the postwar years is Bruce Cumings, TheOrigins of the Korean War: Liberation and the Emergence of Separate Regimes, 1945-1947(Princeton: Princeton University Press, 1981).

JAPAN AND KOREA AFTER V-J DAY

53

Cullen, a Medical Corps officer, to be director of public health and welfare; laterCol. William R. Willard, a Public Health Service officer then serving with theArmy, succeeded Cullen.

Meanwhile, the purely military side of the Occupation also took form. UnderCol. Laurence A. Potter, the Surgeon’s Section, XXIV Corps, opened for busi-ness at Seoul on 11 September 1945, and in the same month the Army ServiceCommand 24 (ASCOM 24) established itself nearby at a former Japanese arse-nal 8 miles from the port city of Inchon. Soon ASCOM 24 was able to providehospitalization and dispensary service to all the troops in Korea from its base,which became known as Ascom City.^*

Their first hard look at Korean conditions was not encouraging, either tocommanders or surgeons. Though South Korea was a land of temperate cli-mate—with pleasant springs and falls, oppressive summers, and severe win-ters—its disease environment was all too typical of undeveloped regions. Thelandscape was varied, mountainous in the east where the Taebaek Rangeformed the spine of the peninsula, flatter in the rice-growing west; the coastfrom Pusan to Seoul was broken, diversified with natural harbors, coves, is-lands, and headlands. The lives of most of its people were bound up with theirvillages; in the uneven landscape, each mountain, valley, and tiny plain with itsfields of rice, millet or barley had a unique appearance and character. Farremoved from the farmer’s life—by time more than by space—was the urbanworld of Seoul, where some American troops coming straight from combat dutyfound themselves quartered in spacious, modern hotels with steam heat andflush toilets.

It was, however, the medieval not the modern Korea that shaped the coun-try’s disease environment. Smallpox, cholera, and typhus were endemic, as werefilariasis and Japanese encephalitis. Tuberculosis was a common cause of death.Water supplies were usually polluted. Mosquitoes and flies abounded. Through-out Korea, shallow privies made easier the work of farmers and night soilcontractors, for here, as in Japan, human excrement was an essential fertilizer.Though spared ground fighting or heavy bombing, Korea showed everywherethe deterioration that resulted from lack of maintenance and repair duringwartime. Roads were rough, especially for ambulances; buildings, includinghospitals, were dirty and decaying; laboratories were empty of supplies, theirequipment worn out or broken; and communications everywhere were difficult.

Under these conditions the inevitable mixing of troops and civilians posedalarming possibilities. The movement of refugees—some 2.8 million either en-tered or left the country by the end of 1946, plus thousands whose movementswere unrecorded—threatened to make all medical problems worse. As in Japan,

Affairs/Military Government Public Health Activities, p. 690; USAFFE and EUSAR, “Lo-gistics in the Korean Operations,” vol. 1, pp. 1-2, RG 319, MMHB; XXIV Corps, Annual Report ofMedical Department Activities, 1946, p. 1, file 319.1-2 (XXIV Corps) 1946, Box 567 (WWIIAdmin Rees, 1940-49), Entry 54A, RG 112, MMFB; Army Service Command 24 (hereinafter citedas ASCOM 24), Quarterly Report of Medical Activities, 1 Oct-31 Dec 45, pp. 1-2, file 319.1-2(ASCOM 24) SWPA, Box 555 (WW II Admin Rees, 1940-49), Entry 54A, RG 112, MMFB; extractfrom SCAP, Summation of Non-Military Activities in Japan and Korea, no. 3, December 1945, p.202, HSF (SCAP Summation, 1945-46), HRB; extract from Ltr, Col John K. Cullen, Director,Department of Public Flealth and Welfare, to Col Crawford F. Sams, Chief, Public Health andWelfare Section, SCAP, 4 Apr 46, HSF (Cullen-1946), HRB.

THE MEDICS’ WAR

American commanders and their surgeons organized to protect the troops whileenergetically seeking to improve the health of the Korean people.^^

Outbreaks of disease soon confirmed early forebodings. Smallpox began anepidemic rise during the winter of 1945-46. Like the Japanese epidemic, itoccurred despite a prewar program of vaccination, apparently because poortechnique had left many people unprotected. The military government ordereda nationwide program aimed at vaccinating properly every person south of the38th Parallel. Three million units of vaccine were made available from Armystocks, and the disease, after reaching a peak in April 1946, fell off rapidly.Though the epidemic was contained, a nationwide effort designed to preventrecurrence got under way in October, using 18 million doses of vaccine pro-duced in the civilian National Veterinary Laboratory at Pusan, which the Kore-ans, with Army assistance, had gotten back into operation. All refugees crossingthe parallel and all Japanese repatriates were inoculated in an effort to preventthe disease from spreading. Efforts among the local population aimed first atschoolchildren, government and railroad workers, and medical personnel. As aresult, in the second winter of the Occupation only 113 cases were reported,most resulting from infection spread by a single person who had visited NorthKorea shortly before taking sick.^"

Typhus too appeared in 1945, its incidence rising into 1946 and reaching apeak in the same month as the smallpox epidemic. In all, there were about sixthousand cases during 1946 and some twelve hundred more during the earlymonths of 1947. The authorities resorted to local spraying and inoculation,finding in the isolation of much of the Korean people an obstacle both to thespread of the disease and to treatment when it did occur. During the spring andsummer of 1946 cholera also appeared. Introduced in May by repatriates fromShanghai, the disease spread along the rail lines west and north from the port ofPusan. The military government immediately clamped drastic control measureson the infected region, which by mid-June seemed to be succeeding. Then, inthe last week of June, a deluge of heavy rain washed out roads and bridges,flooded towns, and disrupted communications. Water from flooded cesspoolsand latrines seeped into the shallow wells on which rural Korea depended.Transport of medical supplies and personnel came almost to a standstill. Greatareas were grossly contaminated with the Vibrio cholerae, the waterborne organ-ism that causes the disease.

The public health and welfare system now got a thorough workout. Each ofthe nine provincial health departments set up a cholera control headquarters

^William R. Willard, “Some Problems in Public Health Administration in the U.S. ArmyMilitary Government in Korea,” The Yale Journal of Biology and Medicine 19 (March 1947):661-70; Takashi Senoo and R. D. Lincicome, “Incidence and Distribution of Malayan Filariasis inSouthern Korea,” Professional Papers, Box 65, Group 2, Medical Historical Unit Collection,Archives, U.S. Army Military History Institute, Carlisle, Penn.; XXIV Corps, Annual Report ofMedical Department Activities, 1947, pp. 2, 11-12, 13-14, 15, file 319.1-2 (XXIV Corps) 1947,Box 567 (WW II Admin Rees, 1940-49), Entry 54A, RG 112, MMFB; Surgeon’s Circular Letter 5,no. 12, Medical Section, FEC, 1 Dec 50, file 300.5 (Circular Letters) FEC, HRB.

“Extract from USAMGIK, Historical Summation, September 1945-May 1947, p. 4, HRB;extract from Commander in Chief, USAFPAC, Summation of United States Army Military Govern-ment Activities in Korea, no. 7, April 1946, p. 32, HSF (USAFPAC Summation-1946), HRB.

Smallpox Ward in the Seoul Communicable Disease Hospital

and sent out case finding teams, for the problem was not only to treat but also tofind the sick. Provincial and community health departments manned by Ameri-cans and Koreans swung into action. Mobile teams set up quarantine barriersand carried out mass inoculations. Houses, neighborhoods, and in some casesentire communities were sprayed with DDT in the belief that transmission byflies might occur. Korean laboratories turned out cholera vaccine. Supply pointswere set up by the military and the provincial authorities to provide safe water.The military government pressed radio, newspapers, posters, community orga-nizations, and itinerant speakers into a massive nationwide information cam-paign. Yet the nature of Korea, the inability of many of its doctors to reportaccurately on disease, the lack of adequate laboratories for analysis, and all theproblems of transport and supply worked against the effort. Incidence declinedmonth by month after the July resurgence, but the disease did not disappearuntil late November. About sixteen thousand cases had occurred, with thenumber of fatalities totaling between eight thousand and ten thousand.

The black death also appeared to threaten. A natural reservoir of the diseasewhich had devastated the civilized world for three centuries existed among thewild rodents of Manchuria. During the period of disorder that stretched fromthe Opium Wars of the nineteenth century to the Japanese invasion and Com-munist-Kuomintang civil war of the twentieth, bubonic plague had broken outfrequently in China. On 26 March 1946 a Korean nurse who vaccinated refugees

JAPAN AND KOREA AFTER V-J DAY

THE MEDICS’ WAR

crossing the 38th Parallel from North Korea and Manchuria died of a diseasethat was diagnosed as the plague. Less than three weeks later a five-year-old girlalso perished. Though laboratory identification was not completely convincing,the military government sensibly treated the diagnosis as confirmed. Militarypersonnel throughout Korea received plague shots, as did civilians inChunchon, northeast of Seoul, where the two cases had been reported. Refugeeswere dusted, immunized, and held at the border for a ten-day quarantine.Examination of rats and mice trapped in the area yielded curious and interest-ing results. Plague is a disease of rodents transmitted to humans by fleas. Theanimals tested had few fleas, possibly because of the DDT, but there were notmany of the rodents themselves. Seriously infested with liver tapeworms, thelocal rats and mice were few in number and so were less available to serve ascarriers of plague.^^

The Army’s veterinary officers also had epidemics to contend with. During1946 rinderpest, a viral disease of cattle that causes fever and diphtheria-likesymptoms, broke out in the Russian zone. Veterinarians obtained laboratoryanimals, began to produce vaccine, and inoculated cattle throughout a zone 15miles wide south of the 38th Parallel. Maintenance of the immune zone effec-tively barred the further advance of the disease. A similar epidemic outbreak indomestic fowl was brought under control by immunizing poultry flocks.^^

Little could be done against the endemic diseases. Studies had shown Kore-ans to be all but universally infected with parasitic worms and protozoa, in-cluding Entamoeba histolytica, the cause of amoebic dysentery. So common wassuch infestation that Koreans appeared to have adapted to it; cases of clinicalsymptoms resulting from the infestations were rather rare, even among peoplecarrying Entamoeba, though tests showed these protozoa to be “pathogenic forcats.” A threatening problem was the commonness of malaria. Caused by Plas-modia, parasitic protozoa that attack the liver and red blood cells, the diseasewas considerably more common than in Japan. Incidence appeared to be risingin the early years of the Occupation. An indeterminate number of cases oc-curred among civilians, guesses ranging from ten thousand to one hundredthousand a year. Surveys among schoolchildren showed that from 1.3 to 8percent were infected, varying from school to school. About sixteen hundredJapanese soldiers were known to have come down with the disease in early1945. Though widespread use of DDT reduced the number of vectors, novictory could be claimed. Most Korean houses were unscreened, antimalarialdrugs were in short supply, the large reservoir of infected people remained, andthe rural, geographically fragmented nature of the country ensured that suppres-sion of the disease would be as difficult as possible.^^

Above paragraphs are based on XXIV Corps, Annual Report of Medical Department Activities,1946, pp. 22-31; USAFPAC, Report of ETMD, November 1945, pp. 13-18. Both in RG 112,MMFB.

^^Extract from Commander in Chief, USAFPAC, Summation of United States Army MilitaryGovernment Activities in Korea, no. 6, March 1946, p. 20, HSF (USAFPAC Summation-1946),HRB.

”XXIV Corps, Annual Report of Medical Department Activities, 1946, p. 27, RG 112, MMFB.

57

American Nurse Instructing Korean Nurses on how to make a hospitalbed properly

Even greater problems beset the effort to control tuberculosis. The Armyestablished a modern sanatorium in a remodeled Japanese hospital, and theDepartment of Public Health and Welfare established a Korean Anti-Tuberculo-sis Association. The organization was active for a short time, but, due to a lackof supplies, it later had to discontinue its work. X-ray equipment was notavailable. Indications were that the disease, as in Japan, was a serious andgeneral health problem. Yet after two years of occupation there was no function-ing tuberculosis section in the Department of Public Health and Welfare.

By and large, the Army conducted a holding operation. The Korean occupa-tion was hasty and ill-prepared, with few Americans realizing the “magnitude,complexity, or technical nature of military government until too late.”^"* Plungedinto an exotic disease environment with inadequate resources. Army doctorsresponded under the direct pressure of epidemic outbreaks and in the face ofalmost heartbreaking difficulties.

Army supplies and war surplus were used generously to aid the Koreanpeople. In 1946 some 360 prepacked medical units arrived, each containingenough supplies to treat ten thousand people for thirty days. Included in theunits were 18,000 bottles of sulfathiazole and sulfadiazine which were distribut-

^Willard, “Some Problems in Public Health Administration,” p. 670.

THE MEDICS’ WAR

ed to the provinces. In January 1947 eighty-seven carloads of surplus medicalsupplies arrived in Korea. Fifty-three carloads of Army rations went to publichospitals and clinics that same year. No less important—indeed, far more im-portant in the long run—were the Army’s contributions of skill. The aim wasnot merely to help Koreans, but to help them to help themselves. Under Ameri-can guidance their laboratories made advances in a variety of sophisticatedtechniques, producing biologies, and making studies in nutrition, toxicology,biochemistry, sanitation, and drug analysis. Efforts to train, upgrade, and im-prove the health care professions included work by American nurses to lift boththe standards and the status of Korean women in what had been, with fewexceptions, an ill-trained and lowly occupation. A National Board of Licensureand Registration was set up to improve the standards of physicians, and anotherfor dentists.

Yet the fact remained that in Korea fewer Americans than in Japan, under asubordinate headquarters, had to do a job of great complexity in less time thantheir colleagues across the Korea Strait. Though the population was less thanhalf that of Japan, its primitive lifestyle and long history of exclusion and abusemade it difficult to enlighten quickly. Recurring political upheavels and revolu-tionary violence placed further obstacles in the way of progress. In mid-1947 themilitary governor reported that “it is doubtful if any project to educate thepublic regarding public health has been successful except to a very limiteddegree.” The permanent upgrading of Korean health care could only be a longprocess, and Korea did not, in this respect or any other, stand high on the list ofAmerican national priorities.^^

Americans in Korea

Typical of the experiences of the American troops who occupied Korea werethose of the 7th Infantry Division. The tide of battle during World War II hadcarried the Hourglass Division from the Golden Gate to the Aleutian fighting;thence, via Hawaii to battle again at Eniwetok, Kwajalein, Leyte, and Okinawa.Poised for the invasion of Japan, the division was instead diverted to Korea,where its advance party landed on 8 September 1945. Initially, its mission, likethat of other elements of the XXIV Corps, was simply to disarm and repatriatethe Japanese occupiers. Instead, for almost four years it performed occupationduties in a poor, remote, and turbulent nation. During that time the 38thParallel turned from a formal demarcation line to an armed border, and rela-tions with the Russians in the North passed from correct to frosty. In conse-quence, the duties of the regiments rotating in outpost duty along the parallel

^^Quoted words from extract of USAMGIK, Historical Summation, September 1945-May 1947,p. 7, HRB. See also ibid., pp. 10-11, 18, HRB; United States Army Military Government in Korea(hereinafter cited as USAMGIK), Annual Report of Medical Department Activities, 1946, pp. 1-3,file 319.1-2 (USAMGIK) SWPA-1946, Box 498 (WW II Admin Rees, 1940-49), Entry 54A, RG112, MMFB; extract from SCAB, Summation of Non-Military Activities in Japan and Korea, no. 4,January 1946, p. 293, HSF (SCAB Summation, 1945-46), HRB; “Nursing Affairs in Military Gov-ernment,” Bulletin of the U.S. Army Medical Department 5 (June 1946); 643-44.

59

shifted gradually from peaceful bivouac to a condition resembling war. Over-looking the crowded valleys and barren, largely treeless hills through which oneof the world’s most arbitrary boundaries ran for 150 miles from the Yellow Seato the Sea of Japan, the men of the 7th came to lead a rigorous, vigilant life thatwas not without danger. Snipers shot at patrols, and lone soldiers were kid-napped on occasion when the North Koreans wished to provoke a borderincident.

Health problems during the first winter were largely confined to widespreadrespiratory complaints as troops who had been fighting in the tropics encoun-tered the Korean winter. By mid-December rivers were frozen to a depth of 1 to2 feet, and snowfalls of an inch or more occurred once or twice a week. Thesoldiers shivered in makeshift quarters with inadequate heat. An engineer con-struction program and the influx of supplies and materiel gradually met theproblem of housing, though medical officers admitted that they, and no doubtthe men they cared for, saw the arrival of spring with relief During the year thatfollowed, the pressures of the new environment became less important andthose of contacts with the civilian population relatively more so.

Meanwhile, the medical system experienced upheavals of its own. The earlyorganization under ASCOM 24 gave way in early 1946 to a new arrangement, asthe service command underwent reorganization into Korea Base Command(KBC). Simultaneously, much of the responsibility for medical and hospitalunits passed to XXIV Corps headquarters, as the 80th Medical Group shiftedfrom ASCOM to become the corps’ medical operating agency. The early excessof medical units intended to support an invasion gave way, as it had in Japan,before the pressures of demobilization. By early 1947 the vast majority of troopsin Korea received dispensary care from their unit medical personnel, while themedical group provided higher-echelon care through five station hospitals, onegeneral hospital, and a dental prosthetic detachment. Transport was the respon-sibility of a motor ambulance company. Medical supplies were received, stored,and issued by the 9th Medical Depot Company attached to the Korea BaseCommand and located in Ascom City. The XXIV Corps surgeon coordinatedand supervised all medical activities for American personnel stationed in Korea,and advised the commander. General Hodge, on all medical questions, in-cluding civilian health as it affected the command.

Within this simple structure, turbulence rather than clarity was the rule.Personnel instability was no less troublesome in Korea than it was elsewhere.Medical units shared fully in the problems caused by shifting criteria for dis-charge, the difficulty of retaining experienced people, and the entry of untrainedreplacements. Retraining was essential if new men whose skills were limited tothose acquired in infantry basic were to replace veteran technicians. Yet thosewho might have trained them also were departing in wholesale batches. Amongofficer personnel, too, make-do became the rule, as nurses took over for lostadministrative officers, young doctors filled in for specialists, and line officerswere temporarily called in to fill medical command slots. Though by March1947 efforts at manpower conservation had reduced the XXIV Corps’ bedstrength by one thousand, as well as Korea’s total medical personnel needs by 35percent, the turnover continued distressingly high. Virtually a complete change

THE MEDICS’ WAR

of nurses occurred in June 1946, due not only to demobilization but also to anEEC rotation policy which was designed to make service in the command lessunattractive to women. Both officer and enlisted replacements generally failedto keep pace with losses. As a result, Koreans by the hundreds were brought intothe hospitals, depots, and motor pools; by the end of 1947, about twelve hun-dred were employed by the medical units.^^

As in Japan, this influx helped to underline what military authorities alreadyhad realized—that permanent separation of soldier and civilian was impossible.The influence of the civilian disease environment was forcefully demonstratedearly in the Occupation when forty-four Americans caught smallpox during theepidemic of 1945-46 and eighteen died, compelling the emergency revaccina-tion of all military personnel. On the other hand. Army health care was perva-sive, discipline strong, and life within the cantonments followed Americannorms. Thus in the first months typhoid was absent as far as the troops wereconcerned; only two cases of typhus occurred, both mild. Though malaria brokeout with the discontinuance of suppressive therapy, doctors comforted them-selves with the belief, which may have been correct, that these cases wereacquired during service in the Pacific war.^^

Off base, the problems that confronted the corps surgeon were less easilymet. Food and drink were evident causes of concern under Korean conditions.Colonel Potter ordered strict inspections of restaurants and put off limits anywhich did not meet minimum standards. As a result, during the last months of1945 there were in all Korea only sixty establishments open to the troops. Barswere put off limits after nineteen cases of wood alcohol poisoning brought localliquor brands to the attention of Army inspectors. “About twenty-five (25)brands were examined,” the surgeon reported, “and no safe liquor was found [;]some contained as high as fifty percent (50%) methyl alcohol. . . Bottledbeer was, for the time being, the drink of law-abiding GIs.

Rigorous inspection of all civilian facilities combined with immunization ofthe troops against the prevalent diseases became the watchword of the com-mand. Municipal water systems were checked out, and the water, especiallyafter the cholera outbreak, heavily chlorinated. Throughout the Army, veteri-nary officers, their traditional function lost to mechanization, already hadturned to food inspection as their primary duty. Their work became exception-ally important in Korea. Attached to ASCOM 24, and later to the Korea BaseCommand, three veterinary food inspection detachments operated at Seoul,Inchon, and Pusan, and inspected all the food that was received, stored, andissued at the quartermaster depots in those cities. They also aided Koreans in

“Above paragraphs are based on ASCOM 24, Quarterly Report of Medical Activities, 1 Jan-31Mar 46, pp. 1-8, file 319.1-2 (ASCOM 24) SWPA, Box 555 (WW II Admin Rees, 1940-49), Entry54A; USAFPAC, Report of ETMD, May 1946, file 350.05 (USA Forces, Pacific, May 46), Box 73(USA Forces, Pacific, Jan-Oct 46), Entry 54B; XXIV Corps, Annual Report of Medical DepartmentActivities, 1947, pp. 1-6, 17-19, 24-26. All in RG 112, MMFB.

^’ASCOM 24, Quarterly Report of Medical Activities, 1 Oct-31 Dec 45, pp. 11-16, RG 112,MMFB.

“XXIV Corps, Quarterly Report of Medical Activities, 1 Oct-31 Dec 45, p. 4, file 319.1-2(XXIV Corps) SWPA-1945/4, Box 567 (WWII Admin Rees, 1940-49), Entry 54A, RG 112,MMFB.

61

the care of their animals, for the departure of the Japanese left only thirtygraduate veterinarians south of the 38th Parallel. The veterinary officers appearto have been very busy men.^’

Sex, like food and drink, brought soldiers and civilians together. During1946 the incidence of venereal disease rose steadily, reaching levels comparableto those for Japan, and then went even higher. Military authorities put off limitsthe brothels that had flourished under the Japanese. Some houses were appar-ently broken up, dispersing the prostitutes and making control more difficult.Most prostitutes had one or more forms of venereal disease; syphilis ran about75 percent, by one study, and gonorrhea about 85 percent. Despite efforts thatincluded indoctrination, sermons, establishment of prophylactic stations, andissuing condoms, the resulting disease rate among American troops rose from 22to 102 cases per 1,000 during 1946, and by mid-1948 stood at 185. Armydoctors recognized that the dreary conditions of Korea, the lack of recreation,and the fact that respectable women were allowed little contact with soldiers,contributed to the situation. The KBC surgeon, toward the end of the Occupa-tion, declared that the anti-VD program had “failed because [the authorities]offered nothing better.” This may have been overly harsh; 1946 levels approxi-mated those of Japan, while the higher 1948 level reflected the loss of militarycontrol over prostitutes following the establishment of the new Korean govern-ment. In any case, under Korean conditions little could have been offered theyoung soldier, in the absence of military brothels, which he would have consid-ered better."*"

Other endemic diseases showed similar patterns. While there were noepidemics among the American troops in 1946, save for the smallpox outbreakthat overlapped from the previous year, indications were that they might beacquiring the more tenacious of the local diseases. Intestinal parasites showedup in the soldiers, the number in a given individual directly proportional to thetime spent in Korea. Amoebic dysentery occurred sporadically. Infectious hepa-titis, a disease of which little was known, first appeared during 1945 and afflict-ed about 250 men in the following year. Malaria rates soared; the illness spreadby a native vector breeding in the rice paddies and irrigation ditches. Yet localconditions were not the only cause of illness. Respiratory diseases followed aseasonal pattern not confined to Korea, and in 1947 a serious epidemic ofscarlet fever was simply the local version of the outbreak then occurring inJapan."**

Yet, though the problems of Korea were many, American troops were at notime seriously incapacitated by disease. Psychiatric problems were commonamong new arrivals, whose state of mind was influenced in part by Korean

'’Ibid., pp. 43-44, RG 112, MMFB.

‘“’Quoted words from Korea Base Command, Annual Report of Medical Department Activities,1948, pp. 6-7, file 319.1-2 (Korea Base Command) SWPA-1948, Box 557 (WWII Admin Rees,1940-49), Entry 54A, RG 112, MMFB. See also extract from USAMGIK, Historical Summation,September 1945-May 1947, p. 7, HRB; XXIV Corps, Annual Report of Medical DepartmentActivities, 1946, RG 112, MMFB; FEC, Annual Report of Medical Department Activities, 1948, p.16, file 319.1-2 (FEC) 1948, Box 498 (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB.

“"XXIV Corps, Annual Reports of Medical Department Activities, 1946, pp. 18-22, and 1947,pp. 10-11, 18-19, RG 112, MMFB.

THE MEDICS’ WAR

conditions and, in no small measure, by their own immaturity. The first winterfound even veterans suffering from such symptoms, at a time when life in Koreafor everyone was singularly bleak. The improvement in living conditions, andperhaps a more rigorous training schedule, later reduced the problem to levelsthat were not considered serious. Even during the epidemic year of 1946 thehealth of the troops was surprisingly good, and conditions improved as theOccupation matured. Though Americans stationed there suffered from illsthey would not have encountered at home, Korea as a duty station was not apesthouse.

The last full year of the Occupation, 1948, found the country in turmoil overthe first elections in Korea’s history. Medical conditions, however, showedmany similarities to those of the previous years. The employment of Koreancivilians increased. On the one hand, this meant improved care for some Armyhospital patients as graduate Korean nurses entered the hospitals to fill vacantpositions and as regular training programs for Korean orderlies brought more,and increasingly skilled, assistants into the wards. But the diseases of the popu-lation at large entered the kitchens, houses, mess halls, offices and hospitals ofthe Army. The system of regular physical examinations for employees and abattery of tests—rectal smears, stool samples, fluoroscopy, blood tests, and soforth—apparently had limited utility. Thousands of people were, in effect, trav-eling back and forth from a medieval to a twentieth-century environment twicea day. Food-handlers may have been the source of the hepatitis that continuedto alarm medical personnel. If so. Western science, which could not yet identifythe virus that caused it, had no way to detect the fact. Diarrheal diseases as wellcontinued to flare from time to time."*^

By this time, the brief American occupation was drawing to an end. One byone, beginning with the 89th Station Hospital, units were reduced by transfersto the status of paper organizations, or simply were shipped home. On 15August 1948, in impressive ceremonies. General MacArthur hailed the birth ofthe Republic of Korea and the presidency of Syngman Rhee. In June 1949 thelast troops sailed for Hawaii. On 1 July the United States Military AdvisoryGroup to the Republic of Korea (KMAG) came into existence. A part of theAmerican Mission in Korea headed by Ambassador John J. Muccio, KMAGremained to counsel and assist the fledgling state on military matters. A medicalsection of one doctor, a dentist, six enlisted men, and a nurse stayed to care forKMAG personnel and their dependents, most living in Seoul at Camp Sobinggo.Because the ambassador as head of the mission did not report to GeneralMacArthur, all EEC responsibilities for events in Korea ceased, except forlogistical support that ended at the waterline.'*^

■'^USAMGIK, Annual Report of Medical Department Activities, 1947, p. 2, file 319.1-2(USAMGIK) SWPA-1947, Box 498; United States Army Forces in Korea, Annual Report ofMedical Department Activities, 1948, file 319.1-2 (USAFIK) 1948 in XXIV Corps folder. Box 567.Both (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB.

'‘^Robert K. Sawyer, Military Advisors in Korea: KMAG in Peace and War, Army HistoricalSeries, ed. Walter G. Hermes (Washington, D.C.: Office of the Chief of Military History, Depart-ment of the Army, 1962), p.53; 8086th Army Unit, Military History Detachment, “Evacuation ofRefugees and Civilians from Seoul, June 1950 and December 1950 to January 1951,” Ms no.8-5.1 A AT, RG319, MMHB.

63

The results of the Occupation seemed at the time to be of little but localimportance. A South Korean state had emerged, its future clouded by a rivalgovernment, but its fate by no means predetermined. American forces by andlarge had endured well an assignment that few cherished. The medics had aflawed but respectable record, for they had struggled against great odds to leavethe health of the troops generally good and that of the Korean people improved.At no time had they possessed the means of bringing about revolutionarychanges in health care. But they were instrumental in spearheading the pro-grams that contained the epidemics and raised the professional standards ofKorean doctors and nurses.

To thoughtful Americans the future of the Koreans seemed problematic.Maj. Gen. William F. Dean had served as military governor from 1 October1947 to the proclamation of independence, and thereafter as commander of the7th Infantry Division. Leaving his command to join the staff of the EighthArmy—he shortly would secure a new post as commander of the 24th InfantryDivision occupying southern Japan—he felt that he would never return toKorea, and he had no desire to do so. The “short Korean chapter in my life,” helater would write, “was definitely over. ... I certainly was not lonesome for thevariable climate of that appendix of northeastern Asia.”"^ In all probability,most of those who served in Korea would have echoed these sentiments.

Japan Under the Later Occupation

Meanwhile, many Americans were finding life in occupied Japan more thansatisfactory. “‘Jim and Julie both look fine,’” wrote a medical officer’s wife fromthe Far East to the wife of an OSG officer, about mutual friends. “‘She is likinglife in Tokyo and he is having a most interesting time as a public health officer.He travels around quite a bit soliciting and apparently getting cooperation fromthe local officials in various towns, and meanwhile picking up some amazinglore on oriental medicine. . . .’” Julie “‘bought Randy, who was three last week,a darling two-piece linen suit for which she had paid fifty-two cents.'*^^ Like theircomrades. Medical Department personnel “obtained, for reasonable prices,rugs, silverware, china, and cloisonne, damascene, and lacquer articles producedin Japan or China.

After July 1949 the Medical Section, Far East Command, had a new chiefsurgeon, Maj. Gen. Edgar Erskine Hume. A controversial figure, Hume was adoctor of good education and wide experience. He was also a cultivated manwith a long bibliography of clinical, scholarly, and military writings, and anofficer of distinguished attainments in both World Wars, most recently in thefield of military government. His communications to the surgeon general re-vealed a broad knowledge of the command as well as a talent for suave flatteryof his superior.

'“William F. Dean, General Dean’s Story (New York: Viking Press, 1954), pp. 12-13.

‘‘Tirst quotation as related in Paul I. Robinson, “About the Medical Department,” Bulletin of theU.S. Army Medical Department 9 (December 1949): 981. Second quotation from ibid., “About theArmy Medical Department,” United States Armed Forces MedicalJournal 1 (May 1950): 603.

THE MEDICS’ WAR

Yet Hume’s service in the Far East was marked by an obsessive pursuit ofnot only objets d’art for his personal collection but also awards and medals,whether significant or not. Voicing an opinion that was widespread in thecommand, Col. Chauncey E. Dovell, the Eighth Army surgeon, said flatly,“General Hume was primarily interested in souvenir hunting. He seemed tocollect the damndest stuff.” Hume’s love of medals inspired even more scornfrom Dovell, who remembered

going to Tokyo to see him decorated by the Nationalist Chinese. They gave him theOrder of the Pink Elephant, or some similarly sounding decoration. It hung down infront of him like a Hottentot’s apron. I almost fell out of my chair laughing when I saw itfor the first time. And do you know, he wrote the award himself I could tell by the waythe citation was phrased that he had actually written it himself

“General Hume’s avidity for decorations,” Dovell concluded, “took some ex-treme forms.

Whether Hume provided more than formal guidance to his capable staff isunclear. Prominent among the staff officers were Hume’s deputy. Col. RichardH. Eckhardt, a physician, and his executive officer. Col. Robert E. Selwyn of theMedical Service Corps, both of whom would serve throughout 1950. The chiefsof the Medical Section’s major divisions—administrative, plans and operations,personnel, and supply and fiscal—were able administrators. Col. Harold G. Otthad responsibility for the dental health of the command. The consultants divi-sion was important not only in maintaining professional quality but also inplacing specialists in the most effective slots. Col. Oral B. Bolibaugh, the ortho-pedic consultant from early September 1949, headed the division.^^

Guided by these men, and with an able Eighth Army surgeon in ColonelDovell, the occupation forces reaped the benefits of the earlier years. Publichealth in Japan now approximated that of the United States in many respects.Mild epidemic outbreaks—of polio, encephalitis, and childhood diseases—didoccur. Troops on bivouac near Mount Fuji in the fall of 1948 suffered twenty-five confirmed cases of scrub typhus, a mite-bome disease known in Japan astsutsugamushi fever, but no deaths resulted. The most common illnesses, possi-bly related to irritation caused by Japanese heating arrangements, were respira-tory infections. Psychoneurotic problems tended to increase, despite or perhapsbecause of the lack of great external stress. The typical patient, if in uniform,was a newly arrived recruit, eighteen or nineteen years old, and away from homefor the first time. Other patients were Department of the Army civilians, anumber of whom were chronic alcoholics.'^

“^Interv, Samuel Milner with Col Chauncey E. Dovell, MC (hereinafter cited as Dovell Interv), 21Sep 66, p. 17, Personal Interviews file (Dovell), HRB.

""FEC, Annual Report of Medical Service Activities, 1950, pp. 1-21, file 319.1-2 (EEC) FarEast-1950, HRB.

"FEC, Annual Report of Medical Department Activities, 1948, pp. 19-20, RG 112, MMFB;Headquarters and Service Group, FEC, Annual Report of Medical Department Activities, 1948, pp.9-10, file 319.1-2 (Headquarters and Service Group, FEC) SWPA-1948, Box 497 (WWII AdminRees, 1940-49), Entry 54A, RG 112, MMFB.

65

Food and sex continued to cause some problems. Americans learned to enjoyJapanese food and found the street stalls and tiny restaurants as interesting asthe Japanese. The “continued and seemingly willful violation” of orders placingmost of the local food sources off limits resulted in enteric complaints thatburdened the medical facilities of the Army. SCAP reaffirmed the ban, butenforcement remained an elusive goal at best. Those other irrepressible vendors,the prostitutes and their pimps, continued to find a market for their wares aswell, even though large sections of Japanese communities were put off limits,some brothels were boarded up, and stringent laws against selling sex whileinfected were passed. The main source of disease shifted to the streets, whereprivateering professionals or simple pickups were the main danger. Contacttracing of such women proved nearly impossible, and a note of resignation creptinto some military reports on the venereal disease problem.'”

A variety of reasons—the fact that Japan was an island nation, difficulties oftransport, care of dependents—ensured a continuing excess of hospitals and bedstrength. The abundance of facilities interacted with the shortage of personnel.The Far East Command justified its many hospitals by the lack of personnel,which restricted unit and dispensary service; on the other hand, the hospitalstended to absorb what personnel were available. The fact that medical officersserved in hospitals, rarely in the field, fitted in well with the professionalizationdrive orchestrated by the surgeon general. Yet the result was to make youngerofficers less capable of meeting their initial tests in field situations.^*

Hospital service had evolved from a war- to peacetime footing in Japan. Theshift from field units to fewer, larger, and more permanent facilities burdenedwith all the gadgetry of a zone-of-interior hospital was not always smooth.Problems in paperwork and mess management were blamed on the inexperienceof Army administrators in running such complex establishments. As inspectionsand experience solved these difficulties, the early policy of holding patientswhose anticipated hospital stay was reckoned at 60 days or less gave way to a120-day policy, meaning that only the most serious and intractable cases wereevacuated to the United States. American forces at first used mainly JapaneseArmy facilities, but later a building program supplemented the extensive reno-vation work that was necessary to bring buildings into line with Americanpractices and needs. Patients were transported to the fixed or cantonment-typebuildings by train or ambulance and, from remote areas, by air.^*

Ironically, in view of their complaints about cutbacks at home, the surgeongeneral and his staff soon began to press for reductions in the number of FEChospitals, transmitting the pressure that they were receiving from Secretary of

**Quoted words from FEC, Annual Report of Medical Department Activities, 1948, pp. 35-36,RG 112, MMFB. See also ibid., 1950, p. 63, HRB; 1st Cavalry Division, Annual Report of MedicalDepartment Activities, 1948, pp. 3-5, file 319.1-2 (1st Cavalry Div), Box 575 (WWII Admin Rees,1940-49), Entry 54A, RG 112, MMFB.

“Japan Logistical Command (hereinafter cited as JLCOM), Annual Report of Medical ServiceActivities, 1950, p. 8, file 319.1-2 (JLCOM) Far East-1950, HRB.

*‘EUSA, Annual Report of Medical Department Activities, 1948, p. 65, file 319.1-2 (EUSA)1948, Box 501 (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB; FEC, Annual Report ofMedical Department Activities, 1947, sec. 5, RG 112, MMFB; USAFPAC, Annual Report ofMedical Department Activities, 1946, pp. 8-11, RG 112, MMFB.

THE MEDICS’ WAR

Defense Louis Johnson. Early in 1950 Deputy Surgeon General Armstrong andthe chiefs of the OSG’s Hospital and Personnel Divisions visited almost everyhospital in Japan. The inspectors found “too many hospitals, too many beds andtoo many people.” Armstrong declared that “the Medical Service in Japan isfine; they are not short of doctors. . . . The hospital buildings in Japan aremuch better than we have over here.” The surgeon general therefore set aboutdoing the same thing for which Johnson would soon be sharply criticized in theUnited States: reducing the number of hospitals on the eve of war. “They haveroughly 14 hospitals in Japan,” said Armstrong. “In the Osaka area there arethree, recommend one. In Tokyo three, recommend one.”^^

Colonel Dovell protested that the cutbacks were excessive because the occu-pation forces were scattered, and the roads poor for purposes of evacuation.Nevertheless, the Far East Command approved a plan to abolish one stationhospital, to close the Tokyo Army Hospital Annex, and to reduce four stationhospitals to dispensaries. However, action on the plan did not get very far. “Itwas one of those orders,” said Dovell, “that we could not carry out right on theminute anyway, so we kind of dragged our feet.” In midyear the thirteen hospi-tals operating in Japan had a maximum bed capacity of about fifty-four hundredand an average bed occupancy of sixteen hundred.^^

In many ways the personnel situation mirrored that of the hospitals. Unitscomplained of an ever-increasing shortage of Medical Department personnel inalmost all categories. Enlisted replacements were untrained, and a variety ofschools—the Technicians School at Osaka and the Dental Laboratory Techni-cians School and the Technical Equipment and Maintenance School at Yokoha-ma—sprang up to turn recruits into specialists. Young ASTPs and recent dentalgraduates needed further instruction, and the Far East Command made haste tobring its own version of a postgraduate training program to the Army’s hospitalsin Japan.

Worse times, however, were coming. The ASTPs proved to be a godsend innumbers, if not in training, but the last large shipment arrived in September1948. At the same time, strength in the other corps was often more difficult tomaintain than in the Medical. The end of the Korean occupation temporarilybrought a welcome influx of personnel, including many doctors, to Japan. Theyear 1949, however, promised a large and mounting deficit in doctors {Table 6),particularly among qualified specialists and in experienced senior officers. Thispressure caused the command to shift the work load by reducing elective sur-gery, evacuating serious cases immediately (though the 120-day policy was notchanged), and urging dispensary physicians not to send patients on to the hospi-tals unless it was absolutely necessary. Medical Service Corps officers weresubstituted for physicians, where possible, and junior men placed temporarily orpermanently in more senior jobs. Civilian doctors were hired in small numbers;the number of Japanese working in the medical installations increased; and

®^Quoted words from SG Conference Notes, 27 Feb 50, Medical Collection, HRB, See alsoJLCOM, Annual Report of Medical Service Activities, 1950, p. 2, HRB.

"Quoted words from Dovell Interv, 21 Sep 66, p.5, HRB. See also JLCOM, Annual Report ofMedical Service Activities, 1950, p. 3, HRB.

JAPAN AND KOREA AFTER V-J DAY

67

Table 6-Anticipated Deficit in Medical Officers, Eighth Army, 1949

| Month    | Officers

Assigned | Officers

Authorized | Deficit |
|----------|--------------------|----------------------|---------|
| January  | 320                | 357                  | 37      |
| February | 324                | 357                  | 33      |
| March    | 320                | 357                  | 37      |
| April    | 265                | 390                  | 125     |
| May      | 139                | 390                  | 251     |
| June     | 99                 | 390                  | 291     |

Source: Eighth United States Army, Annual Report of Medical Department Activities, 1948, pp. 43-46, file 319.1-2 (EUSA) 1948,Box 501(WW II Admin Rees, 1940-49), Entry 54A, RG 112, MMFB. The deficit was a function of both declining assignments andanticipated increased authorizations, which did not materialize.

enlisted men entered the wards to be trained by Army nurses in basic care of thesick. Physicians were rotated from one subordinate command to another.^'*

As 1950 opened. General Armstrong’s view from above (“they are not shortof doctors”) absolutely contradicted that of Maj. Gen. James A. Bethea, theformer FEC surgeon, who had written:

The outlook for medical service within the FEC during the year . . . presents a grimpicture from a personnel standpoint. Commencing in January 1950 and increasing eachmonth through June 1950 the losses of Medical Corps officers will be extremely heavy; infact, so much so that no suitable solution can be foreseen.

The Office of the Surgeon General found and sent sixty residents on temporaryduty to tide the command over. By mid-June the last ASTPs were on their wayhome while the replacements were en route. On the twenty-fifth the Far EastCommand had a surplus of nurses, almost two-thirds of its Women’s MedicalSpecialist Corps personnel and one-half of its authorized doctors, a shortage ofabout 10 percent in Medical Service Corps officers, and smaller proportionaldeficiencies in dental officers and enlisted personnel (see Table 7).^^

The whole command was in similar case, which is one explanation of thesurgeon general’s recommended cutbacks. An infantry division, some 18,000strong in wartime, numbered about 12,500 men; combat elements of the EighthArmy were at less than half their normal strength and service troops at a shadeover a quarter of theirs. Shortages of medics throughout the divisions of theEighth Army—the 1st Cavalry and the 7th, 24th, and 25th Infantry—wereendurable because the units also were depleted. A minimal medical establish-ment was keeping on top of the command’s problems because the command

®^USAFPAC, Annual Report of Medical Department Activities, 1945, pp. 25-26, file 319.1-2(USAFPAC, Chief Surgeon’s Report, Jun-Dec 1945), Box 496 (WWII Admin Rees, 1940-49), Entry54A, RG 112, MMFB; extract from Surgeon’s Circular Letter no. 11, Medical Section, USAFPAC, 1Oct 46, p. 9, HSF (USAFPAC Circular Ltr-1946), HRB; FEC, Annual Reports of Medical Depart-ment Activities, 1947, pp. 105-07, and 1948, pp. 150, 153, RG 112, MMFB; ibid., 1949, pp. 69-70,74, file 319.1-2 (FEC) 1949, Box 498 (WWII Admin Rees, 1940-49), Entry 54A, RG 112, MMFB;extract from Surgeon’s Circular Letter 4, no. 4, Medical Section, FEC, 25 Apr 49, HSF (FECCircular Ltr-1949), HRB.

“Quoted words from FEC, Annual Report of Medical Service Activities, 1950, p. 22, HRB. Seealso JLCOM, Annual Report of Medical Service Activities, p. 6, and SG Conference Notes, 19 Jun50. Both in HRB.

THE MEDICS’ WAR

Table 7-Medical Personnel In Japan, June 1950

Personnel Authorized Assigned

Officers

Medical Corps

Dental Corps

Medical Service Corps ....

Army Nurse Corps

Veterinary Corps

Women’s Medical Specialists Corps

Enlisted Men

Enlisted Women

| 318   | 156   |
|-------|-------|
| 95    | 89    |
| 309   | 271   |
| 452   | 468   |
| 15    | 14    |
| 31    | 21    |
| 5,868 | 5,600 |
| 161   | 132   |

Source: Japan Logistical Command, Annual Report of Medical Service Activities, 1950, p. 6, file 319.1-2 (JLCOM) FarEast-1950, HRB.

itself was understrength, its duties those of peacetime, its environment farhealthier than in the early days of the Occupation, and its own health conse-quently good.^

Upon this scene war broke like a thunderclap.

^‘USAFFE and EUSAR, “Logistics in the Korean Operations,” vol. 1, p. 3, RG 319, MMHB;Eighth United States Army, Korea (hereinafter cited as EUSAK), Annual Report of Medical ServiceActivities, 1950, file 319.1-2 (EUSAK) Far East-1950, HRB; Medical Section, FEC, HistoricalReport, 1 Jan-31 Oct 50, pp. 86-89, Annex XVIII, Medical Section, FEC, file. Box 362 (StaffSection Reports, Annexes XVIII-XXI, Medical-PIO, 1 Jan-31 Oct 50), Entry 429, RG 407,MMFB.

CHAPTER 3

The Medical Service in Retreat

Crossing the 38th Parallel on 25 June 1950, North Korean forces pushedsouth, scattering the defenders and filling the roads with refugees. As the bewil-dered dependents of the United States Military Advisory Group arrived inJapan and as the men of the Advance Command and Liaison Group (ADCOM),still in Korea, retreated to Taejon, new American responses to the crisis beganto take shape in Washington and Tokyo. American planes bombed the NorthKorean attackers, and the Far East Command (FEC), having shifted to a warfooting, pulled medics from hospitals throughout Japan to fill vacancies incombat units. At Yokohama, where the principal medical depot lay, the EighthArmy hastily cobbled together new field units. Among them was an organizationnot previously seen in the Far East Command, the mobile army surgical hospital(MASH).

In early July three MASHs were activated: the 8055th on the first, the 8063don the seventeenth, and the 8076th on the nineteenth. Realizing that forcesoperating in Korea faced severe problems of transport, the Eighth Army surgeonselected the MASH and its backup, the semimobile evacuation hospital, as hisfirst units because they had their own transport and their complements weresmall. Little was known about the MASH; though five had existed since the lateforties (1948 and 1949), none had seen duty in the Far East. One new MASHcommander, rather bewildered by his job, hung out a hand-lettered sign on anunused office in Yokohama and waited for the arrival of his subordinates, mostof them as uncertain of their new duties as he was.*

Yet the concept of the mobile surgical hospital was an old one, dating fromWorld War I, when Americans in France first began to pack both hospitals andmobile surgical teams into trucks with their tentage and equipment. Two suc-cessful experiments carried the idea further during World War II. In the South-west Pacific General Mac Arthur’s staff surgeon devised a portable surgical hos-

"Dovell Interv, 21 Sep 66, p. 5, Personal Interviews file (Dovell); Interv, Samuel Milner with LtCol Kryder E. Van Busldrk, MC (hereinafter cited as Van Buskirk Interv), 7 Jul 66, p. 4, AMEDDOral History file (Van Buskirk). Both in HRB. The five MASHs in existence prior to July 1950 wereorganized under tables of organization and equipment and were not readily available for deploy-ment to Korea. The Army’s make-do response to the Korean emergency is reflected in the organiza-tion of the new MASHs under tables of distribution (TDs). These units were created to performtemporary missions and were not intended to see extended service. Many such units were formedduring the Korean War and were commonly numbered in the 8,000 series to reflect their assignmentto the Eighth Army. It is interesting to note that the Army’s TD MASHs survived as long as they didafter the fighting stabilized. See Chapter 11 of this volume.

THE MEDICS’ WAR

pital to meet the problems posed by the tangled jungles of the region; stripped toits lightest form, hospital gear was carried forward on the human back, downjungle trails where vehicles could not go, accompanied by surgeons chosen fortheir youth and stamina. In Europe and the Mediterranean another form offorward surgical treatment evolved; field hospital platoons strengthened by spe-cial surgical teams worked in tents beside division clearing stations. Both exper-iments had shortcomings, but both demonstrated an impressive capacity to savelives. A mobile surgical hospital, working close to the front line, could reviveand stabilize the severely wounded for their journey to definitive treatment inthe rear.

In 1948 the surgeon general issued a table of organization and equipment(T/O&E) establishing a sixty-bed, tented, mobile surgical hospital as a regularand permanent unit of the Medical Department. The T/O&E provided for aheadquarters and headquarters detachment, a preoperative and shock treatmentsection, an operating section, a postoperative section, a pharmacy, an X-raysection, and a holding ward. Fourteen medical officers, twelve nurses, twoMedical Service Corps officers, one warrant officer, and ninety-seven enlistedmen formed the complement. One medical officer commanded; one was aradiologist; two were anesthesiologists; one was an internist; four were generalduty medical officers; and five were surgeons.

This was the theoretical MASH. The real one was somewhat different. Asorganized at Yokohama, the MASHs were understrength—the 8055th, for ex-ample, had only ten doctors and ninety-five enlisted men—and their surgeonswere not completely qualified. Indeed, the Far East Command did not have anycompletely trained and experienced surgeons to assign. Many who served in theMASHs were residents, and many would continue to be, as the surgeon generalreached into his teaching hospitals to find young officers for forward posts.“Well,” said the chief of surgery at Walter Reed Army Hospital, speaking of theresidents who went to Korea, “there’s only one way to learn good surgery andthat’s to get bloody wet.”^

Opportunities to “get bloody wet” were quick to come. On 6 July the 8055thleft Sasebo on the USS Titania and arrived at Pusan the same day. Command-ing was Maj. Isaac J. Tender, “a short, chunky individual, an extremely activeperson who ran the unit almost as if it were a one-man show. ...” The unitimmediately entrained for Taejon, where it was to support the 24th InfantryDivision. The 8063d left Sasebo on 18 July, headed for Pohang-dong on Korea’ssoutheast coast, where it made an amphibious landing in support of the 1stCavalry Division. Arriving in Pusan on 25 July, the 8076th immediately was

^Quoted words from Seeley Interv, 14 Aug 79, sess. 2, cassette 5, p. 11, HSF (Seeley-1947), HRB.See also comments of Col Oral B. Bolibaugh, Orthopedic Consultant, Medical Section, FEC, at-tached to 8086th Army Unit, Military History Detachment, “The Surgical Hospital in Korea, July1950-February 1953,” Ms no. 8-5.1 A DN, RG 319, MMHB; and Department of the Army Table ofOrganization and Equipment no. 8-571, 28 Oct 48. On the predecessor hospitals, see Charles Lynchet al.. Field Operations, The Medical Department of the United States Army in the World War, vol.8 (Washington, D.C.: Office of the Surgeon General, War Department), pp. 184-205; War Depart-ment Table of Organization nos. 284 W, 15 Jun 28, and 8-231, 1 Dec 40, and Table of Organizationand Equipment no. 8-570, 21 Aug 1943. See also Smith, The Medical Department: Hospitalizationand Evacuation, Zone of Interior, pp. 145-46.

71

South Korean Casualties Awaiting Evacuation to the Rear

dispatched to support the Eighth Army tactical units fighting in the Taejon-Taegu corridor. By 26 July all the MASHs were committed to battle, amidgrowing fears of an American calamity in the making.^

Medics in Retreat

Strung along the main road and rail corridor from Seoul to Pusan were anumber of Korean towns where Americans died. Below Suwon, where ADCOMhad entered, lay Chonan; to the south, Chochiwon, and then Taejon. BeyondTaejon lay Yongdong, with a major center farther to the southeast at Taegu {seeMap 1). Along this route, fight and fall back was the pattern of the war in thefierce heat of July.

The piecemeal commitment of General Dean’s 24th Division began with theairlift of two infantry companies from Lt. Col. Charles B. Smith’s 1st Battalion,21st Infantry. With them went a platoon of recoilless rifles and a platoon fromthe regimental medical company. Welcomed by festive crowds at Pusan, and

^Quoted words from Interv, Samuel Milner with Lt Col Robert H. Mosebar, MC, 30 May 66, p.12, AMEDD Oral History file (Mosebar), HRB. See also 8086th Army Unit, “Surgical Hospital inKorea,” pp. 2, 28, RG 319, MMHB.

Inchon

- Suwon

Chonan

Naktong

Pohang-dong

Yongchon

Taegu

Naktong

Masan

Pusan

KOJE-DO

THE ENEMY ADVANCES

June - July 1950

ELEVATIONS IN METERS

KOREA STRAIT

0 500 1000 ABOVE

0 10 20 30 MILES

1 I 'i I' '

Note: Elevations used on Map 1 arestandard throughout this volume.

0 10 20 30 KILOMETERS

MAPI

73

Tagging an American Casualty at a Forward Aid Station

half convinced that the sight of American uniforms would halt the North Kore-ans, the task force arrived by rail at Taejon on the morning of 2 July. Here theymet the men of ADCOM, and Maj. Gen. John H. Church, ADCOM’s com-mander, briefed Smith on the situation. In effect. Smith was to establish aroadblock to delay the enemy and hearten the collapsing South Korean forces.He found a good position on a 300-foot ridge north of the hamlet of Osan,overlooking the Suwon road that penetrated the ridge through a cut with steepembankments. On 4 July, as the Far East Command established the UnitedStates Army Forces in Korea with General Dean as commander and Church ashis deputy. Task Force Smith, strengthened by howitzers, received orders totake up its position. By 0300 the next morning, in the rain, the men were diggingin; the medical platoon, under 1st Lt. Edwin L. Overholt, set up an aid station inthe center of the perimeter in a muddy dugout 12 feet square and deep enoughto protect against enemy fire.

Between 0800 and 0900 enemy tanks emerged from the continuing rain andpushed through the position, exchanging fire and causing about twenty casual-ties. The rockets of the Americans’ 2.36-inch bazookas bounced harmlessly offthe well-armored Russian T-34 tanks. Two were knocked out by howitzers; therest rumbled on toward Osan. Medics were at work expanding and deepeningthe dugout and caring for the first wounded when a second and larger enemyforce, with both motorized and marching infantry, came into view. Frontal

THE MEDICS’ WAR

attacks were thrown back, but as the North Koreans began to envelop the hill,Smith ordered his men to leave the position in groups and to fight their waysouth. The nontransportable wounded had to be abandoned, two enlisted menvolunteering to remain with them. The medics were second off the hill, follow-ing C Company. Able-bodied men aided the walking wounded. Lt. Raymond F.Adams, a Medical Service Corps officer who was assistant battalion surgeon andpitcher with the regimental baseball team, dropped a hand grenade accuratelyon an enemy machine gun firing at the group. Under cover of the railroadembankment, carrying on litters the wounded who could not walk, the party ofseventy-five men worked their way through rice paddies and over mountainousterrain some 20 miles to Ansong and safety. For their conduct Overholt andAdams won the Silver Star.'*

As the enemy drove south, the regimental medical companies absorbed theworst punishment and drew the first lessons of the Korean fighting. Like theMASH, the medical company was a product of postwar reorganization, whenthe Medical Department sought to apply the lessons of World War II. The ideabehind the unit was to lessen the regiment’s dependence on the division. Thecompany’s three medical platoons followed the regiment’s three battalions; eachplatoon was supposed to have a medical officer as battalion surgeon and aMedical Service Corps officer as assistant battalion surgeon, plus thirty-fiveenlisted aidmen, litterbearers, and aid station personnel. A collecting platooncontained ambulance, litterbearer, and collecting sections. From battalion aidstation to regimental collecting station and thence to division clearing sta-tion—a holding facility meant to be supported by a nearby MASH—the chainof evacuation began to take form. But the medical companies bore the brunt. Inthe fighting north of Taejon one of the most successful but least celebrated unitsof the Korean conflict began to adapt to a new and harsh kind of war.^

Central to the problems faced by regimental medics was the overwhelmingnature of the attack. The enemy was tough, brave, acclimated, and well able tomingle with refugees as necessary to infiltrate the defenders’ lines. Tactics ofarmored thrust, combined with infantry assault and envelopment, proved alltoo effective. The South Korean government never had commanded over-whelming support from its own people; now guerillas moved out of the hills toaid the North Korean attack. Americans were both outgunned and absurdlyoutnumbered. At one point a journalist, Philip Deane, found a single platoon ofthirty-six men guarding a front 3 miles wide. American soldiers proved to be outof condition for fighting on jagged hills in stifling heat; even though salt tabletswere sometimes airdropped, the men collapsed from heat exhaustion. Tor-mented by thirst, they filled their canteens from paddies fertilized with human

The enlisted men were Pfc. Max E. Meyers and Cpl. Ernest A. Fortuna. Both survived threeyears of captivity, and both were repatriated at the end of the war. This account is based on Roy E.Appleman, South to the Naktong, North to the Yalu, United States Army in the Korean War(Washington, D.C.: Office of the Chief of Military History, Department of the Army, 1961), p. 64;Samuel Milner, “Troubled Decade: The U.S. Army Medical Service in the Post-World War II andKorean Era,” ch. 5, pp. 28-34.

^Department of the Army Table of Organization and Equipment no. 8-7 N, 6 Jan 48. At thislevel, Medical Service Corps officers not only performed administrative tasks but also, with propertraining and experience, could carry out first aid and make many triage decisions as well.

75

excrement, adding Halazone (chlorine) tablets of World War II vintage to purifythe water. But the Halazone had lost much of its potency, and dysentery soonhad attacked a quarter of the division.

As the desperate situation became clear, morale plummeted. Exhaustion,disease, the imminence of death or capture, the repeated defeats hammered atthe men and helped to fill the never-ending litters. In the midst of the retreatsoldiers remembered that a few days before they had lived the good life inJapan, where they had been conquerors, not conquered. A seventeen-year-oldsoldier lamented to Deane, “Gee, back in Sasebo I had a car, only a Ford, but ahoney. You should have seen my little Japanese girl. Gee, she was a honey.Lived with me in my little villa. It was a honey, my little Japanese villa. Say, gotany more of that liquor? Give me a slug, will ya?”*^

The enemy was indifferent to the Western etiquette of war. Attacks onmedical personnel, vehicles and tents became the rule rather than the exception.Capt. Donald L. Duerk’s Medical Company, 21st Infantry, was reported “cut topieces” at Chochiwon. The aid station was the first target of North Koreanartillery; enemy riflemen used the red crosses on regimental ambulances asconvenient bull’s-eyes. The wounded had to be evacuated by tank. AfterChochiwon, Duerk’s medics painted out the emblem on their equipment andcarried Ml rifles. In other action at Chochiwon infiltrators cut off the evacua-tion of many wounded and captured the battalion surgeon, Capt. Alexander M.Boysen, and his assistant, Capt. Clarence L. Anderson, both of whom were heldin captivity for three years. A hospital train leaving Taegu at night for Pusanwas hit by fire from rifles or automatic weapons; later, emerging from a tunnel,it was again a target, this time for rifle fire and grenades. As a result, hospitaltrains had to run in daylight hours, and emergency night runs were guarded bymilitary policemen riding on sandbagged flatcars.^

Faced with so many difficulties, the medics learned fast. At Songhwan Capt.Frank D. Thompson, Jr., of the Medical Service Corps learned by experience toplace his collecting station of the Medical Company, 34th Infantry, on the mainroad for quick evacuation, and always “securely within the perimeter of somearmed unit.”* He spent as much time as possible at regimental headquarters;with equipment to load and patients to move, he had to learn not only what washappening but also what might happen from close-mouthed infantry officers.Thompson ordered aid stations set up in positions accessible to litter jeeps, forthe terrain was too rugged, the enemy too active, and the time often too short topermit litter squads to carry the wounded to vehicle loading points. As far aspossible, he aimed to keep the stations empty by continuous and rapid evacua-

‘‘Quoted words from Philip Deane [Gerassimos Svoronos-Gigantes], I Was a Captive in Korea(New York: Norton, 1953), p. 18. See also ibid., p. 20; Appleman, South to the Naktong, pp. 180,262. On Halazone, see extract from 406th Medical General Laboratory Monthly Technical Report,November 1950, HSF (406th Laboratory-1950), HRB.

’’Washington News, 18 Jul 50; Washington Post, 19 Jul 50; Milner, “Troubled Decade,” ch. 5, p.43; After-action Interviews With Personnel of 8054th Evacuation Hospital, in Historical Division,EUSAK, “Guerrilla Attack on Hospital Train, 24 August 1950, Near Samnangjin, Korea,” Ms no.8-5. lA BA 101, RG 319, MMHB.

^Surgeon’s Circular Letter 5, no. 10, Medical Section, EEC, 1 Oct 50, p. 6, file 300.5 (CircularLetters) EEC, HRB.

THE MEDICS’ WAR

Ambulance Driver Covering the Red Cross With Mud

tion to lessen the danger that the wounded might be overrun. Much hard workand a measure of luck kept his patients secure until they were evacuated to therear.

Yet hauling them was difficult, for the roads were rough and snipers com-mon. Overuse broke down the sturdy ambulances, which needed constant care.Like others in similar positions, Thompson placed his collecting station in anexisting building, a girls school in Chochiwon that was convenient to the rail-head. Here the medics used and praised the “Doodlebugs,” gasoline-poweredrailroad cars that shuttled from Chochiwon to Taejon, making the 30-mile tripin about forty-five minutes, carrying seventeen litter and fifty ambulatory pa-tients on each trip. Division medical officers felt that one Doodlebug released 4to 5 ambulances for use elsewhere—an important saving, for ambulances werein hard use and short supply.’

By mid-July the enemy had ousted the Americans from Chochiwon, pene-trated a defense line along the Kum River, and begun his drive toward Taejon.This southwestern rail and road junction was not, in those days, a good place tolive or die. Normally holding about one hundred thousand people, Taejon was

’Ibid., pp. 5-10, HRB. See also 24th Medical Battalion, Annual Report of Medical ServiceActivities, 1950, Enel 6, Ambulance Company Report, file 319.1-2 (24th Medical Bn) FarEast-1950, HRB.

77

flooded with refugees who lived, slept, and performed their bodily functions inthe streets. Peasant women staggered along under huge bundles balanced pre-cariously on their heads, and families with weeping children boiled handfuls ofgrain in tin cans over fires of straw. Here the headquarters and clearing compa-nies of the 24th Medical Battalion arrived on 10 July to find the 8055th MASHalready in operation. The two units occupied the Taejon Primary School. UnderMaj. Austin C. Doren, the clearing company provided basic hospital services,other than surgery to casualties before sending them to the rear. (The seriouslywounded were flown to Japan direct from the Taejon airstrip.) The 8055thMASH, brought with it twelve Army nurses led by Capt. Phyllis M. LaConte. Asthe worst cases arrived, the clearing company officers sent them directly to theMASH for surgery. Because flight nurses were lacking. Captain LaConte accom-panied a trainload of wounded to Taegu and thence, by plane, to Japan.

With great restraint, she reported that work in the primary school was “anew experience for many.” To the medics the place seemed fairly orderly, underthe circumstances. Journalist Deane saw it with a layman’s eyes. The school, hewrote, was a large building whose courtyard was full of vehicles and walkingwounded. The smell of disinfectant hung in the air. Inside, litters covered thelandings and filled the rooms. Doctors operated in blood-spattered fatigues.“Stitch this, clip that, sponge, stitch, clip, saw—faster, faster, there are morewaiting.”’®

The nurses were not alone in having new experiences. The medical battalionwas severely understrength and its training was spotty. At this time its personnelstrength was only 2 or 3 doctors, 3 Medical Service Corps officers, and 124enlisted men. This was not unusual. The 1st Cavalry and 24th and 25th InfantryDivisions went into combat with 14 medical officers each, instead of the regula-tion 42, and at no time during the early months of the war did doctors numbermore than 25 per division. Consequently, sergeants found themselves setting upaid stations and, on occasion, acting as battalion surgeons. In the headquartersof the 24th Medical Battalion the dentists held the administrative posts. Theheadquarters company had received no field training and “had to learn fieldoperations under actual wartime circumstances. . . .”"

On the other hand, the ambulance company had only recently participatedin a field exercise in Japan, was only five men short of its full strength, and hada full complement of vehicles. Operating as far forward as the aid stations, thedrivers carried the wounded to the collecting station at Chochiwon, until thetown fell; to the Doodlebugs bypassing the station; or, if cases were sufficientlysevere, all the way to Taejon. Maps were critically short, and ambulances weredestroyed by enemy fire, or lost their way in blackout trips over precariousmountain trails. Snipers’ bullets whined out of the darkness in the passes. Yet

'"First quotation from Surgeon’s Circular Letter 5, no. 10, Medical Section, FEC, 1 Oct 50, p. 10,HRB. Second quotation from Deane, / fVas a Captive in Korea, p. 15. See also 24th MedicalBattalion, Annual Report of Medical Service Activities, 1950, Enel 7, Clearing Company Report,HRB; Milner, “Troubled Decade,” ch. 5, pp. 37, 53; W. H. Thornton, “The 24th Division MedicalBattalion in Korea,” 106 (July 1951): 12-13.

"24th Medical Battalion, Annual Report of Medical Service Activities, 1950, End 5, Headquar-ters Company Report, p. 3, HRB.

THE MEDICS’ WAR

Unloading Wounded Soldiers at a Battalion Aid Station

the company suffered no casualties and continued to move the wounded. Thiswas fortunate, for already a durable pattern of the Korean fighting had ap-peared: Because of the lack of doctors and the few hospitals, a disproportionateburden was thrown upon medical transport of all kinds.

After the penetration of the Kum River line by the enemy, the 8055thMASH and two platoons of the clearing company moved 30 miles south toYongdong, where they set to work in the agricultural college. One platoonremained at Taejon, operating the station, and a small section from the divisionheadquarters medical detachment ran an aid station at the railroad depot, toassist evacuees on their short ride to Yongdong. Maj. Wade F. Heritage, Sur-geon, 24th Division, meanwhile gathered such supplies as he could, radioing formorphine and for “as many litters as possible.” One day he took a jeep to drivetoward the front. For the last two miles of road, the countryside seemedempty. Then a soldier hailed Major Heritage from a roadside ditch. “Unlessyou’re aiming to desert,” he said, “I wouldn’t move farther.” The enemy wasapproaching.*^

First to fall was the vital airstrip, compelling the evacuation of casualties to asecondary strip by motor vehicle. Mortar shells struck among the medics of the

'Tirst quotation from Milner, “Troubled Decade,” ch. 5, p. 53. Second quotation from Deane, /JVas a Captive in Korea, pp. 19-20.

79

63d Field Artillery Battalion. Ferocious fighting began as frontal attacks hit thedefensive line. Casualties were massive; at Okchon a battalion aid station ex-hausted its medical supplies in treating wounded from the Taejon fighting.Whenever possible, wounded were bundled aboard any available plane andflown to Japan, for the slight hospital facilities in Korea were either on the runor could accommodate no more. Soon the clearing company and the 8055thMASH were moving too, the former to Kumchon on the first leg of a retreat thatwould end only within the soon to be established Pusan Perimeter. The MASHmoved to Taegu. Henceforth, it would also do its work within the perimeter.

Captain Thompson’s collecting station worked steadily, hauling wounded tothe railhead. The remaining platoon of the clearing company joined them.Drivers could rest only while the vehicles were loaded and serviced. At dawn on20 July an enemy tank rolled down the street in front of the station. Fightingbegan in Taejon. A round from a tank gun “smashed through a corner of ourbuilding and exploded over the entrance to the collecting station,” woundingthree but killing nobody. The hours that followed were full of “vast confusionand a great deal of gunfire,”*^ with lulls in which the wounded were carried in.Tank hunter teams, now armed with 3.5-inch bazookas, roamed the city de-stroying T-34s. General Dean led one of the teams. Later, separated from hismen, he found himself behind enemy lines, and was ultimately captured.

At 1600, with most of the wounded already evacuated by train, the 34thInfantry’s medical company moved out, its three ambulances loaded with thelast of the casualties. Much of Taejon was burning, wires down and streetslittered with debris. Outside the town, the convoy was hit by automatic weaponsfire from the hills. “It was a matter of running a gauntlet of fire for about threemiles,” wrote Thompson. “The entire valley was under a pall of dust and smokefrom burning trucks.” Again and again the infantry cleared the road and thetrucks and ambulances continued to move, on into Yongdong.^"*

The Pusan Perimeter

With its commodious deep-water harbor, Pusan was the most importantpoint of entry for American forces moving to the Korean battlefields {see Map2). It was also the center of the logistical buildup, its Pusan Base Command thefirst in a series of headquarters whose prime duties were the maintenance oforder, the policing of prisoners, and the storage and movement of supplies.Arriving in Pusan on 6 July, the 8054th Evacuation Hospital, Semimobile,under Lt. Col. John M. Willis, Jr., set up shop in a Korean school. As bloodbanks opened in Japan, the first shipment of sixty-nine bottles of whole blood inrefrigerated marmite cans arrived on the night of the seventh, a few hours beforethe hospital received its first patients. The 25th Division passed through Pusan

'^Surgeon’s Circular Letter 5, no. 10, Medical Section, FEC, 1 Oct 50, p. 9, HRB.

‘‘‘Quoted words from ibid., p. 9, HRB. See also SG Conference Notes, 17 Jul 50, MedicalCollection, HRB; Appleman, South to the Naktong, pp. 127, 174; Eighth United States Army, Korea(hereinafter cited as EUSAK), Report of ETMD, September 1950, as given in 8086th Army Unit,“Surgical Hospital in Korea,'” p. 17, RG 319, MMHB.

MAPI

81

Col. Chauncey E. Dovell {center) and the Eighth Army Medical Staff

during 10-15 July on its way to support the 24th Division, then bracing for theenemy’s push against the Kum River line. As the provisional capital of theSouth Korean government, the city was the point around which American andSouth Korean forces gathered for what might prove to be their last stand on theKorean mainland.*^

The Americans reorganized as Lt. Gen. Walton H. Walker, the Eighth Armycommander, assumed control of the Korean fighting and moved his headquar-ters—now called Eighth United States Army, Korea (EUSAK)—to the Asiaticmainland. With Walker came Col. Chauncey E. Dovell, the able, burly surgeonwho headed the Medical Section, and who had given up plans for retirement totake part in the Korean fighting. An officer of the full-blooded sort, Dovellbullied his subordinates, believed himself to be put upon by uncomprehendingsuperiors, and despised rear echelons generally. With Dovell went his deputy,Lt. Col. Charles A. McAllister; his executive officer, Capt. Harry L. Gans, MSC;his supply officer, Capt. Leonard A. Crosby, who also headed operations;WO(jg.) Joseph A. Mikos as administrative officer; and six enlisted clerks underSgt. Edward A. Peters. The Medical Section set up shop in Taegu in a school,sharing a single room, and the officers bunked together in the chapel. Dovellrequisitioned medical units from the zone of interior and pulled still moredoctors out of Japan to strengthen the shortage-plagued fighting forces. Under

**8054th Evacuation Hospital, Semimobile, Annual Report of Medical Service Activities, 1950,p. 3, file 319.1-2 (8054th Evacuation Hospital, Smbl) Far East-1950; 406th Medical GeneralLaboratory, Annual Report of Medical Service Activities, Administrative Section, p. 2, file 319.1-2(406th Medical General Laboratory) Far East-1950. Both in HRB.

THE MEDICS’ WAR

his eye the Korean medical system developed further, though neither its basicproblems nor its fundamental means of handling casualties changed.

The shortage of doctors and experienced Medical Service Corps officersremained acute. Triage and transportation continued to take the place of physi-cians and bed strength. By frequent sorting of the wounded, medics shunted theserious cases either to available hospitals in Korea or direct to Japan. There,however, doctors were also in short supply, and cases requiring services normal-ly performed in forward or communications zone hospitals were sent on insteadto the United States. Abuses of the system, some avoidable and some not,appeared; on occasion, men with minor wounds or stress reactions were dis-patched to Japan or to the zone of interior. Yet for the wounded, arrival in theUnited States within ten to fourteen days of the time they fell on a Koreanbattlefield meant opportunities for definitive treatment that was, for the mo-ment, beyond the capability of the Far East Command.*^

Interviews with casualties indicated the remarkable speed that evacuationsometimes attained. On 21 July, near Taejon, Pvt. Thomas J. Banta of the 34thInfantry, 24th Division, was shot by a sniper in the left arm. A jeep brought himto an aid station; within half an hour a “train” (probably a Doodlebug) took himto the MASH at Taejon. Here he stayed for one day before a plane carried himto Japan, where he received treatment in turn at the 118th Station Hospital andthe Osaka and Tokyo Army Hospitals. A week after his original injury he was inFairfield, California. Doctors there found that a cast on his arm was too tight,the only deficiency noted in his treatment; his general condition was termed“good with some pain.” Queried about their experiences, one soldier com-plained that plane flew too high, making the patients gasp for air; another thatmedical attendants should have been on his flight to Walter Reed. Anotherwondered, “Would it be possible to have hot food on board transport planesinstead of sandwiches?” But the commonest remark was that of a 25th Divisionprivate machine-gunned while evading encirclement at Taejon: “Good treat-ment all the way.”*^

Heavy fighting ensured a continuous flow of casualties. While the 25thDivision with its medical battalion faced North Korean thrusts north ofKumchon, the 1st Cavalry Division, supported by its 15th Medical Battalionand the 8063d MASH, waded ashore on 18 July at the little east coast port ofPohang-dong. On 22 July the 1st Cavalry—paradoxically, an infantry unit atthis time—relieved the 24th Division, which had suffered 30 percent casualtiesand had lost its commander. The divisions fought delaying actions, Maj. Gen.William B. Kean’s 25th Division troops holding up the enemy for eleven days ina stubborn, bloody defense of Sangju, a town some 40 miles northeast of Taejon.

“Eighth United States Army, Korea, General Order no. 1, 13 Jul 50, MMFB; Medical Section,EUSAK, Historical Reports, 13-17 Jul 50, Ends 20 to Eighth United States Army, Korea (hereinaf-ter cited as EUSAK), War Diary, files 108 (War Diary-EUSAK, 13-17 Jul 50), Boxes 1082-83(EUSAK, Section 3, War Diary, 13-16 and 17-20 Jul 50), and Medical Section, EEC, HistoricalReport, i Jan-31 Oct 50, pp. 64-66, file Annex XVIII (Medical Section, EEC), Box 362 (StaffSection Reports, Annexes XVIII-XXI, Medical-PIO, 1 Jan-31 Oct 50), both Entry 429, RG 407,MMEB; Gans Interv, 29 May 66, pp 2-3, AMEDD Oral History file (Gans), HRB.

'Ttr, Walter Reed Army Hospital to The Surgeon General, DA, 23 Aug 50, sub: CasualtyQuestionnaire (100 Enclosures), file 704 Casualties (Questionnaire) Korea-1950, HRB.

83

The clearing company of the 25th Medical Battalion and the MASH, sharing aschoolhouse at Kumchon, were flooded with wounded men. ‘T’ll never forgetthese casualties,” wrote a MASH nurse, Capt. Oree Gregory, in her diary. “In allmy 17 years of experience I’ve never seen such patients. Blind, or with legs orbuttocks blown off. Many died despite skilled surgery.” The July heat wasintense; the flies swarming around the school were “green, large, and heavy.”**

Members of the 25th Division band volunteered to serve as medics at theclearing station. Liaison aircraft, playing a role soon to be assumed by thehelicopter, flew fresh whole blood to the MASH and carried some casualtiesaway. The main reliance for evacuation, however, remained the trains. Under-strength, short of drivers, and equipped with ambulances of World War IIvintage that required constant repair, the battalion obtained one self-propelledcar and three Korean rail coaches and refitted them with crudely built litterracks. The coaches were coupled to supply trains headed for Taegu and Pusan,with orders to the attendants to hitch a ride back in the same way. Familiardifficulties showed up again in the shortage of doctors and the lack of fieldtraining, especially severe in the case of the 25th Medical Battalion because,before the war, it had been stationed in the heart of Osaka. Yet the clearingcompany’s thirteen doctors, headed by Lt. Col. Paul C. Sheldon, treated 1,086patients during July 1950.*’

A new threat now hastened the Eighth Army’s withdrawal behind theNaktong River into what would soon be called the Pusan Perimeter. While themain battle raged on the road and rail corridor, and a lesser one in the TaebaekMountains and on the east coast where South Koreans stubbornly contestedother North Korean forces, the enemy’s 6th Division moved undetected downthe western part of the peninsula and by month’s end threatened the town ofChinju near the south coast. This flanking movement posed the greatest possibledanger to the defending forces: By a sudden thrust through Masan the Commu-nists hoped to capture Pusan itself, cutting off supplies and reinforcements. Inconsequence. General Walker pulled the battered 24th Division, now underGeneral Church, out of reserve and dispatched it to southwestern Korea. The25th Division next redeployed to Masan, pushing its way along roads swarmingwith “carts, A-frames and animals.”^® Depleted by the need to support the newfront. Eighth Army on the night of 1 August began to withdraw across theNaktong.

The 8063d MASH left Kumchon on a flatcar, its commander, Maj. Frank A.Neuman, remaining behind with a severely wounded man, who died shortlyafter. Neuman buried him in the schoolyard, then followed the hospital in theunit’s jeep with another doctor and the enlisted driver. At Taegu he rejoined his

’*Diary of Capt Oree Gregory, 23 and 25 Jul 50, as excerpted in Technical Information Office,OSG, “Tokyo to Pusan: An Army Nurse’s Diary From the Battlefield” (hereinafter cited as Gregory,“An Army Nurse’s Diary,” entry date), 13 Mar 51, file 211 (Nurses) Korea, HRB.

’’Medical Section, EUSAK, Historical Reports, 20-31 Jul 50, Ends 20 to EUSAK War Diary,files 108 (War Diary, EUSAK, 20-31 Jul 50), Boxes 1083-87 (EUSAK, Section 3, War Diary,17-20, 21-23, 24-26, 27-29, 30-31 Jul 50); 25th Medical Battalion History, 20-31 Jul 50, annex11, 25th Infantry Division History, July 1950, file Book VII (Unit Reports, 25th Inf Div), Box 3747(25th Inf Div, Supporting Documents, Books V-VII, Jul 50). Both Entry 429, RG 407, MMFB.

“Milner, “Troubled Decade,” ch. 5, p. 60.

THE MEDICS’ WAR

unit, and both, at Dovell’s orders, moved south to Pusan. Here, however, the8063d soon turned its patients over to the 8054th Evacuation Hospital or the8055th MASH and moved by rail to support the 25th Division.^’

Both desperation and hope marked General Walker’s defense of the perime-ter, an oblong roughly 50 by 100 miles. Fighting was bitter and almost continu-ous, with heavy casualties rising to a peak during the enemy’s climactic assaultsof early September. But troop strength was increasing as the 5th RegimentalCombat Team, the 1st Provisional Marine Brigade, and the 2d Infantry Divi-sion arrived to strengthen the defenders. The 8076th MASH and two hospitalships were now on hand to provide additional medical support. Old methods ofevacuation were refined, and a new one, the helicopter, began to take an increas-ing role in the struggle. Congested with refugees, encircled by battle, the perime-ter was also a place of growing strength, assurance, and competence. Anyoneviewing the now bustling harbor rightfully could have concluded that, logistical-ly at least, the tide already had turned.

Stabilization of the line enabled preventive medicine officers to reestablisharea control over environmental sources of disease. Therapy against malariahad already begun; chloroquine was issued along with Sunday rations, and, intheory at least, administered under supervision to the troops. (Many men, itwould seem, failed to receive or else to take the tablets in the stress of battle.)The Far East Command had launched a program to ensure that all personnelmoving to Korea received shots against Japanese encephalitis. Temporarily, theflow of refugees that had brought some half a million civilians into the perime-ter was shut off by the fighting, enabling harried military and civilian reliefworkers to get on with the job of providing food, medical assistance, and DDTdustings to the throngs already behind the line.^^

In combat support, medics benefited from the relatively stable line and shortevacuation distances. Yet the fierce heat and even fiercer fighting made forheavy casualties, and exhausting effort was required to move the wounded overthe steep Korean hills. Each of the regimental medical companies was fortunateto have between twenty-five and fifty Korean soldiers who served as lit-terbearers. During the fight west of Masan, Capt. Arthur P. Wickstrom, surgeonof the 35th Infantry, reported that six men were needed to carry a single litterdown Battle Mountain (Hill 665), plus medics to administer aid during the longhaul and riflemen to protect the party from enemy snipers. Capt. James A. Balland Capt. Ernest M. Bradley, surgeons of the 17th and 24th Infantry regiments,respectively, drew similar pictures. This pitiless warfare that spared no onecomplicated the medical problem, which already was sufficiently great.

To the rear of the fighting line the 25th Division clearing station was set upin Masan’s city hall. Here Lt. Col. Herbert C. Wallace, the division surgeon, wasin charge. Malaria, heat exhaustion, and psychiatric problems as well as battleand nonbattle injuries swelled the flow of patients. The seriously wounded weresent on to the 8063d MASH in nearby Changwan, or to the hospitals in Pusan.Another of the invaluable self-powered railway cars shuttled between the clear-

^'Neuman Interv, 28 May 66, p.5, AMEDD Oral History file (Neuman), HRB.^Tor a fuller treatment of these topics, see Chapter 10 of this volume.

85

ing station and the MASH, only 3.5 miles away, and Air Force helicopters, aninnovation rapidly gaining ground in Korea, supplemented wheeled transport toPusan. The MASH, as usual, occupied a schoolhouse, a building singularlyverminous even for Korea. A nurse recorded that the windows in her quarters,where nurses slept seventeen to a room, had to be shut tight in the stifling heatto exclude the rats. Wounded jammed the building. As Captain Gregory record-ed in her diary.

We have patients in every place—every known type of wound and burn—men of all agesand from all walks of life. One private had lost an arm and was likely to lose a leg. Hewanted to be the first to let his mother know. ... All the men have bloodstained lettersthey never had time to read. They’re begging for water. But they’re mostly due forsurgery, so fluids are limited. After that was explained, they just accepted it. Sometimeswhen they heard our voices, the boys would think they were back in the States. Oneprivate said: ‘My God! Not a real American nurse! Take off my bandages so I can seeher!’ But he was blind.”

Under Maj. Kryder E. Van Buskirk, the 8076th MASH had meanwhileestablished itself in a woolen mill at Miryang, convenient to the central part ofthe front and the units that fought there—the 24th Division (later relieved bythe 2d Division) and the 1 st Marine Provisional Brigade. Additionally, becausethe other MASHs were now located to the south, casualties from the 1st CavalryDivision also reached the 8076th. Fortunately for its overburdened staff, theMarine brigade surgeon with five or six Navy doctors and thirty hospitalcorpsmen joined forces with them. Van Buskirk later recalled that

during this time . . . the 8076th had its finest hour. Everybody worked around the clockwithout orders of any kind. Indeed, it became Van Buskirk’s duty as MASH commanderto point-blank order people to bed. There was no end to the work. You would work 24hours pretty well straight through. The next day, you would nap between cases. Youwould go to sleep at midnight, and sleep till you were needed and someone woke you up,and the cycle would start all over again. The nurses would work every bit as hard. Mostwould work 12 to 16 hours a day without rest and some until they collapsed.

Supply problems added to the difficulties of front-line surgery. Though the8076th never lacked for blood, it was usually short of sponges, bandages, su-tures, and surgical knives. Bandages and sponges had to be washed andrewashed; nurses would “give the doctors hell if they so much as wasted asuture.

Handling more patients than the other two MASHs combined, the 8076th atMiryang had a collective style that reflected the attitudes of its commander.Alone of the EUSAK medical units, the MASH did not send its nurses away

“Quoted words from Gregory, “An Army Nurse’s Diary,” 8 Aug 50, HRB. See also Appleman,South to the Naktong pp. 369-70; 25th Medical Battalion, Annual Report of Medical ServiceActivities, 1950, p. 5, file 319.1-2 (25th Medical Bn) Far East-1950, HRB; 35th Infantry RegimentWar Diary, 1-31 Aug 50, in 25th Infantry Division History, August 1950, file Book VIII (25th InfDiv, War Diaries, Unit Reports), Box 3750 (25th Inf Div, Supporting Document, Book VIII, Aug50), Entry 429, RG 407, MMFB; Milner, “Troubled Decade,” ch. 5, p. 63.

“Quotations in this and the following two paragraphs from Van Buskirk Interv, 7 Jul 66, pp. 4and 11-13, HRB.

THE MEDICS’ WAR

when danger became acute; Van Buskirk argued that the hospital could notoperate without them, and if a situation was too dangerous for the nurses, it wastoo dangerous for the MASH. Periods of all-out work alternated, wheneverpossible, with relaxation, as the commander did not believe in looking busywhen there was nothing to do. Accomplished scroungers, the MASH peopleseemed to acquire equipment wherever they lingered; the well-equippedmarines, for example, left Van Buskirk a 220-volt generator and a walk-in“electric reefer [refrigerator] mounted on a truck,” while “similar goodies” werepicked up by other MASH officers. By his own admission Van Buskirk was notaverse to good whiskey, and he maintained a “very liberal” policy for bothofficers and men. When times were easy “the thing to do was to play, to relax—aphilosophy that he strictly observed in running his MASH.”

The style of mingled competence and casualness suited the nature of thehospital’s professional staff. The MASH had only ten doctors including itscommander; of those, seven had just finished internships. Yet these same sevenhad served as enlisted men in World War II, and, according to Van Buskirk,“practically all of them had served as infantrymen of the line.” They might benew doctors, but they were, like Van Buskirk himself, old soldiers, and per-formed accordingly.

Backed up by the hospitals at Pusan and in Japan, the clearing stations andthe MASHs provided a successful system of emergency medicine. For the fewmedics there, the costs were exhausting work and sometimes needless evacua-tion. Improvised in the course of a few weeks, the system met the needs of thehour while establishing patterns that were to last through much of the Koreanconflict.

The Other Side of the Line

North Koreans also were mortal, received wounds, and needed aid. Thenature of their medical service affected the outcome of the battle and, bycontrast, threw a sharp light upon the achievements of the United Nations(U.N.) forces. Structured on Russian models, the North Korean medical serviceshowed up well in organization charts that provided for medical personnel inline outfits; for hospitals; and for separate medical units. Division medicalbattalions, regimental medical sections, battalion medical detachments, andcompany aidmen in theory formed an imposing array. But serious practicalweaknesses existed in the quality of the personnel and in materiel. Medicalequipment was a mix of Russian, Japanese, and captured American implementsand drugs. By and large, the quality of medical officers was poor. Communist“cultural officers,” whose mission was to assure the political reliability of thearmy, apparently produced ill-feeling because they tended to view doctors asintellectuals, a class about whom Stalinist ideology entertained dark suspicions.Despite some contradictory evidence, POWs generally reported that the supplysystem, though it continued to deliver ammunition and weapons even duringU.N. air attacks, failed as early as July to provide adequate food to the troops.

Medical and morale problems resulted. Evacuation and treatment of the wound-ed were also seemingly poor.

But North Korean units differed markedly from one another. By late Augustsome elements of the 1st Division had fought for as long as eight weeks, cut offfrom their sources of supply. POWs reported a diet of two or three riceballs aday, supplemented by food seized or proffered by captured villages. Yet theirphysical condition was better than their history suggested. American intelligenceofficers judged that “the modest wants of the Korean soldier, the practice offoraging off the country-side, and the high morale engendered by initial success-es probably compensated for the effects of the physical privation.” In the 2dDivision, by contrast, POWs unanimously declared that the physical conditionof the men had seriously deteriorated by the end of July; all complained ofundernourishment and extreme fatigue. In the 6th Division, the desertion ratewas reported by a prisoner to be “very high,” as was the death rate among thewounded. “There were no doctors in the division,” interrogators concluded,“and only two medical aidmen to each battalion.” Men seriously wounded wereevacuated but reportedly received little treatment in the rear. Those lightlywounded were given first aid and returned to the front lines. “Lack of medicalattention” was reported a source of discontent in the 9th Division, and a cause ofsurrender among men who feared death if they were wounded.^®

Indeed, conditions among the enemy wounded reportedly were dismal. In-fection was a fact of life on both sides. Even U.N. soldiers arrived in hospitalswith “most wounds . . . grossly contaminated with field dirt,” leaves of riceplants and crumbs of human excrement plainly visible in some of them. Wound-ed North Korean prisoners of war showed the same problems in exaggeratedform, their injuries “frequently infested with hordes of maggots.” Lack of immu-nizations must have accounted for the seventy-five active cases of tetanus seenamong POW patients at the 8054th Evacuation Hospital, in marked contrast tothe almost total absence of tetanus among U.N. personnel. By September andOctober, when masses of prisoners came in, many of their wounds were “old,having been treated in North Korean hospitals,” and 90 percent were grosslyinfected, many “dressed with leaves or with old paper.

Another indication of the enemy’s medical failings was the systematic loot-ing of South Korean facilities, poor as these were. Nearly all the South Koreanhospitals were commandeered for the invaders’ use, and a large number ofSouth Korea’s eighteen hundred to two thousand doctors were impressed intothe invading army. In mid-September the North Korean government orderedcomplete stripping of all hospitals as its forces retreated. Instruments, blankets,drugs, even dressings were removed and carried north. On the whole, the im-

‘Tirst quotation from Intelligence Summary no. 2905, 23 Aug 50. Second and third quotationsfrom Intelligence Summary no. 2910, 28 Aug 50. Fourth quotation from AXIS Interrogation Reportno. 949, 11 Sep 50. All in Enel 7 to Weekend Letter no. 7, Maj Gen Edgar Erskine Hume, ChiefSurgeon, Medical Section, EEC, to Maj Gen Raymond W. Bliss, Surgeon General, DA, 27 Oct 50.See also AXIS Advance Echelon Report no. 0030, 10 Oct 50, in Enel 4 to Weekend Letter no. 13,Hume to Bliss, 2 Jan 51. Both in file 200 (Personnel Letters Between SGO and Medical Section,EEC), Box 3099 (Medical Section, EEC, General Records, 1950), RG 338, MMFB.

^‘8054th Evacuation Hospital, Annual Report of Medical Service Activities, 1950, pp. 6-7, HRB.

THE MEDICS’ WAR

pression left by North Korean medical practice was one of tragic poverty. At thesame time, American surgeons and commanders complained of ghastly condi-tions in South Korean Army hospitals, where basic measures of cleanliness wereneglected and ill-trained doctors ruthlessly carried out amputations. In thisrespect, there was little practical difference between the two Koreas. Both halvesof the nation bore the marks of their common history during recent centuries asa poor and excluded people.^^

The effect of all this on the course of battle is largely a matter for educatedconjecture. By common agreement the generally excellent care provided U.N.soldiers was essential to their morale, which tended to slump in any situation,such as Battle Mountain, where slow evacuation or other factors reduced theirchance of survival. (A study of one hundred American casualties in Augustindicated that 88 percent received medical aid of some sort within two hours ofwounding.) The contrast between the two armies was great.

Yet American casualties were lost to further service by hasty evacuation, asthe North Koreans were by incapacity or death. The American forces (and theirallies, such as South Koreans serving with American units and other U.N. forceswho also were treated by American hospitals) had the kind of medical systemthey required in order to function successfully. The North Koreans lacked sucha system, functioned gallantly without it, and failed in their great gamble be-cause of losses—estimated by some analysts at 4 to 1, during the Naktongoffensive—that no medical service could have restored to duty in time and insufficient numbers to make it succeed.^*

The Medical System Takes Form

The U.N. system was evolving rapidly. As in most wars, very few things inKorea worked exactly as Army planners had forseen. Typical was the transfor-mation of the MASH during its harsh introduction to battle. Intended to sup-port one division, to handle only the most serious cases, and to forward itspatients as soon as possible to an evacuation hospital equipped to hold them,the MASH found every one of these principles reversed. Each MASH had tosupport more than one division, and its range of clients grew as the U.N.forces—the United Nations endorsed the defense of South Korea during July,member nations pledged support, and the first British forces arrived duringAugust—grew in numbers. As usual, the tactical forces increased faster than thesupport troops, and by year’s end the 8055th MASH reported that its operatingroom had worked on British, Turkish, Filipino, Greek, Thai, and Dutch fightingmen; on Americans from the 1st Cavalry and the 2d, 24th and 25th Infantry

^Summary Intelligence Report no. 2982, 7/8 Nov 50, in End 4 to Weekend Letter no. 13, Humeto Bliss, 2 Jan 51, RG 338, MMFB. Dovell spoke of “amputating geniuses” in South Koreanhospitals who “were in the habit of chopping off legs, arms, feet, whatever else was in the way, with agreat deal of gusto.” See Dovell Interv, 21 Sep 66, p. 9, HRB.

^®Appleman, South to the Naktong, p. 310.

89

South Korean Casualties Receiving Medical Attention at the SouthKorean Army Hospital in Taejon

Divisions; on Korean civilians; and on prisoners of war. Because only oneevacuation hospital was available, and transport was poor and overburdened,the MASH quickly developed into an all-purpose hospital, treating both sickand wounded, though the condition of its laboratories and its lack of medicalspecialists caused it to ship the ill as quickly as possible to other facilities. Ineffect, the MASH became a small evacuation hospital and its bed strength,instead of the regulation 60, fluctuated with need. From the 8076th MASHCapt. Elizabeth N. Johnson reported in August that “we are anything but a 60-bed mobile surgical unit. Our holding wards alone have held 200 patients.”^’Whether they worked in the MASHs or elsewhere, young doctors by mostaccounts had a hard time adapting to the battlefield. Colonel Dovell recalledthat the first nine physician replacements to arrive in the Eighth Army informedhim that the job they were best qualified to perform was tissue pathology. In

^Quoted words from Ltr, Capt Elizabeth N. Johnson, Chief Nurse, [?] MASH, to Chief, ANC, asexcerpted in Technical Information Office, OSG, “Army Nurses in Korea—Background Informa-tion,” 24 Aug 50, file 211 (Nurses) Korea, HRB. The formal conversion of the MASH’s table ofdistribution and allowance that occurred later in the year changed its bed strength from 60 to150-200. See 8086th Army Unit, “Surgical Hospital in Korea,” pp. 2, 9-14, RG 319, MMHB.

THE MEDICS’ WAR

reply he assured them that they would make good battalion surgeons, and eightactually did so. The ninth, on his first encounter with war, went “wild as ajackrabbit. . . . We had to evacuate him that same day as a psycho.” In afteryears, the officer who was chief of surgery at Walter Reed during the KoreanWar recalled the words of a medical officer who had served there. “I don’t wantever to be caught again as ignorant as I was about the conduct of the MedicalDepartment activities in a theater of war and not know what to do,” the physi-cian averred. “I was strictly a professional man and I just wasn’t capable.”^”

Among surgeons, clinical retraining as well was essential to “unlearn . . .the very excellent and beautiful principles necessary in civil practice” in favor of“the rapid and adequate sort of care of massive wounds, massive trauma.”There were too few surgeons, and those mostly young with much to learn.Neurosurgeons and orthopedists were, and remained, in short supply. Yet onthe battlefield, orthopedic injuries—especially compound comminuted frac-tures (crushed or shattered fractures accompanying wounds)—were the com-monest of all. As a result, both types of wound further burdened the transportsystem, neurosurgical cases going to a center established in Japan.^*

The surgeons who succeeded in mastering their new jobs—mostdid—learned to perform the brisk, decisive interventions required by a flood ofmassive traumas in a septic environment. A surgeon following Eighth Armyrules would approach an abdominal wound in this way. He first performed a“bold para-median incision,” a vertical cut extending from 3 inches above thenavel to 3 inches below. Entering the peritoneal cavity, he arrested any visiblebleeding. He then completely eviscerated the patient and examined the mesen-tery—the tissue holding the intestines to the abdominal wall—for bleedingvessels, which he ligated. He marked and clamped intestinal perforations toprevent further contamination, performed the necessary suturing or resectionsof the bowel, cleaned out any oddments of breakfast that had gottenloose—“wandering pork and beans, floating bits of canned chicken, errantchunks of hot dog”—replaced the viscera, and sewed the patient up.^^

Sometimes the surgeon encountered surprises. At the 8076th MASH inMiryang during the perimeter battles, a surgeon working in the belly of a Koreansoldier felt something crawling into his glove. “I got out of there fast,” headmitted. In time operating room personnel learned to be casual about thephenomenon. Every Korean, said Capt. Genevieve A. Connors, a surgical nurseat the 8055th MASH,“‘had a belly full of worms, and as soon as you opened it,they would start crawling out. They would be better than a foot long and wouldmove slowly, rather like angle-worms in sidewalk puddles after a heavy rain.’”Worms crawled into and blocked nasogastric tubes. She recalled how she dealt

“First quotation from Dovell Interv, 21 Sep 66, p. 11. Second quotation from Seeley Interv, 14Aug 79, sess. 1, cassette 1, p. 32. Both in HRB.

^'Quoted words from Seeley Interv, 14 Aug 79, sess. 2, cassette 5, pp. 11-12, HRB. See also FEC,Annual Report of Medical Service Activities, 1950, pp. 35-38, file 319.1-2 (FEC) Far East-1950;EUSAK, Annual Report of Medical Service Activities, 1950, pp. 62-64, file 319.1-2 (EUSAK) FarEast-1950. Both in HRB.

“First quotation from EUSAK, Annual Report of Medical Service Activities, 1950, p. 62, HRB.Second quotation from W. L. White, Back Down the Ridge (New York: Harcourt, Brace, 1953), p.91.

91

Surgeons at Work in Taegu

with them: ‘“As they crawl out, all you do is pick them up, drop them in a pailand go on [working].

Similar in some ways to the surgical story were the initial errors in thehandling of neuropsychiatric cases (NPs) during the early months of the conflict.NPs were common during the retreat when exhaustion, despair, and the fear ofencirclement shattered the morale of many men and some units. They reached ahigh point in September, precipitated by the heavy North Korean assault. Avariety of factors contributed. Many veterans of World War II felt that theKorean fighting was more intense than any they had known. The landscape ofdenuded hills gave a feeling of “no place to hide,” and the process of fighting upone hill only to be confronted with another beyond was psychologically as wellas physically wearing.

Throughout the early months, failures by both commanders and medicalofficers amplified psychiatric losses. The basic lesson learned in World War Iand relearned in World War II—that men suffering from symptoms of battlefatigue should be held as close as possible to the front line—was, partly fromnecessity, forgotten. Men with mild nonpsychotic symptoms were hustledaboard planes or ships and dispatched to Japan, the worst possible treatmentbecause it took a soldier from the line and taught him the lesson that escape

”As related in White, Back Down the Ridge, p. 95.

THE MEDICS’ WAR

from danger was the reward for bi-zarre behavior. The result was the lossof many men who, with a few daysrest, a sedative, and a hot meal, couldhave returned to duty.^"*

With the formation of the PusanPerimeter, the psychiatric admissionrate soared, from 50 cases per thou-sand troops per year in July to 258 inAugust. These figures accompanied ageneral improvement in Americanmorale and battle performance andprovided a sharp commentary on thesingle most notable failing of the Med-ical Service during the early months inKorea. In part, the problem continuedto be a simple lack of bed space; over-whelmed by casualties, the few Koreanhospitals could not accommodate allField Psychiatry of the combat fatigue cases. Between

July and December 1950 the 8054thEvacuation Hospital evacuated 85 percent of its NPs and returned only 15percent to duty, reversing normal expectations.

The major exception to this generally gloomy picture tended to prove therule. In the 2d Division a vigorous effort was made from the first days of battle(about 10 August on) to hold NPs at the clearing station level, where most“could be dealt with by ... a few days rest and returning them to duty.” Whenthe division surgeon arrived in Korea on 19 August, he brought with him aqualified psychiatrist, Capt. Martin J. Schumacher. During the first week ofSeptember, Schumacher set up a neuropsychiatric treatment center—outsidethe existing regulations, which provided for no such establishment—with equip-ment borrowed from the 2d Medical Battalion and from the division’s SpecialServices. The center operated at Miryang only during September, after whichthe division went over to the attack. Then movement made the holding opera-tion impossible, while at the same time the psychological lift of advancinghelped to make it unnecessary.

During September, however, when the 2d Division engaged in fighting as hotas any along the perimeter, out of its 612 NPs 71 percent were returned to dutyand only 29 percent evacuated. Many of the division’s men were newcomerswho faced the stress of battle suddenly and among strangers. As a result, theratio of NPs to wounded almost doubled the World War II norm. Schumacher’ssuccess in salvaging a large proportion of such losses underlined the need fordealing rationally with the consequences of stress.^®

^''United States Army Forces, Far East (hereinafter cited as USAFFE), Annual Report of MedicalService Activities, 1953, p. 49, file 319.1-2 (USAFFE) Far East-1953, HRB.

”Above three paragraphs are based on 2d Infantry Division, Annual Report of Medical Service

93

Command failures continued to bear some responsibility for the commonerpicture of heavy neuropsychiatric losses. One of the leading psychiatrists in theEighth Army was assigned to work as a venereal disease officer rather than in hisclinical specialty. Other contributing factors were beyond the power of com-manders to control. Young and inexperienced men working as battalion sur-geons had to make many difficult triage decisions, and inevitably made somepoor ones. The record of the hospitals, too, was generally bad. The combinationof retreat, bad command decisions, inexperienced doctors, quick evacuation,and lack of bed space caused combat psychiatry to founder. Its failures weak-ened the Army in Korea at a time when manpower losses were critical.^^

Besides psychiatry, the medical system in Korea had another basic problem.Emphasis on strictly professional training had provided many new personnelneither field experience nor the type of wide, cursory, but essential knowledge ofmany kinds that combat demanded. The problem showed itself in many forms,among enlisted men as well as officers. The 2d Division surgeon wrote:

Experience in the present conflict indicates [a] necessity for reinstating a basic medicaldepartment officer’s course in which administration and tactical aspects of field opera-tions are presented to every medical department officer during the early years of hisservice. Similarly, the present concept of strictly compartmentalized career . . . plan-ning of enlisted medical department personnel, is not conductive to a well-rounded,capable, jack-of-all-trades enlisted man. This is especially true of non-commissionedofficers who have received their rating since the Career Management Program had beeninstituted. This is not an attempt to belittle or decry the specialist technician whether hebe x-ray, dental, etc., but merely to point out that the overall efficiency of a unit would begreatly benefitted if the technician possessed in addition to this specialist knowledge, thewell-rounded experience and background found formerly in the ‘old’ Medical Depart-ment non-commissioned officer.^’

Enter the Helicopter

Not only men and organizations but machines as well showed the impact ofexperience in Korea. Few technical innovations were equal in importance to thegrowing use of the helicopter for medical evacuation. A product of World WarII, the helicopter early had attracted the surgeon general because of its potentialas an evacuation vehicle. In 1947 the Medical Department had studied the

Activities, 1950, p. 17, file 319.1-2 (2d Inf Div) Far East-1950, HRB. In October the number ofNPs fell by three-fourths; the proportion evacuated was about the same.

“Surgeon’s Circular Letter 6, no. 3, Medical Section, FEC, 1 Mar 51, pp. 48-52, file 461(Circular Letters) FEC; Surgeon’s Circular Letter 5, no. 10, Medical Section, FEC, 1 Oct 50, p. 19.Both in HRB. See also 8054th Evacuation Hospital, Annual Report of Medical Service Activities,1950, p. 9, HRB; Albert J. Glass, “History and Organization of a Theater Psychiatric Service Beforeand After 30 June 1951,” in Recent Advances in Medicine and Surgery Based on ProfessionalMedical Experiences in Japan and Korea, 1950-1953, Medical Science Publication no. 4, 2 vols.(Washington, D.C.: Walter Reed Army Institute of Research, [1955]), 2:365-66. Before his death.Dr. Glass prepared a complete clinical history of psychiatry in the Korean War, which is on file atthe Center of Military History.

^^2d Infantry Division, Annual Report of Medical Service Activities, 1950, p. 29, HRB.

THE MEDICS’ WAR

Loading a Casualty on a Marine Corps Helicopter

possibility of an Army evacuation squadron to serve under the surgeon of a fieldarmy. In Korea, however, the Air Force was the first to use helicopters forevacuation. In late July 1950 a detachment of the 3d Air Rescue Squadronarrived in Korea under the command of Capt. Oscar N. Tibbetts. Its primarymission was to recover downed pilots. But the rapid decline of the NorthKorean air force meant that the detachment’s job was not very burdensome.Tibbetts began to receive and answer requests from Army units to rescuecasualties who could not be reached by ambulance. By August 1950 the unitwas answering so many calls that “it found itself in the medical evacuationbusiness.”^*

Colonel Dovell was intensely interested in the helicopter. He requested anAir Force helicopter on loan for a test. On 3 August, in the schoolyard of TaeguTeachers College, amid “some telephone poles and a couple of old buildings thatwere still standing,” the Sikorsky touched down, blowing dust that stung likepowdered glass into the eyes of the onlookers. Loaded with two litters behindthe pilot’s seat, and additionally burdened with Dovell’s bulky form, the heli-copter flew without trouble to the 8054th Evacuation Hospital in Pusan.^’

^*8086th Army Unit, Military History Detachment, “Helicopters in Korea, 1 July 1951-31August 1953,” Ms no. 8-5.1A AJ, RG 319, MMHB.

'’Dovell Interv, 21 Sep 66, p. 14, HRB.

95

Dovell began to press for Army helicopters to work under his own controland soon received support from his superiors. General Hume, the EEC surgeon,became an enthusiastic backer. In October Surgeon General Bliss visited the FarEast Command and spent several hours closeted with General MacArthur dis-cussing medical problems. He reported to his staff that “MacArthur feels thathelicopters should be in the T/O&Es and should be a part of medical equip-ment—just as an ambulance is.” With such strong support, the Office of theSurgeon General requested two helicopter ambulance companies of twenty-foursmall craft each. By 20 October definite word had come from the port of SanFrancisco that eight helicopters were being purchased for immediate airlift tothe Far East Command. Meanwhile, four detachments of four copters each werebeing activated for medical use. “This,” noted the staff, “will make GeneralHume very happy for this apparatus is badly needed.”^®

With all its remarkable implications for the future of Army medicine—indeed of emergency medicine, whether military or civilian—the rapid adoptionof helicopter evacuation resulted from the nature of the Korean conflict and ofthe Korean countryside. The broken terrain separated fighting units from theirmedical support. The poor road net, the prevalence of guerillas, and the NorthKorean tactics of infiltration and envelopment contributed to the problem.Because roads were few, traffic was forced onto a few main routes that enemyartillery could interdict; overuse made the roads worse; and theirform—“extremely narrow, sharply winding, and steep in ascent and de-scent”—imposed much added suffering upon the wounded. Early in the fight-ing, a passenger in an ambulance wrote that the vehicle “tears along, bumping fitto break the chassis. Speed is vital. . . . But it is also essential not to bump thewounded more than can be helped. Which is to come first? . . . The driverserves both masters as well as he can.” By contrast, the smoothness of thehelicopter’s ride prevented many hemorrhages and reduced the danger to menwith head and spinal cord injuries. Finally, the rotary-winged aircraft was swift,and speed as much as its ability to land in a constricted area or the smoothnessof its flight made it an ideal vehicle for the movement of the wounded.'”

From the beginning of its career the medical evacuation helicopter wasassociated with the MASH. Its normal route of travel was from the aid station orclearing station to the surgical hospital, bearing the critically wounded (the so-called nontransportables) to immediate, often radical stabilizing treatment.Typical of the early days was the experience of the 2d Division surgeon. Col.Donald E. Carle, with helicopter evacuation. The division was the first to arrivein Korea direct from the United States, debarking at Pusan 10-20 August andmoving to Miryang, site of the 8076th MASH as well as of the division’s ownforward command post. On 1 September, as the enemy’s “Great Naktong Offen-

'“First quotation from SG Conference Notes, 10 Oct 50. Second quotation from ibid., 15 Nov 50.Both in HRB. See also EUSAK, Annual Report of Medical Service Activities, 1950, pp. 8, 69-70;FEC, Annual Report of Medical Service Activities, 1950, pp. 114-15. Both in HRB.

“"Quoted words from Deane, / fVas a Captive in Korea, p. 14. See also Spurgeon H. Neel,“Medical Considerations in Helicopter Evacuation,” cited in 8086th Army Unit, “Helicopters inKorea,” pp. 28-31, RG 319, MMHB; 24th Infantry Division, Annual Report of Medical ServiceActivities, 1950, p. 2, file 319.1-2 (24th Inf Div) Far East-1950, HRB.

THE MEDICS’ WAR

sive” hit the line, Carle contacted Colonel Dovell at Eighth Army and asked forhelicopter evacuation. Two machines—it is unclear where they camefrom—were placed at his disposal and stationed near the command post. Thedivision surgeon then dispatched them on call to the various clearing stations,but only for patients whose head, chest, or abdominal wounds made evacuationby field ambulance undesirable. The helicopters, too fragile and too scarce to berisked, were not allowed to evacuate battalion aid stations, or even regimentalcollecting stations, “due to their vulnerability to small arms fire.”'*^ Their contri-bution was qualitative—to bring the worst cases to the MASH in the first hoursafter wounding.

Clearly, the helicopter was only beginning its career in medical evacuation inthe summer of 1950. The machines that were available belonged to the AirForce, the Marine Corps, or the Air Section of Eighth Army headquarters. Mostpatients were, and would continue to be, moved by train or ambulance. Yet thenew link to the century-old evacuation chain in time would transform thesystem radically and, in wars to come, would make the chain itself at leasttemporarily obsolete.

At no time was medical evacuation the only use for helicopters. Resupply,troop deployment, and use as a command vehicle early claimed many helicop-ters, for all the problems that beset the medics in the Korean countryside alsoafflicted the line. A status symbol for commanders, available machines too oftenwere taken (as Dovell complained) by “generals and top brass ... for theirpersonal use.” Amid many jobs by many branches of the Army and by the AirForce, helicopter pilots found opportunity to perform medical evacuation onreturn flights. Yet it was the medical function that attracted the most attention.The sheer spectacle of the flights, the lives hanging in the balance, the noisy,dust-flailing arrivals and departures stamped an unforgettable image on theminds of onlookers and led to a contemporary judgment that “the most dramat-ic and most publicized employment of helicopters in Korea was their use inevacuation of combat casualties.

For all the changes beginning to emerge from the Korean experience somethings remained the same. Most basic was the courage of people, unarmed orlittle trained in the use of arms, who either brought casualties out or worked tosave them. Company aidmen, battalion surgeons, collecting and clearing stationpersonnel, MASH surgeons, and many others withstood the pressures, bore thedangers, and on occasion lost their lives aiding the wounded. At Chonui, ahamlet north of Chochiwon, Pvt. Jack Bolen of the Medical Company, 21stInfantry, won the Distinguished Service Cross for conspicuous heroism; Pvts.Ronald R. Dusek and Donald V. Bailey—the first a company aidman, thesecond a battalion ambulance driver—won the same award at the defense of theKum River line. Near Changnyong on 6 September, Pfc. Richard L. Fleisch-mann, an aidman with a machine gun platoon of Company H, 23d Infantry, 2dDivision, first pulled two wounded men to safety and then took their place at

*^2d Infantry Division, Annual Report of Medical Service Activities, 1950, p. 2, HRB.

■’^Quoted words from Dovell Interv, 21 Sep 66, p. 16, HRB. See also 8086th Army Unit,“Helicopters in Korea,” p. 16, RG 319, MMHB.

97

the gun until killed. He, too, received the Distinguished Service Cross. Andmedics were not the only ones to risk their lives. At Taejon Sgt. George N. Libbyof the Corps of Engineers won the Medal of Honor posthumously for his feat inaiding a tractorload of wounded to run an enemy roadblock. No doubt for eachrecorded instance of bravery, the deeds of many others will forever escape thenotice of history.^'*

By mid-September General Walker’s defense of the perimeter appeared like-ly to triumph. After a month of almost continuous fighting, the North Koreansat last conquered Battle Mountain. But the defenders turned back the threemain enemy thrusts of the September offensive—in the south at Masan, in theeast around Pohang-dong, and in the center at the approaches to still uncon-quered Taegu. Though fighting in the area was not over, the war by this timehad taken a new and startling turn that ended the bitter months of retreat andsiege. Following their comrades of the line, some medics already had gone overto the attack.

“^Eighth United States Army, Korea, General Order no. 50, 3 Sep 50, MMFB; Appleman, Southto the Naktong, p. 173; Clark C. Munroe, The Second United States Infantry Division in Korea,1950-1951 (Tokyo: Toppan Printing Co., 1952), p. 21; Department of the Army General Order no.62, 2Aug51,PAB.

CHAPTER 4

The Medical Service inthe Attack

General Mac Arthur’s experience in the Pacific war combined with Koreangeography to make an amphibious attack against the enemy rear an early possi-bility. Commanding the sea and air, and well able to strike the Korean peninsulaat many points along its lengthy coast, United Nations (U.N.) planners alsowere aware of the fact that the Communists had committed almost all theirforces to the attack on the Pusan Perimeter. Staff studies began during July andAugust. The proposed strategy was to counterattack, but several times theshortage of troops and heavy enemy pressure against the Eighth Army delayedaction.

At last, on 6 September, MacArthur confirmed the fifteenth of the month asD-day for a landing against Inchon, the port of Seoul. A commercial city whosemilitary importance lay in its proximity to the capital, Kimpo Airfield, and themain north-south transport corridor, Inchon presented an altogether differentkind of objective from the Pacific Islands of the Second World War. Describedby a Marine Corps officer as “about the same size and general attractiveness asJersey City, New Jersey,” Inchon, like the capital beyond, was packed withcivilians whose wounded would become charges of the Medical Service. The 30-foot-plus tides troubling that portion of the Korean coastline also posed evacua-tion problems. To meet the many difficulties of the landing, MacArthur estab-lished X Corps under his chief of staff, Maj. Gen. Edward M. Almond.Spearheaded by the 1st Marine Division, Almond’s force had the 7th InfantryDivision as its main Army component. With X Corps, a strong infusion of freshmedical units entered Korea to meet the needs of a new front in the three-month-old war {Table 8)}

Medical Support for the Invasion

The hasty assembling and equipping of the invasion force—primarily atKobe, Sasebo, and Yokohama in Japan, and Pusan in Korea—brought the usual

'Quoted words from Robert D. Heinl, Jr., Victory at High Tide: The Inchon-Seoul Campaign([Annapolis, Md.]: Nautical & Aviation Publishing Company of America, 1979), p. 25. Except asotherwise noted, the general account of this campaign is from Appleman, South to the Naktong, pp.488-776.

99

Table 8-Nondivisional Medical Units in Korea, August 1950

| Eighth Army                               | X Corps                               |
|-------------------------------------------|---------------------------------------|
| 8055th MASH                               | 1st MASH                              |
| 8063d MASH                                | 121st Evacuation Hospital, Semimobile |
| 8076th MASH                               | 4th Field Hospital                    |
| 171 St Evacuation Hospital, Semimobile    | 6th Army Medical Depot                |
| 8054th Evacuation Hospital, Semimobile    | Advance Platoon                       |
| 64th Field Hospital                       | Blood Distribution Section            |
| 6th Army Medical Depot                    | 150th Veterinary Food Inspection      |
| 8065th Army Medical Depot                 | Detachment                            |
| 38th Malaria Control Detachment           | 163d Medical Battalion (Separate)     |
| 207th Malaria Survey Detachment           | 559th Medical Ambulance Company       |
| 66th Veterinary Food Inspection           | 560th Medical Ambulance Company       |
| Detachment                                | 618th Medical Clearing Company        |
| 95th Veterinary Food Inspection           | (Separate)                            |
| Detachment                                | 421 St Medical Collecting Company     |
| 476th Veterinary Food Inspection          | (Separate)                            |
| Detachment                                |                                       |
| 461 St Dental Prosthetic Detachment       |                                       |
| 52d Medical Battalion (Separate)          |                                       |
| 567th Medical Ambulance Company           |                                       |
| (Separate)                                |                                       |
| 514th Medical Clearing Company (Separate) |                                       |

Source: Far East Command, Report of ETMD, August 1950, p. 2, file 350.05 (EEC) 1950, HRB. The Eighth Army absorbed the XCorps in December 1950.

quota of mix-ups worsened by a natural calamity. As field units arrived from thezone of interior, their equipment turned up piecemeal on the docks. The JapanLogistical Command (JLCOM) discovered that, instead of being combat loaded,the materiel had been dispersed through many ships. Only the reserve medicalassemblies already on hand in Japan enabled all units designated for the landingto be ready in time.

The old problem of assuring an adequate supply of drinkable water took anew turn. Municipal supplies at Inchon were not likely to remain potable oncethe fighting started. When the engineers reported that no distillation units wereavailable, the Medical Section, Far East Command (FEC), experimented withtransporting water in Japanese oil tankers. This last-minute decision set offfrantic activity. Workmen scrubbed and decontaminated the tanks, coveredthem with cement wash, and filled them with lightly chlorinated water. At seathe expedient quickly failed, for seawater or oil from leaks in the ships’ ownmachinery invaded several tanks. Medical units around Inchon later reported“many hardships ... in regard to [the] supply of water,” and the chief cause ofillness among the troops was gastroenteritis.^

^Quoted words from 4th Field Hospital, Annual Report of Medical Service Activities, 1950,Sanitary Service sec.. Water Supply, file 319.1-2 (4th Field Hospital) Far East-1950, HRB. See alsoibid.. Patient Status sec.; JLCOM, Annual Report of Medical Service Activities, 1950, p. 11, file319.1-2 (JLCOM) Far East-1950; FEC, Annual Report of Medical Service Activities, 1950, p. 79,file 319.1-2 (FEC) Far East-1950. All in HRB. Gastroenteritis is a general term denoting inflamma-tion of the stomach and bowel; diarrhea often results.

THE MEDICS’ WAR

Adding to the normal problems of loading a large force on short notice,Typhoon Jane thundered into Kobe harbor on the morning of 3 September. Astorm surge, driven by winds of 110 miles per hour, swept across cargo-ladenpiers. Cranes toppled, ships broke loose from moorings, and equipment wassoaked and scattered. As winds abated in the afternoon, port troops and the 1stMarine Division faced “exhausting and dangerous work” to secure driftingvessels and to reassemble, dry, and load essential cargo.^ Yet the fleet sailed ontime.

Early on the fifteenth, under a lowering sky, the marines landed on Wolmi,an island off Inchon harbor. On the evening of the same day they scaled theInchon seawalls and began to move inland. Behind them came 7th Divisionforces. Hard fighting began as initially weak enemy resistance stiffened, andboth military and civilian casualties mounted. Medical units were reportedashore on D + 2. Soon both the Navy medics who accompanied the marines andthose of the Army had their work cut out for them.**

The organization of the Army medical effort grew directly out of the plan-ning process for the invasion. Meeting in Tokyo, the Far East Command’s JointStrategic Plans and Operations Group included a medical section, and on 26August, when X Corps was organized, this section became the office of the corpssurgeon. Col. Alvin L. Gorby. A tall, heavyset man, capable and well-liked,Gorby at one time had been favored by General Hume to become the EighthArmy surgeon. Because General Walker preferred Dovell, Surgeon General Blisssought to have Gorby appointed as the JLCOM surgeon. But if Walker had notwanted Gorby, Almond did, and he refused to release him. Gorby found himselfserving for four months as the surgeon of an independent corps, “a position,”said Hume, “hardly less important than that now held by Dovell.”^

Gorby’s authority, too, resembled Dovell’s in the Eighth Army. Though hecommanded only the personnel of the Medical Section, X Corps, he providedpolicy and guidance to all corps medical units. Additionally, several operateddirectly under corps headquarters, including the 4th Field Hospital, the 121stEvacuation Hospital, Semimobile, and the 163d Medical Battalion (Separate).This battalion was actually a headquarters detachment whose staff of six of-ficers, one warrant officer, and sixteen enlisted men coordinated the activities ofa number of separate units that had been attached to it in Japan—a collectingand clearing company and two ambulance companies. With the 7th Division’smedics and the 1st MASH, attached to the division, these units provided thebackbone of X Corps medical care.*^

Appleman, South to the Naktong, p. 501.

“TELECON 202100Z Sep 50 TT 3792, sub: Routine Medical Matters, file 024 (Telecon Commu-nications Between OTSG, Washington, and EEC) 1950, HRB.

Ttr, Maj Gen Edgar Erskine Hume, Chief Surgeon, EEC, to Maj Gen Raymond W. Bliss,Surgeon General, DA, 4 Sep 50, file 312.3 (Correspondence-SGO-Washington), Box 3106 (MedicalSection, EEC, General Records, 1950), RG 338, MMEB.

‘See X Corps, 4th Eield Hospital, 121st Evacuation Hospital, Semimobile, and 163d MedicalBattalion (Separate), Annual Reports of Medical Service Activities, 1950, files 319.1-2 (X Corps),(4th Eield Hospital), (121st Evacuation Hospital, Smbl), and (163d Medical Bn, Sep) Ear East-1950,HRB. On 26 December 1950 X Corps became a tactical corps of the Eighth Army.

101

Led by MacArthur’s chief of staff and more than adequately supplied, theinvasion force was known to the hard-fighting Eighth Army as the “GildedLily.” However, there was nothing cushiony about the struggle that developedon the approaches to Seoul. During the early phase of the fighting, casualtieswere light among the marines and the soldiers that followed them. As the enemydug in for a last-ditch defense. Marine losses soared.

Meanwhile, Army units struggled into position and sought to open a usableroute of evacuation. After nightfall on 19th September the 7th Medical Battal-ion came ashore on LSTs at Yellow Beach, the divisional landing area. March-ing through darkness to an assembly point, the men bedded down in abandonedbuildings to await their equipment. But the Inchon tides intervened; three dayselapsed before the battalion’s vehicles were unloaded. On the twenty-second aplatoon of the clearing company plus an ambulance platoon moved out tosupport the 32d Regimental Combat Team, setting up shop in a deserted brew-ery in Anyang-ni. The Marine hospital took the company’s evacuees, but asfighting intensified it became full to overflowing. Now the medical battalionevacuated to the beach where the medical detachment of 2d Special EngineerBrigade had set up as shore party, receiving wounded and loading them on LSTsfor transport to the hospital ship USS Consolation, which was anchored off-shore. Again the tides intervened, causing long waits for the wounded on thedismal beach.

The fall of Kimpo Airfield on the twenty-first opened a new route of evacua-tion. Again supply planes received the injured for return flights, and Japan wasonce more providing backup to the Army and Navy hospitals in Korea. Duringthe first fifteen days of fighting, 870 patients were carried to the hospital shipand 1,271 flown out of Kimpo.^

Then General Almond grew impatient with the marines, halted by the des-perate defense west of Seoul. On 25 September the 32d Regimental CombatTeam crossed the Han River and joined the encirclement of the capital. Aplatoon of the 7th Medical Battalion’s clearing company supported the advance.Though street fighting was now raging in parts of Seoul and its suburbs, theNorth Koreans stripped the city of most of its doctors and medical supplies.Hundreds of injured men, women, and children flooded the clearing station,even as military casualties were increasing. Problems multiplied because enemyartillery and sniper fire, as usual, did not spare the medics. Another platoonmoved in to assist. Civilian injuries were severe, with many traumatic amputa-tions and complex surgical cases. Clearing station personnel, at work in aschoolhouse, turned over one wing to the civilians, provided medical suppliesand supervision, and found two Korean doctors and two nurses to bear thebrunt of the work. An officer with a party of thirteen enlisted men entered Seoulto organize civilian medical facilities there. Withdrawal of the enemy main

’X Corps, Annual Report of Medical Service Activities, 1950, pp. 1-7, HRB. For the story ofNavy medics serving the marines, see U.S. Bureau of Medicine and Surgery, The History of theMedical Department of the United States Navy, 1945-1955, NAVMED P-5057 (Washington, D.C.:Government Printing Office, 1958), pp. 126-35.

THE MEDICS’ WAR

forces, rapid evacuation of U.N. casualties, and the efforts to organize civilianrelief brought some improvement in the situation. By the end of the month,fighting on the 7th Division front had almost ended, and the South Koreangovernment once again controlled its capital city.*

Behind the fighting line the hospitals found themselves facing a similar mixof wounded soldiers, civilians, and, as the tide of battle turned, increasingnumbers of prisoners of war (POWs). The men and women of the 1st MASHclambered down the side of the USS General W. A. Mann on 16 September intosmall boats “in what seemed,” said a nurse “to be mid-ocean.” Ashore at In-chon, the hospital secured its favorite shelter in an abandoned and “prettyawful” school building and attempted to start work minus its equipment, whichhad been shipped separately. Nevertheless, makeshift wards opened, mainly forcivilians and POWs, using borrowed Marine equipment. An advance group ofthe 121st Evacuation Hospital, which had sailed with the invasion convoy toprovide medical care for the troops, already had established a temporary hospi-tal for civilians, working under almost impossible conditions with virtually nosupplies at all. Taking over this task, the 1st MASH treated some three hundredcivilians, most of them wounded and burned. Among the patients were a sub-stantial number of children who, when the hospital was ordered up to support7th Division, had to be consigned to Christian orphan homes.’

Meanwhile, the two larger hospitals also had opened. After landing on thetwenty-fifth, the 4th Field Hospital moved to a site in Ascom City. Here,damaged by bombs and shellfire, stood abandoned buildings, once officers’quarters for the Republic of Korea (ROK) Army. The parade grounds wereovergrown with brush and small trees. Hired labor quickly cleared the area andrepair crews made the buildings serviceable. With steam heat, electricity, andmovies at night, the hospital now enjoyed conditions of relative comfort. Aonetime service club served as the main hospital building. Evacuees from for-ward aid stations and direct admissions arrived by ambulance convoys and byhelicopter. Additionally, a substantial number of sick and accident cases helpedto fill the wards.

A wide range of services reflected the hospital’s growth. The surgical servicehandled primarily abdominal and chest wounds. The medical service spentmuch of its time fighting a near epidemic of bacillary dysentery plus outbreaksof hepatitis and malaria. A psychiatric service operated separate wards andprovided the typical pattern of brief directive therapy and rest, with evacuationonly for the seriously disturbed. The average length of hospital stay for neuro-

*7th Medical Battalion, Annual Report of Medical Service Activities, 1950, pp. 3-4, file 319.1-2(7th Medical Bn) Far East-1950, HRB.

’Quoted words from Ltr, Maj Eunice Coleman, Chief Nurse, 1st MASH, 15 Nov 50, as excerptedin Technical Information Office, OSG, “Background Information: Army Nurses in Korea” (herein-after cited as Coleman, “Army Nurses in Korea”), 2 May 51, file 211 (Nurses) Korea, HRB. See also1st MASH, Annual Report of Medical Service Activities, 1950, p. 1, file 319.1-2 (MASH, 1st ArmyUnit) Far East-1950; 121st Evacuation Hospital, Annual Report of Medical Service Activities,1950, p. 3. Both in HRB.

103

Korean Civilian Hospital at Inchon, operated by the 1st MASH

psychiatric patients (NPs) was two to three days, with 65-70 percent returningto duty—a marked improvement over the conditions of the Pusan Perimeter amonth earlier. Though the front eventually moved as much 200 miles ahead ofthe hospital, NPs found small reason to prolong their illness in “a Field Hospitalshorn of luxury, in a town devoid of much beauty.”^®

As often happened in Korea, the 4th Field Hospital’s bed strength increasedwith little regard to its table of organization and equipment (T/O&E). Withsome one thousand beds, with additional equipment and bedding supplied bythe medical and quartermaster depots, and with its varied services and perma-nent location, it rapidly evolved, for practical purposes, into a station hospitalor a small general hospital serving the installations and units of the Seoul-Inchon area.

On the other hand, the 121st Evacuation Hospital retained its basic charac-ter during its brief stay near the capital. Primarily devoted to treating X Corpspersonnel at the town of Yongdung-po, the hospital aided about six hundredpatients before its departure on 8 October. The staff achieved marked successwith medical and surgical patients, but less with the psychiatric. Apparently the

‘Mth Field Hospital, Annual Report of Medical Service Activities, 1950, Neuropsychiatric Ser-vice sec., para. 7, HRB.

THE MEDICS’ WAR

4th Field Hospital in Ascom City

atmosphere of an evacuation hospital, with its clear suggestion that the nextstop was Japan, was not a good one for NPs; additionally, the facility lackedprivacy for the treatment of such cases. For a few days in late September thehospital also treated six hundred POWs, the first wave of a massive influxwhich, during late October, was to impose a heavy additional burden on the 4thField Hospital as well.*^

The X Corps soon moved in pursuit of the fleeing enemy. Despite its loca-tion on the west coast, the corps did not invade North Korea by this route.Instead, its hospitals barely had time to unload their belated equipment whenorders arrived for a second planned invasion, this time on the east coast. On 6October, the day when its equipment at last left the ships, the 1st MASH wasattached to 7th Division and began to load up to join the medical battalion atAnyang-ni. The part of the invasion fleet they were rejoin lay 350 miles to thesouth, in the harbor of Pusan. The fact that hospitals could move overland,through areas recently held by the North Koreans, reflected an extraordinaryfact. The enemy army in South Korea had virtually ceased to exist.

“Above paragraphs are based on ibid., 1950, HRB. See also 4th Field Hospital CommandReport, September 1950, file MDFH-4 (Command Report, 4th Field Hospital, 25 Jul-Sep 50), Box4715 (Nonorganic Units, MDDP-4 to MDGH-457, 1949-50), Entry 429, RG 407, MMFB.

105

Medics in the Breakout

MacArthur’s plan called for theEighth Army to break out of the PusanPerimeter on 16 September. The mainthrust was to aim toward Taejon alongthe well-worn invasion corridor.

Chances for success were better thaneven the planners in Tokyo, misled byoverestimates of enemy strength, hadimagined. Outnumbering their foes byas much as 2 to 1, and aided by tacti-cal air support and by naval gunfirealong the coast, the U.N. forces were afar cry from the battered troops thathad retreated southward in July. Yetthe first two days of fightingwere confused and indecisive, withNorth Korean attacks continuingeven as the counterstroke was launched,cessful invasion at Inchon—was known to U.N. troops but not to most of theirfoes.) But on 18-19 September a general enemy withdrawal began, veiled bysometimes desperate rearguard actions. Not until days later did the cumulativeeffects of heavy losses, the news of Inchon, and Eighth Army victories producewidespread disintegration in enemy units. Then the retreat turned rapidly into arout.

For medics the first effect of the breakout was a surge of wounded, thesecond a tumultuous advance that brought new problems in handling casualties.Simultanously the influx of wounded POWs rose sharply, burdening tacticalunits and hospitals alike at a time when their supply lines were overextended.Yet frequent moves, intermittently heavy work loads, and the continuing dan-gers posed by enemy stragglers and brigands in the devastated countryside couldnot dampen the elation of the time. Victory seemed to be at hand.

Division medics experienced the full range of battle, breakout, and pursuit.Toward the southern end of the perimeter, the 2d Infantry Division scored oneof the earliest successes, driving the enemy into the Naktong River and securinga beachhead for its own forces on the western side. Here the 38th Infantrycaptured a large bag of prisoners, including thirty-two female nurses. By 22September what the 2d Medical Battalion’s commanding officer called “the racenorthward” had begun. On the twenty-eighth the division command post stoodat Anui, on 1 October at Chonju, on the ninth at Suwon, and the following dayopened in the technical college at Seoul. Through these changes of station,covering hundreds of miles by the twisting Korean roads, division evacuationroutes shifted frequently. When the move to Anui placed the clearing stationoutside the range of helicopters flying from Pusan, a division L-5 fixed-wing

THE MEDICS’ WAR

reconnaissance plane was reserved for evacuating the seriously wounded. FromChonju the division was able to send its casualties to the 8063d and 8076thMASHs, themselves on the move. When it reached Seoul, the division evacuat-ed to the 4th Field Hospital in Ascom City. Medical supply was at first main-tained by leaving a section at the Miryang railhead; the rest of the supplypersonnel moved forward with the division headquarters. At Chonju the supplyofficer reunited his people, and by October the division was able to draw uponan advance section of the 6th Army Medical Depot, then issuing supplies atAscom City.‘^

Variations on this story reflected the differing experiences of other divisions.Once the pursuit began, the 24th Medical Battalion found casualties “ex-tremeley [sic] light” and its main duty to “keep up with the rapidly advancingcombat elements.” Ruined rail lines made evacuation a problem, and for a timelong ambulance hauls to a terminal at Waegwan, northwest of Taegu, becamenecessary. Wounded North Koreans meanwhile “descended on the ClearingStations in what appeared to be a never ending stream.” Forward combatelements carted POWs in by the truckload, many in appalling condition withlong-neglected wounds that the clearing stations were not equipped to treat.With resupply already a problem such patients drained the medical supplies onhand and left little for future emergencies. Wounded civilians also appeared,and because no other treatment was available to them, they were not turnedaway. Whenever possible, the battalion secured the services of Korean doctorsand nurses for their suffering countrymen. Battalion members established civil-ian hospitals, staffed them with the best local help available, and attempted tosupervise the work. Begun in South Korea, the same methods were applied inthe North after U.N. forces crossed the 38th Parallel. In such homely ways theimmense job of providing medical relief in the newly liberated areas began evenbefore the fighting had ended.

The experiences of 25th Infantry Division medics were somewhat different.When the breakout started, the division advanced rapidly from its old battle-fields near Masan to Taejon, scene of the first major U.N. defeat in July.Division medics moved by the well-established technique of leapfrogging theclearing station platoons, one remaining to care for casualties until the othershad moved ahead and opened in a new location. After its arrival at Taejon,however, the 25th Medical Battalion suspended its travels for a month (7 Octo-ber to 6 November), while the division cleaned up enemy pockets left behind inthe pell-mell advance. With few casualties to care for, the medics spent most oftheir time in training and in repairing and replacing lost and damaged equip-ment. The battalion then moved astride the 38th Parallel, with one clearingstation at Kaesong below the line and one at Kumchon above. On 19 Novemberthe unit again moved out by motor convoy to support a renewed offensive.

'^Quoted words from 2d Medical Battalion, Annual Report of Medical Service Activities, 1950,p. 2, file 319.1-2 (2d Medical Bn) Far East-1950, HRB. See also 2d Infantry Division, AnnualReport of Medical Service Activities, 1950, pp. 13-14, file 319.1-2 (2d Inf Div) Far East-1950;Appleman, South to the Naktong, 548-51.

*^24th Medical Battalion, Annual Report of Medical Service Activities, 1950, file 319.1-2 (24thMedical Bn) Far East-1950, HRB. All quotations from End 7, Clearing Company Report.

107

Unloading Casualties From a DUKW at a Naktong River crossing

Almost bewildering were the movements of the MASHs as they sought tomaintain close support of the advance to and across the parallel. “The month ofOctober,” wrote a nurse with the 8055th, “proved how mobile a Mobile SurgicalUnit can be.” During that month the 8063d advanced from Chinju near theKorea Strait via Taegu, Taejon, Ascom City, Kupaballi, and Sari won—the lastin North Korea—to Pyongyang, some 300 miles by air and much further overthe twisting roads. The 8076th moved from its base at Miryang about 240 milesto the northwest to Haeju, a North Korean town on the Yellow Sea. Theitinerary of the 8055th was more complex still. During the perimeter battles the“Double Nickel” had moved to Pusan but, even before the breakout, had re-turned to provide forward support at Taegu, the embattled anchor at the north-western corner of the U.N. line. After the breakout the 8055th shifted toKumchon on the twenty-seventh and to Taejon on the thirtieth. At Taejon the

‘''25th Medical Battalion, Annual Report of Medical Service Activities, 1950, especially pp. 2-3,file 319.1-2 (25th Medical Bn) Far East-1950, HRB.

'^Quoted words from 1st Lt Nan L. Porter, ANC, “History of the 8055 Mobile Army SurgicalHospital, October 1950” (hereinafter cited as Porter “History”), in 8055th MASH Monthly Histori-cal Report, 1-31 Oct 50, file MDSU-8055 (Historical Report, 8055th MASH, Oct 50), Box 4717(Nonorganic Units, MDSU-1 to MGGP-304, 1949-50), Entry 429, RG 407, MMFB. Except asotherwise indicated, all information on the 8055th MASH is from this source. See also MASHchronologies and maps in 8086th Army Unit, Military History Detachment, “Surgical Hospital inKorea,” pp. 28-43, Ms no. 8-5.1A DN, RG 319, MMHB.

THE MEDICS’ WAR

MASH took over a hospital building, the first it had occupied in Korea. Former-ly a facility of the United States Military Advisory Group to the Republic ofKorea, the structure resembled a one-story Army cantonment hospital withconnecting wards and quarters. A total cleanup was needed, which hospitalpersonnel finished “just in time to pack and move north again.” The patientload was small, however—accident victims for the most part, and casualtieswounded unintentionally, some when trash fires set off unexploded ordnance.Evacuation to and from the hospital was entirely by air, either because of itsavailability and a small patient load or, more likely, because the trains were notyet running to Taejon.

Taejon, the town where the 8055th MASH had begun its battlefield servicein July, now wore a new and grim aspect. On their retreat the North Koreanshad massacred thousands of soldier and civilian prisoners, including at leastforty Americans. “The dead,” Colonel Dovell recalled, “who included childrenas young as 18 months and women over 80, had first been buried up to the neck,and then dispatched by being hit over the head, apparently to save ammuni-tion.” Bodies had been thrown into wells that emitted a terrible stench; whenwater was drawn out, “pieces of human tissue are found therein.” Hospitalmedics who visited the scene returned deeply impressed by “the terrors of warand the fanaticism of the enemy.”*^

On 4 October, with the arrival of elements of the 64th Field Hospital inTaejon, the 8055th MASH—leaving its nurses behind for safety—advanced toKupaballi, a town 10 miles north of Seoul. From Kupaballi, the MASH took along, dusty ride of 125 miles that included a period of tedious waiting to cross asingle-span floating bridge over the Han River into Seoul. Here the hospitaloccupied the customary wooden frame schoolhouse, while most of the menlived in tents in the yard. Patients continued to be few, most from vehicleaccidents in the north-bound convoys. The MASH evacuated by ambulance tothe 121st Evacuation Hospital at Seoul and later to the 4th Field Hospital atAscom City. Six days of light work ended as the 8055th MASH split andleapfrogged to Kaesong, only 5 miles south of the 38th Parallel, along roadslined with burned villages and the wrecks of enemy tanks. North Koreans stillwere resisting north of the line, a field artillery outfit was ambushed, andoperating rooms ran twenty-four hours a day. Helicopters and L-5s flew themost serious cases to Ascom City; the others endured a 72-mile ambulance rideover rough roads. By now the nurses had rejoined the unit. They left Seoul inambulances, huddling at the rear windows to stare at the city, “a mass ofwreckage and debris.

The invasion of North Korea impended. On 7 October the United Nationsdebated the question of crossing the parallel, approving at last a resolution

'‘First quotation from Dovell Interv, 21 Sep 66, p. 12, Personal Interviews file (Dovell), HRB.Second quotation from Ltr, Maj Gen Edgar Erskine Hume, Chief Surgeon, EEC, to Maj GenRaymond W. Bliss, Surgeon General, DA, 30 Oct 50, file 312.3 (Correspondence-SGO-Washington), Box 3106 (Medical Section, FEC, General Records, 1950), RG 338, MMFB.Third quotation from Porter “History,” in 8055th MASH Monthly Historical Report, 1-31 Oct 50,RG 407, MMFB.

'Torter “History,” in 8055th MASH Monthly Historical Report, 1-31 Oct 50, RG 407, MMFB.

109

Enemy Soldier Receiving First Aid near Han River crossing

allowing MacArthur to invade, if he deemed it necessary. In fact, the determina-tion of the South Korean government to reunite the country and the momentumof the U.N. drive made any other outcome most unlikely. In the eastern part ofthe peninsula the ROKI Corps struck along the coast of the Sea of Japan towardthe North Korean port of Wonsan. The ROK Army in quick, hard thrustsdisrupted the enemy defense and advanced an average of 15 miles a day. In thecentral mountains the ROK II Corps advanced more slowly through harshterrain against slight enemy resistance. In the west the recently formed Ameri-can I Corps, with its attached British, Australian, and Philippine units, relievedX Corps in the Seoul-Inchon area. At noon on 7 October the 4th Field Hospitalshifted over to the Eighth Army. I Corps troops swept the enemy from the areanorth of Seoul and, on the ninth, crossed the 38th Parallel {see Map 3).

Shortly afterward the 8055th MASH followed. On the eighteenth, half thehospital moved to Sinmak, a town on the main road through Kaesong about 70miles north of Seoul, becoming the first Eighth Army hospital to cross theparallel and its nurses the first to enter North Korea. Reunited, the MASH hadto set up tents around an airstrip, for “there was no building left anywhere.”** Asa cold, wintry rain fell on the medics, the nurses knew that their efforts back atTaejon to round up long Johns and other winter gear from the 24th Infantry

'"Ibid.

^ tHyesanjift

MANCHURIA

Pujon

(Fusenp'

Reservoir

\hosmi Reservoir

Ham hungr^ Hun^rram

Kunu-ri

SEA OF JAPAN

Sukchon

Sunchon

[onsan

Pyongyang

Sariwon

Pyonggang

Kaesong

THE U.N. ADVANCES

September - November 1950

0 10 20 30 MILES

YELLOW SEA

0 10 20 30 KILOMETERS

MAPS

111

Division were not in vain. For the first time large numbers of enemy POWspoured into the 8055th, while the number of U.N. casualties remained small.Evacuation was easy, carried out from the airstrip at their doorstep.

Between the twenty-first and twenty-third, the hospital moved in the famil-iar leapfrog fashion into the enemy’s capital of Pyongyang. Again, as at Seoul,ponton spans replaced bombed bridges and “dust, mud, traffic, and confusion”reigned among convoys seeking to cross. In Pyongyang the South Koreansassumed the role of executioner. Throughout the city of broad avenues andshade trees, firing squads were disposing of political prisoners. Dovell recalledthat during the First World War a French veterinarian would hold sick call at anartillery corral every morning by shooting the injured horses. In Pyongyang heremarked to General Walker, who also had served in World War I, “The Veteri-narian is holding sick call again.”*^

Housed in a former teachers college at the end of an airstrip, the 8055thMASH had its most comfortable building up to that time. Business picked up ascasualties from an airborne drop to the north began to arrive by helicopter andL-5. The weather cooled noticeably, frost appeared at night, and the aircraftthundered overhead to the airstrip twenty-four hours a day. Medics evacuatedthe most serious cases to Japan by air, the less serious also by air to KimpoAirfield for treatment at the 4th Field Hospital. Again the lack of functioningrailroads and the difficulties of wheeled travel forced a total dependence onaircraft. Despite the continuing losses, the increasing cold, and the somewhatgrim surroundings of Pyongyang, amenities appeared. The 2d Division hadportable showers; fresh meat and fresh eggs returned to the menu; and themonth ended with a feast of steak and ham. Above all, rumors of the impendingend of the war were everywhere: “Most of us,” wrote a nurse, “hoped that ournext journey would be southward.” But the Double Nickel had not yet complet-ed its journey to the north.^®

Meanwhile, the diversification of the medical system continued. DuringSeptember a change of organization within the Eighth Army had brought intobeing two new corps, the I and IX. Corps surgeons initially found themselves tobe the fifth wheels of the medical system. Coming belatedly to an organizationthat had operated since the beginning of the war without a corps level, theyfound that the medical administrative channels ran direct from the divisions toArmy headquarters. The Eighth Army also controlled the hospitals and medicalsupport functions, including helicopter evacuation from the divisions to theMASH. Under the reorganization the corps surgeons screened requests andauthorized evacuation. But aside from these functions, their duties apparentlywere slight. The IX Corps surgeon, for example, spent the majority of his timerunning a dispensary for his headquarters and, during October, supervisingmedical service for a prisoner-of-war stockade at Taejon.^*

■’First quotation from Ltr, Hume to Bliss, 30 Oct 50, RG 338, MMFB. Second quotation fromDovell Interv, 21 Sep 66, p. 13, HRB. Description of Pyongyang in Interv, Samuel Milner with ColRudolph P. Czaja, MSC, 1 Jul 66, p. 3, AMEDD Oral History file (Czaja), HRB.

^’Porter “History,” in 8055th MASH Monthly Historical Report, 1-31 Oct 50, RG 407, MMFB.and IX Corps, Annual Reports of Medical Service Activities, 1950, pp. 3-4 and pp. 1-2,respectively, files 319-1.2 (I Corps) and (IX Corps) Far East-1950, HRB.

THE MEDICS’ WAR

Another medical unit, the 171st Evacuation Hospital, also joined the grow-ing complex at Pyongyang, rather than remaining at Seoul, its planned location.Even more than the usual confusion attended its movement into Korea. Most ofits professional complement at one point were dispersed to other units, and itsenlisted people and equipment spent twenty days on an “abominable” Japanesecargo ship waiting to berth at Inchon. Arriving on 25 October, the 171st set upshop in a former hospital and medical college once maintained by Russianadvisers. Much of the medical supplies captured along with the building werestill in good condition, and the X-ray equipment was soon in use again by itsnew owners. On a visit Hume was amused to find that signs throughout thebuilding were written “in large letters in Russian, in medium-sized letters inChinese, and in small letters in Korean.” By November this building, which hadserved such varied uses, was receiving heavy casualties from increased fightingin the North.^^

The Advance to the Yalu

The withdrawal of X Corps units from Seoul had presaged a new landing,this time on the east coast, at Wonsan, the objective also of the ROK Armydrive. For this movement, the 1 st MASH was attached to the 7th Division and,early on 8 October, left Inchon on a motor convoy to link up with the 7thMedical Battalion south of Seoul. Here word arrived that guerillas hadambushed the preceding serial of the convoy, delaying departure for Pusan.About 0300 on the ninth the convoy was attacked. Under fire for eleven hours,the sky “lit up from gunfire and burning vehicles,the MASH treated infan-trymen who were wounded trying to clear the enemy-held area. Until afternoonan impromptu hospital worked at the roadside, giving blood, doing necessarysurgery, treating for shock, and putting the wounded into ambulances. At lastthe roads were cleared, the convoy rolled, and the 1 st MASH reached its desti-nation without further incident.

For a few days its medics stayed with the 64th Field Hospital, caring forPOWs. On 16 October the 1st MASH boarded the USS General Edwin D.Patrick and waited on shipboard for thirteen days of “clean comfortable living”while the invasion plan was revised. The ROK I Corps had captured Won-san—indeed. General Hume was there on 25 October when arriving U.S.Marines received welcomes from Bob Hope and his theatrical troupe, in town toentertain U.N. forces. (“Just how this will fit in [with] . . . the Halls of Monte-zuma,” Hume wrote the surgeon general, “I cannot say.”) The 7th Division nowwas diverted to Iwon, a coastal town far to the north. From there the division

^Tirst quotation from 171st Evacuation Hospital, Semimobile, Annual Report of Medical Ser-vice Activities, 1950, p. 5, file 319.1-2 (171st Evacuation Hospital, Smbl) Far East-1950, HRB. Seealso ibid., p. 6, HRB. Second quotation from Ltr, Maj Gen Edgar Erskine Hume, Chief Surgeon,EEC, to Maj Gen Raymond W. Bliss, Surgeon General, DA, 13 Nov 50, file 312.3 (Correspon-dence-SGO-Washington), Box 3106 (Medical Section, EEC, General Records, 1950), RG 338,MMFB.

^^Coleman, “Army Nurses in Korea,” 2 May 51, HRB.

113

CoRPSMAN Treating Daughter of a North Korean Officer.South Korean soldiers had executed the child’s mother.

was to strike over “a poor dirt road that twisted its way through the mountainsand the Korean upland” to Hyesanjin on the Manchurian border, 70 air milesaway.^'*

After landing, the 1 st MASH spent a frigid night near Iwon in an unheatedwindowless building. Next day it moved on to the larger inland town ofPukchong and opened for business in a schoolhouse. Reunited with its equip-ment, the unit functioned as the surgical hospital envisioned in the T/O&E—amost unusual condition. Three surgical teams worked steadily, the postopera-tive section was just as busy, and the holding ward was overfull. Increasinglyharsh weather and enemy activity both contributed to rising casualties. In Koreaas a whole, the daily average of 40 per day during October rose to 326 inNovember, with worse to come. The vile roads slowed evacuation from theMASH to the major northern city of Hamhung, where the 121st EvacuationHospital, after similar travels, had set up near X Corps headquarters. Herealmost three thousand patients were admitted between 5 November and 10December.

^“First quotation from ibid. Second quotation from Ltr, Hume to Bliss, 30 Oct 50, RG 338,MMFB. Third quotation from Appleman, South to the Naktong, p, 732. See also 1st MASH, AnnualReport of Medical Service Activities, 1950, p. 1, HRB.

^Coleman, “Army Nurses in Korea,” 2 May 51, HRB; 121st Evacuation Hospital, AnnualReport of Medical Service Activities, 1950, p. 4, HRB.

THE MEDICS’ WAR

Of growing concern was the question of Chinese intervention in the war. On25 October strong assaults hit the South Korean forces advancing on the right ofthe Eighth Army. Others struck the X Corps. Then the new combatants with-drew behind a screen of North Korean forces, for the moment biding their time.In the first week of November tactical units probed toward the Manchurianborder, engaged the Chinese, and sent back prisoners from a variety of units tothe stockades. Anxiety rose among American officers. Dispersed between theEighth Army advancing in the west and the X Corps forces moving inland fromthe east coast, with the central mountains between them, U.N. forces werepoorly situated to meet an attack.

“As you may well suppose,” wrote Hume on 13 November, “our thoughtsjust now are chiefly concerned with the part the Chinese Communists areplaying and may in the future play in the war. . . . We may find ourselves in afar larger military adventure than has been contemplated thus far.” Yet thenorthward drive continued, now sustained largely by a fading hope that large-scale intervention would not occur. On the morning of the twenty-first men ofthe 7th Division’s 17th Regimental Combat Team entered the battered, frozentown of Hyesanjin. From the bank of the Yalu River they gazed across sheets ofice and a narrow, still running channel of water into the People’s Republic ofChina, a landscape of wintry fields and snow-powdered dun hills.

The 7th Medical Battalion provided continuous support. When the 17thRegimental Combat Team made its initial assault landing at Iwon, the clearingcompany and an ambulance platoon had come ashore with them. The bulk ofthe medical battalion moved inland to Pukchong and set up a clearing stationbeside the 1st MASH. For a time one clearing platoon provided shore to shipevacuation at Iwon until the start-up of regular runs to the 121st EvacuationHospital at Hamhung. During the northward drive, another clearing platoonaccompanied the 17th, while the one at Iwon moved forward to provide anintermediate station between the Yalu and Pukchong. A tortuous evacuationroute took form, running 40 miles from the advanced elements at Hyesanjin to aclearing station in the hamlet of Kapsan; thence another 42 miles to Pungsan;and from there over mountainous and rough terrain 68 miles to Pukchong. Hererail service and ambulances were available for the last 80 miles to the 121st. Tocover a relatively brief air distance, the injured had to travel some 230 roadmiles in temperatures that dropped as low as -24 °F.

The route had its dangers. On one occasion an ambulance with five patientslost its way and failed to report at its destination. In savage cold a search partyset out under the 7th Medical Battalion commander, Maj. Oren C. Atchley, aMedical Service Corps officer, only to run into an ambush. Atchley becameseparated from his men and ultimately was listed as missing in action. Led by asergeant, the survivors started on a long trek through unknown country in anattempt to circle back to their own lines. The cold was the worst enemy now.“The two drivers were in very bad shape,” the sergeant reported. “Williams’ feetwere so bad he couldn’t get his shoes on. His feet were swollen and the toe nails

^^Quoted words in Ltr, Hume to Bliss, 13 Nov 50, RG 338, MMFB. See also Appleman, South tothe Naktong, pp. 736-38.

115

were dropping Captured by North Koreans, the last two members of the

ill-fated relief party unexpectedly regained their freedom, rescued by an Ameri-can patrol, and eventually reached the 121st Evacuation Hospital for treatment.The ambulance and its patients and most of the would-be rescuers had vanishedinto the forbidding Korean hinterland.

A unit new to Korea, the 3d Infantry Division, also sustained losses. Be-tween 12 and 17 November divisional elements arrived in Wonsan to strength-en the invasion of the North. The division had formed its regiments—7th, 15th,and 65th Infantry—into regimental combat teams, each supported by its regi-mental medical company plus an ambulance and a clearing platoon from the 3dMedical Battalion. As the division moved inland, evacuation routes becametortuous and long, about 70 miles from the aid stations to Wonsan where twoNavy hospital ships lay offshore. Because guerillas were active, armed truckconvoys became essential; yet such a convoy might only draw the guerillas’attention. Near Majon-ni, a town about 20 miles southwest of Wonsan, twoconvoys of the 15th Regimental Combat Team were ambushed on 27 and 29November. Ambulances were in the columns, and four were destroyed. Twomedics were wounded in the action, and four were reported missing.^*

Meanwhile, in western Korea, the advance of the Eighth Army also hadcarried medical units into the northernmost regions. In a drive to theChongchon River, troops of the 187th Airborne Regimental Combat Teamdropped north of Pyongyang near Sukchon and Sunchon, hoping to cut offfleeing North Koreans and rescue American POWs. The airborne troops wereaccompanied by unit medics, one of whom, Pfc. Richard G. Wilson, a companyaidman, gave his life in night fighting, as he struggled to reach and care for thewounded. For this he was awarded the nation’s highest military decoration, theMedal of Honor.

On 24 October Eighth Army crossed the Chongchon, at a latitude roughlyequal to that of Hamhung. With it moved the 8063d MASH. On 3 Novemberthe hospital left Pyongyang for Anju, near the Chongchon, and during the daysthat followed occupied a number of sites—at Sukchon, Sinanju, and Anjuagain—before the end of November. For a time at the end of the month the8076th MASH operated in Kunu-ri, a few miles from the river’s southern bank.On the twenty-eighth a section of the 8055th MASH reached Sunchon, only tobe ordered back again. During field operations in these northern areas, medicslearned only too well that not one but two new enemies were in the field. TheKorean winter had closed down, filling the hospitals with men who had beendisabled as effectively by the cold as by enemy weapons.

^’DF, Commander, 7th Medical Battalion, to Surgeon, 7th Infantry Division, 28 Nov 50, sub:MIA Report on Battalion Commander, 7th Medical Battalion, Enel 1 to 7th Medical BattalionCommand Report, December 1950, file 307-MED (Command Report, 7th Medical Bn, 7th Inf Div,Dec 50), Box 3185 (7th Inf Div, 307-MED to 307-TK, 1950), Entry 429, RG 407, MMFB.

^*3d Infantry Division and 3d Medical Battalion, Annual Reports of Medical Service Activities,1950, pp. 1-2 and p. 3, respectively, files 319.1-2 (3d Inf Div) and (3d Medical Bn) Far East-1950,HRB.

^’Appleman, South to the Naktong, pp. 655-59; MASH chronologies in 8086th Army Unit,“Surgical Hospital in Korea,” RG 319, MMHB; 64th Field Hospital, Annual Report of MedicalService Activities, 1950, p. 9, file 319.1-2 (64th Field Hospital) Far East-1950, HRB; U.S. Con-

(Continued)

THE MEDICS’ WAR

The Forces of General Winter

“The weather ... is now bitterly cold,” wrote General Hume from Pyong-yang in mid-November. “Even when wearing all of the winter clothing that wepossessed, it was uncomfortable.” Icy winds stripped the heat from the body. Inremote mountainous areas, where troops were fighting near the reservoirs thatsupplied North Korea’s electric power, conditions were worst. In the 7th Divi-sion 142 men were treated for frostbite, and 83 of these were from the 31stInfantry, operating near the Pujon Reservoir. In the Changjin (Chosin) Reser-voir area, the temperature dropped forty degrees over the night of 10-11 No-vember, from 32° to -8°F. More than 200 marines had to be hospitalized byNavy medics. Water-soluble medicines froze; plasma had to be warmed for anhour or more to be usable. The Eighth Army also suffered. On the thirteenthextremely cold weather struck the 2d Division. Here, too, aid stations com-plained that plasma was freezing, and Dovell himself suffered frostbitten feetwhile visiting the division.^®

The paradox of the situation was that the Far East Command had anticipat-ed the problem and made preparations to meet it. Senior officers of the MedicalService knew the losses suffered during the winter of 1944-45 in Europe—someforty-six thousand casualties requiring an average hospitalization of fifty days,almost all of them front-line riflemen who could ill be spared. During WorldWar II as a whole, over ninety thousand hospital admissions had occurred frominjuries associated with cold, including frostbite, trenchfoot, and immersionfoot. The severity of the Korean winter was also well known, from the Americanoccupation there. Consequently, the Far East Command during the summerassigned one quartermaster officer and one enlisted man to each division of theEighth Army to educate supply officers, line officers, and troops in preventingcold injuries. Every soldier underwent a two-hour period of instruction on thesubject. Working closely with the quartermaster, the command’s Medical Sec-tion developed a program that emphasized not only adequate winter clothingand equipment, which units had started to receive, but also command actionand continuous education of the troops. Two results of the program were theprinting and distributing of a pamphlet called “Cold Facts for Keeping Warm”and, on 22 September, the issuing of a command letter on preventive measures.

Yet many men succumbed to the fierceness of General Winter’s first attackin November. In the rapid advance some units outran their suppliers and failedto receive a full issue. In early November, nurses in the 1st MASH at Pukchongwere “wearing the same winter issue that the men do,” with “two or three pairsof socks” to fill the empty space in the smallest soldier’s boot, which was size

(Continued)

gress, Senate, Committee on Veterans’ Affairs, Medal of Honor Recipients, 1963-1973, 93d Cong.,1st sess., 22 October 1973, Committee Print no. 15 (Washington, D.C.: Government PrintingOffice, 1973), p. 804.

^"Quoted words from Ltr, Hume to Bliss, 13 Nov 50, RG 338, MMFB. See also 2d InfantryDivision, Annual Report of Medical Service Activities, 1950, p. 4, HRB; Appleman, South to theNaktong, pp. 738, 744.

117

eight. Though efforts continued to ful-ly equip the troops, numerous injuriesappeared with the mid-November coldwave, shot upward in the week of 24November-1 December, and reacheda peak of 293 admissions in the weekof 29 December-5 January 1951. Dur-ing 1950 a total of 1,791 cases wererecorded, an incidence of 34 per 1,000troops per annum. The 121st Evacua-tion Hospital alone recorded 850 casesbetween 12 November and 24 Decem-ber and termed cold injury “our mostoutstanding clinical experience.” As aresult, the Far East Command on 29November opened a cold injury treat-ment center at Osaka Army Hospital.

But the early months of 1951 wouldsee the problem become still moresevere.^*

Over the months that followed, research at Osaka and in the United Statesdeveloped a picture of cold injury that revealed it to be far more than a matterof frozen toes. Involved in its incidence were factors of environment and heredi-ty, military sociology, and battlefield realities. Basic of course was the climate ofKorea, with its harsh Siberian winters and drastic temperature changes. Racewas a factor. Black soldiers suffered more than whites, even in integrated unitswhere differences in motivation, training, and discipline were at a minimum.Lower ranks (especially privates and privates first class) suffered far beyondtheir proportional numbers; line units, for evident reasons, more than supporttroops. For whatever cause, younger soldiers appeared to be more susceptiblethan men over twenty-five, perhaps because of a lack of personal discipline.Soldiers from warm states apparently were more subject to injury than thosefrom cold states. Surprisingly, no clear data emerged to justify the logical as-sumptions that veterans were less susceptible than replacements, and non-smokers—because tobacco causes constriction of peripheral blood ves-sels—than smokers.

A typical case was that of a seventeen-year-old black soldier who sufferedfrostbitten feet when pinned down for twelve hours at 0°F. When he finally wasable to remove his boots, his feet swelled to such an extent that he was unable toreplace them. Evacuated, he went through a lengthy period of hospitalizationduring which his toes became mummified. Forty-three days after the initialinjury, eight toes were amputated. Final closure and grafting were performed ina zone-of-interior hospital ninety-nine days after his frigid hours under fire. As

^'First quotation from Coleman, “Army Nurses in Korea,” 2 May 51. Second quotation from121st Evacuation Hospital, Annual Report of Medical Service Activities, 1950, p. 9. Both in HRB.See also FEC, Annual Report of Medical Service Activities, 1950, pp. 69-71, HRB. Besides Armycasualties, the Marine Corps sustained 400-500 cold injury losses as well.

The Effects of Frostbite

THE MEDICS’ WAR

this case indicated, a prime problem with cold injury was not only the numberof men it disabled but also the lengthy treatment they often required.^^

Cold injury struck both armies. The common American notion that Asianpeasant soldiers were used to the winters of their homeland had some validity,yet General Winter took his toll among them as well. In one group of 227Chinese prisoners taken by the 1st Marine Division, for example, 90 percentwas reported to have varying degrees of frostbite. This did not indicate a similartoll on the entire Chinese Army, for frostbite, by disabling the victim, was acommon cause of capture. Nevertheless, the enemy clearly possessed no immu-nity, and lacked adequate clothing and facilities. (POWs reported that there wasno evacuation for cold injury cases.) “‘When the fighters bivouac in snow-covered ground their feet, socks and hands freeze together in one ice-ball,”’declared a Chinese officer in early 1951, and an American medic during thewinter fighting viewed with pity enemy corpses dressed only in quilted cottonand the equivalent of tennis shoes.^^

From the viewpoint of U.N. forces, however. General Winter made commoncause with the invaders. Men pinned down in the snow or isolated by envelop-ing attacks were in no position to prevent frostbite by any available means.Peaks in cold injury coincided with peaks in enemy activity, winter’s ice con-spiring with hostile fire.

The unavoidable factors of weather, heredity, and war, however, were notthe whole story. Conceding the realities of the situation, the Far East Commandadmitted that many injuries were “without question . . . preventable.” A basicproblem was the prescribed item of footwear—the shoepac, a winterized bootworn over heavy socks and felt insoles. Many complaints had surfaced duringWorld War II about this piece of equipment. Indeed, a form of injury carried itsname. “Among those who wore it,” wrote two Army surgeons, “a cycle was oftenset up of perspiration, maceration, and the development of so-called shoepacfoot,” followed by “hospitalization for 10 to 15 days, return to duty, and arepetition of the cycle.” To avoid injury, troops in Korea, like those in WorldWar II, were urged to remove the boot frequently and dry the socks and insole.Unfortunately, this was not very realistic under battlefield conditions. “Werethere nothing else for troops to do but protect themselves from the cold,”reported the command’s Medical Section with some irony, “protection might beafforded [by the shoepac]. . . . However, the present equipment, particularlythe footgear, will not provide the needed protection during active combat underthe cold conditions which have been experienced in Korea.

^^Kenneth D. Orr and D. C. Fainer, “Cold Injuries in Korea During the Winter of 1950-51,” pp.1-18, 32-33, Professional Papers, Box 52, Series 2, Medical Historical Unit Collection, Archives,U.S. Army Military History Institute, Carlisle, Penn. Later studies confirmed the genetic susceptibil-ity of blacks. See Kenneth D. Orr et al.. Cold Injury—Korea, 1951-52, Report no. 113 (Fort Knox,Ky.: Army Medical Research Laboratory, 1953), pp. 205-568, especially p. 374.

^Quoted words as related in Goulden, Korea, p. 463. See also Summary Intelligence Report no.3018, 13/14 Dec 50, in End 4, to Weekend Letter no. 13, Hume to Bliss, 2 Jan 51, file 200(Personnel Letters Between SGO and Medical Section, FEC), Box 3099 (Medical Section, FEC,General Records, 1950), RG 338, MMFB; Narrative Ltr, V. J. Navarre, M.D., to Samuel Milner, 19Feb 67, p. 28, AMEDD Oral History file (Navarre), HRB.

^Tirst and third quotations from FEC, Annual Report of Medical Service Activities, 1950, pp.

119

The year ended with cold injury a problem still to be solved. General Win-ter’s assult would have been serious under any conditions. But the course of thewar now intervened to make it incomparably worse.

''An Entirely New War”

Though startled by the early Chinese attacks and confused by the enemy’ssubsequent withdrawal, the Eighth Army resumed its advance through westernNorth Korea in late November. On the left the I Corps comprised the 24thDivision, an ROK division, and the 7th British Commonwealth Brigade. In thecenter the IX Corps included the 2d and 25th Divisions and a Turkish brigade.To the right the ROK II Corps, hard hit in the attack, was again ready to move.The 1st Cavalry Division remained in reserve. Chinese opposition to the move-ment was spotty; seemingly random attacks came, interspersed with long-rangerifle fire and mortar shells. Casualties remained light through 24 and 25 Novem-ber. All units gained ground, and General Walker planned a further advance onthe twenty-sixth.^^

After dark, however, Chinese bugles announced enemy assaults against theunits in the Chongchon valley and against the 38th Infantry along the Paeng-nyong River, a tributary of the Chongchon. In the darkness, confused fightingmarked by enemy tactics of infiltration and encirclement spelled the end of theadvance. Soon after, the collapse of the ROK sector brought a far graver threatto the U.N. forces. General enemy assaults on the nights of 26 and 27 Novemberincreased the pressure. By the end of the month the Eighth Army was in retreat.

Chinese attack columns infiltrated and then disrupted the 2d Division.Along the line of the retreat wounded piled up in roadside ditches, their com-panions the dead and men yet uninjured who were sheltering from enemy fire.In one such ‘‘shattered mass,” wrote historian S. L. A. Marshall,

the men who were still partly mobile crawled forward along the chain of bodies towardthe upper end of the ditch. As they moved, those who were down and hurt cried: ‘Water!Water!’ or ‘First aid! First aid!’ Long since, nearly all canteens had been drained dry. But[M. Sgt. Owen] McGregor witnessed how the able-bodied checked long enough to dowhat bandaging they could as they made the upward climb; there were some whostripped to the waist in the bitter cold and tore up their undershirts to use them fordressings. ... In his dark hour McGregor saw more of the decency of men than he hadever expected to fmd.^*^

70-71, HRB. Second quotation from Tom F. Whayne and Michael E. DcBakey, Cold Injury,Ground Type, Medical Department, United States Army (Washington, D.C.: Office of the SurgeonGeneral, Department of the Army, 1958), p. 158. See also S. L. A. Marshall, Commentary onInfantry Operations and Weapons Usage in Korea, Winter of 1950-51, ORO-R-13 (Chevy Chase,Md.: Operations Research Office, Johns Hopkins University, 1951), pp. 49-50.

’‘Billy C. Mossman, Ebb and Flow, United States Army in the Korean War (Washington, D.C.:U.S. Army Center of Military History, forthcoming), ch. 4. Background on the Chinese attack andthe U.N. withdrawal is based upon this source, except as otherwise noted. Quoted words in subheadfrom Radiogram C 69953, CINCFE to JCS, 28 Nov 50, JCS Outgoing file. Box 43, RG 9 (Collectionof Messages, 1945-51), MacArthur Memorial Archives, Norfolk, Va.

’‘This and the following two paragraphs are from S. L. A. Marshall, The River and the Gauntlet:

(Continued)

THE MEDICS’ WAR

In the 38th Infantry the medical support system failed. Stacked several deepin litter jeeps and trailers, the wounded were too many for the available vehi-cles. “‘There was no way to keep them warm,”’ said Lt. Paul A. Maxson, theassistant surgeon. “‘We had no blankets for them . . . The men in the toplitters urinated on the men below them.’” When enemy fire sprayed the convoy,Maxson and Sgt. Robert Gilstrap, himself injured, shared the burden of crawl-ing with a wounded corporal from the medical company on their backs forhundreds of yards. With a shattered left arm and a bullet in his groin, the manbecame violently ill on Maxson’s back, vomiting and defecating on him. Even-tually Maxson was able to crowd six wounded men on a jeep sent out to collectcasualties. Maxson then walked behind the jeep, leading the ambulatory wound-ed. By this time he was soaked in blood, none of it his own.

With four drivers, two first-aid men, and a motley collection of ambulances,vans, and deuce-and-a-halfs loaded with blankets and bedding, Capt. WilliamO. Burla, an intelligence officer from the 2d Division set out on orders to collectthe wounded. Again they were stacked up, rolled in blankets with no medicationbut a shot of morphine. Most “‘asked only for water, and of that we were notshort,”’ said Burla. When a machine gun blasted away the radiator of an ambu-lance, a deuce-and-a-half took it in tow. Despite enemy fire, the rough roads,and the cold, only 2 of the 140 men crowded into the vehicles died.

In the eastern mountains soldiers and marines assigned to X Corps wereadvancing near the Changjin Reservoir (the famous Frozen Chosin, to use itsJapanese name) when the enemy struck. On the night of 27 November, as abitter wind blew off the reservoir, Chinese bugles and whistle blasts guidedsharp attacks against Marine positions. Soon the forces near the reservoir hadbeen isolated. Air evacuation proved itself again, as Marine helicopters flewcasualties from isolated units to airstrips, where small fixed-wing L-type XCorps planes shuttled them out to medical aid. On return trips the fixed- androtary-wing aircraft of “Little Lift” brought medicines and supplies to the front.

The Chinese attacked Army troops as well. Typical of many were the adven-tures of Capt. Vincent J. Navarre, surgeon of the 1st Battalion, 32d Infantry,and of Sfc. D. E. Wagoner, platoon sergeant of the regimental medical compa-ny’s 1st Platoon that was attached to support the battalion.^^ (Wagoner wasacting platoon leader for lack of a Medical Service Corps officer.) The men hadaccompanied a thrust up the east side of the reservoir in clear, increasinglybitter weather. When the attacks began, Navarre argued vigorously with twolightly wounded infantrymen that only a patrol action was involved. Ironicallyhe was winning the dispute when the first wave of serious casualties flooded intohis aid station. Among them was a friend, gray-faced and badly hurt. “He

(Continued)

Defeat of the Eighth Army by the Chinese Communist Forces, November, 1950, in the Battle of theChongchon River, Korea (New York: Morrow, 1953), pp. 315-17, 324-36. First quotation on p. 301;second quotation on p. 315; third quotation on p. 326.

^This and the following six paragraphs on Navarre and Wagoner’s ordeal are based on NarrativeLtr, Navarre to Milner, 19 Feb 66, HRB; Narrative Ltr, Maj. D. E. Wagoner, MSC, to SamuelMilner, 5 Oct 66, AMEDD Oral History file (Wagoner), HRB. Quotations, as they appear in thetext, are: Navarre, p. 13; Wagoner, p. 3; Navarre, p. 28; ibid., pp. 35-36; ibid., p. 41; ibid., p. 46;ibid., p. 46; Wagoner, p. 6; ibid., p. 7; ibid., p. 7; Navarre, p. 55; ibid., p. 57.

121

smelled of powder, his clothes were smeared with mud and snow; and hegroaned with pain and muttered about the cold.” As the attacks became heavier,the battalion packed up its equipment, loaded its wounded on any availablevehicle, and began a nightmare trek back through the mountains, harassed byroadblocks and repeated attacks. There was no way to evacuate the wounded,and the men of the aid station began to learn the burden of nursing care. Bedpans were improvised from cardboard boxes and urinals from C-ration cans.One casualty, feeling the sharp metal edge, told the corpsman, “‘Watch it. Doc, Ionly want to urinate, not be circumcized.’”

Attrition wore down the battalion. Fights were usually at night, fiercelycontested. “We were told of the artillerymen firing muzzle bursts from theirhowitzers, and the two quad-fifty machine gunners, manning those anti-aircraftguns, raking the advancing enemy.” But the medics were running low on every-thing, including bandages. They used T-shirts, or cut the unused sides and endsof bandages from one man to use on another. A mortar round dropped nearNavarre. “The force lifted me a few inches, tipped me over, chewed the outsideof my right pants leg in a moth-eaten pattern, and wafted the helmet from myhead.” Marine Corsairs appeared whenever the weather permitted, droppingnapalm on the Chinese. One canister fell short, engulfing Americans at thecolumn’s front. “I could feel the heat,” said Navarre later, remembering that hesaw “a man or two black as soot and whirling about with a blue flame issuingfrom his head like a bunsen burner’s.”

Then a richocheting bullet broke Navarre’s right knee. Getting him evacuat-ed seemed impossible, for the trucks were “a fantastic sight . . . piled . . .just as full of wounded as could possibly be held.” Wounded lay across thefenders and hoods. Finally, an infantry officer took him by the seat of the pantsand the back of the coat and threw him into an ambulance, observing, “‘There’salways room for one more.’” Here in a warm pile of bodies Navarre rode in faircomfort until the driver was killed at a roadblock after dark. He extricatedhimself and fell outside into shocking -30°F cold. On his elbow and good knee,one hand frostbitten and the other losing sensation even as he sought to flex it,he dragged himself through brilliant moonlight, listening to the Chinese chasethe Americans and shoot at them.

Meanwhile, Sergeant Wagoner was having adventures of his own. At a road-block he encountered the thickly quilted form of a Chinese soldier. Wagonershot him with his .45 pistol, the first time he had killed a man at close enoughrange to see his facial expression. “As the powerful round hit him his bodyjumped a foot or more. His look of stunned surprise amused me and at the sametime arouse an overwhelming rage. I happily pumped rounds into his lifelessbody until I realized that I was wasting very scarce ammunition.”

Later, in the darkness, a mortar round landed on a truckful of wounded menand flung Wagoner to the ground, stunned. He woke under the same brilliantmoon. Chinese soldiers walked among the wounded and the dead, probingbodies with their rifle butts. Both kindness and cruelty walked with them. “Ifthere was a response they would offer the casualty a drink from a steamingcanteen, if not they searched for watches.” Later on another soldier thrust hisbayonet into a body. His companions laughed. Crawling away. Wagoner collect-

THE MEDICS’ WAR

ed about fifteen wounded who had escaped “the carnage on the road.” Taking asmall man on his back, he led the way south until he blundered into a Marineperimeter.

Navarre, broken leg and all, had made it to a Korean village, where he wasfed and warmed by a solicitous farmer. He had no way to tell how his hostviewed him—as a guest, or perhaps as a commodity for future trade with thewinning side. A North Korean soldier wandered into the house and out again;then a South Korean. Eventually a loud-mouthed GI found his way into thesame refuge, setting off an episode of gross comedy. “T’ve got to s—t,’ he said.Papasan didn’t arrive in time [to show him the latrine] and an accident oc-curred. Now the poor man began almost to cry, and kept repeating that he hadnever done that before. I consoled him saying that it could happen to anyone,and the whole scene must have been ludicrous.”

Placed in an oxcart by another GI and a hard-faced peasant woman, Navarreand his unlikely party started south. They met some Marine aidmen in a jeep,and the doctor watched as one of them splinted his broken leg with a carbine.Then came a dimly remembered succession of vehicles—ambulance, lightplane, more ambulances, a small boat, a hospital ship riding in the Sea of Japan.Here an officious sailor wanted to know who had tied the carbine to his leg.“‘Do you know,”’ he demanded, “‘that gun was cocked and loaded?”’

By the end of November all of X Corps had begun to withdraw towardHamhung and its port city of Hungnam. Retreating marines counted losses of20 percent. By 10 December the corps as a whole numbered almost nine thou-sand killed, wounded, and missing since the Chinese attack had begun thirteendays before. On the following day General Almond published plans for a generalevacuation by sea from Hungnam. Whether this would be a complex logisticalexercise or a Dunkirk-style departure under fire remained to be seen.^*

While the eastern forces withdrew into a defensive perimeter, the retreat inthe west continued as well. Though not a rout—units retained their coher-ence—the Eighth Army was infected with “bug-out fever,” in the phrase of thetime, to which there was no medical cure. Unit medics struggled with theproblems of the new retreat. Typical was the 2d Medical Battalion. On 29November the battalion formed a motor convoy and started south towardSukchon. Eight miles beyond Kunu-ri they ran into a massive Chinese road-block and were obliged to detour by way of Anju and Sinanju to their destina-tion. After a brief rest they pushed on to Pyongyang. Under the attack casualtiessoared, which meant that maximum work for all personnel coincided with theretreat. The battalion’s own losses included eight doctors, two dentists, and nineMedical Service Corps officers. Evacuation was by any means available. Heli-copters, despite their fragile reputation, proved invaluable, on one occasionremoving 29 casualties from an area that was completely cut off by the Chinese.Men isolated by the attack straggled in after walking around the enemy, overmountains and through icy streams. When the division halted to reorganize, itssurgeon counted 143 cases of cold injury.^’

'**Mossman, Ebb and Flow, ch. 11.

^’2d Infantry Division, Annual Report of Medical Service Activities, 1950, pp. 4-5, HRB,

123

Behind the fighting units the hospitals were also in retreat, and thus thechain of evacuation shifted from day to day. At Kunu-ri the 8076th MASH nosooner had finished its Thanksgiving dinner than 2d Division casualties beganto arrive. Rapidly the hospital was overloaded with hundreds of wounded men.Surgeons and nurses had to cope with them despite below-zero cold. Intrave-nous solutions froze in liter flasks. Diesel fuel for heating would not flow unlessmixed with kerosene. Space heaters burned out under continuous operation,and ice forming in gasoline caused electric generators to fail. Lights in theoperating room winked out, leaving surgeons to work by the glow of potbelliedstoves and the unsteady beams of hand-held flashlights. Nurses boiled water onthe stoves to clean surgical instruments, but ice formed in the water before theywere finished washing. Surgeons’ hands were so cold they could hardly holdtheir instruments, much less operate, and the bodies of the wounded steamed asthe surgical knives cut them open. This

was the situation on 27 November. The surgeons had worked straight through the day,without a break. It had turned dark at six that evening. The lights went off and theoperating lamps went out. But no sooner did the surgeons begin operating by flashlight,when the lamps went on again. They didn’t stay on very long. Within 5 minutes theywent off again, and the surgeons had to go back to the flashlights. It went on like this formost of the night, with the lights going on and off; the bellies steaming when you openedthem up; and with everything cold and threatening to freeze up."*®

At a division staff meeting the next day. Colonel Van Buskirk learned that“the ROK’s and the Turks had given way on the Division’s right flank; and theenemy was pouring in around the flank. Loading its wounded in the bittercold, the 8076th MASH moved south in a vast, creeping traffic jam—the 2dDivision in retreat. Avoiding the roadblock, the hospital was able to join the8063d MASH at Anju, to eat and to drink hot coffee, and to plan the retreat thatboth must make, further south to Pyongyang.

When the 8076th MASH withdrew, surgical cases evacuated from the clear-ing stations went instead to the 8063d MASH now at Sinanju. C-47s flying froman airstrip at Anju lifted other wounded to the 171st Evacuation Hospital atPyongyang. Then on 29 November Dovell ordered the 171st to close. Shifted toYongdung-po, it was overtaken by the retreat and, in mid-December, evacuatedby ship to Japan."*^

At the North Korean capital many streams of the river of men and vehiclesrunning toward the south briefly converged. After a leisurely advance during theautumn the 64th Field Hospital found itself in the enemy capital and, on 28November, took over the building by the airstrip where the 8055th MASH hadworked. The following day—the first workday—began quietly, the familiarround of receiving casualties. Then the influx increased beyond all expectations.During that day the hospital expanded its bed strength three times. Cots filled

"“Van Buskirk Interv, 7 Jul 66, p. 18, AMEDD Oral History file (Van Buskirk), HRB.

^'Ibid.,p. 19, HRB.

''This and the following four paragraphs are based on 64th Field Hospital, Annual Report ofMedical Service Activities, 1950, HRB. First quotation on p. 10; second quotation on p. 11; thirdquotation on p. 12.

THE MEDICS’ WAR

every available room and corridor. In the first sixteen hours, 278 admissionstook place. By the next day “rumors were rife that the Chinese Communistswere coming down from the north in full force.” The hospital’s evacuationpolicy was cut to seven days. One doctor took up full-time duty at the airstrip totriage incoming patients. A three-story building nearby became an annex forambulatory patients. Meanwhile, visits from “Midnight Charlie,” a light planethat flew over in the darkness dropping bombs in an attempt to hit the airstrip,enlivened the evenings.

On the afternoon of the thirtieth, patients from retreating medical unitspoured into the hospital from every conceivable kind of vehicle. Trucks haltedlong enough to discharge a few wounded, then moved on. Bumper-to-bumperconvoys filled the roads, all headed south. In the meantime, evacuation from thehospital went at a feverish pace, using a newly opened railroad line to Seoul aswell as the air. Surgeons of the 8063d MASH joined the 64th Field Hospitalsurgeons in a 24-hour round of continuous operations, stealing an occasionalcatnap when overcome by exhaustion. On Friday, 1 December, the nurses leftby plane for Ascom City, in line with General Walker’s orders that they were notto be allowed to fall into the hands of the enemy. At Pyongyang the scenes wereas before. “All roads were jammed with vehicles, pieces of equipment, wagons,and anything [else] that had wheels. Many of these same vehicles dropped out ofconvoy to carry patients to our hospital. The liaison officer at the airportpromised that he would obtain airplanes as long as we had patients forevacuation.”

Late at night the 64th Field Hospital was ordered to move south the follow-ing day, for the 8055th MASH was returning to occupy its old building. Anyremaining niceties now went by the board as patients were prepared for massevacuation. In a large auditorium doctors hastily examined casualties and sentto the evacuation area any whose condition would require more than three daysof treatment. Interrupted once by Midnight Charlie, the process continued until0430 on 2 December. Half an hour after the last patient was tagged for airevacuation, the 64th Field Hospital closed. The 8055th MASH was already inplace and working over the nontransportables.

The final days passed “like the pages of a nightmare.” The enlisted men andtwo officers were to accompany the 64th Field Hospital’s supplies, loaded intofourteen boxcars on a spur beside the airstrip. The rest of the officers were toshare two coaches with a quartermaster detachment. But a party of Turkishsoldiers seized one of the coaches, and the other, hooked to their troop train,started south very slowly. The supply train was left behind. Beside the railroadtrack the airport buildings were burning now, and demolition squads set offintermittent blasts. Late in the afternoon an engine appeared and pulled thehalf-frozen men and their equipment out of the marshaling yards. After a seem-ingly interminable journey the hospital’s two parts reached Ascom City on 6 and7 December, respectively. For a week they thawed out and enjoyed the hospital-ity of the 4th Field Hospital. On the fourteenth the 64th Field Hospital wentaboard a troopship in Inchon Harbor; thirty-six hours later, the outfit was on itsway to Japan.

125

Hospital Train Evacuation From Pyongyang

The MASHs added more steps to their already lengthy itineraries. On 4December the 8055th closed at Pyongyang and, after eight days at Seoul, movedon to Ascom City. Here solid buildings, steam heat, and the opportunity toplunder the supplies of the 4th Field Hospital brought joy to Colonel Tenderand his hard-bitten crew. Also on the fourth the 8063d escaped Pyongyang, oneday before the Eighth Army abandoned the burning city. Until the end of theyear it, too, enjoyed Ascom City, while the 8076th set up at Suwon, south ofSeoul.^^

As Eighth Army units fell back below the 38th Parallel, the phased evacua-tion of the Hamhung-Hungnam perimeter began. Battered in the hills, U.N.forces, once within the perimeter, were little disturbed by light enemy attacks.The X Corps moved out by the numbers to waiting vessels. Typical was theexperience of 3d Division medics. Successive withdrawals to previously pre-pared lines keynoted their evacuation; the division’s mission was to cover thewithdrawal of the other units, then make its own. As it had done both in theadvance and in retreat, the 3d Medical Battalion leapfrogged its clearing sta-

“^MASH chronologies in 8086th Army Unit, “Surgical Hospital in Korea,” RG 319, MMHB. On27 November 1950 the 8076th MASH was formally redesignated Mobile Army Surgical Hospital,8076th Army Unit. The other MASHs received similar designations. No notice of this insubstantialchange will be taken in the text. See Eighth United States Army, Korea, General Order no. 210, 27Nov 50, MMFB.

THE MEDICS’ WAR

tions. On 22 December the third clearing platoon set up its last position inHungnam, with orders to close four hours before its scheduled departure; thethird ambulance platoon waited to carry its personnel and supplies. Meanwhile,the regimental medical companies set up beach evacuation stations for theiroutfits. When the clearing company had departed, the remaining aid stationsevacuated with their tactical units during the final withdrawal, to carry any lastcasualties that might occur. Offshore, two Navy hospital ships received theinjured, including the victims of a prematurely exploded demolition charge inthe dock area.'*'*

By this time, the other X Corps unit already had boarded ships. Withdrawnby motor convoy from northeastern Korea on 2 December, the 7th MedicalBattalion at Hamhung cared for Marine survivors of the Changjin Reservoirfighting. A clearing platoon and the 1 st MASH lingered to support division unitsstill in the hills, but arrived at Hamhung on 5 December. On the fourteenth bothboarded the USNS General H. B. Freeman; a clearing station that had remainedbehind left five days later, when relieved by 3d Division medics. After providingtemporary quarters for many colleagues from other units, members of the 121 stEvacuation Hospital moved on the eleventh to the USNS Fred C. Ainsworth.Here they resumed work, performing 163 operations in the hospital ship’sfacilities."*^

The 1 st MASH bunked in with the 121 st Evacuation Hospital for two daysbefore moving to Hungnam beach, where it opened its own hospital in a school.On the evening of 15 December the patients were moved out to the waitinghospital ships. That same night the nurses moved to the USNS Ainsworth, whilethe doctors and enlisted men stayed on shore to pack their gear and see itproperly shipped. Four days later they in turn boarded the Towanda Victory.

From shipboard the nurses watched the demolitions proceeding inHungnam. Fires started by naval artillery burned in the surrounding hills. Atnight the warships were “blasting and shooting flares as though it were a Fourthof July celebration.” Near the USNS Ainsworth lay the battleship Missouri,whose big guns jarred her smaller neighbor at every firing. Air Force planesbusied themselves over the shrinking perimeter during daylight hours, and smallboats made endless runs to the hospital ships with patients and new evacuees.Colonel Gorby, the X Corps surgeon, visited the ship and told the nurses thatthey would not, as they had expected, be rejoining the men of the 1st MASH forthe voyage, because the old Towanda had no accommodations for them exceptin the brig. Luxuriating in what seemed “a stateside hotel” compared to whatthey had been accustomed to, the women bathed, washed their hair, andrejoiced at being able to eat “food from a table again.”"*^

At 1415 on Christmas Eve, Hungnam shuddered under the blast as theammunition dump blew up. In less than an hour the whole fleet was moving,carrying the men of X Corps, their wounded, their hospitals and nurses, and

'“'3d Infantry Division, Annual Report of Medical Service Activities, 1950, pp. 1-2, HRB.

“^Tth Medical Battalion and 121st Evacuation Hospital, Annual Reports of Medical ServiceActivities, 1950, p. 5 and p. 2, respectively, HRB.

‘‘‘Coleman, “Army Nurses in Korea,” 2 May 51, HRB.

127

scores of thousands of Korean refugees fleeing the Chinese advance. From thedeck the members of the 121st Evacuation Hospital and their guests watchedthe burning city until it disappeared from view. Then they settled down tocelebrate the holiday. “The ship had Christmas for everyone”—a tree, SantaClaus, and words of cheer for the four hundred patients. The medics ended theevening with a dance in the operating room. The convoy sailed on toward itsdestination, Pusan. The expedition to the North was over."*^

The New Shape of Army Medicine

For those who served in Korea, the last six months of 1950 packed in morecritical events, more extraordinary changes of fortune, than years of normal life.Members of the Medical Service underwent a radically compressed and inten-sive learning experience. Though many initial problems were overcome, theformative period left durable marks upon the conflict. The importance of theJapanese hospitals, the heavy emphasis on transport to compensate for lack ofpersonnel and bed space in Korea, and the burgeoning role of the helicopterremained to shape the future.

All things considered, the health of U.N. troops was good. The MedicalService reported a normal rise in upper respiratory infections with the onset ofcold weather. Dysentery and hepatitis continued to be serious causes of disabili-ty. But the cold that brought frostbite and influenza suppressed many otherdiseases, such as malaria. Overall, the war of movement that characterized thefighting of 1950 probably prevented or retarded the spread of illness; armies hadsmall chance to pollute their surroundings or spread disease by huddling togeth-er in bunkers. On the other hand, preventive medicine was almost impossible, atleast in the sense of area control, and cold injury was directly linked to a type ofwarfare in which the front-line soldier often had no means at all of getting warmor changing his shoes and socks. No illness caused a medical emergency in theautumn and winter fighting, for which, as usual, a mixture of medical discipline,quick evacuation, and luck must be credited.'*^

Medical supply often was catch-as-catch-can during the advance. One consis-tent problem was providing for the exchange of blankets and litters. Forwardhospitals, especially in the X Corps, reported other serious shortages. The 121stEvacuation Hospital found difficulty in getting antibiotics, and the 1st MASHtermed the blood supply “sporadic and inconstant.” Travel on the rough Koreanroads caused the red cells to break apart, and the blood became useless. Eitherhelicopter supply had not yet been widely adopted or the lack of machinesprevented its employment. Despite such difficulties, medical supply apparentlywas not a fundamental problem."”

^TEC, Reports of ETMD, October 1950, pp. 7-8, and November 1950, p. 5, file 350.05 (EEC)1950, HRB.

““’As a primary function of the rear areas, supply is treated at length in Chapter 5 of this volume.Sources of the above paragraph include the 121st Evacuation Hospital and 1st MASH, AnnualReports of Medical Service Activities, 1950, p. 11 and p. 10, respectively, HRB.

THE MEDICS’ WAR

Surprisingly few difficulties resulted from the presence of soldiers of manynationalities in the hospitals. Languages differed, but wounds and illness wereuniversals. Quartermasters labored to supply the varied diets demanded by menof different countries. Some Ethiopian soldiers, according to Dovell, insistedthat the attending doctor taste the prescribed medication before they wouldswallow it themselves. “Of course,” he remarked, the doctor “couldn’t keep thatup all day long.” But the sick and injured were not, by and large, in anycondition to pursue unreasonable demands, even if they were so inclined. TheU.N. system handled many kinds of casualties with a minimum of fuss and withgreat clinical success.^”

Clear improvements appeared in the psychiatric service. After reaching apeak of 249.7 NPs per 1,000 troops during August, rates dropped rapidly afterthe breakout from the Pusan Perimeter and fell during the triumphal month ofOctober to 18.4 per 1,000, only to rise again with the onset of cold weather, theChinese attack, and the beginning of a new retreat. At first extremely limited,the number of psychiatrists in the Far East Command increased steadily. By theend of August, the command had assigned psychiatrists to the 1st Cavalry and2d, 24th, and 25th Infantry Divisions. However, most of the men who served inKorea during the first year, especially in forward posts, were young, possessedlimited professional experience, and had no background in war. As a conse-quence, they became part of the psychiatric problem as well as a key to itssolution. “Initially and in rear assignments,” wrote the energetic FEC consultantCol. Albert J. Glass, “the psychiatrist new to combat problems is quite im-pressed by the manifestations displayed by psychiatric casualties. He is prone toover-identify with the patients. . . . He, also, feels guilty when making recom-mendation for a more hazardous duty than he fortunately must endure.”^^

The solution for the psychiatrist was to move forward, sharing the dangers ofthe troops to some degree, and gaining their respect while losing his own diffi-dence. A policy of bringing some basic counseling even to the aid stationssignificantly improved the rate of men returned to duty. Small psychiatric teamsworked at the evacuation and field hospitals, where they provided first- orsecond-echelon treatment. As a result, the number of psychiatric evacuees toJapan markedly decreased. In pressing for these changes Glass, much to hissurprise, found that most line officers were sympathetic and that some divisionsurgeons were not. The effectiveness of psychiatric help in cutting personnellosses at small cost was a constant source of support for his reforms.^^

Typically, in the 4th Field Hospital Capt. Harold Kolansky practiced briskfield psychiatry. “Patients were seldom held for more than four days,”^^ he

^‘’Dovell Interv, 15 Jun 62, tape 2, Personal Interviews file (Dovell), HRB.

^'Quoted words from Glass, “History and Organization of a Theater Psychiatric Service Beforeand After 30 June 1951,” in Recent Advances in Medicine and Surgery, 2:365-66. Except as noted,the following section is based on this essay. See also copy of Technical Liaison Office, OSG, “FactSheet: Three Years of Medical Service in Korea,” 14 Jul 53, HSF (TIO Fact Sheet-1953); FEC and121st Evacuation Hospital, Annual Reports of Medical Service Activities, 1950, pp. 26-34 and pp.7-8, respectively. All in HRB.

”FEC, Annual Report of Medical Service Activities, 1950, pp. 26-34, HRB.

*Tbid., p. 29, HRB.

129

reported. Brief psychotherapy followed the relief of physical exhaustion by restand food. Sedation was given only when indicated. The basic rule of combatpsychiatry—hold the patient as close as possible to the front—proved, however,to have some interesting exceptions. During the fierce fighting that accompa-nied the recapture of Seoul, the Marine Corps suffered heavy psychiatric as wellas physical casualties. NPs airlifted to a Navy hospital ship standing just off-shore at Inchon were very difficult to treat, for they felt they had escaped fromthe combat zone into the relative luxury of the ship. On the other hand, patientsevacuated 100 to 150 miles behind the fighting line in Korea showed no adverseeffects and responded well to treatment, for they perceived the whole devastatednation as an extension of the front. In short, “distance” was psychological, not amatter of miles.

By the end of 1950 field psychiatry evidently had reached a level of perform-ance at least equal to that of World War II. Even evacuation hospitals, tradition-ally the least successful facility for treating such problems, had found ways toimprove their performance. After difficulties at Ascom City the 121 st Evacua-tion Hospital claimed much better results at Hamhung by setting up two sepa-rate wards to treat the large influx of patients produced by the Chinese invasion.

Surgeons, too, were learning better how to work in battlefield conditions,though performance in the Korean hospitals was still marked by some errors indebridement—the surgical removal of dead and dying tissue from a wound. Inmost major aspects of surgery, however, the Far East Command noted im-proved performance. “Wounds were never sutured,” typically reported the121st Evacuation Hospital of its own clinical practice. When patients withsutured wounds arrived from other hospitals, the stitches were promptly re-moved and, where necessary, further debridement carried out. Cleaning anddraining wounds, administering a broad range of antibiotics, and employinghelicopter evacuation of the seriously wounded were keys to preventing infec-tion and reducing mortality rates. As for the physical conditions endured bysurgeons in the field, little could be done. Since entering Korea, surgeons hadworked in weather so hot that rubber gloves filled with sweat and in weather socold that plasma froze. Surgical cases, unlike most forms of illness, came inspurts, “intense periods of around the clock work corresponding to admission oflarge numbers of wounded at critical times.” Coffee and catnaps provided theonly relief for surgeons and nurses at the few and usually understaffed hospitals.The lack of certain kinds of specialists, notably neurosurgeons, continued un-abated. At one point the FEC consultant, on a visit to the 121st EvacuationHospital, was obliged to pitch in and perform twenty-four operations himself

The treatment of shock became highly sophisticated. The 121 st EvacuationHospital had a special shock section where victims were aided with “prompt useof whole blood, oxygen, airway aspiration, proper position, external heat, andindicated narcotics.” Whole blood, administered usually through the veins butin “desperate cases” through the arteries, remained the most important weaponagainst shock. Plasma, markedly less effective, was used only to initiate treat-ment before the blood arrived. Medics routinely matched blood groups before

*T21st Evacuation Hospital, Annual Report of Medical Service Activities, 1950, p. 5, HRB.

THE MEDICS’ WAR

giving a transfusion, but in the most urgent cases they administered unmatchedType O (universal donor). When doctors suspected a concealed hemorrhage,they performed surgery at once as a resuscitative measure, rather than followingthe traditional practice of attempting to revive and stabilize the patient first as aprerequisite to an operation. Methods were brusque, but the results were re-markable: The 121st claimed a death rate of only 0.2 percent among its patients.By adding radio-dispatched helicopters to the shock trauma units they hadinherited from earlier wars, the hospitals—working under the brutal necessitiesof the Korean fighting—devised an integrated system of emergency treatmentthat would not enter civilian medicine for more than a decade to come.^®

Much of the medical system’s success was due to young men, often residentsincompletely trained in their specialties. ‘T would watch these fellows work,”Colonel Dovell recalled, “and . . . they did magnificently, they did beautifully.And they would work on shifts, untiring.” Next in importance were surely thenurses, to whom Dovell also gave unstinted praise:

I’ve seen those nurses giving anesthetics, and scrub nurses that would work there [in theoperating rooms] until they were practically gone. Somebody would hold up a cup ofcoffee [to them]. . . . And of course they had a bath last week sometime, I suppose whenthey got down to a branch of a stream. . . . My hat’s off to the people who did a job. Inever heard a woman that was a nurse complain as to the roughness and the hardships oranything of the kind.^^

Dovell himself was an important part of the medical system in Korea. En-joying a special relationship with General Walker, to whom he owed his ap-pointment as Eighth Army surgeon, Dovell exerted powers far beyond those ofan ordinary staff officer. On occasion he moved Eighth Army medical units likechess pieces—for example, detaching the 8063d MASH from the 1st CavalryDivision “on his own authority” and ordering it to Pusan at the end of July.Increasing his power was his ubiquity. Despite his bulk—Maj. Gen. Hobart R.Gay, the division commander, referred to Dovell as “‘that fat S.O.B.” in hisabsence, and some of his subordinates called him “Buddha”—the Eighth Armysurgeon was a man on the move. To his subordinates this was a mixed blessing.He was there when they needed him; he was also there when they felt they didnot. Some, like Tender of the 8055th MASH, could do no wrong in Dovell’seyes, while others, like Van Buskirk of the 8076th MASH, found him a hardmaster. Van Buskirk

knew that Dovell was personally very fond of him and heard that, when he himself wasn’tthere, [Dovell] was boasting about his accomplishments to others and [would] take pridein how well he was doing. But when the two were together, Dovell would bully [Van]Buskirk unmercifully, and try to make it appear that he could do nothing right.®’

^%id.,Encl l,p. 2, HRB.

^‘Dovell Interv, 15 Jun 62, tape 2, HRB.

^Tirst quotation from Neuman Interv, 28 May 66, p. 5. Second quotation from Interv, SamuelMilner with Col Wayne S. Hume, MC (hereinafter cited as Hume Interv), 19 May 66, p. 19. Thirdquotation from Cans Interv, 29 May 66, p. 18. All in AMEDD Oral History files (Neuman),(Hume), (Gans), HRB. Fourth quotation from Van Buskirk Interv, 7 Jul 66, p. 9, HRB.

THE MEDICAL SERVICE IN THE ATTACK

131

Dovell relished the grueling pace, despite his sixty years, though it broughthim painful and embarrassing moments, as, for example, when he suffered coldinjury at the front. Despite fatigue and frostbite, he was a formidable andunforgettable figure, ordering people and units about in his soft Virginia drawl,indulging in barbed ridicule of General Hume, smoking Webster Fancy-Tailcigars, and drinking his favorite Ballantine Scotch. He kept .50-caliber machineguns on his jeep, and a carbine firing tracer bullets ready at hand, and whenclose enough to the line would stand up and blaze away, in plain sight ofeveryone, including the enemy.^*

The personnel shortages demanded some such figure, invested with authori-ty and able to shift men and units where they were needed most. “We lackeddoctors, we lacked nurses, we lacked qualified people like anesthetists,” saidDovell of his Korean experience, and the lacks helped to define his own role.Though his acerbic personality and feuds with higher-ranking officers preventedhim from winning the star he coveted, he became one of the best known officersin Korea, especially among the medics. As a Medical Service Corps officer said,he could hardly have avoided knowing Colonel Dovell: “Almost every time weturned around, Dovell was there.

By year’s end the regimental medical companies, the medical battalions, theMASHs, and the field, evacuation and station hospitals had matured into veter-an units, able to move and work under the most varied and trying conditions. Acomposite picture might portray a young surgeon using Japanese sutures to sewup a casualty lying on a World War II operating table in a schoolhouse beside ahelicopter landing pad; nurses in bulky men’s winter clothing assisting him; anarray of antibiotics—not only penicillin but also streptomycin, aureomycin, andChloromycetin—standing in a medical chest or cabinet; blood dripping into thesoldier’s veins and more warming for transfusion; everyone very tired; and,outside, trucks gunning motors, preparing a move to a new station.

Such an image drawn from the operating room could not, of course, show thereal complexity of the medical system, with its administrators, ambulance driv-ers, hospital train companies, litterbearers, and clearing station personnel. In sixmonths of battle, this array of men and women, mustering the most variedskills, had learned not only how to do their jobs but, more important, how to dotheir jobs together. Now they needed every gain in experience and knowledge,for they faced a new war against a new enemy.

^®Gans Interv, 29 May 66, p. 18; Dovell Interv, 21 Sep 66, pp. 18-19. Both in HRB.

^’Dovell Interv, 15 Jun 62, tape 2, HRB; Mosebar Interv, 30 May 66, p. 12, AMEDD OralHistory file (Mosebar), HRB.

CHAPTER 5

Behind the Lines

While the fighting forces endured the extraordinary changes of fortune of thefirst six months of war, an increasingly elaborate system of depots, hospitals,and transport facilities developed behind the shifting front. Much of the logisti-cal system was medical. The number of medics and medical units increased, theevacuation pipeline took form, and the supply system stabilized. In Japan afterthe initial drawdown, hospitals grew in number of personnel and specialists andin the complexity of the medical and surgical procedures they could perform.Yet in both Korea and Japan, hospitals remained too few to handle the massivecasualty flow. In consequence, the rapidly growing transport system was oftencalled upon to substitute evacuation for forward treatment.

Meanwhile, the conflict became a limited war with a worldwide cast. Seldomin history have forces so diverse traveled so far to fight in a struggle in whichtheir nations had so little immediate stake. On 24 July 1950 the General Head-quarters, United Nations Command, was established under General MacAr-thur. The addition of Korean soldiers and United Nations (U.N.) units to U.S.divisions reshaped medical responsibilities. The American line of communica-tions served U.N. and South Korean soldiers in American units, and theircasualties followed the same evacuation routes as Americans, except that theywere not returned to the zone of interior. Army hospitals admitted soldiersspeaking a babel of tongues, and U.S. soldiers in turn occasionally receivedtreatment in the hospitals of other nations.*

Early in July General Walker split the Eighth Army headquarters into twoparts, sending an advance section into Korea to conduct operations and keepingthe Eighth Army, Rear, at Yokohama. Colonel Dovell went with his commanderto Korea, and Dovell’s deputy. Col. John A. Worrell of the Medical Corpsremained in Japan to oversee the medical facilities there. A none too aggressiveman, in Dovell’s opinion, he acquiesced in the Eighth Army surgeon’s desirethat Col. Frederick R. Wunderlich, an experienced dental officer and a crony ofDovell’s, exercise actual control. Soon, however, the Far East Command (EEC)realized that the Eighth Army could not carry out both combat and logisticalfunctions, if only because the officers remaining in Japan felt unable to makeroutine decisions without the approval of higher-ups in Korea.

'United Nations Command General Order no. 1, 24 Jul 50, MMFB; extract from DF, AssistantChief of Staff, G-4, UNC, to The Surgeon General, DA, 10 Oct 50, sub: Policy for Integration ofForces Into the United Nations Command, HSF (U.N. Command-1950), HRB.

133

In late July and early August staff officers at the Far East Command held around of conferences on the problem, concluding that the Eighth Army wouldhave to be divorced from its logistical responsibilities if its combat mission wereto succeed. On 25 August the general headquarters created the Japan LogisticalCommand (JLCOM) under Maj. Gen. Walter L. Weible. For a short timeColonel Worrell served as the JLCOM surgeon. But Brig. Gen. Silas B. Hays, thesurgeon general’s foremost expert in medical supply, was already on orders totake over the top medical post in the new command. He reported for duty inSeptember 1950. The personnel of Eighth Army, Rear, were transferred enmasse to the command. While the Eighth United States Army, Korea (EUSAK),carried on the fighting, the Japan Logistical Command in effect established acommunications zone in the Japanese islands.^

Linked by ship and plane, the station and general hospitals in Japan sup-ported EUSAK not only by providing complex care for evacuees but also, onoccasion, by receiving casualties direct from the front-line units and the surgicalhospitals. During the Pusan Perimeter fighting, Japan’s role resembled Eng-land’s during the fighting on the Normandy beachheads during World War II.But when defeat overtook the North Koreans, the area behind the U.N. linesexpanded and in time acquired its own area commands to handle the duties ofsupporting the front-line troops.

Sources of Supply

Coming only five years after the end of World War II, the Korean fightingwas sustained during 1950 largely with weapons and supplies left over from thatconflict. To save the lives of their wounded, the U.N. forces depended on storedmedical supplies in Japan, with resupply from similar sources in the UnitedStates. When rapid use depleted the stocks of some items, the imitative geniusof Japanese manufacturers, drawing upon local cottage industry, provided sub-stitutes of variable quality.

Luckily for the U.N. forces, during a two-year period before the outbreak ofthe Korean conflict medical supply personnel had devoted a major portion oftheir time to a roll-up of supplies throughout the Far East Command. Every-thing that could be packaged and stored was saved, and because the only suit-able storage facilities were in Japan, materiel of every type was collected andshipped to the main island of Honshu. A large part of Yokohama Medical Depotwas set aside for processing. Workers broke down old standard assemblies andput together new ones from the contents. Maintenance was an endless task.Deterioration caused by the tropical climates of Saipan, Guam, and other placeswhere supplies had been kept since World War II had to be repaired. In early1950 the depot’s warehouse branch consisted of seven buildings with an aggre-

TEC, Report of ETMD, August 1950, p. 13, file 350.05 (EEC) 1950; EUSAK, Annual Report ofMedical Service Activities, 1950, pp. 1-2, file 319.1-2 (EUSAK) Far East-1950. Both in HRB. OnWorrell and Wunderlich, see Dovell Interv, 21 Sep 66, p. 7, Personal Interviews file (Dovell), HRB.Hays later became surgeon general (1955).

THE MEDICS’ WAR

gate storage space of over 200,000square feet. Here mountains of cratesand barrels bound with metal strapswere piled on skids for movement byforklift.^

With these supplies the U.N. forcesmet their medical needs during thefirst months of war. The conflict begansuddenly, with no time to requisitionfrom the zone of interior. The depotsof the Republic of Korea (ROK) Armywere quickly overrun, and the retreatduring July brought repeated losses ofmateriel to the onrushing enemy.From 25 June to 15 September almostno bulk supplies were received fromthe United States; the war had to besupported from what was on hand un-til after 1 October, when sizeablequantities began to arrive. As a result,American soldiers in some instanceshad to learn the value of reducedexpectations, and items that they would have considered substandard and unfitin time of peace proved to be “lifesavers . . . [after] the beginning of theconflict.”'* Short of all materiel, the ROK Army was glad to get any supplies, andan entire warehouse of obsolescent medical goods, unusable under peacetimestandards, was quickly distributed to their fighting forces.

Three other sources supplemented these bulk supplies. The Navy and AirForce made their stocks available to the Army. Certain items that were in shortsupply in the Far East Command—new antibiotics, smallpox vaccine, and cor-tisone, among others—were airlifted to Japan from the San Francisco Port ofEmbarkation. Unlimited funds also were made available to the command topurchase nonstandard medical items in the United States. Though the Yokoha-ma Medical Depot shipped to Korea four times the tonnage of supplies that itreceived from the zone of interior, the qualitative impact of U.S. imports appar-ently was great. Quantitatively, goods obtained in Japan itself were more impor-tant. Occupation funds bought from the Japanese jerry-built but functionalsubstitutes for items that were not immediately available elsewhere. In conse-quence, more and more requisitions found their way into the local market place.Tubing and needles from Japanese sources, for example, allowed the 406thMedical General Laboratory to embark on an immediate blood program withlocal donors.

Tec, Report of ETMD, October 1950, p. 11, file 350.05 (EEC) 1950; Yokohama MedicalDepot, 8061st Army Unit, Annual Report of Medical Service Activities, 1950, Receiving Branchand Maintenance Division secs., file 319.1-2 (Yokohama Medical Depot, 8061st Army Unit) FarEast-1950. Both in HRB.

TEC, Report of ETMD, October 1950, p. 11, HRB.

Maj. Gen. Silas B. Hays(1952 photograph)

135

The Army met some problems in such procurement. Quality was compro-mised, and mass production was nonexistent. Hand labor in scattered indepen-dently owned shops turned out the needed goods, and a medical supply officerwas later to remember “needles that wouldn’t penetrate the skin; sterilizergaskets that would blow out at the slightest pressure; sterilizers that simplywouldn’t work; [and] operating tables that would buckle and collapse under theweight of an average American soldier. . . .” Because various agencies bidagainst each other, prices rose in an inflationary spiral. Aspirin sold for about$1.50 a bottle in July but rose to almost $4.00 in November. Yet the EighthArmy surgeon concluded that “all in all the military was able to exploit the localeconomy to decided advantage.” Field units reported most of the Japaneseproducts to be flimsier than current American standards, more apt to wear outin hard service, but entirely usable during their shorter lifespan.®

Getting Supplies to the Troops

The hasty dispatch of critical supplies by air was a feature of the earlymonths of the war. Of the first six planes that left Japan with supplies, two weresaid to contain medical materiel. Supplies in greater quantity and obtained inmore orderly fashion equipped the medical units forming in the Japanese is-lands. Here a kind of controlled chaos reigned during July and August as neworganizations were activated and shipped out on extremely short notice. Fortu-nately, equipment had been pre-stocked at Yokohama in unit assemblies, oneassembly for a MASH, another for a field hospital, and so forth. Unpredictabledemands continued to come in from the field, however. At one point virtuallythe entire medical equipment of the 24th Infantry Division had to be replaced.As supply personnel responded to such demands, wild fluctuations in invento-ries resulted. “A stock that was adequate on one day,” reported the Eighth Armysurgeon, “would become critical with the passing of the next 24 hours.”^ InKorea, problems developed in the early days because supplies were shipped pre-packaged in medical maintenance units, each intended to support ten thousandmen for 30 days. Designed for World War II, these units contained muchsophisticated equipment but lacked items essential in Korea. At one pointCaptain Gans, the Eighth Army medical supply officer, had to borrow opiumand paregoric to treat dysentery from the South Korean medical depot at Taegu.

Requisitions were forwarded to the zone of interior with mechanical regular-ity. Yet in the early days of the war much depended on a kind of large-scalescrounging. Quartermasters found quantities of bedding for the hospitals. AirForce hot-air blowers, designed to keep engines operating in below-zero weath-

Tirst quotation from Interv, Samuel Milner with Lt Col Lynn B. Moore, MSC (hereinafter citedas Moore Interv), 28 Jul 66, p. 12, AMEDD Oral History file (Moore). Second quotation fromEUSAK, Annual Report of Medical Service Activities, 1950, p. 29. Both in HRB. See also SupplyDivision, OSG, History of the Korean Conflict, 25 Jun 50-8 Sep 51, pp. 4-8, file 314.7-2 (ArmyMedical Service Activities, 25 Jun 50-8 Sep 51); Ltr, Col E. W. Partin (Ret.) to Col. R. L. Parker,MSC, Historical Unit, U.S. Army Medical Service, 31 May 61, HSF (Partin-1961). Both in HRB.

TUSAK, Annual Report of Medical Service Activities, 1950, p. 27, HRB.

THE MEDICS’ WAR

er, served as heaters in hospital tents. Ordnance shops fabricated truck litterbrackets, and the naval hospital at Yokosuka made up deficiencies in itemscritically short. General Walker told his surgeon to call on the other technicalservices for anything he needed. Eighth Army medical supply officers on theirown “would trade or borrow . . . and get what was needed overnight.”^

“The transportation of materiel to Korea,” reported the Far East Commandat the end of 1950, “has been uniformly excellent since the beginning of thewar.” Air, water, and rail systems of both Japan and Korea contributed to theflow of medical supplies. Lying only 140 miles from Japan, Korea could bereached by air in forty-five minutes, and this fact alone made the more spectacu-lar achievements of emergency supply—like those of emergency evacua-tion—possible. In early July, however, a more conventional system began totake form. Ships moved the bulk cargo, and a depot was needed at Pusan toreceive and distribute. On 8 July a platoon of the 8065th Army Medical Depot,formed from Yokohama Medical Depot personnel, was organized and shortlyafterward dispatched. For a month this group of four officers and thirty enlistedmen provided medical support to the Eighth Army, other U.N. forces, and theROK Army. On 10 September the 6th Army Medical Depot arrived in Pusanfrom Texas and absorbed the personnel of the 8065th. Henceforth, the depot’stwelve officers, five warrant officers, and two hundred enlisted men carried outsuch functions as storage, maintenance, issue, and repair, as well as the manu-facture of eyeglasses. Forward of the depot the movement of medical supplies torequisitioning organizations depended largely on the Korean railroads, operat-ing under the Eighth Army’s Transportation Section. Perhaps not since the CivilWar had railroads so directly served American troops on the battlefield. Herewere the workhorses of the system, which moved materiel forward as theycarried casualties to the rear.®

As the expedients of the early months gave way to system and routine, thewhole logistical structure matured. On 4 July the Far East Command hadestablished the Pusan Base Command under the United States Army Forces inKorea. By that time port operations were under way, and a melange of person-nel—24th Division officers and men, the Advance Command and LiaisonGroup transportation officer. United States Military Advisory Group officersand civilians who had stayed to help, Korean civilians, and convalescents dis-charged from military hospitals—assembled in rough and ready fashion to orga-nize traffic and to help unload ships. On 13 July the Eighth Army, taking over inKorea, established the Pusan Logistical Command, a table of organization and

^Quoted words from Dovell Interv, 21 Sep 66, p. 11, HRB. See also Laurence J. Potter, “MedicalService in Support of Operations in Korea,” Address before the American Pharmaceutical Associa-tion, Technical Information Office, OSG, release, 30 Mar 51; Gans Interv, 29 May 66, pp. 5-6,AMEDD Oral History file (Gans), HRB.

^Quoted words in EEC, Annual Report of Medical Service Activities, 1950, p. 124, file 319.1-2(EEC) Ear East-1950, HRB. The complement of the depot company fluctuated; the figures given aretable of organization and equipment. See also 6th Army Medical Depot Historical Report, 1950, pp.1-3, file 319.1-2 (6th Army Medical Depot) Ear East-1950, HRB; 3d Transportation MilitaryRailroad Company Historical Report, June 1950-September 1953, p. 21, as cited in 8086th ArmyUnit, Military History Detachment, “Transportation of Supplies, 1 July 1951-31 July 1953,” Msno. 8-5.1A AA.B, RG 319, MMHB.

137

equipment unit that absorbed the personnel of the base command plus addition-al manpower from service units in Japan. But transporting supplies, assistingrefugees, guarding prisoners of war (POWs), operating additional ports in thesouth, and—after the Inchon invasion—supervising the newly established 3dLogistical Command on the west coast soon overburdened the Pusan LogisticalCommand. On 19 September the 2d Logistical Command, an expanded organi-zation, took its place as a major subordinate command of the Eighth Army.Until the creation of the Korean Communications Zone (KCOMZ) two yearslater, the 2d Logistical Command remained in charge of the Korean rear areas.Its authority expanded as the front moved forward and its people providedsupport for the Eighth Army and, while it existed as a separate command, for XCorps as well.’

Water, Blankets, and Litters

Two matters of particular interest to the medics were the supply of potablewater to the troops and the establishment of a property exchange system thatwould ensure an adequate supply of litters and blankets in the forward hospitalsand aid stations. Both were basic to health and survival, and both entailedspecial problems under Korean conditions.

Water supply was especially important because most of the available Koreansources were contaminated. Halazone tablets were unsatisfactory—the 406thMedical General Laboratory randomly tested the tablets for quality, but manythat were worthless slipped through anyway—and North Korean infiltrationand guerilla attacks disrupted supply lines and isolated units. Municipal watersupplies in Korea were and remained insufficient because of power and equip-ment failures. The rapid spread of common diarrhea was not surprising amongtroops dependent upon “an inferior sterilizing agent to disinfect a pollutedwater supply.” Prime responsibility for supply belonged to Corps of Engineerswater points, which, as the tide of battle stabilized and then turned, provedincreasingly adequate for the troops both in quantity and quality. The MedicalService cooperated closely with the engineers, checking the water points fre-quently to ensure uniform standards of chlorination. During cold weather theengineers enclosed the points, either in tents or in improvised wooden shelters,and used immersion heaters to warm unit water trailers. On the whole, entericdiseases, although very common, were relatively mild among Americans fight-ing in Korea, and by the end of 1950 the Eighth Army surgeon could speak withguarded satisfaction of the water supplies available to the troops.*’

Far less successful were efforts to arrange a workable system of propertyexchange. The rules for maintaining a supply of litters and blankets were basedupon the standard chain of evacuation. As the wounded arrived at a new unit,

’USAFFE and EUSAR, “Logistics in the Korean Operations,” vol. 1, pp. 5-19, Ms no. 8-5.1 AAZ, RG 319, MMHB. Functionally, the logistical command resembled the advance section of thecommunications zone in the European Theater of Operations during World War II.

'“Quoted words in FEC, Annual Report of Medical Service Activities, 1950, p. 78, HRB. See alsoEUSAK, Annual Report of Medical Service Activities, 1950, p. 41, HRB.

THE MEDICS’ WAR

Winter Supplies

the litters and blankets of the previous aid station or hospital were to be re-turned on a one-for-one basis, without paperwork or other formality. Koreanconditions defeated this system. Planes flying in supplies were filled for thereturn journey with wounded, many still on their litters, and dispatched toJapan. The wounded went to hospitals, the planes were reloaded with high-priority war materiel, and the blankets and litters remained behind. AtTachikawa Air Base Colonel Partin, the EEC medical supply officer, “found averitable mountain of litters” unloaded by the Air Force and left there.*^ Japan,in turn, was shipping extraordinary numbers of casualties to the United Statesunder similiar conditions. On balance, blankets and litters accumulated wherethey were not needed and disappeared from the Far East Command where theywere. In addition, large numbers were lost in battle or by pilferage.

Efforts by the Far East Command to return as many as possible to Koreaonly revealed that a loss of some ten thousand litters had occurred in the firstthree months of combat. Other parts of the command were called upon for aid.Okinawa shipped four thousand during September, and the surgeon generalordered an airlift of four thousand more from the zone of interior. Advanceplatoons sent forward by the 6th Army Medical Depot maintained near thefront stocks of fast-moving items, including blankets and litters. Though the

“Gans Interv, 29 May 66, pp. 9-10, HRB.

139

shortage was alleviated, by the end of the year General Hume was obliged toreport that “no amount of effort in the last six months has produced a workablesystem for exchange of property on transfer of patients.” Only when the shortageof litters and blankets in forward areas became critical did their priority rise tothe point that airspace could be obtained for shipment. Like an ill-regulatedthermostat, the logistical system responded only to crisis. The result was a“continual shortage in combat areas” of these basic and absolutely essentialitems.*^

Personnel

Supplies meant little unless skilled hands were available to use them for thebenefit of the wounded. The Korean crisis appeared to have been contrived by amalign fate at the precise moment when medical officer strength in the Far EastCommand “was at the lowest [point] since the beginning of the occupation.” Inmany ways skilled enlisted men were even more difficult to obtain than generalduty physicians (though certain types of physician specialists were the mostdifficult of all). Yet strength as well as weakness characterized the MedicalService, and at the end of six months of sometimes desperate improvisation thecommand declared that the medics were “in many respects, better prepared forimmediate action than was the case at the time of Pearl Harbor and perhaps forabout one year thereafter.” So paradoxical a conclusion deserves furtheranalysis.^^

Immediately before the outbreak of war the Far East Command lost twogroups of medical officers—not only its remaining Army Specialized TrainingProgram graduates but also some participants in the civilian internship programwho had completed their obligation of two years’ active service for every year ofgovernment-supported training. The census of medical officers fell from 264 inJanuary 1950 to 197 in June. Still more striking, however, was the comparisonwith May 1949, when 330 had served in the command. (No equivalent reduc-tion had taken place in the FEC personnel they served.) The command foundonly a partial answer in a variety of expedients aimed at persuading nonregularofficers to extend their overseas service. Civilian physicians were hired, and inmid-May fifty-four residents arrived from the zone of interior on three months’temporary duty (TDY). Still, continuing losses reduced command medical of-ficers to half the table of organization number. Anticipating the problems, theDepartment of the Army in April and May put 147 medical officers on specialorders, reassigning them to the Far East Command in August and September.Most of these replacements were young men, participants in the civilian intern-ship program, who had had no prior contact with military service. For a varietyof technical reasons having to do with the terms of their enlistments, the length

*^Both quotations from FEC, Annual Report of Medical Service Activities, 1950, p. 125, HRB.See also EUSAK, Annual Report of Medical Service Activities, 1950, p. 30; FEC, Report of ETMD,August 1950, pp. 13-14. Both in HRB.

'^FEC, Annual Report of Medical Service Activities, 1950, HRB. First quotation on p. 142;second quotation on p. 151. Except as otherwise noted, the following section is based on this report.

THE MEDICS’ WAR

of their overseas tours was short. The prospect was that the regular officers, withtheir longer tours and generally wider experience, would have to juggle short-term colleagues with excellent professional backgrounds but, very often, with noArmy experience whatever.

Inevitably, a personnel crisis followed the outbreak of war. Understrengthdivisions had to be made operational. Medical field units had to be formed.Already understaffed, the hospitals in Japan gave up both officers and enlistedmen. At the same time, casualties began to arrive from Korea, and the hospitalsystem was faced with the need for expansion to handle an anticipated floodlater on. In short, the first two weeks of July brought a totally impossiblesituation.

On 1 July the Far East Command asked the Department of the Army to shipthe replacements at once, and by the thirteenth the movement was under way.The surgeon general added any other physicians he could spare, and by mid-August 240 had arrived. Meanwhile, on 2 July General Mac Arthur receivedauthority to impose a personnel freeze that, among many other effects, held theresidents on TDY. (An influx of replacements permitted their release in mid-November, when the war appeared to be won.) These actions ended the immedi-ate crisis. As the FEC surgeon reported, “We no longer had our backs to the wallas was the case during the first two weeks of July.” The Chinese interventionthen brought a new crisis. In late November, as the hospital census soared,doctors were again in urgent demand. The year ended in a new personnel freeze,with uncertain prospects for the future.

Of great importance during these successive shocks was the assignment ofninety-eight Navy doctors, who arrived in the Far East Command during No-vember and December. The Navy attached no strings to the use of these men,most of whom went to the Eighth Army and X Corps in Korea. Wearing Armyclothing for lack of any Navy uniform appropriate to their new duties, theywere, as General Hume wrote, “indeed welcome,”*^ though no one anticipatedthat they could be retained for long.

Between the Navy doctors, most of them residents, and the Army’s ownresidents and interns, the general picture was one of innocents in the field. TheFar East Command remarked that the new doctors’ lack of military experiencemight have been “a serious handicap to their medical mission and a threat totheir very existence in the combat areas in Korea.” Mitigating the situation wasthe military experience of Medical Corps officers (MCs) in command positionsand of many Army Nurse Corps officers (ANCs), Medical Service Corps officers(MSCs), and enlisted men. The Second World War was only five years in thepast, and most regular officers and many reservists as well had battlefield expe-rience. The first commander of the 8055th MASH later recalled that his hospitalhad survived the opening months in part because he had “learned to run in theBattle of the Bulge.” The commanders of the 8063d and 8076th MASH wereveterans and had prior Korean service as well.“^

“'Ibid., p. 144, HRB. See also EUSAK, Annual Report of Medical Service Activities, 1950, pp.19-20, HRB.

‘Tec, Annual Report of Medical Service Activities, 1950, p. 147, HRB.

“Ibid.,p. 148, HRB.

141

Hence, lucky newcomers diffused as junior officers into units whose seniormembers were more familiar with the ways of war than many of the regularofficers of 1941. Young men “wearing their first uniforms” were teamed withveterans and many of the veterans, graduates often of training programs similarto those that had drawn the civilians into the service, were exceptionally wellqualified to treat the injured as well as to administer. Though casualties exceed-ed all predictions, hospital death rates were the lowest in the history of warfare.At a time when the draft had not yet come to solve the problem of procuringdoctors, this accomplishment belonged to the Medical Service almost alone, toits cadre of experienced officers and men, and to its highly educated newcomerswho occupied the most forward positions. “I feel,” wrote Dr. Howard D. Fab-ing, consultant to the surgeon general in neurology and psychiatry, after a tourof the Far East Command, “that [the Army residency training program] savedthe bacon in the Korean War, and if it can never demonstrate another value,this alone proved its worth.

All, however, were not fortunate. Young physicians with little rank too oftenfound themselves in forward positions, faced with the task of organizing themost difficult of medical maneuvers, a retreat burdened with casualties. If thiswas sometimes the fate of the medical officer, that of the veteran MedicalService Corps officer or enlisted man was occasionally to be placed in a positionhe was not clinically qualified to fill. Instances occurred when the duties ofbattalion surgeon devolved upon enlisted men. The Medical Detachment, 38thField Artillery Battalion, 2d Infantry Division, did not have a single commis-sioned officer, either Medical Corps or Medical Service Corps, for its first sixmonths in combat—which included the Chinese breakthrough at Kunu-ri. Thefirst sergeant of the detachment acted as surgeon, daily treating casualties fromhis own battalion and as many as 30 infantry patients as well. Similarly, M. SgtJerry J. Novosad, surrounded for three days at Chipyong-ni, saw the unitscaught in his pocket suffer 556 casualties. He cared for all these men in the 23dInfantry collecting station, which had no assigned officers at all. As the stationwas without protection from incoming mortar rounds, he walled his tents withrailroad ties. He gave his patients penicillin and painkillers; dressed theirwounds; when necessary, administered whole blood; and provided two meals aday. Besides Novosad, the heroes of the piece were the helicopter pilots who, indefiance of standard operating procedures, flew into the embattled enclave toevacuate the most serious cases—100 in all—which even Novosad could nothandle. In Korea such situations too often resulted, not from the accidents ofwar, but from a continuing deficiency in the number of doctors and in thequality of their training.^*

‘’First quotation from Telecon, author with Isaac J. Tender, October 1981. Second quotationfrom Rpt, Howard D. Fading, M.D., 30 Dec 50, sub: Recent Trip to Far East Command, p. 13, file730 Neuropsychiatry (Consultants Visits) Far East 1950-51, HRB.

‘*Army Field Forces Observations, FEC, March 1951, End to Ltr, Brig Gen Robert P. Williams,MC, Chief, Medical Section, Office of the Chief of Army Field Forces, to Deputy Surgeon General,DA, Attn.: Maj Gen George E. Armstrong, MC, 12 May 51, file 319.1 (FEC) AA, 1951-52, Box 69,Accession no. 56A-179, RG 112, WNRC.

THE MEDICS’ WAR

At higher levels the Medical Service during the early period in Korea re-mained, despite the residency programs, persistently short of certain kinds ofphysician specialists. It simply had no way, using its own resources, to approxi-mate the riches of specialized knowledge that a World War Il-style draft couldmuster. Hence, specialists in certain critical areas—neurology, urology, anesthe-siology—remained in short supply, and the professional training of others wasdeficient. At the start of the war the Far East Command had only one generalsurgeon who was board certified, and the surgeons who arrived in August,though better trained clinically, lacked battlefield experience. As 1950 drew to aclose, shortages were relieved in most specialities, other than neurosurgery, inthe hospitals of Japan. The command kept a card file on the professionaltraining of new physicians and assigned skilled men where their abilities couldbe used most fruitfully. Finding neurosurgeons to serve at forward posts inKorea, however, was a job for the future.*^

The inexperience of so many new MCs meant opportunities for the othercorps. The number of ANCs and MSCs had never fallen to the critical levelreached by physicians, though nurse anesthetists were in short supply. For both,wartime meant a drastic increase in demand. As its medical management andhousekeeping functions expanded, the Far East Command asked for additionalMSCs from the zone of interior, and their duties multiplied even beyond thediversity of World War II. Almost without exception, the MSCs in the Far Eastwere veterans with five to ten years’ service already behind them. A majorsource of stability and continuity, they commanded medical units, provided afund of experience for new MCs to draw upon, and trained fresh arrivals of allranks. By early 1951 the MSCs would command the medical battalions of fourof the six U.S. divisions. Nurses, too, were relatively more abundant thandoctors and the majority on duty in the command had served during World WarII. The first shock of combat, when eighty-seven ANCs were sent to Korea, didnot diminish the care available in the hospitals in Japan. However, as casualtiesmounted in July and no new nurses appeared, an acute shortage developed.Relief came on 14 August with the arrival of the first shipment of ANCs fromthe United States. Nurses also began to arrive from other U.N. countries; someThai nurses served for a time with the 8054th Evacuation Hospital, as othersdid in Japan, releasing ANCs for duty in Korea. Except for the crisis period inJuly, when there seemed to be enough of no one, the ANCs and MSCs wereadequate in numbers. On account of their broad military experience, theyplayed a crucial role in the functioning of the Medical Service.

Trained enlisted men were both necessary and in short supply. Moreover,the supply improved more slowly than among the officers. Understaffed andoverworked, the enlisted component in both units and hospitals was reported tobe “wearing out from long hours of hard work in trying circumstances. . . .”For a time the arrival of new medical units depleted instead of expanding thesupply. A long list of such outfits—the 121 st and 171 st Evacuation Hospitals,the 4th and 64th Field Hospitals, the 1st MASH, the 559th and 560th Medical

■’Surgeon’s Circular Letter 6, no. 3, Medical Section, FEC, 1 Mar 51, pp. 52-53, file 461(Circular Letters) FEC, HRB.

143

Ambulance Companies, the 514th and 618th Medical Clearing Companies (Sep-arate), plus a miscellany of smaller organizations—showed up in the Far EastCommand with “glaring shortages in enlisted personnel.” The 560th MedicalAmbulance Company alone was short fifty-one enlisted men; the two fieldhospitals could staff only two platoons each. “In order to avoid committingcrippled units to action,” the command complained, “these units were madeoperational through pulling medical service enlisted men from hospitals inJapan that, due to their patient census, could ill afford to lose a single man.” TheMedical Replacement Training Center, set up at Fort Sam Houston, Texas, on22 August, partly relieved the problem. Yet from the beginning of the war untilthe end of 1950, the number of enlisted medics had slightly more than doubledin a command where the total number of non-Korean ground troops had in-creased by almost four times.^®

Training the newcomers was another critical problem in a service where skilland intelligence were at a premium. Nurses in Korea complained that their“greatest difficulty . . . was with the untrained corpsmen,” who, without amedical background, struggled to acquire basic skills on the fighting front.Hence, the hospitals in Japan set up a refresher course for wardmasters andward attendants. At year’s end the Eighth Army counted about 9,500 enlistedmedical corpsmen as against an authorized strength of 10,264.^^

Such were the personnel resources of the command. A method of handlingthem with considerable portent for the future appeared during 1950 with thebeginning of a theater rotation policy for nurses and doctors. The reasons givenfor selecting the two most professional corps for the experiment were quitedifferent. The Far East Command viewed rotation of nurses as “obvious,” basedon its “experience that women officers, because of their physical limitations,cannot be expected to undergo for prolonged periods of time the hardships andadverse environmental conditions on equal terms with men.”^^ Unmentioned inofficial reports was the fact that the women officers were volunteers, not subjectto the pressures of the draft—a factor that already had influenced the grantingof rotation rights during the peacetime occupation of Korea.

The Far East Command’s chivalric treatment of its female officers was madeeasier by the fact that nurses, with few exceptions, repeatedly chose duty inKorea over safer and more comfortable stations. “We are faced,” wrote General

^“First and second quotations from FEC, Annual Report of Medical Service Activities, 1950, p.151. Third quotation from ibid., p. 152. Both in HRB. See also EUSAK, Annual Report of MedicalService Activities, 1950, p. 23, HRB; Weekend Letter no. 5, Col R. H. Eckhardt for Maj Gen EdgarErskine Hume, Chief Surgeon, Medical Section, FEC, to Maj Gen R. W. Bliss, Surgeon General,DA, 8 Sep 50, file 200 (Personnel Letters Between SGO and Medical Section, FEC), Box 3099(Medical Section, FEC, General Records, 1950), RG 338, MMFB. On the Medical ReplacementTraining Center, see Education and Training Division, OSG, History of the Korean Conflict, 25 Jun50-8 Sep 51, pp. 1-3, file 314.7-2 (Army Medical Service Activities, 25 Jun 50-8 Sep 51), HRB.

^'Quoted words from FEC, Report of ETMD, July 1950, p. 38, file 350.05 (FEC) 1950, HRB. Seealso Weekend Letter no. 5, Eckhardt for Hume to Bliss, 8 Sep 50, RG 338, MMFB. The increase ofground troop strength, U.S. and U.N., was from 51,745 in July to 208,265 at the end of December.See Statistical Summary, Program Review and Analysis Division, Office of the Comptroller of theArmy, 7 Oct 54, sub: ROK and UN Ground Forces Strength in Korea, 31 July 1950-31 July 1953,Geographic V file 320.2 (Strength), HRB.

^TEC, Annual Report of Medical Service Activities, 1950, p. 154, HRB.

THE MEDICS’ WAR

Army Nurses of the 121st Evacuation Hospital

Hume at one point, “with the happy problem of having far more volunteers forKorea than can be accommodated. Almost all the ANC officers want to leavetheir relative comforts in Japan and go to the uncertainties of Korea.” Neverthe-less, the Army Nurse Corps itself sought special treatment, for the rotationpolicy was established on 19 October at the request of the chief nurse. Hence-forth, ANCs with ninety days of duty in Korea were scheduled for transfer to theJLCOM hospitals. Ninety nurses had rotated by year’s end. “We have notrequired any nurse wishing to remain to leave Korea,” Hume summed up to thesurgeon general, “but those who feel that they should be replaced will be. Afterall, the war has been going on between four and five months and these womenhave had a very rugged time, as you well know.”^^

By the end of 1950 plans also had matured to rotate medical officers toJapan after six months in Korea. The mechanics of the process were similar. Asin the case of the nurses, the Far East Command required replacements to beactually on hand. The justification, however, was quite different. Here the aim

^Quotations from Weekend Letter no. 4, Maj Gen Edgar Erskine Hume, Chief Surgeon, MedicalSection, EEC, to Maj Gen R. W. Bliss, Surgeon General, DA, 5 Sep 50, file 200 (Personnel LettersBetween SGO and Medical Section, EEC, General Records, 1950), RG 338, MMEB, and fromextract of Ltr, Hume to Bliss, 29 Nov 50, HSE (Hume-1950), HRB. See also Headquarters, JapanLogistical Command (hereinafter cited as JLCOM), Command Report, October 1950, NarrativeSummary, pp. 20-22, file AYUT-8000 (JLCOM, Command Report, Oct 50), Box 4614 (JLCOM,AYUT-8000, Narrative w/encls 1-9, Oct 50), Entry 429, RG 407, and Msg, CINCEE ZX 21376 toCG, ARMY EIGHT, 19 Oct 50, Enel 4 to Weekend Letter no. 7, Hume to Bliss, 27 Oct 50, file 200

145

was professional renewal through contact with hospital work, and the plan wasto rotate first the divisional and other unit officers because “they were thefurtherest [^/c] removed from intensive professional work of all those on duty inKorea.” While other corps could not be rotated “due to the logistical andpersonnel problems involved,” the command did put into effect toward the endof the year a plan to allow all officers and enlisted men in Korea to return toJapanese centers to enjoy five days of “rest, recreation and recuperation.”^^

The personnel system during 1950 could record as its major achievementsthe survival and growth of medical support for the Eighth Army and its backupin Japan under the two great shocks of the North Korean invasion and theChinese intervention. In conditions that twice approached crisis, men and wom-en were found to fulfill the mission of evacuating and treating the wounded andsick. In the doctor draft, enacted during August, and in the beginnings of therotation system, durable elements of what would become the Korean normemerged. But the first influx of drafted doctors was not expected until January1951. During 1950 the Medical Service was thrown largely on its own resources,and its rotation policy was ad hoc and related to the special situation of nursesand doctors. The maturing of the system lay in the future.

Preventive Medicine

Meanwhile, on the ground in Korea, the stabilization of the rear areas andthe arrival of new units allowed the growing medical establishment to preventand treat disease with greater assurance than at any time since the onset of thewar. Preventive medicine was virtually impossible during the weeks of with-drawal and defeat. The shock was great to troops newly arrived from Japan. Aprimitive battle-wracked Korea, where even the elementary improvements ofearlier years were lost, took a heavy toll of illness on the men who had come tohelp defend it. Nevertheless, efforts at control began early, for malaria surveyand control detachments were among the first units to enter Korea in July.

Heat, multiplying insects, and impure water provided obvious sources ofdisease. Inspection during August by the sanitary engineering and preventivemedicine consultants indicated that water purification was still a problem, andthat, though mosquitoes were few, fleas were a “universal plague.” Patientsevacuated from the front line were infested, as were the doctors, nurses, andattendants working over them. DDT dusting and spraying of clothing, beds,billets, and hospital wards was in progress, but airplane dusting, begun in lateJuly, was interrupted on occasion because of equipment breakdowns. Fly con-trol was judged “an insurmountable task in this [Korean] area.” Lack of person-nel meant that Korean KPs were working in Army messes; their personal hy-giene was judged “extremely poor.” Carriers were many for the multiple ills ofKorea. Taking into account men, rodents, and insects, diseases were borne tothe troops on two, four, and six legs, as well as on the wing.^^

(Personnel Letters Between SGO and Medical Section, FEC), Box 3099 (Medical Section, FEC,General Records, 1950), RG 338. Both in MMFB.

^TEC, Annual Report of Medical Service Activities, 1950, p. 156, HRB.

“Quoted words from FEC, Report of ETMD, August 1950, p. 9, HRB. See also EUSAK, Annual

(Continued)

THE MEDICS’ WAR

Diarrheal disorders formed one of the greatest single groups of medicaldisabilities. Shigellosis, a form of bacillary dysentery, was the commonest.Symptoms of enteric cramps and diarrhea added to the other woes of fightingmen during the Pusan Perimeter battles, the recorded incidence reaching 120cases per 1,000 troops per annum during August. Thereafter, the diarrhealdisorders declined in response to many factors, among others improved engi-neer water supplies and increasingly rigorous medical discipline.

Even more common than enteric problems during September were fevers ofundetermined origin. These were believed to include a number of viral ills and,for a time, were a serious cause of disability. Incidence reached what the EighthArmy surgeon called the “rather astounding figure” of 138.9 admissions per1,000 troops per annum. Mixed in were cases of malaria that were atypical orresisted diagnosis, and possible cases of enteric fever and dengue. A fundamen-tal factor in the rise of this catchall category was the difficulty of obtainingproper laboratory analyses under battlefield conditions. With the onset of coolweather, the incidence of fevers dropped off sharply to a low of 14.1 per 1,000 inDecember. These two general categories of illness—enteric and feb-rile—together with a third, psychiatric problems, represented the most impor-tant causes of lost manpower to the U.N. forces during the early months inKorea.^^

Malaria was not as great a problem as originally feared. Five cases occurredin July, 129 in August, and 225 in September. Though prophylaxis as alwaysproved difficult to enforce under battlefield conditions, the Medical Servicemade every effort to do so. Additionally, two control units began operatingbehind the lines in July, destroying not only mosquitoes but also flies and fleas.Some used Japanese-made foggers and motor dusters, which proved to be “high-ly satisfactory and effective” substitutes for American machines. After thereconquest of Seoul, Air Force planes began an aerial spraying program usingspecially equipped C-47 aircraft. Cases of malaria reached their high of 29 per1,000 troops per annum when U.S. soldiers were crowded into the Pusan Perim-eter with hundreds of thousands of infected Korean civilians, who formed thechief reservoir of the disease. On the whole, however, the combination ofchloroquine prophylaxis and early, heavy use of insecticides held malaria to alower incidence than expected, given Korea’s disease environment and theconditions of war. The disease declined after the breakout and ended with thecoming of winter.

(Continued)

Report of Medical Service Activities, 1950, p. 32, HRB; Medical Section, EUSAK, Summary ofActivities for Period 25 June-13 July 1950, End 20 to EUSAK War Diary, file 108 (Sec. 1,Prologue, EUSAK War Diary, 25 Jun-12 Jul 50), Box 1081 (War Diary, EUSAK, Table of Contents,Secs. 1-2, Prologue, Summary, Jul 50), Entry 429, RG 407, MMFB.

“Quoted words from EUSAK, Annual Report of Medical Service Activities, 1950, p. 35, HRB.See also 406th Medical General Laboratory, Report of ETMD, September 1950, p. 10; “A Summaryof Medical Experience in Korea, July 1950-December 1952,” reprinted from Health of the Army,January, February, and March 1953, file 720 (Health of the Army-Summary of Medical Experience)Korea-Jul 50-Dec 52, HRB.

^^Quoted words from 38th Malaria Control Detachment, Annual Report of Medical ServiceActivities, 1950, file 319.1-2 (38th Malaria Control Detachment) Far East-1950, HRB. See also406th Medical General Laboratory, Report of ETMD, September 1950, p. 3. All positive tests formalaria showed the culprit to be Plasmodium vivax. See also 207th Malaria Survey Detachment,

147

Battalion Aidman Vaccinating South Korean Troops

The detachments worked as well to control other insect-spread diseases,dusting thousands of POWs to reduce the threat of typhus and heading off anoutbreak of mosquito-bome encephalitis around Chinhae on the south coast ofKorea. The 357 cases of encephalitis that occurred anyway were mostly amongtroops on the front line where, for obvious reasons, the environment was be-yond control. Victims were sent to Japan, where the 361st Station Hospital atTokyo became a center for the study and treatment of the disease. In similarfashion the 35th Station Hospital in Kyoto specialized in hepatitis, an ill-understood viral disease that was endemic in Korea. Other diseases meant littlein terms of the numbers of Americans who were stricken: a few cases of small-pox; one fatal case of tetanus; two cases of diphtheria; twenty-one possible casesof dengue; eight of relapsing fever; and seven of meningitis. At least one deathfrom polio also occurred. Typhus and typhoid were nonexistent among Ameri-cans, as were cholera and plague.^*

Annual Report of Medical Service Activities, 1950, file 319.1-2 (207th Malaria Survey Detach-ment) Far East-1950; FEC, Report of ETMD, August 1950, p. 15; 406th Medical General Laborato-ry, Annual Report of Medical Service Activities, Professional Section (Annual Historical Report),1951, pp. 14-18, file 319.1-2 (406th Medical General Laboratory) Far East-1951; EUSAK, AnnualReport of Medical Service Activities, 1950, pp. 45-47. All in HRB.

^*FEC, Annual Report of Medical Service Activities, 1950, pp. 23-25, 52-53, 67-68, HRB. InDecember, arrival in Korea of the 37th Preventive Medicine Company was reported. See Surgeon’s

(Continued)

THE MEDICS’ WAR

The immunization programs that played so important a role in controllingdisease were not confined to those in Korea. Early in the war, thousands ofKorean recruits began to arrive in Japan for training and integration into unitsof the American Army. These young men, known as the Korean Augmentationto the United States Army (KATUSAs), were destined to live in close contactwith American personnel. Massive immunizations helped to prevent the intro-duction of disease either into the training camps or among the Japanese popula-tion. Some fifty thousand KATUSAs received smallpox vaccinations and dosesof typhoid-paratyphoid vaccine, as well as typhus and cholera shots. Althoughthe American soldiers already had received the Army’s usual battery of shots inthe United States, the dangers in Korea were such that they, too, were given newimmunizations for typhus and cholera, revaccinations in cases of need, andtetanus toxoid to protect against one of the commonest of battlefield contamina-tions. Meanwhile, during each day of August the 8054 the Evacuation Hospitalimmunized about four hundred recruits for the ROK Army.^^

As in the days of peace, the work of the Veterinary Corps was exceptionallyimportant. The corps’ food inspection units provided the only medical controlon the quality of foodstuffs shipped into Korea. The 95th Veterinary FoodInspection Detachment was typical. With one officer and seven enlisted men theunit arrived at Pusan in early July and was attached to the 8054th EvacuationHospital for billeting. During the chaotic period at the port its personnel strug-gled to inspect incoming goods, to sort out what was edible for issue to thetroops, and to prevent pilferage by Korean laborers. The arrival of the 476thVeterinary Food Inspection Detachment and of another veterinary officer withthe port unit finally assured an adequate number of personnel, even though the95th’s commander, Maj. Jack E.Wittrock, feelingly described his struggles withlaborers who spoke no English, disintegrating cartons of food, a variable supplyof electric power, and canned goods of uncertain quality. Nevertheless, suchwork by very small numbers of Medical Service personnel made a large andessential contribution to the health of the troops.^®

A sign of changing conditions in Korea was the evolution in the venerealdisease (VD) situation.^’ During July and August most cases among Americansin Korea resulted from the troops’ last flings in Japan. During September, rates

(Continued)

Circular Letter 5, no. 12, Medical Section, FEC, 1 Dec 50, p. 3, file 300.5 (Circular Letters) FEC,HRB. The work of this company is discussed in Chapter 8 of this volume.

”JLCOM, Annual Report of Medical Service Activities, 1950, p. 9, file 319.1-2 (JLCOM) FarEast-1950; EUSAK, Annual Report of Medical Service Activities, 1950, pp. 40-41; FEC, AnnualReport of Medical Service Activities, 1951, pp. 52-53, file 319.1-2 (FEC) Far East-1951. All inHRB. See also Surgeon’s Weekly Letter, 22 Dec 50, pp. 3-4, tab 3, document 5, Medical Section,JLCOM, Command Report, December 1950, Supporting Documents, file AYUT-8000, Annex 24(Medical Section, JLCOM, Dec 50), Box 4627 (JLCOM, AYUT-8000, Annexes 19-28, Dec 50);8054th Evacuation Hospital, Semimobile, Report of Public Health and Sanitation Activities, August1950, file MDEH-8054 (Report of Activities, 8054th Evacuation Hospital, Jul-Aug 50), Box 4715(Nonorganic Units, MDDP-4 to MDGH-457, 1949-50); Medical Section, EUSAK, HistoricalReport, 22 Jul 50, End 20 to EUSAK War Diary, file 108 (War Diary, EUSAK, 22 Jul 50), Box 1084(EUSAK, Sec. 3, War Diary, 21-23 Jul 50). All Entry 429, RG 407, MMFB.

^66th, 95th, 150th, and 476th Veterinary Food Inspection Detachments, Annual Reports ofMedical Service Activities, 1950, files 319-1.2 (66th VFID), (95th VFID), (150th VFID), and(476th VFID) Far East-1950, HRB.

^‘This and the following paragraph are based on EUSAK, Annual Report of Medical ServiceActivities, 1950, pp. 36-40, HRB. First quotation on p. 39; second quotation on p. 36.

BEHIND THE LINES

149

were quite low, reflecting the rapid movement of forces through areas almostdevoid of civilians. Beginning in October, venereal disease seemed to be ac-quired largely in Korea, often in cribs so unsanitary that a medical officer wasmoved to wonder “how an American soldier can frequent these places.” Thedecline of formal brothels in favor of assignations in buildings that existedprimarily for other purposes made the posting of off-limits signs virtually use-less. In Pusan, for example, an area with a large concentration of troopsand—according to one estimate—some eight thousand prostitutes, dance hallsopened to accommodate the troops. After visiting such establishments, soldiersretired with chosen partners to finish the evening in a crib, private home, hotel,or paddy field. Prophylactic stations had to provide showers and DDT dustingsin addition to specific anti-VD services, because other diseases, such as typhus,also were transmitted during sexual contact. The social breakdown associatedwith the war, the poverty of the refugees, and the influx of professional prosti-tutes all contributed to the spread of venereal disease.

At the same time, wartime conditions made the gathering of accurate statis-tics impossible. The Eighth Army reported that VD rates declined from 183cases per 1,000 troops per annum in 1949 to 143 in 1950. The reduction wasattributed to the war, which removed large numbers of men to front-line loca-tions where the opportunity for sexual contact was small. However, the EighthArmy surgeon admitted that the figures were “not a true indication of theincidence among the troops in Korea” and that they were reported for whateverthey might be worth.

Overall, the record of preventive medicine under the near impossible condi-tions of 1950 was by no means a poor one. With every circumstance ripe formajor disease outbreaks, none occurred that caused significant loss of life ordanger to the operations of the military forces. Into this result had gone asubstantial measure of good luck and a vast amount of hard work. But thecourse of the war was a fundamental adverse factor. Until the fighting linesstabilized, the effort to prevent disease would remain a hit-or-miss affair.

Hospitalization and Evacuation

Besides moving supplies and replacements forward and seeking to establishmedical discipline, medics moved the sick and injured out. In every respect theevacuation system remained expedient and informal, yet by the end of 1950signs of greater order and sophistication had appeared.

Within Korea the major means of moving large numbers of wounded re-mained the railways. Early hospital trains were improvised, consisting largely ofconverted boxcars and coaches, plus a few ancient hospital cars. One job of themalaria control detachments was to destroy the abounding population of fleasand lice that inhabited such vehicles. At Taegu a freight car was kept stockedwith C-rations, fruit juice, litters, and blankets to supply the hospital trains asthey were made up. Two sandbagged flatcars were attached to each train.Equipped with machine guns and manned by twelve military policemen carry-ing automatic weapons, the flatcars were the major protection against guerillas,though the red crosses were painted out to reduce the possibility of attack. Inthis condition, with a single nurse to care for the patients and a corpsman or twoto assist her, a train was ready for its run to Pusan.

THE MEDICS’ WAR

This rough-and-ready period of medical railroading did not last through1950. On 1 August the Office of the Surgeon General received from GeneralMacArthur a request for two hospital trains for use in the Far East. ThoughAmerican trains could not use the narrow Japanese tracks, Korean tracks werestandard gauge. Toward the end of the year hospital cars began to arrive fromthe zone of interior, and by year’s end two hospital train units were runningtrains on a continuous shuttle between Pusan and the front-line hospitals.Meanwhile, other means of transport had developed to assist the railroads.Ambulances, litter jeeps, helicopters, and a variety of fixed-wing aircraft playedessential roles. The fixed-wing craft operating within Korea were controlled bythe Combat Cargo Command of the Far East Air Forces. The Air Force retaineda monopoly of these planes, and moved significant numbers of wounded withinthe country, as well as from Korea to Japan. On the ground the litter jeepquickly won the approval of many medical officers, not merely as a field expedi-ent to replace unavailable ambulances but as a preferred vehicle because its lowprofile made it a less inviting target. Whether the injured moved by rail, road, orair, the formal evacuation policy established at twenty-one days in July andexpanded to thirty days in August meant little in practice. As the Eighth Armyadmitted, the actual disposition of the wounded varied from day to day with thetactical situation.

However they traveled, Pusan was the destination of all who were not air-lifted directly to Japan or returned to duty from the forward hospitals (Chart 1).Here the major in-country hospital complex awaited them: the 8054th Evacua-tion Hospital, the Swedish Red Cross Hospital, the 1 st Prisoner of War FieldHospital, plus the hospital ships and a growing array of special units. Thecommanding officer of the 5 2d Medical Battalion (Separate), attached to the 2dLogistical Command, acted as medical regulating officer, sorting the casualtiesand designating the hospitals to which each was to be sent. Evacuation fromPusan was carried out by air or sea to the 118th Station Hospital in Kyushu.Here patients were screened and either hospitalized or carried further to hospi-tals in Honshu.^^

Quickly outgrowing its original quarters in the Pusan Middle School, the8054th Evacuation Hospital spread out to include two other schools plus aholding company. At one time this four-hundred-bed hospital actually hadtwelve hundred beds set up, though its complement remained twenty-four maleofficers and forty-one nurses. Its average daily admissions virtually doubledtwice, from 108 in July to 204 in August, and again to 412 in September—over12,000 admissions for that month, or about 10 patients for every bed even interms of the hospital’s maximum capacity. And this was not all. Some of the8054th’s personnel and equipment was tapped to organize the 1st Prisoner ofWar Field Hospital (Provisional), which quickly expanded to over four thou-

^^Medical Section, EUSAK, Summary of Activities for Period 25 June-13 July 1950, Enel 20 toEUSAK War Diary, RG 407, MMFB; EUSAK, Report of ETMD, November 1950, p. 5, file 350.05(EUSAK) 1950, HRB. See also MFR, Hospitalization and Operations Branch, Medical Plans andOperations Division, OSG, 2 Aug 50, sub: Hospital Trains for Far East Command, file 322 (Hospi-tal Trains); EUSAK, Report of ETMD, August-September 1950, file 350.05 (EUSAK) 1950;EUSAK, Annual Report of Medical Service Activities, 1950, pp. 6-8. All in HRB.

”52d Medical Battalion (Separate), Annual Report of Medical Service Activities, 1950, sec. 1,file 319.1-2 (52d Medical Bn, Sep) Far East-1950, HRB. The chain of evacuation is discussedfurther in Chapters 7 and 8 of this volume.

Chart 1—Medical Evacuation, September 1950

MASH^

Battalion Aid Station

nI'

Regimental Collecting Station

'i'

- Division Clearing Station

Evacuation HospitalPusan

I'

Korean Airfields

\1/

118th Station HospitalFukuoka

Other Army Hospitals in JapanHaneda International Airport

'I'

Tripler Army HospitalHawaii

n1/

Travis Air Force BaseCalifornia

'I

Zone-of-Interior Hospitals

Source: Adapted from Warner F. Bowers, “Evacuating Wounded from Korea,” Army In formationDigest 5 (December 1950): 50. Though schematic and oversimplified, this sketch indicates somemain lines of evacuation. Within Korea, movement was by road, rail, or air; between Korea andJapan, by air or sea; within Japan, by road, rail, or air; between Japan and the zone of interior, by airor sea.

THE MEDICS’ WAR

U.N. Patients in a Pusan Hospital akd, formerly a school auditorium

sand beds to provide care for both prisoner-of-war and U.N. patients. Onlycontinuous evacuation enabled the 8054th to perform its function. Until Sep-tember, when air service increased, evacuation to Japan was carried out mainlyby water, with four vessels—the USS Consolation, USNS Sgt. Andrew Miller,HMHS Maine, and USNS Sgt. George D. Keathley—providing the backbone ofthe service. Yet several times the hospital’s commander. Colonel Willis, wasobliged to press into service ferry vessels, which were called “Red Ball” ships, tocarry more evacuees. During July-September the hospital evacuated more than15,000 patients.

Within its limitations, however, the 8054th Evacuation Hospital accom-plished a near miracle, considering its origin and staffing. First organized on 1July 1950 and staffed with personnel drawn from hospitals all over Japan, the8054th had no opportunity to train as a unit. Yet this collection of officers and124 enlisted men treated some 33,000 admissions during the last six months of1950. The five operating tables were the scene of more than 6,000 surgicalprocedures; more than 5,000 enemy prisoners received treatment; and the deathrate among U.N. patients was less than 1 percent. Both the numerical weaknessof the Medical Service and its high professional competence were strikinglyexhibited.^

^8054th Evacuation Hospital, Semimobile, Annual Report of Medical Service Activities, 1950,pp. 1-4, file 319.1-2 (8054th Evacuation Hospital, Smbl) Far East-1950, HRB.

153

Facilities at the 3d Station Hospital in Pusan

Particularly welcome because eight of its ten doctors were surgeons, theSwedish organization, though equipped as a four-hundred-bed evacuation hos-pital, functioned more like a rear-area MASH with expanded holding facilities.Between the time when it opened its doors on 25 September and the year’s end,the hospital handled some 3,190 patients from thirteen nations, the majorityeither Americans or North Korean prisoners of war. By that time, the wholePusan hospital complex had matured. Three hospital ships had taken up dutiesas “station hospitals afloat” off the coast and as ferries transporting the wound-ed to Japan. In addition, the 3d Station and 3d Field Hospitals were activated,the former using the personnel and equipment of the 8054th Evacuation Hospi-tal and the latter that of the 1 st Prisoner of War Field Hospital. Counting twohospitals briefly committed to Korea but withdrawn after the Chinese attack,thirteen hospitals, plus the ships, had served U.N. casualties at some timeduring the fighting of 1950, caring for more than 78,000 admissions.^^

The system had many advantages. The surgeon general preferred evacuationover local treatment whenever possible, in part because scarce specialists could

^*Quoted words from Plans and Operations Division, Medical Section, FEC, Daily Diary, 7 Sep50, file Daily Diaries, 1950, Box 3146 (Medical Section, FEC, Day Files, 1950), RG 338, MMFB.See also 3d Station and 3d Field Hospitals, Annual Reports of Medical Service Activities, 1950, p. 1and p. 5, respectively, files 319.1-2 (3d Station Hospital) and (3d Field Hospital) Far East-1950,HRB; USAFFE and EUSAR, “Logistics in the Korean Operations,” vol. 3, pp. 18-20, 23, RG 319,MMHB; Swedish Red Cross Hospital, Annual Report of Medical Service Activities, 1950, file319.1-2 (Swedish Red Cross Hospital) Far East-1950, HRB.

THE MEDICS’ WAR

be more efficiently utilized in a few large treatment centers in Japan. There wasalso a political aspect to the system, for the Medical Service could avoid theWorld War II errors of having many idle or underemployed doctors in uniform,while the needs of civilian life were depleted. The effect in Korea, however, wasto place a heavy burden upon the baker’s dozen of installations there. As timeprogressed, holding capacity increased and statistics for the year showed thathospitals in Korea had returned about 50 percent of all casualties to dutywithout evacuation. Yet in many ways the hospitals throughout 1950 kept theirearly character as all-purpose medical turnstiles providing excellent emergencycare and quick evacuation for all serious and many nonserious cases. To thefuture belonged specialized treatment centers and high-echelon care—in short,the emergence of a communications zone within Korea.

The Blood Program

For what was in essence a system of emergency medicine, one particularitem of supply—fresh whole blood—was of paramount importance. The firstresponse to the sudden need on the Korean battlefields came from Japan. Here,before the war, Tokyo and Osaka Army Hospitals had maintained small blood-banks to serve their own needs. Clearly, such sources could not meet the re-quirements of the fighting front as well. Hence, on 7 July the 406th MedicalGeneral Laboratory set up an organization that included a mobile collectingteam, a collecting and processing center in Tokyo, and an advance blood depotin southern Japan. A courier service ensured delivery to Korea. During Julyalmost 3,000 units were collected and about 1,600 shipped. American noncom-batants and dependents supplied most of the blood. After 28 September Japa-nese volunteers also were accepted, though their blood was used only for injuredKoreans. The first blood dispatched to Korea, in 70-pound refrigerated marmitecans, went to the 8055th MASH and the 8054th Evacuation Hospital.^^

In May 1950 the World War II blood and plasma program that had collapsedduring the interwar years experienced a revival in the United States. The RedCross maintained a system of blood banks, but only to supply civilian needs.Military hospitals, like those in Japan, secured donors to answer their own day-to-day requirements. No adequate stockpiles of plasma—which, unlike wholeblood, could be kept for long periods—existed, and World War II stocks werenearing the end of their usefulness. With the onset of the emergency the surgeongeneral launched a program for collecting whole blood through the Red Cross,and the Department of Defense signed a contract with a biologies firm to

“406th Medical General Laboratory, Report of ETMD, July 1950, p. 5; 406th Medical GeneralLaboratory Activities Report, July 1950, file MDLB-406 (Activities Report, 406th Medical GeneralLaboratory, Jul 50), Box 4717 (Nonorganic Units, MDSU-1 to MGGP-304, 1949-50), Entry 429,RG 407, MMFB; Milner, “Troubled Decade,” ch. 5, p. 38; John M. Howard, ed., Battle Casualtiesin Korea: Studies of the Surgical Team, 4 vols. (Washington, D.C.: U.S. Army Medical ServiceGraduate School, Walter Reed Army Medical Center, 1955), 2:150-65. Japanese blood differsgenetically from that of Western European peoples in the relative absence of the Rh-negative factor.A unit of blood is 500 cc and is roughly equal to a pint; each can held nine units. It is not clear fromthe sources whether technical considerations or covert racism caused the policy of segregating blood.See 406th Medical General Laboratory, Annual Report of Medical Service Activities, ProfessionalSection (Annual Historical Report), 1950, pp. 155-58, file 319.1-2 (406th Medical General Labora-tory) Far East-1950, HRB.

155

process plasma. At first the Far EastCommand saw no need for wholeblood from the zone of interior, but bymid-August, with the casualties of thePusan Perimeter fighting crowding thehospitals, the command asked forlarge quantities. Red Cross collectionfor the military began that month, andabout the end of August the first wholeblood arrived in the command. By theend of 1950 the United States had de-livered 21,188 pints from both civilianand military sources, while donors inJapan had provided 22,099. In this re-spect at least, the home front and rearareas were bleeding pretty freely forthe sake of the fighting men.

A key to the high Korean survivalrates among the wounded, wholeLoading Blood in a blood was especially important during

Helicopter Pod the critical first hours of treatment.

Most wounded men bled, and the con-dition known as shock—with its characteristic marks of low blood pressure,chill, and rapid heartbeat—could rapidly become irreversible and end in death.To halt the circulatory failure that was a consequence of hemorrhage and thebasic factor in shock, whole blood had no equal. The Far East Commandoriginally estimated that each injured man would need less than a pint of wholeblood (about 0.8), but battlefield experience steadily increased the amount to3.3 pints. For a critically wounded soldier on the day of injury, a transfusion of15 to 30 pints—up to three times his total blood volume—sometimes provednecessary. Transfusions maintained life even as hemorrhage continued; theystabilized the patient’s condition, enabling the doctors to perform the necessarysurgery. The rapid improvisation of a blood supply network that embracedvaried donors—American servicemen, civilians, and Japanese—was fundamen-tal to the survival of many thousands of wounded men.^*^

The Growth of Psychiatric Support

The initial errors of evacuating nonpsychotics to Japan, installing them incomfortable hospitals, and allowing them to observe that those even more

^’406th Medical General Laboratory, Report of ETMD, September 1950, p. 8; Douglas B.Kendrick, Blood Program in World War II, Medical Department, United States Army (Washington,D.C.: Office of the Surgeon General, Department of the Army, 1964), pp. 713-33; SG ConferenceNotes, 20 Oct 50, Medical Collection, HRB; Surgeon’s Circular Letter 5, no. 12, Medical Section,FEC, 1 Dec 50, pp. 8-9, HRB; JLCOM, Annual Report of Medical Service Activities, 1950, p. 38,HRB.

“Theodore C. Prentice et al., “Studies of Blood Volume and Transfusion Therapy in the KoreanBattle Casualty,” in Recent Advances in Medicine and Surgery, 1:163.

THE MEDICS’ WAR

disturbed than themselves were rewarded with evacuation to the States demand-ed early attention. The record of combat psychiatry could easily justify pessi-mism about the ability of human beings to learn from experience. Less than fiveyears after World War II, basic lessons already were forgotten or stored on ashelf, and the sudden demands of a new emergency required improvisation. Yetas the EEC psychriatic consultant emphasized, the system of psychiatric treat-ment that had taken two years to introduce during World War II was in opera-tion within months in Korea. The presence of veteran officers was the key to thequick revival of proven methods. Individual, not institutional, memory madethe achievement possible.

An interesting new development in handling stress was a morale-enhancingprogram of what might be termed preventive psychotherapy. World War IIstatistics showed that sharp increases in casualty rates of all types occurred whentroops experienced combat for more than 180 days without relief. Hence, at theend of September the Department of the Army authorized temporary duty inJapan for the purpose of rest and recuperation (R&R). The Japan LogisticalCommand undertook the necessary logistical studies and, in October, presenteda plan to the Far East Command for a five-day R&R period for personnelserving in Korea. The first combat soldiers to take part arrived on New Year’sEve. During the months that followed, the daily arrival rate increased from twohundred to five hundred and by the end of August 1951 some ninety-onethousand U.N. officers and men had enjoyed a furlough from the war. All in all,a sensible and in some ways unique program to relieve combat fatigue had takenshape in the command. Though astute commanders always had pulled individu-als and units from the line in wartime for periods of rest, the Korean R&Rprogram further systematized the practice. Utilizing the unique geography of theconflict, the Army encouraged its fighting men—somewhat as a swimmer gulpsair—to taste the real world beyond the battlefield. Except for rotation, no morepopular program came out of the war.^’

Dental Care

The dental service worked in a variety of settings, from advanced field unitsto the station and general hospitals of Japan. In forward areas dental officerswith the medical battalions normally rotated through their divisions. In the 24thDivision two dentists served with each of the 24th Medical Battalion’s threeclearing platoons during July, while the rest operated a clinic. Chaotic condi-tions made it “difficult to accomplish much dentistry.” Here, as elsewhere,during times of crisis dentists assisted the medical officers. Once the PusanPerimeter had formed, teams of dental officers visited the regiments to surveyproblems and treat patients who were in immediate need. In August, too, thedivision’s Dental Section rigged a makeshift laboratory on a %-ton truck.Events began to take a more normal course. By the end of September a regularlaboratory, housed in a 2V2-ton truck, had arrived. Now dental clinics worked

^’Japan Logistical Command, “Logistical Problems and Their Solutions, 25 August 1950-31August 1951,” pp. 13-17, Ms no. 8-5.1 A AE, RG 319, MMHB. For psychiatric treatment in thehospitals in Japan, see Chapter 9 of this volume.

157

Dental Prosthetic Section Making Dentures near the front lines

out of vans either at the battalion headquarters or at the rear clearing station,which acted as a holding unit/”

Similar accounts could be given of other battalions. In the 25th InfantryDivision dental officers were assigned to each regimental combat team, some-times serving as battalion surgeons to make up the deficit of physicians. Eachclearing station had at least one dentist, and a central clinic worked at thebattalion headquarters. A full prosthetic unit was set up in August. The samepattern—a central clinic with front-line service at regimental level—showed upin the 1 st Cavalry Division. In all cases only emergency treatment was availableduring combat. In consequence the 7th Infantry Division found that at leastthree dental officers were needed for each regiment in a rest area, where soldiershad time to catch up on neglected problems and the dentists were at last free topractice dentistry.

Dentists were not assigned to the MASHs during 1950, though a few divi-sional dentists were attached—during October, for example, one from the 2dDivision joined the 8076th MASH. Evacuation hospitals, however, had twodentists each. At the 8054th Evacuation Hospital in Pusan, two oral surgeonsand one prosthodontist were assigned to the staff. An active clinic gave morethan six thousand sittings, including among its patients American soldiers, U.N.

‘“24th Medical Battalion, Annual Report of Medical Service Activities, 1950, End 4, DentalSection Report, file 319.1-2 (24th Medical Bn) Far East-1950, HRB.

THE MEDICS’ WAR

troops, and POWs. In its familiar mingling of evacuation and station hospitalduties the 8054th treated both evacuees passing through to Japan and localforces stationed around Pusan. Among the former, jaw fractures and maxil-lofacial injuries caused by gunshot wounds were common. The prosthetic sec-tion did work for men from the divisions whose own laboratories could notprovide, among other items, the necessary bridges and false teeth. Field hospi-tals, by contrast, lacked dental laboratories. They depended on the divisionswhen within their areas, and otherwise did without."*^

A distinctive feature of the dental officers’ work was its variety. Quite apartfrom their professional specialty, they served as utility infielders for the MedicalService, taking on a melange of tasks. As dentists they carried out proceduresranging from the routine ones of filling cavities and extracting teeth to complexoral surgery of the wounded. As a rule, their work involved few life-threateningsituations. Yet untreated dental problems could drastically diminish a soldier’sefficiency, to say nothing of his personal comfort. In all respects, the contribu-tion of Army dentists and their enlisted assistants was an important one.

Professional Services

As a repository of knowledge and a means of control the consultant systemagain proved its worth in Korea. Specialists from the Medical Service’s ownranks staffed the consultants division at the Far East Command. They per-formed dual tasks in maintaining professional standards and ensuring properassignment of replacements arriving in their own specialities. The consultantvisited command hospitals, observed work in progress, and, without directlyintervening or attempting to supplant the medical officer in charge, providedexpert guidance and counseling. When new men arrived in the consultant’sspecialty (or, in the case of the nursing consultant, new women) he interviewedthem; his recommendations were often equivalent to assignment. As regularofficers, consultants sought not only to place men in the jobs best suited to thembut also, by providing challenging assignments, to sell “the army to youngdoctors on duty in this theater.” Consultants appear to have worked in fullknowledge of the problems that had surfaced during World War II and with thewill, if not always the means, to prevent their recurrence.'*^

In choosing his civilian consultants, the surgeon general had similar motives.General Bliss told his staff on 19 July that

during the last war ... he found an excess of doctors except where they were needed.He considers it most desirable that we have consultants, preferably civilians, going tothose places who will see and know the difficulties. They can show the public that we aredoing a good job or not. It would be very valuable to have intelligent men, top men, andas one part of their duty check on us and what we are doing. We could get the [support] ofthe American [medical] profession. They look on us now with the greatest of suspicion.'*^

‘"8076th MASH, 121st and 8054th Evacuation Hospitals, Semimobile, and 64th Field Hospital,Annual Reports of Medical Service Activities, 1950, files 319.1-2 (MASH, 8076th Army Unit),(121st Evacuation Hospital, Smbl), (8054th Evacuation Hospital, Smbl), and (64th Field Hospital)Far East-1950, HRB.

“TEC, Annual Report of Medical Service Activities, 1951, p. 16, HRB. The nursing consultantwas Lt. Col. Alice M. Gritsavage of the Army Nurse Corps.

“"SG Conference Notes, 19 Jul 50, HRB.

BEHIND THE LINES

159

Hence, the surgeon general yearly selected distinguished physicians for the tripletask of providing professional guidance, bringing any misuse of doctors to hisown attention, and serving the Army as ambassadors to the civilian profession.

Finally, teams of experts visited the Far East Command to deal with specificproblems that had arisen in the field. A surgical team stayed from 26 November1950 to 9 January 1951, providing instruction for medical officers on newtechniques in antibiotic therapy, bum treatment, and the use of the intramedul-lary pin for mending breaks in the long bones of the body. A one-man “team”consisting of an anesthesiologist from Massachusetts General Hospital broughtnew studies in methadone, a morphine substitute then receiving its first trials,and a new compact field anesthesia machine. The malaria research team arrivedin August, during the Pusan Perimeter battles, to test the effectiveness of thenew antimalarial primaquine. In all, the first year of the war saw nine researchteams operating in Korea, studying subjects that ranged from wound ballisticsto DDT-resistant lice.^

At the end of 1950 the Medical Service tallied its gains and losses in theconflict: six of its officers, including one nurse, killed; twenty-two missing inaction; and eleven wounded. Its accomplishments had not gone unnoticed,General MacArthur declaring that in all his seventeen campaigns he had neverseen better care.

Despite the roughness of conditions in Korea, the repeated crises occasionedby reverses in the field, and the shortages in trained medics and hospital units,the medical system that evolved during 1950 proved successful in its basicendeavor: saving the lives of the troops. The fatality rate of the wounded whowere admitted to treatment was distorted by the rapid evacuation, but it wasclearly lower than the 4.5 percent of World War II. Sharp questions wouldsurface later about front-line evacuation, but none about the skill exhibited inthe hospitals. The system of emergency care and quick evacuation that charac-terized the period, and the mix of veteran and tyro officers upon whom itdepended, “saved the bacon” in a war an ill-prepared nation had not expected tofight. It shored up morale, especially in situations where the spirit of the Ameri-can troops was fragile at best, and saved countless lives—an achievement be-yond calculation.

‘“Information on research teams in Medical Research and Development Board, OSG, History ofthe Korean Conflict, 25 Jun 50-8 Sep 51, pp. 1-10, file 314.7-2 (Army Medical Service Activities,25 Jun 50-8 Sep 51), HRB.

CHAPTER 6

Field and Bunker

An early casualty of the winter fighting in Korea was the old system ofdivided commands. In late December the X Corps became part of the EighthArmy. General Walker, however, did not live to reap the benefits of a unifiedfield army; on the twenty-second he died in a jeep accident. Yet a majorinnovation of Walker’s—-extending United Nations (U.N.) forces across theKorean peninsula from sea to sea—survived him. General MacArthur planneda fighting withdrawal to lengthen the Chinese lines of supply and a final defense,if necessary, in a new Pusan Perimeter. But Lt. Gen. Matthew B. Ridgway,Walker’s successor, from the beginning focused his thoughts on attack. Untilmid-January, however, retreat remained the order of the day.^

The winter was harsh even by Korean standards. Temperatures rarely rosemore than a few degrees above zero, and cold injuries were excessive. The 25thInfantry Division, which fought on the western coastal plain rather than in theeven colder mountains of central and eastern Korea, recorded 684 cold injurycases in the first three months of the year, 319 of them in the all-black 24thInfantry. Equipment remained less than satisfactory. The shoepac still gavetrouble, and infantrymen risked head wounds by throwing away their helmets,because no cap suitable for subzero weather would fit under the steel pot.

Disease seconded cold, for the Four Horsemen of the Apocalyse were in thesaddle. During six months of war the movement of armies and refugees hadbroken down Korea’s cellular structure of village communities. Millions livingunder great stress daily encountered strange pathogens, and epidemics flaredlike brushfires. Americans taking shelter in towns and farmhouses found civil-ians ill with smallpox and typhus. Infected towns were evacuated, their peopledusted with DDT and booster shots given to the soldiers.^

In the last days of the old year, heavy attacks fell on the South Koreandivisions holding the Imjin River line. U.N. forces retreated, first to the HanRiver, then farther south. For the second time the Chinese raised the NorthKorean flag over Seoul. But supplies faltered, and cold and disease thinnedNorth Korean and Chinese ranks. On 15 January the 25th Division moved to

’Except as otherwise noted, the tactical narrative for this part of the chapter is based on Moss-man, Ebb and Flow, chs. 12-24.

^25th Infantry Division, Annual Report of Medical Service Activities, 1951, pp. 1, 7-8, file319.1-2 (25th Inf Div) Far East-1951, HRB; Marshall, Commentary on Infantry Operations, p. 49.

the attack in the west. Other strikes followed along the U.N. line, and initialsuccess rapidly turned a reconnaissance in force into a full-scale attack.

During February the enemy struck again, this time at the X Corps in centralKorea and the Republic of Korea (ROK) Army as well, and won some groundonly to run out of steam. In a late-winter thaw U.N. forces counterpunched inOperation Killer, pushing forward over a landscape cut by rushing streamsfilled with ice. Subsequent advances brought them to the 38th Parallel. InMarch Seoul changed hands again for the fourth, and last, time in the war.

In two successive waves during late April and mid-May, the enemy’s long-prepared and long-awaited spring offensive struck. U.N. forces, retreating slow-ly into prepared positions, drew the Chinese and North Koreans into intensefields of fire and inflicted enormous casualties—over 160,000 by Americancount. In the aftermath U.N. troops advanced to the extreme limits set byGeneral Ridgway, who, as a result of President Truman’s dismissal of GeneralMac Arthur, was now supreme commander in Tokyo. Under its third com-mander in six months, Lt. Gen. James A. Van Fleet, the Eighth Army now heldessentially the positions that it would occupy until the end of the war.

On the Battlefield

Such a cut-and-thrust campaign compelled medics and their patients toencounter flying steel as well as cold and disease. Sometimes the danger camefrom friendly fire, as it did to a clearing platoon of the 24th Medical Battalionduring January. A winter gale tore loose the panels identifying the unit to fliers,and Air Force planes strafed it, killing an enlisted man as he struggled to fastenthe panels down again. But the chief danger came from hostile fire. The attacksof April struck the medics along with the line troops. Part of a collectingcompany serving the 5th Regimental Combat Team was caught in an ambush,losing seven men; a platoon of the 24th Medical Battalion lost six men includingits dental officer. All were killed inside a dental van, where they were riding forwarmth.

During the advance that followed the enemy debacle of May some Chineseunits were bypassed when the advancing 24th and 7th Infantry Divisions met atSinpori, North Korea. On 27 May Chinese soldiers trying to regain their ownlines blundered into a terraced rice paddy where the Medical Company, 21stInfantry, had pitched its tents for the night. About 0200 guards, who weredoubled because of the dangerous situation, challenged the intruders andopened fire. Shouting that they were South Korean soldiers to gain a momentaryrespite, the Chinese opened up with burp guns, killing a rifleman and a chaplain.Father Francis Xavier Coppens, who were drawn to the disturbance, like othersin the medical company.

Quickly the firefight degenerated into a formless melee, for the night wasprofoundly dark and clouded and a heavy spring rain had begun to fall. TheChinese infiltrated the nearby regimental headquarters and fighting beganaround the command post. Firing and occasional grenade blasts continued

THE MEDICS’ WAR

Medic Treating Wounded Chinese Soldier

through the hours of darkness. When dawn enabled the defenders to see theenemy, Pvt. Joseph Chisholm, who had been broken from sergeant only twoweeks before, led a party that captured thirty prisoners. Other medical companypersonnel seized twenty-eight more, and medics and headquarters companypersonnel combined forces to capture a group of the enemy that had set up aroadblock nearby. About two dozen bodies of Chinese soldiers lay sprawled inthe company area. The night’s darkness and confusion had helped the lightlyarmed medics far more than they realized at the time, for in numbers andequipment the Chinese were incomparably stronger. Troops of the 5th Regi-mental Combat Team, arriving at daylight, began a roundup that bagged elevenhundred prisoners. Nonetheless, the medical company had done well for itselfand its patients. In the aftermath the men were heard demanding, “Who in Hellsays the medics can’t fight?”^

Casualties were mainly victims of cold and combat, though injuries causedby accident were also common. Medics faced all the familiar problems of evacu-

Mst Lt. John Atkins, MSC, won the Silver Star and both companies received the PresidentialUnit Citation for this action. See 24th Infantry Division, Annual Report of Medical Service Activi-ties, 1951, p. 2, file 319.1-2 (24th Inf Div) Far East-1951, HRB; 3d Historical Detachment,“Medical Company Under Attack: Medical Company, 21st Infantry Regiment, 27 May 1951,” Msno. 8-5.1 A BA 44, RG 319, MMHB. See also John F. Harris, “Practice of Field Medicine onOperation " Military Surgeon 109 (December 1951): 683-88.

163

ating the injured and sick in a war of movement and in temperatures that sankon 7 January to -27°F. They also faced in a more severe form the old difficultyof evacuating from the mountains. U.S. forces had made forays into the moun-tains before, but the line now stretched across the peninsula, and the IX and XCorps lived, fought, and sought to move their wounded in some of the harshestcountry to be found in Korea’s corrugated landscape. Medics hauled casualtiesover twisting roads that were steep and sheathed in ice and through narrowdefiles that were deep in snow. The 2d Infantry Division surgeon, Lt. Col. JoelN. McNair, described some of his difficulties. Losses were high, as many as sixhundred wounded reaching the medical companies in a single day and night.Doctors were too few, as were trained aidmen—many either killed, wounded, orcaptured during the December “bug-out.” Long hauls exhausted the lit-terbearers. Riflemen had to be pressed into service, and the Medical ServiceCorps officers labored to teach them medical rudiments in spare moments whenthe flow of casualties slacked off. The %- and 21/2-ton trucks had to replaceambulances lost in the retreat, though the vehicles were open and highly unsuit-able for moving injured men in bitter cold.

By the time the major attacks took place in the spring, conditions hadimproved. The weather moderated, the new aidmen had learned their jobs, andin March nine Navy medical officers arrived to alleviate the doctor shortage.But the fighting brought a surge in the number of casualties, with monthlyadmissions to the clearing stations reaching 3,873 during May. Medical person-nel and equipment suffered new losses. In the 38th Infantry two battalion aidstations with all their equipment and many of their personnel were lost infighting around an enemy roadblock north of Hoengsong. Infantrymen ran intoantitank and antipersonnel mines thickly strewn by the enemy to slow theadvance, and massive injuries resulted. Traumatic amputations becamecommon.''

Evacuation continued to depend primarily upon human muscle and increas-ingly battered wheeled vehicles. But the helicopter, now coming fully into itsown, won praise from all surgeons. Everything seemed to increase its value—theharsh mountains, the bad roads, the constricted landing areas, the increasinglysevere wounds. Even the cold weather seemed made for it, for rotor blades bitinto heavy, frigid air better than into warm air, providing greater lift. (“It ismuch easier,” said a pilot, “to take off with three people in the winter than withtwo in the summer.”)^

Three medical helicopter units of four pilots and four mechanics each en-tered Korea in 1951. By early March the 2d Helicopter Detachment (soon to berenamed the Helicopter Detachment, 8191st Army Unit), with four machines,served the left of the line from its base at the 8055th MASH. The 3d HelicopterDetachment (later renamed the Helicopter Detachment, 8192d Army Unit),with three machines, was attached to the 8063d MASH; the 4th Helicopter

‘‘2d Infantry Division, Annual Report of Medical Service Activities, 1951, pp. 1-2, 6, file319.1-2 (2d Inf Div) Far East-1951, HRB; Paul T. Buerger, “Medical Support for MountainFighting in Korea,” Military Surgeon 109 (December 1951): 694-700.

*8th Historical Detachment, “Helicopter Evacuation,” p. 1, Ms. no. 8-5.1 A BA 28, RG 319,MMHB.

THE MEDICS’ WAR

Litterbearer Coming to the Aid of a Casualty

Detachment (later renamed the Helicopter Detachment, 8193d Army Unit),with four helicopters, to the 1st MASH. Over the course of the year the IXCorps moved fifteen hundred critical cases by helicopter, “and it is safe to say,”the corps surgeon reported, “that many lives were saved that would otherwisehave been lost.”'^ The helicopters were almost as important in what they movedforward as in the human load they brought back from the front. In the IX Corpsthey carried some five thousand pints of whole blood and a variety of urgentlyneeded medical equipment as far forward as the battalion aid stations.

Among the pilots a mystique began to develop, an “intrepid spirit” that,accordingly to the 8076th MASH commander, “saved many many lives.Sepa-rated from the crowd, working alone, and pushing their fragile craft ever closerto the enemy, such men came to resemble the pilots of World War I in theirsingularity and taste for derring-do. Though the helicopter’s course still lay fromthe collecting station to the MASH on normal runs, pickups from aid stationsbecame common and some even occurred forward of the battalions. Early on, a

*IX Corps, Annual Report of Medical Service Activities, 1951, pp. 13-14, file 319.1-2 (IXCorps) Far East-1951, HRB. A 1st Helicopter Detachment was also set up, but machines and menwere transferred to strengthen other units, in December 1952, after a ghostly existence of almost twoyears on paper, the outfit was abolished and replaced by the Helicopter Detachment, 8190th ArmyUnit.

’8076th MASH, Annual Report of Medical Service Activities, 1951, p. 12, file 319.1-2 (MASH,8076th Army Unit) Far East-1951, HRB.

165

marked contrast showed between the rarity and value of the few availablemachines, which implied great prudence in their use, and the spirit of the menwho flew them, urged on by the exigencies of war.

With the objective of making evacuation more responsive and quicker, theEighth Army tapped corps surgeons instead of the Eighth Army surgeon todispatch the medical helicopters. But calls from forward units still had to travelfrom headquarters to headquarters through poor communications lines, delay-ing the quick response that was supposedly the helicopter’s trademark. Limita-tions in the performance of the Bell machines also showed up during early 1951.One corps surgeon concluded that the Bell, because it was small and maneuvera-ble and could land and take off quickly in a small space, was useful in front-lineservice. But a machine to carry larger numbers of wounded for greater distanceswas necessary for evacuation farther from the line. He suggested the eight-placeSikorsky H-19, which the Air Force already used in more innovative ways thanthe Army was yet willing to contemplate. In March, for example. Air Forcemachines evacuated injured paratroopers from a drop at Munsan under mortarand small arms fire.®

Organization remained anomalous. The helicopter detachments belonged tothe Eighth Army; were assigned to its Air Section; and, because of their medicalmission, were attached to the MASHs. Despite these complications the detach-ments were, in every practical way, medical units, and successful ones at that. Acontemporary study of the 8192d Army Unit gave a picture of such a detach-ment at work. The unit served the MASHs in the IX Corps area. The winter wasa time of long hauls, for the front was too fluid for the MASHs to set up near thefighting line. Pilots carried extra gasoline in cans stowed in the litters, and attheir destination points they refilled their tanks and strapped the empty cansinto the pilot’s compartment while the wounded were being loaded. In this waymachines with a maximum range of 100 miles made round trips of up to 120miles.

The ensuing months witnessed the stabilization of the front, which broughtthe MASHs forward and meant shorter hauls, and also a series of technicalchanges in the helicopters, which improved overall performance. The Hiller23As of the 8192d Army Unit had engines that were too weak to lift twopatients at one time. They also had Stokes litters; however, these wire baskets,which were standard in the Navy, proved to be unsuitable, especially for theseriously wounded who were difficult to lift into and out of them. At therecommendation of a pilot, Capt. Ame H. Eliasson, the Hillers were modified totake the conventional flat Army litters instead. In early July the 8192d receivednew helicopters with aluminum platforms equipped with plastic lids to protectthe patient from the wind, and also Bell H-13Ds, with additional horsepower,to replace the Hillers.

Such changes improved the capacity of a device that was still experimentaland operating far short of its true potential. Theory held that patients could not

*2d Infantry Division, Annual Report of Medical Service Activities, 1951, p. 2; I Corps, AnnualReport of Medical Service Activities, 1951, p. 4, file 319.1-2 (I Corps) Far East-1951. Both in HRB.On Air Force rescue work, see Robert Frank Futrell, The United States Air Force in Korea,1950-1953 (New York; Duell, Sloan and Pearce, 1961), pp. 536-43.

THE MEDICS’ WAR

Capt. Hubert D. Gaddis Piloting a Helicopter with two patients aboard

be treated in flight—indeed, that they could not even receive intravenous fluids.The pilots, coming from other branches of the Army, had received no medicaltraining. It remained for the pilots and the needs of the moment to show moreof the helicopter’s true worth. Actual operations violated every one of thegeneral rules, undoing standard operating procedures and revealing wide capa-bilities. Some pilots devised field expedients to warm patients in flight by animprovised shroud over the engine manifold and to give transfusions in flightfrom bottles of plasma attached inside the cabins. 1st Lt. Joseph L. Bowler, aninfantry officer flying with the 8191st Army Unit, worked with Lt. Col. JamesM. Brown, commander of the 8063d MASH, to perfect the device. With needlesinserted into the patients’ arms and plasma ready, the pilot could monitor theflow through plastic tubes to either of the two litter pods and, by means of arubber bulb, could increase pressure in the bottle to regulate the flow. Later inthe war Capt. Hubert D. Gaddis improved the device to permit administrationof whole blood. The manufacturer adopted both expedients in turn for later-model Army helicopters.^

Similarly, general rules that pilots could neither fly at night nor bring theircraft under fire made obvious sense when helicopters were so few, so fragile, and

’Capt Peter J. Dorland, MSC, “Army Air Ambulance Evacuation,” ch. 2, pp. 24-25, in fldr 20,box 2 of Dust OjfT'Background Materials, RG 319, WNRC.

FIELD AND BUNKER

167

lacked lighted instrument panels, and radios. But war did not always allowprudence to prevail. Like other pilots, Bowler flew at night in extreme emergen-cies, holding a flashlight between his legs, peering at his instruments through itsflickering beam. Capt. Oscar N. Tibbetts of the Air Force, whose rescue detach-ment had launched the experiment with medical helicopters in Korea, won aSilver Star in March 1951 for a mission on behalf of his own service, whichArmy rules might have rendered impossible. During the Chinese attack he flewout of Sinanju over 80 miles of enemy-held territory to pick up a downed andinjured F-51 pilot. An Air Force medic, T. Sgt. James Bryson, accompaniedhim. They found the pilot, loaded him aboard under small arms fire that dam-aged the tail cone of the helicopter, and got away. Tibbetts flew the last forty-five minutes of the trip in darkness without night-flying instruments. Armypilots also flew in under mortar rounds and descended on encircled units, rulesor no rules. How else were they to do their jobs?‘®

Yet, derring-do or not, so few machines, their fliers and mechanics furtherburdened by parts shortages and difficulties in resupply, could not under ex-isting circumstances be more than emergency vehicles in the most restrictedsense. Despite hints of future potential the number of wounded moved byhelicopters remained relatively small. In May—the premier month for the8192d Army Unit during 1951—the detachment on its biggest day transportedthirty-two patients on sixteen flights. A Bell, carrying two patients per trip, costmore than ten times as much as a ground ambulance that carried five, andhelicopters had much higher maintenance costs and required more extensive(and expensive) training for both pilots and mechanics. Costly, experimentaland cranky, the helicopter could be justified only on the grounds that those itcarried, almost to a man, would have died without it."

The mission of the MASHs had not changed significantly. They remainedEighth Army units attached to one division or another for logistical support andcourt-martial jurisdiction only. Their distinctive Korean War form as smallevacuation hospitals (two hundred beds) with medical as well as surgical func-tions endured. Larger than contemplated by the 1948 tables of organization andequipment, the MASHs were also less mobile. They still evacuated to the rear ina variety of ways: by helicopter in neurosurgical and some eye injury cases only;by railroad; or by fixed-wing aircraft direct to Japan. Their burden of casualtiesvaried with the course of battle, averaging, in the case of the 1 st MASH, fifty tosixty a day during the first four months of the year when parked ambulances hadto be used as shelter for the “weary patients” because of the crowding. Intendedto support one division each, they continued to support many. From 2 Februaryuntil 23 April the 1st MASH typically treated the seriously wounded, injured,and ill of the 2d, 3d, and 7th Infantry Divisions and the 187th RegimentalCombat Team. At no time didjhe MASH support fewer than three divisions.

'"Surgeon’s Circular Letter 6, no. 3, Medical Section, FEC, 1 Mar 51, pp. 52-53, file 461(Circular Letters) FEC, HRB; 8th Historical Detachment, “Helicopter Evacuation,” p. 4, RG 319,MMHB.

"8th Historical Detachment, “Helicopter Evacuation,” pp. 2-7; 8086th Army Unit, MilitaryHistory Detachment, “Helicopters in Korea,” Ms no. 8-5.1 A AJ. Both in RG 319, MMHB.

THE MEDICS’ WAR

Field conditions, of course, prevailed throughout the period. The MASHswere now usually under canvas, for the war had destroyed almost all publicbuildings in the central Korean battleground. The enemy was often close. AtChechon the Chinese pushed to within a few miles of the 1st MASH, and“gunfire was easily heard.” But because of the great number of patients and thecondition of the roads the commander, Maj. Jesse F. Brown, refused to evacu-ate. Instead, the Chinese were driven back. In mid-April the MASH advanced toChunchon. But the enemy spring offensive at Chunchon soon drove everyoneback, and the hospital retreated to Wonju {Map 4). Later—renamed the 8209thMASH—the unit advanced to Hongchon where, as the most forward hospital, itcared for the wounded of X Corps during the Battle of the Soyang River.

Men of several MASHs had to be detailed to guard duty, for the countrysidewas dangerous and infantrymen were unavailable for the task. Here an ironicreversal of roles occurred. Throughout American military history, line units hadmade a practice of detailing their least useful men to duty with the medics. Inthe 8076th MASH the most inept and least intelligent men were now detailed toguard duty, with predictably unsatisfactory results. Consequently, the hospitalhad to assign many of its best men to an additional task that the presence ofguerillas and enemy stragglers from shattered units made impossible to shirk.

The stories of the other MASHs were similar in outline, though in somecases their itineraries were more complex than those of the 8209th. Like the8055th, the 8076th operated in nine locations between New Year’s Day and theend of May, shifting from one corps to another to meet successive enemyattacks. What all MASHs had in common was a habit of being extremely busy.During the year the 8076th would admit 21,408 patients—1,048 during a singlemost active week in February, of whom 741 were battle casualties. Not only thesheer numbers but also the large proportion of wounded (47 percent overall)suggest a staggering burden on surgeons and nursing staff. A capacity of twohundred beds clearly meant little when, as happened in early January at Suwon,130 new patients were admitted on an average day. As in 1950 the burden stilllay upon the transport system to enable so few hospitals to work successfully inbattles of such intensity.*^

In addition to the four original MASHs, a fifth—called at first the 2d MASHbut in May renamed the 8225th—arrived to lend a hand in the spring offen-sives. Organized at Fort Bragg, North Carolina, during November and Decem-ber 1950, the unit was comprised of medical officers drawn from many dutystations (five were Navy surgeons) and enlisted men transferred from the 188thMedical Battalion (Separate) and the 82d Airborne Division. After training inthe United States and Japan the hospital reached Korea on 28 March. It under-

'^Quoted words from 1st MASH, Annual Report of Medical Service Activities, 1951, p. 2, file319.1-2 (MASH, 1st Army Unit) Far East-1951, HRB. See also ibid., p. 1, and 8209th MASH,Annual Report of Medical Service Activities, pp. 1-3, file (MASH, 8209th Army Unit) FarEast-1951. Both in HRB. Technically, the MASH personnel and equipment were transferred to thenew unit and the old one inactivated.

'^8076th MASH, Annual Report of Medical Service Activities, 1951, pp. 4-5, HRB.

'"Ibid., pp. 2-3; 8055th MASH, Annual Report of Medical Service Activities, 1951, pp. 13-14,file 319.1-2 (MASH, 8055th Army Unit) Far East-1951. Both in HRB.

LAND LOST AND REGAINED

January - May 1951

20 MILES

10 20 KILOMETERS

MAP 4

THE MEDICS’ WAR

went the usual expansion and, by mid-April, was working at Hoengsong, undertents whose dirt floors were covered with sand or tarpaulins. Aided by an AirForce helicopter detachment, the new unit took over the four divisions previ-ously handled by the 1st MASH, admitting almost 3,000 patients during May,two-thirds of whom were battle casualties. The success of the MASH in Koreawas now beginning to result in the formation of new units, not only in theUnited States but abroad. A MASH organized and sent by the Norwegiangovernment arrived in June and started work at Uijongbu on 9 July.^^

Farther to the rear, the 121st Evacuation Hospital returned from Hungnamwith the X Corps to a temporary station in the east coast town of Ulsan. Thehospital quickly received its new mission: to take the overflow of patients fromall the Eighth Army forward hospitals. A period of six months in the mud beganfor the 121st. Its first station was at Tuksong-dong, a town near Taejon, whereits personnel worked in small buildings and lived in tents pitched in rice pad-dies, the only level ground available. Late in February the hospital advanced toTaejon, finding better quarters in a former station hospital built for U.S. forcesduring the Occupation.

With the general advance of U.N. forces under way, however, the 121stEvacuation Hospital moved again in early April to Seoul, where it supportedonly the I Corps. Here in a reprise of early days in Korea the hospital occupied athree-story school building, its dormitories, and a crowded tent city huddledbeneath the walls. For a month in April and early May the Communist offensivedrove it back to Taejon, but by the end of the month the hospital was working inthe war-battered buildings of the Yongdung-po Industrial College in a westernsuburb of Seoul on the Kimpo peninsula. Amid a sea of mud an engineerplatoon hammered together quonset huts to accommodate new personnel andpatients as the bed strength rose from 400 to 750. Set at a major transport hub,the hospital handled all Eighth Army patients who were being evacuated to thesouth, or flown direct to Japan.

Life was rough during this period, work heavy, and amenities few. Some menregaled themselves too frequently with women of the villages, resulting in six-teen cases of venereal disease (VD). Other forms of recreation were virtually nil.Type B rations prevailed in the single mess where officers and men consumedthe standard Vienna sausage, luncheon meat, canned salmon, and other prepara-tions supplied by the quartermaster. “The most unappetizing of these,” reportedthe commander, “were the ‘pork and gravy’ and the ‘beef and gravy’.”^^

In the wards and operating rooms work responded in barometric fashion tothe fluctuations of battle and the shifting locations of the evacuation hospitalsand the MASHs. During 1951 nearly 46,000 admissions flooded the 121stEvacuation Hospital. Concealed in the average of 126 per day, however, were

**8225th MASH, Annual Report of Medical Service Activities, 1951, pp. 1-3, file 319.1-2(MASH, 8225th Army Unit) Far East-1951, HRB; 8086th Army Unit, Military History Detach-ment, “Surgical Hospital in Korea,” Ms no. 8-5.1 A DN, RG 319, MMHB.

'M21st Evacuation Hospital, Semimobile, Annual Report of Medical Service Activities, 1951,pp. 1-2, file 319.1-2 (121st Evacuation Hospital, Smbl) Far East-1951, HRB. All information onthis hospital is from this report.

■Jbid., p. 7, HRB.

171

Norwegian MASH Surgeon Amputating an Arm

drastic quantitative and qualitative changes. Admissions ranged from none onsome days to more than 600 on others. Surgical patients—usually the onesneeding the greatest care—were few or many in number, according to thecurrent state of the fighting. Their wounds were mainly peripheral, provided theMASHs were operating normally and intercepting the abdominal and chestcases. Only when the MASHs were unusually far behind the fighting, or were onthe road and unable to receive patients, would they shunt the more serious casesto the evacuation hospitals.

The location of the 121st Evacuation Hospital—forward at Yongdung-po orfar to the rear at Taejon—also had a visible effect on the number of battlecasualties. Surgical cases crested in June, outrunning the medical by more than600 and then falling behind as the intensity of the fighting dropped off. Bymidsummer evacuees were fewer, local cases more. Medical problems, notablyhepatitis and hemorrhagic fever, gained at the expense of the surgical andsometimes required as much nursing as the most difficult battle wounds. In theintervals between battles the 121st found itself changing willy-nilly into some-thing that resembled a large station hospital for the Seoul-Inchon area.**

Despite mud, movement, field conditions, and the staggering patient load,some notable clinical advances highlighted the spring months. A urologist

’*Hemorrhagic fever is treated at some length later on in this chapter.

THE MEDICS’ WAR

Neurosurgical Team at the 121st Evacuation Hospital performing abrain operation

joined the staff, not so much to perform traumatic surgery—though missilewounds of the genitourinary system did occur—but to provide at an advancedlocation regular treatment of lesser problems that were distressing to the patientand an obstacle to performance of duty. Bladder inflammation and problemcases of venereal disease were common. The genitourinary unit did cystoscopiesand performed some circumcisions. Urological work varied inversely with battlewounds, the unit serving as part of the surgical service when battlefield admis-sions were high. During lulls men found opportunity to seek care for lesserproblems, or were referred by dispensaries, in either case finding themselvesstretched out on the cystoscopic table that an operating room technician hadcontrived out of wood and scrap metal.

The most important surgical innovation was the Eighth Army’s organizationon 25 April of the 1st Provisional Neurosurgical Detachment. The new unit wasassigned to the 52d Medical Battalion and attached to the 121st EvacuationHospital. The treatment of neurosurgical cases was problematic from the outsetof the war, for in no form of injury was quick action more important than inwounds of the brain and spinal cord. Yet the shortage of specialists initiallyprecluded such work in Korea, except under emergency conditions, and broughtundesirable delays even in Japan. The new unit of two neurosurgeons, twonurses, and four enlisted men under Capt. Griffith R. Harsh was designed as an

173

experimental answer to a persistent failing, and it proved to be a successful one.For a time the able but abrasive neurosurgical consultant of the Far East Com-mand, Lt. Col. Arnold M. Meirowsky, spent half of each month working withthe new unit. Until mid-October, when Meirowsky set up and headed a seconddetachment at the 8209th MASH, the one at the 121st Evacuation Hospitalperformed the only neurosurgery available to U.N. forces in Korea.

Besides the skill of the specialists, other elements dovetailed to make theneurosurgical venture a success. At Yongdung-po the hospital received patientsfrom all three corps areas and evacuated them through airfields that lay close athand. The 121st Evacuation Hospital offered the convenience of a permanentneurosurgical operating room stocked with a variety of useful equipment, in-cluding adjustable beds and Stryker frames for holding and turning patients withspinal cord injuries. By the end of July the neurosurgical detachment at the121st had performed 331 operations with an operative mortality rate of 8.5percent, a significant improvement over the 11-15 percent common in WorldWar II.

In sum, a specialized channel now existed for such casualties, running fromaid station by helicopter to the neurosurgical team, by helicopter again to anairport, and by an Air Force C-54 direct to Tokyo. The wheeled ambulance waseliminated, as were stop-offs in hospitals not specially equipped. This totalsystem, rather than the neurosurgical team alone, made the Korean War amilestone in the management of such injuries in the field.

And yet, despite important innovations, the first half of 1951 was primarilya time of basic field medicine in Korea’s forward hospitals. Medics wereobliged, like the Red Queen in Through the Looking-Glass, to run as fast aspossible in order to stand still. Their improvements were only seeds that wouldflower in the coming period of static warfare. So long as the armies were on themove, the medics’ main task was simply to keep up.

The Third Horseman

The third of the traditional Four Horsemen of the Apocalypse was disease,and the first half of 1951 saw epidemic illness at its worst in war-wrackedKorea. No part of the peninsula and none of those who lived and fought therewere entirely immune to its dangers, though U.N. soldiers were almost certainlythe healthiest single group because of the rigorous medical discipline underwhich they lived. Contagious hepatitis continued as a severe problem, but the

”On the makeup of Meirowsky’s detachment, see 8086th Army Unit, “Surgical Hospital inKorea,” p. 26, RG M9, MMHB. Meirowsky was not a favorite with his colleagues, some of whomcalled him the “Mad Russian.” See Interv, Samuel Milner with Col Harry L. Berman, MC, n.d.,AMEDD Oral History file (Berman), HRB.

“U.S. Army Medical Service, Neurological Surgery of Trauma, ed. Arnold M. Meirowsky (Wash-ington, D.C.: Office of the Surgeon General, Department of the Army, 1965), p. 18; Far EastCommand and United States Army Forces, Far East (hereinafter cited as FEC and USAFFE),Annual Report of Medical Service Activities, 1952, pp. 39-40, file 319.1-2 (FEC) Far East-1952,HRB.

THE MEDICS’ WAR

Primitive Stretchers Used by Chinese Medics

threat that epidemics already afflicting civilians and enemy troops might spreadwas even more alarming.

In South Korea the United Nations Command struggled to suppress out-breaks among civilians and prisoners of war (POWs) with mass inoculations andheavy applications of DDT to individuals and (by aerial spraying) to the envi-ronment at large. Medical aid flowed in through several channels, American andinternational, with the United Nations Civil Assistance Command, Korea, allo-cating funds, equipment, and manpower. In North Korea health conditionswere at least as bad and far more difficult to deal with, because China’s medicalcapability was almost as slight as North Korea’s and because direct Russianintervention was limited by several factors, including the need to avoid directconfrontation with the United States.

Hence, the picture of the enemy’s health that United Nations Commandtechnical intelligence officers pieced together was a dark one. Disease was ram-pant among North Korean civilians and the troops of both Communist allies. Ahigh incidence of typhus appeared among the soldiers; only about a fifth of theNorth Korean fighting men had received inoculations, and the Chinese, thoughgiven shots before they were sent to Korea, were not reimmunized until July1951. Additionally, effective antibiotics were lacking to use against typhus if itdid occur. Relapsing fever and malaria were also common in early 1951, as thediseases of winter overlapped those of spring. In one enemy unit Chinese medics

175

reported that typhoid and “recurrent fever” were spreading among both soldiersand civilians. Not surprisingly, with the medical facilities of the country nowcontrolled by the military, the civilian population appeared to be in even worsecondition than the soldiers. In the disrupted central provinces, where fightingcontinued into midsummer, outbreaks of typhus were widespread. Agents inNorth Korea reported plague near Wonsan, bringing MacArthur’s chief of pub-lic health and welfare on a risky expedition behind enemy lines.^*

On 25 February a radio report from an agent in the Wonsan area describedenemy soldiers who were dying of a disease characterized by high fever, back-ache, headache, and running sores. Though bubonic plague had not attackedKorea since 1912, it was endemic in Manchuria, where, as in the western UnitedStates, a reservoir existed among wild rodents. If the Chinese inadvertently hadbrought the disease with them, a serious danger loomed for U.N. troops whowere not immunized against it. Because the immunity lasted only three to fourmonths, inoculations against plague normally were not given and large stocks ofvaccine were not maintained. Adding to the danger was the main road and railroute that ran south from coastal Wonsan to the front lines, which made contactbetween infected enemy soldiers and U.N. fighting men only too easy. Becausethe plague could assume the pneumonic form and could spread like influenza bydroplet infection, with almost 100-percent mortality, ascertaining whether ornot the Black Death was afoot in Korea became a matter of first priority forMacArthur’s headquarters.

As the public health and welfare chief. Brig. Gen. Crawford F. Sams led aparty of three to Wonsan to make the determination. With him were Lt. EugeneF. Clark of the American Navy, Lt. Comdr. Youn Joung of the ROK Navy, andan interpreter. The Navy placed at Sams’ disposal a landing craft, LCIL-1091,fitted up as a floating laboratory to aid in epidemic control. By noon on 9 Marchthe craft was moving in choppy seas through the minefields of Wonsan harborunder escort of a frigate, the USS Sausalito, which was part of the squadronblockading the port. A waiting game ensued as Sams attempted to get ashorewithout falling into the hands of the Chinese and North Koreans, whose recordin trapping agents was a good one. He hoped to get access to one of the villagesused as hospitals by the Chinese, who drove out the inhabitants and filled thehouses with their own sick and injured. Here, if he had any doubt of the

^’Conditions in South Korea are treated in Chapter 10 of this volume. On North Koreanconditions, see Rpts, Capt Ralph M. Takami, MC, Medical Intelligence Officer, Medical Section,FEC, 30 Jun 51, subs: The Present Status of the Medical Service in the Chinese Communist Forcesand The Present Status of the Medical Service in the North Korean Army, file 350.09 (Intelligence),Box 3129 (Medical Section, FEC, General Records, 1951), RG 338, MMFB. See also, by the sameofficer, copy of Rpt, 31 Jan 51, sub: The Enemy Winter Health Potential, HSF (Takami-1952),HRB, and Rpt, 31 Dec 51, sub: Disease Incidence in Enemy Troops, End to DF, W. E. S. [WilliamE. Shambora], Medical Section, FEC, to G-2, FEC, Attn.: Maj Lovelace, 11 Jan 52, sub: MedicalIntelligence, file 350.09 (Intelligence), Box 3087 (Medical Section, FEC, Decimal File, 1952), RG338, MMFB; Chinese Medical Rpt, 8 Mar 51, in Military Intelligence Section, General Headquar-ters, Far East Command, Operations of the Military Intelligence Section, GHQ, SWPA/FEC/SCAP,Supplement: Korea, 1950-1951, vol. 3, Intelligence Series, ch. 8, insert 37, item 26 (202487), pp.121-22, LIB. On conditions in the Chinese forces, see also Goulden, Korea, pp. 462-67. Accordingto Goulden, the Central Intelligence Agency caused a shipload of medical supplies destined forNorth Korea to be pirated, worsening the enemy’s situation.

THE MEDICS’ WAR

diagnosis, he “intended to knock out one of these men, and, if necessary, killhim, to get him out of the building where we could whack off a finger or takesome smears from these so-called running sores—couldn’t very well lug a bodyaround and drag it out to this ship, the way some people thought we were goingto do.”^^

For a time, based on an offshore island, Sams interrogated agents from themainland but found their stories contradictory. At other times, from the deck ofthe destroyer Wallace L. Lind he watched “some fine shooting,” as naval gunsset villages afire with white phosphorus and battered enemy gun positions alongthe beach. On the evening of 13 March Sams and his party at last were able toembark on a whaleboat towing a rubber raft. In growing darkness and chill windthey watched the lights of Chinese vehicles moving along a road that paralleledthe beach. Ashore they met three agents, tough-looking characters armed withcarbines, an M1, and a Russian burp gun. Among them was the man who hadmade the initial report.

The agent turned out to be a man of education, a chemist who had worked inthe oil refinery at Wonsan before the war. On orders to determine the diseasesituation among enemy troops, he had joined one of the parties of peasantscarrying sick soldiers to a nearby health resort where the Chinese had set up ahospital for communicable diseases. Here he observed about fifteen hundredcases of smallpox and typhus, plus the suspected plague victims. Under closequestioning he described their precise appearance, including the eruptions onthe arms, legs, and torso that gave Sams the answer he had sought. The diseasecould only be smallpox in its hemorrhagic form. The confusion with plaguestemmed from a misassociation; the bodies became black at death, because ofsubcutaneous bleeding, and the Korean phrase for plague was huksa byung(“black pest”). So precise was the account that Sams decided against making aneffort to obtain blood from a victim for testing on the laboratory ship, and plansto kidnap a patient, if necessary, also were abandoned. Sams returned to thewaiting ship through rough surf and thence to Sasebo with information thatenabled the United Nations Command to put aside for the present any cam-paign against plague in Korea.”

On the whole, the United Nations Command was lucky as well as efficient inits efforts to control epidemic disease. Though beset by cold injury, hepatitis,and respiratory ills, its forces were incomparably healthier and better fed thantheir opponents. Evidence is lacking to assess the impact of disease on thecourse of battle. But a combination of three factors—difficulties of supply, thesavage weather, and the reduced physical efficiency of the fightingmen—formed a serious obstacle for the Communists in their attempts either to

^Presentation, Brig Gen Crawford F. Sams, MC, Washington, D.C., 8 Jun 51, file 352 (Korea) F,1951, Box 53, Accession no. 56A-179, RG 112, \^RC. Quotation in the following paragraph isalso from this source.

”Rpt, Brig Gen Crawford F. Sams, MC, Chief, Public Health and Welfare Section, SCAP, toChief of Staff, FEC, 17 Mar 51, sub: Special Operations in North Korea, file Special Operations inNorth Korea-General Sams, Box 3179 (Public Health and Welfare, Medical Section, FEC, Ko-rea-Reports to Korea-Sanitation), RG 338, MMFB. See also Sams’ account in his manuscriptautobiography, “Medic,” 2:707-20, LIB. Sams received the Distinguished Service Cross for hisaction.

177

take advantage of their initiative in January or to resist the U.N. counterthrustslater on. Perhaps the best estimate is that these factors delayed the Communistspring assaults, allowing crucial time for Ridgway to infuse new confidence intohis dispirited army.

Chinese and North Korean charges that Americans were conducting germwarfare—then beginning to be heard—had no basis in fact. But there is littledoubt that the natural disease environment of Korea, all its effects worsened bywar, fought primarily for the best immunized, best cared for, best nourishedtroops. Disease was not a weapon of the U.N. forces, but it was an ally.^"*

Into the Bunkers

June found the fortunes of the Communists at a low ebb. Famine conditionsand heavy losses had disordered their armies. Epidemics of the winter lingeredand overlapped those of the spring, as malaria joined other ills afflicting theirlong-suffering troops. Chinese stores of vaccine at home were confiscated to aidthe fighting forces, and medical supplies had begun to arrive from the SovietUnion and other Communist nations, but the effects as yet were small. In Maythe North Korean Army inoculated 90 percent of its men with a formidableRussian polyvaccine called Nisin Baktin. The vaccine was supposed to protectagainst six major diseases but, by one account, had such violent side effects asalmost to constitute a disease in itself. A widespread but sporadic effort toimmunize both soldiers and civilians, and even POWs, was under way bymidsummer, but the Communists did not launch a major program to containthe chaotic disease situation until late summer and fall.

Against an enemy depleted in numbers, in stamina, and in morale, U.N.troops advanced through eastern North Korea and halted along a defensible linechosen by General Ridgway. American reluctance to commit more resources tothe conflict in Korea and the Communist setbacks of January-June 1951 creat-ed conditions in which a compromise settlement of the war became possible.^^

Even if not the hoped-for road to peace, a new phase of the struggle began on8 July. Representatives of both sides met at the North Korean town of Kaesongto arrange for the first negotiating session, which they agreed was to take placetwo days later. While the peace talks started on what was to prove a long andacrimonious course, the Joint Chiefs of Staff adopted a strategy based on theassumption that U.S. forces must remain in Korea and exert pressure on theenemy to “encourage him to negotiate.Systematic air strikes against enemycommunications and daily patrol activity along the line helped to define thenature of the new war. The Chinese and North Koreans seized upon the lull to

^‘‘Germ warfare charges are treated in Chapter 7 of this volume, and information on the treat-ment of hepatitis may be found in Chapter 8. On the probable impact of disease and supplyproblems on the Communist forces, see Presentation, Sams, 8 Jun 51, RG 112, WNRC.

^Except as otherwise noted, the general narrative of the period that follows is based upon WalterG. Hermes, Truce Tent and Fighting Front, United States Army in the Korean War (Washington,D.C.: Office of the Chief of Military History, Department of the Army, 1966). On the effects ofNisin Baktin, see Deane, / Was a Captive in Korea, pp. 170-71.

^‘Hermes, Truce Tent and Fighting Front, p. 58.

THE MEDICS’ WAR

Bunker-Type Forward Aid Station, showing log construction of roofand walls

move supplies forward and build up their forces. U.N. fighting men dug in alongthe main line of defense, code-named Kansas, and the outpost line, code-named Wyoming, that screened the western sector of Kansas.

By 1 July, after energetic digging and building, Kansas resembled the forti-fied Western Front of World War I. Sandbagged bunkers, strengthened with logwalls and roofs and connected by trenches, housed automatic rifles and machineguns. Shrubbery and camouflage nets concealed mortar and artillery positions.Mines and barbed wire fronted the line in cleared fields of fire, except whereWyoming screened Kansas. In the bunkers fighting men became housekeepers,ingeniously scrounging or building the amenities that could give a measure ofcomfort to their situation, or at least make it more endurable—flooring, furni-ture, cots. Patrol bases forward of the main line of resistance drew enemyattacks but provided depth to the line and made surprise less likely. Continuouspatrolling and intermittent fierce battles for strongpoints shaped the course ofthe fighting.

The first of these battles developed around a valley near Mundung-ni ineastern Korea, which journalists named the Punchbowl. General Van Fleet,hoping to straighten his line, forestall enemy attacks, and restore the fightingedge of his troops, ordered the capture of the western heights overlooking the

179

Punchbowl—Heartbreak Ridge and Bloody Ridge. Here, late in August, ROKArmy forces moved to the attack, soon to be followed by a major push of XCorps against tenacious enemy defense. Bloody Ridge fell in August; fightingthen began on Heartbreak, a narrow ridgeline with three main hills and spursarching east and west that caused a viewer to compare it to the “spinal columnof a fish, with hundreds of vertebrae.” Here desperate fighting developed interrain so harsh and swept by enemy fire that litterbearers sometimes took tenhours to haul a casualty down from the forward 23d Infantry of the 2d Division.Costs were heavy. The allies sustained twenty-seven hundred casualties atBloody Ridge, the 2d Division alone some thirty-seven hundred at HeartbreakRidge. Similar losses followed offensives further west in which the 1 st CavalryDivision lost 2,900 men.^^

Typical of the medics’ battle experience was that of the 1st Cavalry Divi-sion’s 15th Medical Battalion during the October campaign. Operation Com-mando, as the I Corps advance was dubbed, entailed savage fighting on thedivision front where defenses like those the North Koreans had dug into Heart-break Ridge awaited—“strong bunkers supporting each other with automaticweapons fire, and . . . heavy concentrations of artillery and mortars interdict-ing the approach routes to the hills and ridges.”^* Under Maj. Robert C.MacDuffee of the Medical Corps, the battalion located one clearing platoon, itsmedical supply, and the ambulance company headquarters at Yonchon, a townon the railroad line that led north toward the Iron Triangle (Pyonggang-Kumhwa-Chorwon). Another clearing platoon set up a holding station down therailroad line at Tongduchan-ni, and the third platoon with the remainder of thebattalion lay still further to the rear at Chongong-ni. Farthest forward were theambulance platoons, which were attached to the regimental collecting stationsbut often evacuated from battalion aid stations when litter jeeps were unable tohandle the load of wounded. Drivers worked around the clock, sometimes underfire; their machines clocked over 5,000 miles in the eighteen days of fighting. Onone occasion maintenance men worked on three shell-damaged vehicles at nightin a blacked-out tent and had them back on the road at 0200. Helicopters gotmaximum use, with first preference given to patients who had head injuries. Onone afternoon (3 October) there were 20 flights; sometimes three aircraft wereloading at one time. In all, 110 patients were carried in this way during thebattle.

More important numerically were two rail buses that used tracks to bring theseriously wounded back to the 8055th MASH. The buses worked at night, whenhelicopters could not fly, were smooth and rapid in movement, carried morethan twice as many men (250 in all), and allowed transfusions and other treat-ment to be given en route. Yet like the other vehicles they were subject tobreakdowns, and delays in service of up to two days occurred when they were

^^Quoted words from ibid., p. 88; see also pp. 90 and 96. For an extended account, see 2d, 3d,4th, and 8th Historical Detachments, “Action on ‘Heartbreak Ridge’,” especially pp. 17 and 34, Msno. 8-5.1 A BA 55, RG 319, MMHB.

^“Hermes, Truce Tent and Fighting Front, p. 99.

THE MEDICS’ WAR

Evacuation by Tank During the October 1951 Fighting

sidelined. Hospital trains came as far forward as Yonchon, hauling out some900 patients during the battle, most to the 121st Evacuation Hospital to avoidthe overcrowded MASHs. In the Yonchon railroad yards medics set up a mobilekitchen and served full meals to all the wounded who were not headed forimmediate surgery at the MASHs. Medics fed litter patients—those who couldwalk hobbled to tables—and, as time permitted, scrubbed some of the grime offthe wounded in hasty baths.

Division medics complained that the 8055th MASH was located too far tothe rear (25 miles) and that the Norwegian MASH, though a little closer to thefighting line at 20 miles, was too small to absorb many patients. Lengthy hauls,mechanical failures, and heavy casualties gave greater importance to an in-creased emphasis on holding patients within the division. Small holding sec-tions were set up at regimental collecting stations, and one clearing platoonprovided a holding station at division level as well. The aim was, of course, tokeep minor wounds, injuries, and illnesses out of the crowded evacuation chan-nels and to avoid needless personnel losses. Another advantage of the systemwas that it sopped up neuropsychiatric cases. Prolonged close combat, withoutfood or rest, brought its usual crop of stress and fatigue victims. Mild casesnever left their regiments. A total of 265 more severe cases reached the rear ofthe 1st Cavalry Division medical chain at Chongong-ni, where they got baths,clean clothes, and plentiful food in four meals a day. After two to five days of

181

Road-Rail Bus, with flanged wheels raised

rest, 170 (65 percent) returned to duty, and the rest were evacuated. The timewas not far distant when the Eighth Army’s entire system would adapt to thenew conditions of war along lines suggested by the division’s experience. Regi-mental and division medics would do more basic surgery and hold more pa-tients; MASHs would move closer to the line.

Despite difficulties, the evacuation and treatment system seems to havedone its job. One persistent problem that had afflicted all the Korean operationsin 1950 reappeared in local form as blankets and litters piled up at the MASHand vanished from the forward elements. But even when the system failed thepeople succeeded. Rotation by this time was working well, sometimes too well,and new personnel had come en masse into the division during the late summer.Despite their inexperience most reportedly adapted to the difficult conditionsand did well in their baptism of fire.^’

The 1951 fighting also found the non-American U.N. forces fully deployedin Korea. Totaling 36,200 men at the end of March, this category was comprisedof allied units from many countries: Great Britain and Australia, whose menhad arrived in the summer of 1950; Turkey, Canada, New Zealand, Thailand,Holland, France, and Greece, whose men had followed before the end of the

"1st Cavalry Division, Annual Report of Medical Service Activities, 1951, Enel 1, After ActionReport-Operation Commando, pp. 1-5, file 319.1-2 (1st Cav Div) Far East-1951, HRB.

THE MEDICS’ WAR

year; and Belgium, Ethiopia, Colombia, South Africa, and the Philippines,whose men joined the effort in 1951. Sweden and India each had sent a fieldmedical unit in late 1950, as did Norway the following year.

At first all foreign forces were attached to larger American units, whichhandled their supply and evacuation needs while integrating them tactically. InJuly 1951, however, the various forces of the British Commonwealth formed the1st Commonwealth Division. The British already had an autonomous medicalsupply system that served their units up to the level of the MASH, at whichpoint their casualties entered the American chain of evacuation. The seriouslywounded, on reaching Japan, often were shunted to the British Command ofForces hospital in Kure. More typical were the Greeks, who—despite the pres-ence of their own doctors, dentists, litterbearers, and aidmen—sent theirwounded through U.S. channels; the French and Dutch, who had their ownmedical personnel for front-line units as far back as the aid stations; and theEthiopians, whose German-trained European surgeon, sixteen aidmen, and twolitter jeeps cared for the battalion’s needs but then evacuated through the Amer-ican chain.

Other problems were slight. Language difficulties proved less serious thanexpected, despite the paucity of translators and the general American incompe-tence with foreign languages. The fact that many foreigners spoke at least asmall amount of English helped; so did the presence of American advisers withthe Turks and the British background of some other Third World forces. Inmany cases doctors were obliged to rely on objective clinical signs, rather thanquestioning the patient. This technique worked out well in surgical cases wherethe injury was usually evident but less so in medical cases where a sick mancould only point to his pain and use sign language to explain it. In the view ofAmerican medics, doctors with the U.N. forces ranged in quality from fair togood, but their facilities were invariably less elaborate than the Americans’ andtheir personnel less numerous. No possibility existed of putting one or more ateach level of evacuation to see to the needs of their own wounded and sick andto serve as interpreters. Despite this, and despite some difficulty caused byvarying demands for rations, treatment proceeded without interruption. Thepattern of the integrated medical system was like a river in which tributariesrising in many nations flowed into an American mainstream.^”

Life on the Line

In units not directly involved in the fighting, in those temporarily in reserve,and in all units during the summer and winter lulls, life had changed utterlyfrom the days of fluid warfare. Units remained stationary for months at a time.Patrols went out accompanied by aidmen and Korean litterbearers. In the

“Military History Section, FEC, “History of the Korean War,” vol. 3, pt. 2, sec. B, “Inter-AlliedCo-operation During Combat Operations,” pp. 138-46, Ms no. 8-5.1 A AI VI, RG 319, MMHB.The rotation system is treated at some length in Chapter 7 of this volume. In December the 1stCavalry Division moved to Japan and the National Guard’s 45th Infantry Division took its place onthe line.

183

bunkers men counted the time until rest and recuperation (R&R) leave gavethem a few days off, either in Seoul or in Japan, and added and readded theirrotation points. The arrival of replacements was always cause for rejoicing. Inmedical units frequent movies and increasing stocks of athletic equipmenthelped to while away the time. Some men and women enrolled in study courses,and day rooms in squad tents provided books and magazines for those stationednear a division headquarters. The character of medical work changed also. Inthe 25th Division battle casualties reached a high of nearly 800 cases per 1,000troops per annum in June, fell to less than 100 in July, rose sharply during theSeptember-October fighting, and plummeted almost to none during December.Whatever the course of battle, casualties from sickness consistently outnum-bered the wounded once the fighting of the spring had ended.^^

Preventive medicine became correspondingly important. Aided by a stablefront and by what a division surgeon called “good fortune with the environ-ment,” medics assured U.N. forces systematic care and generally good health.Problems were primarily those of administration. Individual “shot registers”held by soldiers deteriorated from usage and perspiration and were frequentlylost. Keeping systematic immunization registers was a tiresome but necessarychore, and administering repetitive inoculations and boosters, checking vaccina-tions, among other measures, were an essential part of preventing disease. An-other was insect control. Malaria control teams guided antimalaria details,appointed by each company or battery commander. Sprayers and dusters wereissued down to company level, and the tents, bunkers and trench lines weresoaked in residual DDT spray and DDT powder. Mosquito netting was used inall areas except the front lines, and chloroquine was issued to the men under thecustomary tight controls. Flies, like mosquitoes, were reduced in numbers, andcontrol of water supplies, burying enemy corpses, and disinfecting and buryingbody wastes helped to keep dysentery to an insignificant level.^^

The quieter front, R&R leaves, and contacts with villages up and down themain supply route all helped to bring venereal disease back as an annoying,though not militarily significant, problem. A division surgeon philosophicallyviewed the problem as “an occupational disease of soldiers,” but that did notprevent determined efforts to keep it under control. Nonpunitive measures werein force, for punishment often led only to evasion and self-treatment. Divisionsset up VD clinics, maintained syphilis registers, and held frequent lectures of thesort that emphasized man-to-man candor, appeals to moral sentiment, and soforth. Divisions also supplied prophylactic kits and condoms, which were freelydistributed at “orderly rooms, latrines, MP stations, town service [clubs], of-ficers’ clubs and all dispensaries.” A common method of control was that stapleof ribald and rueful GI memory, the physical inspection. This ritual was per-formed before men went on R&R leaves and after they returned, on newlyarrived replacements and on men leaving for home. Dr. Hawkeye Pierce, fic-

^‘25th Infantry Division, Annual Report of Medical Service Activities, 1951, Enel 2, HRB; 25thMedical Battalion Command Report, September 1951, file 325-MED (Command Report, 25thMedical Bn, 25th Inf Div, Sep 51), Box 3870 (25th Inf Div, 325-MED, 25th Inf Bn, Jan-Oct 51),Entry 429, RG 407, MMFB.

^Mst Cavalry Division, Annual Report of Medical Service Activities, 1951, pp. 7-8, HRB.

THE MEDICS’ WAR

Quartermaster Shower Point on the Songgang River

tional hero of the popular novel M*A*S*H, gave instructions for carrying out ashort-arm inspection that can hardly be improved upon. “It is very simple,”Hawkeye explained.

You get a chair. You sit on it backwards with your arms clasped behind its back and yourchin resting on the top. You gotta have a big cigar in your mouth. You sit there and look.Most of the guys will know what to do. If they don’t you growl, ‘Skin it and wring it,soldier.’ Sound mean when you say it. If you think there is a suspicion of venerealdisease, you make a gesture with your thumb like Bill Klem calling a guy out at the plate.Then somebody hauls the guy off somewhere. I never found out what happens to them.Every now and then, just so they know you’re alert, you grunt, ‘Don’t wave it so close tomy cigar, Mac!’ If you follow these simple rules, you can’t go wrong.”

By far the greatest problem in both the prevention and treatment of disease,however, was an illness for which, in the beginning, the medics did not evenhave a name.^'‘ The center of the outbreak was a region north and northeast of

”First quotation from ibid., p. 11, HRB. Second quotation from Richard Hooker [H. RichardHomberger], M*A*S*H (New York: Pocket Books, 1968), p. 178. Homberger served as a MASHsurgeon during 1952-53.

^The following section on what was later identified as epidemic hemorrhagic fever is based on agreat number of sources, among which the following are important: FEC, Annual Report of MedicalService Activities, 1951, pp. 54-55, file 319.1-2 (FEC) Far East-1951; 121st Evacuation Hospital,Annual Report of Medical Service Activities, 1951, pp. 20-22; 8228th MASH, Annual Reports ofMedical Service Activities, 1951 and 1952, pp. 1-4 and pp. 1-2, respectively, files 319.1-2 (MASH,

185

Seoul along the 38th Parallel, in the I and IX Corps areas. U.N. forces hadentered the endemic region for the first time during the fall of 1950, passingrapidly through it on their way north. Again, they had fought there during thespring of 1951, but in a war of movement. Now they lived there, month in andmonth out, in daily contact with soil and water, insects and flora, and the wildrodents that came to their bunkers, attracted by food and warmth. If scatteredcases had occurred before, they had remained unrecognized. But beginning inJune 1951, as many cases of a little-known disease flooded the hospitals, Ameri-can military medicine had no choice but to take notice.

The illness was painful in its onset, often fatal in its course. Sore throat,headache, nausea, and backache marked the first phase, followed quickly by theappearance of red spots on the soft plate, in the armpits, and on the chest. Thepatient was thirsty; he drank heavily and doctors, fearing dehydration, adminis-tered intravenous fluids. In the second phase the temperature fell, as did theblood pressure. Weakened vascular walls were allowing blood fluids to seep intothe tissues—hence the thirst and hemorrhagic symptoms. As the victim slippedtoward hypotensive shock, his vision became blurred and mental confusionsometimes ended in delirium, convulsions, or coma. Capillary bleeding, thecrux of the disease to this point, became more marked, with swollen eyelids andmultiplying red spots; sometimes the patient’s extremities became blue andcold. In the next phase the kidneys ceased to function, resulting in accumula-tions of fluid in the lungs, dangerous levels of urea in the blood, and irritableoutbreaks that sometimes verged on mania. This phase ended in a profusediuresis, followed on occasion by new manic episodes as the depletion of essen-tial chemicals by the body’s falling fluid levels disturbed the electrical function-ing of the cells. Then came a rapid subsidence of symptoms and the beginning ofa long convalescence, marked often by continuing inability to concentrate theurine.

This formidable disease produced, in some line units, an early mortality of20 percent among those affected and was variously diagnosed as leptospirosis,malaria, infectious hepatitis, fever of undetermined origin, and even leukemia.The 1st Cavalry Division, whose fate during 1951 seemingly was to be in thewrong place at the wrong time, suffered more than any other division, reporting42 percent of the 887 cases and 42 percent of the deaths. Treatment at divisionlevel was impossible, and both treatment and clinical investigation fell to the121st Evacuation Hospital. At first the hospital kept all patients, until an ex-

8228th Army Unit) 1951 and 1952; 1st Cavalry Division, Annual Report of Medical ServiceActivities, 1951, pp. 8-9; FEC and USAFFE, Annual Report of Medical Service Activities, 1952,app. IX, Preventive Medicine Division sec.; JLCOM, Annual Report of Medical Service Activities,1951, p. 45, file 319.1-2 (JLCOM) Far East-1951. All in HRB. See also 406th Medical GeneralLaboratory, Report of ETMD, December 1951, p. 14; Interv, author with John W. Vester, M.D., 5Feb 81, HSF (Vester Intervs), HRB; Rpt, Capt Ralph M. Takami, Medical Intelligence and Epide-miology Officer, Medical Section, FEC, 13 Aug 51, sub: Epidemic Hemorrhagic Fever, file 710(Songo Fever), Box 9431 (Public Health and Welfare Section), RG 331, MMFB. For contemporaryprinted records, see “Commission on Hemorrhagic Fever,” in Collected Reprints of the U.S. ArmedForces Epidemiological Board, vols. 11 and 12 (Washington, D.C.: Office of the Surgeon General,Department of the Army, 1953 and 1954), where a number of important papers and symposia areconveniently reprinted. For early references, see War Department Technical Bulletins MED 88,

(Continued)

THE MEDICS’ WAR

traordinary surge in October—when incidence rose from 1.8 to 8.9 cases per1,000 troops per annum—forced evacuation of 500 victims to Japan. Deathrates ran to 8 percent in the early days at the hospital, though this would falllater, while the Far East Command reported an overall death rate for the year of7 percent.

Efforts to find out more about the disease took many forms. References toepidemic hemorrhagic fever occurred in several Army manuals. Japanese andRussian reports also were found, for both nations had encountered it, the Japa-nese in the Songo region of Manchuria in 1939. In the forties Japanese research-ers using human subjects—“it is strongly suspected by some of our staff,” wroteGeneral Hume, “that the anthropoid apes on whom they experimented werereally prisoners of war. . . .”—concluded that the disease was caused by afilterable virus and transmitted by a mite whose host was a common fieldrodent.^^ With these hints turned up by medical intelligence and with transla-tions of the foreign reports sent by the Army library in Washington, fieldresearch took over and predominated until late in the year. At the 1st CavalryDivision, members of the 37th Preventive Medicine Company checked out casehistories in an effort to pin down the precise area of infestation, running into amaze of difficulties because the disease had a long incubation period, troopunits moved about, and towns had interchangeable Japanese and Koreannames. A preventive medicine detachment of the Mobile Medical Laboratory,8217th Army Unit, trapped live rodents and catalogued their parasites. InNovember the Far East Command, moving to bring some order into randomresearch efforts among unit medics, set up a laboratory at the 121 st EvacuationHospital, where a research team under Capt. Julio Barbero of the Medical Corpslaunched a detailed study of 30 representative cases. Meanwhile, at Osaka ArmyHospital Capt. George M. Powell, also a Medical Corps officer, embarked on astatistical analysis to uncover the disease’s epidemiological pattern.

Unfortunately, none of the information that was gathered proved to be ofmuch value in meeting the autumn epidemic. Tests at the 406th Medical Gener-al Laboratory in Japan failed to find the cause of the disease. Lacking this,neither vector nor host could be confirmed. No cure was found. The newepidemic rise peaked in November with 356 fresh cases. Meanwhile, epidemichemorrhagic fever in Korea met its only effective counter in better managementof the patient and more adept nursing. Medics learned how to handle a diseasethey could neither prevent nor cure. In particular, the careful and tediousmonitoring of the patient’s urinary output proved essential in dealing with thecritical changes in the body’s fluid levels. Round-the-clock care was essential.

(Continued)

Medical and Sanitary Data on Khabarovsk Krai and Maritime Krai (Far Eastern Territory),U.S.S.R., 29 Aug 44; MED 208, Medical and Sanitary Data on Korea, December 1945; and MED216, Medical and Sanitary Data on Manchuria, February 1946, in Medical Collection, HRB. For thepresent view—that the disease is caused by a virus infecting common field rodents—see TinsleyRandolph Harrison, Harrison’s Principles of Internal Medicine, ed. Kurt J. Isselbacher et al., 9th ed.(New York: McGraw-Hill, 1980), pp. 840-42.

”Ltr, Maj Gen Edgar Erskine Hume, Chief Surgeon, Medical Section, FEC, to Maj Gen GeorgeE. Armstrong, Surgeon General, DA, 24 Aug 51, p. 4, file 319.1 (Far East Command) AA, 1951-52,Box 69, Accession no. 56A-179, RG 112, WNRC.

187

Doctors slept at their patients’ sides to be available when some new crisisdeveloped. Nurses bore the brunt of the burden, and enlisted corpsmen per-formed the ceaseless monitoring of the urine. Understanding the course of thedisease permitted better care, and proper nursing enabled the victim’s body inall but the most serious cases to cure itself.

In December 1951 hemorrhagic fever claimed 118 new patients, but then felloff rapidly, reaching zero incidence in March 1952. It was obvious, however,that warm weather would bring another outbreak. In April the 8228thMASH—a unit that had existed for some time on paper but had only begun tocome to life during the closing months of 1951—became fully operational as theEighth Army’s designated hemorrhagic fever center. Its mission was to providea specialized hospital near the center of the infected area, permitting short haulsfor the helicopters and quick treatment for the patients. Located at Songu-rinortheast of Seoul, the unit under Lt. Col. George S. White presented theparadox of a surgical hospital without surgical duties.

As the new season began in May with a fifteen-fold rise over the initial smallApril total, the 8228th MASH got down to business. Because hemorrhagic feverwas grounds for helicopter evacuation, the 8228th during 1952 received almostall its 885 confirmed cases by air. Never had the helicopter been more impor-tant, for any rough movement could rupture the patient’s weakened vascularwalls, causing fatal hemorrhages. At the MASH systematic study under fieldconditions still failed, however, to provide a diagnostic test or to identify thevector with certainty. Mortality in the spring outbreak—the two humps inyearly incidence remained remarkable features of the disease—was 5.22 percentand in the fall, 5.11 percent.

Other efforts at control through the methods of preventive medicine pro-duced dubious results. On the assumption that mites were the vector (andsimilarity in the pattern of incidence to mite-spread scrub typhus made thisseem likely) the Eighth Army launched a program to soak all clothing in amiticide. Rodents also were trapped and poisoned. Yet at the end of 1952 theproblem had not abated from a year earlier, except for the steadily decreasingmortality. Case rates never again reached the shocking 18 per 1,000 of Novem-ber 1951, when the steepness in the disease’s rise seemed to threaten a majorepidemic. As a menace, epidemic hemorrhagic fever faded, for the medics hadlearned how to cope. As a mystery, it remained little less obscure than when itfirst appeared.

How Good Was the Field Medical Service?

Despite the mystery of epidemic hemorrhagic fever, medics had good reasonfor pride over their performance in Korea. Statistics indicated that they weresaving record numbers of the casualties who had reached the hospitals. Buoyedby these results, the medics sometimes exhibited a self-congratulatory mood,tempered by their belief that in future wars the casualty and death rates wouldgo “up as sure as the world.” On his return home from the Far East Command,in May 1951, however. General Sams opened a sharp debate, imperfectlyshielded from the public, over the effectiveness of Army medics in getting the

THE MEDICS’ WAR

wounded off the battlefield and intothe hospitals. Charging that front-lineevacuation was actually less effectivein Korea than during World War II, hequestioned the effect of the prewarprofessionalization program upon thepractice of field medicine.

When Sams left Tokyo for home,he could look back not only on re-markable achievements in publichealth and his recent adventure inNorth Korea but also on a shockingpersonal loss and a major professionaldisappointment. On 27 November1950 his son-in-law, Capt. Charles M.Struthers of the Medical Corps, losthis life defending his patients duringthe Chinese attack on the 2d Division.Sams knew that Struthers had fired aweapon for the first time only a fewmonths earlier during an enemy attackon his aid station in the Pusan Perimeter. Like so many other young residents,Struthers had passed direct from the corridors of Letterman General Hospital asa specialist in pathology to a front-line aid station as a battalion surgeon, ill-prepared for his assigned responsibilities and largely ignorant of field proce-dures, organization, and weapons. Sams, by contrast, was a product of theMedical Department of the late 1920s and 1930s, when most medical officershad lacked specialized professional training but had acquired broad experienceas soldiers.

In the spring of 1951 came a blow of quite a different kind when PresidentTruman relieved General MacArthur of his command. Sams had expected tobecome surgeon general of the Army, but those who were known as “MacArthurmen” also fell with their chief Maj. Gen. George E. Armstrong became the newsurgeon general. As a result, when Sams raised sharp questions about medicaltraining and went at least partly public with them, some of Armstrong’s support-ers—and perhaps the surgeon general himself—saw his action, in the words ofGeneral Hume, as motivated by “bitterness [and] envy.”^"^

Yet Sams was not alone in raising the issue of the Medical Service’s effec-tiveness on the front lines. The famed Dr. Charles H. Mayo expressed the beliefthat soldiers wounded in Korea were more likely to die in aid stations than weremarines. Anna M. Rosenberg, the assistant secretary of defense, concerned

^Quoted words from statement of Maj Gen George E. Armstrong in Transcript of the Meeting ofthe Board on Dispensary and Field Medical Service of the Army, 14-15 Sep 51, p. 48, file 334(Martin Board), Box 34, Accession no. 58A-1095, RG 112, WNRC.

^’Ltr, Maj Gen Edgar Erskine Hume, Chief Surgeon, Medical Section, FEC, to Maj Gen GeorgeE. Armstrong, Surgeon General, DA, 6 Sep 51, p. 4, file 312,3 (Correspon-dence—SGO—Washington), Box 3124 (Medical Section, FEC, General Records, 1951), RG 338,MMFB.

Maj. Gen. George E. Armstrong

189

herself particularly with questions relating to the people of the armed services.Known for her sharp tongue, rough language, and penchant for asking pointedquestions and insisting on replies, Rosenberg had a faculty for making evengenerals uneasy. She queried Dr. Richard L. Meiling, chairman of the ArmedForces Medical Policy Council in the Office of the Secretary of Defense aboutMayo’s charges. Thus when Sams spoke out, the demand for answers convergedon the council from two directions.

At Meiling’s invitation, Sams attended the regular meeting of the ArmedForces Medical Policy Council on 18 June.^* Here Sams recalled that MacAr-thur, as a special additional duty, had ordered him to inspect the front-linemedical services at frequent intervals. Viewing American dead, he often won-dered “whether the men would [have] lived or died if they had reached amedical installation.” Of the quality of the front-line hospitals and the profes-sional care available in them he had no doubt: “I think they are unequalled byany I have seen anywhere in the world.” But “our death rate—talking aboutmen who are hit—is far higher than the last war because many do not reach thehospitals. . . . My impression is about 4,000 men [who have died] should bealive.”

Sams linked defective evacuation directly to that centerpiece of Army medi-cal policy since World War II, medical specialization and professional develop-ment. The civilian medical profession had specialized, indeed overspecialized,he held, and the Army had followed suit with beneficial effects as far as hospitalmedicine was concerned. But the trend had gone too far and had broughtadverse effects as well. Military medicine was not, and could not be, the same asits civilian counterpart. It most resembled civilian medicine in the hospitals. Itdiffered widely in preventive medicine, because soldiers lived so differentlyfrom civilians. It differed absolutely in “the evacuation of battle casualties, andthat has no parallel in civilian medicine. That particular responsibility we arenow failing in.” Because Army training had followed the civilian model tooslavishly, many a young man in Korea had faced an impossible situation.

Our younger men were thrown into combat without a day’s training—similar to taking aboy out of a drugstore and saying ‘I’ll give you a gun—go fight the Koreans.’ We did thisto our young doctors. They were pulled out of the specialty programs, arrived in Japan,because we had nothing else; given field equipment which they had never seen before,told they were going to be assigned to field units the names of which meant nothing tothem. Those young men, within five days after their arrival, were being shot at by theenemy. . . . That, I think, was one of the most disgraceful things in the military service.And still, a year later, we are almost in the same fix insofar as the men who are physicallyin the forward echelons are concerned at this time.

^*The account that follows is drawn primarily from the minutes of the Armed Forces MedicalPolicy Council, files 334 (AFMPC), Boxes 32-35, Accession no. 58A-1095, RG 112, WNRC.Quotations by Sams are from transcript of 18 June 1951 meeting, filed with the minutes of the 30June meeting. The surgeon general’s quoted reaction to Sams’ presentation is from the 30 Juneminutes. Sams later elaborated on his argument to Brig. Gen. Frank Berry, the assistant secretary ofdefense for medical affairs. See Memo, Sams to Berry, 18 Jun 54, Personal file (1 Apr-30 Jun 54),Crawford F. Sams Collection, Hoover Institution Archives, Stanford, Calif. See also Interv, authorwith Sams, 28 Sep 82, HSF (Sams-1982), and Ltr, Sams to author, 29 Aug 83, HSF (Sams-1983).Both in HRB.

THE MEDICS’ WAR

Sams went on to compare the record of the Army with that of the Marine Corps,particularly at the Changjin Reservoir where the marines brought out not only“all of their wounded but also many of their dead.” By contrast, on manyoccasions the Army, in withdrawing, had abandoned its wounded. This was notthe sort of statement the council expected to hear from an Army medicalgeneral.

Reaction to his presentation—and to his later open discussion of the issue atthe Atlantic City meeting of the American Medical Association—was vigorous,especially on the part of the surgeon general. On 30 June Armstrong declaredthat he felt “no little surprised to learn of General Sams’ biased report to theArmed Forces Medical Policy Council.” When Meiling took Armstrong to taskfor his “defensive attitude,” the surgeon general assured him that in the nearfuture he would go on an inspection trip to the Far East and would look into thematter.

Meiling then revealed that on the day before he had discussed the issue withRosenberg and Robert Lovett, the under secretary of defense, and had giventhem a report for George C. Marshall, the secretary of defense. Meiling recom-mended that the field medical services of all three service branches be broughtup to the same level of efficiency as hospital medicine; that a board of the threeservice secretaries be appointed to find ways and means; that the Army and AirForce be given authority to create an enlisted hospital corps similar to that ofthe Navy; and that the fact be reemphasized that evacuation was a commandresponsibility. (Navy corpsmen, who also served the marines, received morevigorous specialized training than Army enlisted medics and, once trained,remained in their specialty.) The chairman added that the board he wished toset up should be on the secretarial level because “top patronage” would beneeded in order to carry it through.

Meanwhile, a memo drafted for Armstrong’s use at the session—perhaps byCol. Warner F. Bowers, a Medical Corps officer assigned to the Office of theSurgeon General—admitted that many junior officers who were residents in theArmy’s professional training program had entered Korea without field training.“The situation (known to all of us) that existed in the medical profession duringthe postwar years precluded the training of any considerable number of medicalofficers in field medicine. [But] no time was it the policy of the Surgeon Generalto discontinue or discredit field medical training” at the Medical Field ServiceSchool at Brooke Army Medical Center in Texas, even though the September1950 class was broken up to provide medical officers for the Far East. Now“new and improved courses have been devised and classes this year are alreadyselected.” Doctors brought in under the draft would get five weeks of training inTexas before going to their first assignment. In any case. Bowers implied, defec-tive training meant little because field-grade medical officers in Korea hadeither field training or experience, and Medical Service Corps officers had beentrained in field medical procedures.^’

^’Col Warner F. Bowers, MC, OSG, 15 Oct 51, sub: Status Report on Army Dispensary and FieldMedical Service, file 334 (AFMPC), Box 34, Accession no. 58A-1095, RG 112, WNRC.

191

Indeed, there was little to be done with this part of Sams’ charge, except toadmit its truth and aver that changes were under way. Some residents hadreceived no field training at all prior to combat. Those who had completed theirstudies, and begun their obligated time of service, received at the Medical FieldService School a brief introduction to military lore that, in the view of many,was ineffective. In a survey conducted in Korea during March 1951, EighthArmy doctors reported that they needed more training in a variety of basics: inmap reading, in setting up and packing medical and dental chests under fieldconditions, on the chain of command, and on their “specific duties as Battalionor Regimental Surgeon[s].” Additional training, they felt, was needed in fieldtactics and the organization of a medical company. A division surgeon opinedthat medical officers should learn more about tactical defense of a medical fieldinstallation, how to set up a perimeter defense, and how to use the hand grenadeand bayonet. For existing deficiences the doctors admitted that the MedicalService was not alone at fault. “All officers,” concluded the report, “felt that thecourse [in field medicine] would have been of more value if they had beenimpressed with its usefulness.” But “at that time the majority were preparing tospecialize in surgery. X-ray, laboratory, therefor[e they] had little or no interestin field medicine.”^®

Some officers who could have contributed to the debate were not available in1951, for they were POWs in enemy prison camps, where they would remainuntil 1953. Capt. Alexander Boy sen has appeared once in this narrative, at thetime of his capture; he will appear again on a death march in North Korea.During a debriefing in Washington following his liberation, he remarked that ifmedical officers in Korea in 1950 “had had any field training, which he regret-ted not having, a good number of men and equipment [5/c] could have beensaved and gotten out. They could at least have known something about thetactics being used.” Another returnee bluntly told a gathering of medical gener-als, “I went to the Medical Field Service School in 1947 and I feel that it was acomplete waste of my time.” Capt. Sidney Esensten of the Medical Corps con-tinued: “I didn’t learn anything about taking care of people in the Army; and Ididn’t know what a gun looked like; I didn’t even know how to head up amedical unit.”'**

Soon the Eighth Army surgeon was to protest that a military assignment nowseemed paradoxical even to Regular Army medical officers whose viewpointhad been thoroughly professionalized, to say nothing of the drafted civilianswho saw military service as an intrusion upon their lives. His devastating con-clusion was that “most of the young doctors coming to Korea have not beengiven the word on the simple fundamentals of the care of the wounded man, orof the problems involved in the management of battle casualties.” To remedythis. Brig. Gen. L. Holmes Ginn, Jr., a graying, acerbic medical officer of the old

“"EUSAK, Report of ETMD, March 1951, pp. 30-33. First quotation on p. 30; second and thirdquotations on p. 31.

“‘Medical Corps, OSG, U.S. Army, 1 Dec 53, sub: Report of Conference With RepatriatedP.O.W. Personnel, Document no. LD 1192897 F, Box 584, Accession no. 59A801, DIA Archives,Washington, D.C.

THE MEDICS’ WAR

school, later developed an extensive program of field training within Koreaitself/^

But the first reaction, not only of the surgeon general but also of the men inthe field, was defensive in the extreme. In the summer of 1951 Armstrongvisited the Far East Command and personally questioned both line and medicalofficers on the efficiency of front-line evacuation. According to his memoran-dum on the trip, all without exception reported that it was superb. Meanwhile,Meiling’s report had ascended to the desk of the secretary of defense andreturned as a directive to the three service secretaries. Each was to appoint aboard of officers in his own department to prepare and implement plans forbringing the field medical service for the combatant forces up to the level ofcompetence already existing in the hospitals.^^

In turn the secretary of the Army ordered Armstrong to appoint the board,'^which met in the Main Navy Building on 14-15 September under its president,Maj. Gen. Joseph I. Martin of the Medical Corps. After some discussion of thescope and form of the report to be written. General Martin in effect gave theboard its marching orders.

“We don’t want,” he said, “to get into the attitude of admitting that we havehad a poor field medical service, you see.”

“Let’s by all means avoid being on the defensive,” Colonel Bowers agreed.Martin then continued:

Let’s take the offensive and show in our background [section of the report] what wehave actually done; and where somebody could tear it to pieces as a weakness, then onlyinclude something that was a fact and not explain that fact too much. We all knowpersonally, for instance, there was a terrific urge to get people for the Regular [Medical]Corps and the trend was [to say] we will offer the man something professionally, put thefield aspects of medicine on a quietus status until we get them in, and then ease them intofield medicine as a field later on; and unless we do that we get no one. We all know that,but I do not think we need to mention it in those words. ... I still maintain we have agood Medical Service but never that it cannot be improved, but any improvement shown[i.e., recommended in the report] is going to be minimum—that is personally what Iwould like to see the Board come up with.

Having settled their conclusions, the board turned to taking testimony. Firstto appear was Surgeon General Armstrong. It quickly became apparent thatArmstrong intended to speak candidly, at least in private. He deprecated hisown report on the Far East Command: “This report of mine . . . was writtenperhaps with something in the back of my mind which for the moment I will try

“•TUSAK, Annual Report of Medical Service Activities, 1952, annex VII, p. 2, file 319.1-2(EUSAK) Far East-1952, HRB. Colonel Ginn replaced Col. Thomas N. Page as Eighth Armysurgeon on 27 January 1952.

“^MFR, Maj Gen George E. Armstrong, Surgeon General, DA, 31 Aug 51, sub: Inspection Trip tothe Far East Command, 331.1 (Far East Command) AA, 1951-52, Box 69, Accession no. 56A-179;Transcript of the Meeting of the Board of Dispensary and Field Medical Service of the Army, 14-15Sep 51, p. 22. Both in RG 112, WNRC.

'“Quotations in this and the following three paragraphs from Transcript of the Meeting of theBoard of Dispensary and Field Medical Service of the Army, 14-15 Sep 51, pp. 6-7, 45-52, RG112, WNRC.

193

to disabuse myself of and think again . . . not in the defensive attitude thatperhaps I may have taken here [indicating report].” As against Sams he stronglyfelt “that our current program of field training of five weeks is sufficient” forjunior medical officers; forty-eight hours of field experience and the assistanceof Medical Service Corps officers and a leavening of trained enlisted menshould enable most of them to perform well. But he saw a weakness in anotherplace. The most important element in the whole medical system was the medicalaidman, and here, according to Armstrong, training was clearly inadequate. Athird or more arrived through the replacement pipeline with no medical trainingand the best the divisions could do was “to give them a ‘quickie’ three-weekscourse which, believe it or not, in general satisfied the line, and in generalsatisfied the front-line Medical Corps officers, but that does not make it right.”Six to eight weeks of basic medical training should be the minimum.

Another problem was the lengthy litter carry that typified Korea—“this one-half day or six-hour litter haul.” Korean topography and the quirky nature ofhelicopter evacuation seemed to preclude any reduction. The seriously woundedman for whom a helicopter was unavailable was “still a long way from majorsurgery.” Perhaps aidmen, with some training, could take over and begin treat-ment for shock—“we see pictures of men, enlisted men holding bottles of bloodplasma and whole blood, but it is always in the aid station.” Meantime, despitethe vaunted helicopter, it was a long way for most wounded from the front lineto the aid station, and again from the aid station to the MASH.

How could death rates be lowered further? Means other than clinical wereneeded. Body armor, improved training for aidmen, and treatment for shockforward of the aid station might be the answer. Too many autopsies showeddeath due to kidney failure resulting from hypotensive shock. Perhaps theMASH could move forward, closer to the line, and in bad weather, when heli-copters were grounded, MASH surgical teams could move forward to the clear-ing stations to begin treatment. As for the rotation system—soon to bringmaximum personnel turbulence to the front lines where trained men were al-ready at a premium—the surgeon general’s opinion was blunt: “This matter ofrotation for the Medical Corps officers is a thing which you can discuss forhours and hours, and on paper it looks all right but in the field it is ‘bunk’, asyou all know.”

The board followed the line set by Martin and produced a document similarin many respects to a corporation’s report to its stockholders. It did, however,endorse the proposals made by Meiling and contained in the directive of thesecretary of defense, including one for which the Medical Service had longcampaigned, a Medical Enlisted Corps equivalent to the Navy’s Hospital Corps.Here, however, Meiling, the board, and Secretary of Defense Marshall all ranafoul of the Army’s centralizing policy. The Army disapproved the proposal onthe grounds of opposition to “any recommendations which tend to establish acellular autonomy within the over-all staff and command structure.”'*^

'‘Twenty-fourth Meeting of the Armed Forces Medical Policy Council, 4 Feb 52, file 334(AFMPC), Box 33, Accession no. 58A-1095, RG 112, WNRC. The Office of the Surgeon General

(Continued)

THE MEDICS’ WAR

Sams’ accusation that front-line evacuation was less efficient than in WorldWar II had meanwhile become mired in competing statistics. Armstrong be-lieved that his report on his trip to the Far East Command had quieted thepolicy council, the General Staff, Pace, and Lovett. “I have not, however, satis-fied Mrs. Rosenberg,” he confessed to General Hume. The result was a long andclosely reasoned memorandum to Rosenberg in which Armstrong put forward acreditable statistical argument. He first noted that those who died of wounds inmedical facilities to date represented 2.4 percent of those wounded in action, ascompared to 4.5 percent in World War II. But then he raised the real question:Were those killed in action actually wounded men whom the evacuation systemhad failed? The question in essence was whether the decrease in the case fatalityrate was accompanied by an increase in the proportion killed in action. InWorld War II 293 were killed in battle for every 1,000 wounded or injured inaction; in Korea the number had decreased to 225. By his own calculations theoverall ratio of deaths by hits (that is, killed in action or died of wounds) per1,000 reported hits had fallen from 261 to 203. Upon this analysis he rested thequestion of the adequacy of front-line evacuation, and by implication the com-petence of the men who directed it.'*^

Armstrong’s figures, however, differed from those later derived by MedicalService statisticians who studied World War II casualties. A question remainedalso with respect to the total figures of the men missing in action (MIAs). Samslater averred that the excessive number of MIAs, and the impossibility of ac-counting for more than about half from the number of POWs known to be heldin North Korea, had provoked his own early doubts about front-line evacuation.Figures submitted to the policy council showed that, as of 20 April 1951, MIAswere equal to 27 percent of the total of wounded for the Army, less than 3.5percent for the Marine Corps {Table 9). Striking too was the fact that the ratio ofkilled in action to wounded in action for the period of active warfare was 1 to 4for the Army, only 1 to 6 for the Marine Corps. End-of-war statistics wouldpresent a suggestive picture. The adjutant general was ultimately to declare3,791 MIAs dead and 2,294 more dead of nonbattle causes while captured ormissing. The ratio of all battle deaths, including MIAs declared dead, to surviv-ing wounded plus battle deaths was higher in Korea than in the Europeantheater of World War II, though lower than in the war as a whole, and muchlower than in the Pacific theaters.^^

It was not clear, however, that any single factor, such as Sams’ indictment ofArmy training programs, could explain these figures, or the difference betweenthe Army and the Marine Corps in Korea. Broad qualitative differences existedbetween the two services that fought the Korean ground war. The unity of a

(Continued)

ordered twenty-five thousand copies of the Martin board report and distributed them as a publicrelations document.

““Memo, Maj Gen George E. Armstrong, Surgeon General, DA, to Anna M. Rosenberg, AssistantSecretary of Defense, 10 Sep 51, sub: Battle Casualty Data, p. 2, file 312.3 (Correspon-dence—SGO—Washington), Box 3i24 (Medical Section, EEC, General Records, 195i), RG 338,MMFB.

‘‘Trank A. Reister, Battle Casualties and Medical Statistics: U.S. Army Experience in the KoreanIfhr (Washington, D.C.: Office of the Surgeon General, Department of the Army, [1973]), p. 15.

FIELD AND BUNKER

195

| Table 9-                                                        | -Battle Casualty Data, April 1951“    |              |
|-----------------------------------------------------------------|---------------------------------------|--------------|
| Category                                                        | Army                                  | Marine Corps | Total |
| Wounded in ActionDied of wounds ....Surviving wounded . . .     | . . 826. . 32,539                     | 243

7,287   | 1,069

39,826 |
| Total                                                           | . . 33,365                            | 7,530        | 40,895 |
| Killed in Action

Total                                         | . . 7,861                             | 1,279        | 9,140 |
| Missing in Action

Died

Returned

Captured

Currently MIA .... | . . 88

. . 1,126

. . 110

. . 8,937 | 262          | 88

1,126

110

9,199 |
| Total                                                           | . . 10,261                            | 262          | 10,523 |
|                                                                 |                                       |              |  |
| Grand total ....                                                | . . 51,487                            | 9,071        | 60,558 |
| ‘Based on notification up to 20 April.                          |

Source: Minutes of the Armed Forces Medical Policy Council, 30 Apr 51, file 334, Box 35, Accession no. 58A-1095, RG 112,WNRC. Deaths totaled 10,297—8,775 for the Army and 1,522 for the Marine Corps.

small, elite, professional service imbued with powerful esprit de corps con-trasted sharply with the looseness of the Army’s varied contingents, heavilylaced with draftees. Marine spirit found a practical expression in the policy,which Sams had noted, of carrying out their wounded and their dead. Finally,Army training of aidmen, as Armstrong remarked, was often deficient.

More complex was the comparison between Korea and the two major thea-ters of World War II. In the manner of warfare and the short evacuationdistances, Korea resembled the European Theater of Operations more than itdid the Pacific, where jungles and interminable evacuation routes caused theloss of many wounded men. That Korea should show better statistics than thewar against Japan was only reasonable. But why did it show worse results thanthe European theater? The roadlessness, primitive conditions, and harsh topog-raphy of Korea were certainly basic reasons. The enemy there routinely tried tokill medics and destroy medical vehicles, while the European Axis powers usual-ly had obeyed the conventions of warfare in dealing with the Western Allies.North Korean and Chinese tactics of infiltration and encirclement fatally dis-rupted medical evacuation, except by helicopter, for the whole concept of evacu-ation as conventionally practiced in Western warfare rested upon the willing-ness of armies to deploy in a front so that forward and rear areas could bedistinguished. Above all, the tumultuous retreats of 1950-51 had no analogue inthe European theater, except in the Battle of the Bulge.

The practical results of the controversy that Sams had launched were largelypositive. More rigorous field training was undertaken both in the zone of interi-or and in Korea. By autumn aidmen were giving plasma, or, in very coldweather, serum albumin. In September 1951 Surgeon General Armstrong ap-pointed General Sams assistant commandant of the Medical Field ServiceSchool, a post which he retained until June 1953, under General Martin ascommandant. Despite friction between the two, Sams reorganized the course in

THE MEDICS’ WAR

field medicine to emphasize demonstration and practical exercises by the stu-dents. In Korea, because the war of movement had ended, General Ginnlaunched his ambitious training program for both officers and enlisted men.“Field training with a division,” he declared, “is an indispensable ingredient of[the medical officer’s] education, especially if he is in the regular service, nomatter how rarified and sacrosanct his MOS[;] ... along with knowledge andskill, a young medical officer must be taught a sense of mature responsibilitytoward his patients which comes from experience and from living with hismistakes.” Few could dispute Ginn’s goal of giving his doctors “an impressivepost graduate training bearing the stamp of the Eighth Army and unattainable inkind anywhere else in the world.

The controversy also served to put the achievements and limitations of theMedical Service in a more realistic light than subsequent legend would allow. Itnow seems clear, with the documents available to scrutiny, that one of the mostfrequently repeated statements about the war, that death rates among thewounded in Korea were reduced below World War II levels, must be limited tothe wounded who reached the hospitals before it can be fully accepted. Toooften the nature of the war, the topography of the land, and the Army’s systemfor obtaining aidmen and training doctors and enlisted medics alike combinedto prevent the wounded from reaching the clinical miracles that waited in thehospitals. Once there, casualties received exceptionally competent care. No sin-gle cause can be given praise and blame for that mixed record, but the evolutionof Army medicine between the wars was a basic factor. So, too, was the generalcourse of American medicine during those years, remote as its professional andscientific concerns may have appeared from the battlefields and bunker lines ofKorea."*^

■**EUSAK, Annual Report of Medical Service Activities, 1952, annex VII, p. 3, HRB.

''’Ltr, Col Douglas B. Kendrick, Jr., MC, Chairman, Blood & Blood Derivatives Group, Office ofthe Directorate, Armed Services Medical Procurement Agency, to Chief, Supply Division, OSG, 30Nov 51, sub: Recommendations for Use of Serum Albumin in Place of Blood Plasma by FieldMedical Units in Korea During Cold Weather, file 444.2 (Korea) F, 1951-52, Box 50 (GeographicFiles, 1951-53, 386.3 (Korea) F to 721-End (Korea) F), Accession no. 56A-198, RG 112, WNRC.Questions similar to those treated in this section have been raised regarding Vietnam casualties. SeeKarl D. Bzik and Ralph F. Bellamy, “A Note on Combat Casualty ^XzXisXics'''Military Medicine 149(April 1984): 229-30.

CHAPTER 7

Static Warfare

The winter of 1951-52 brought scattered fighting along the line. The coldought to have been an ally of the United Nations (U.N.) forces, who were betterequipped than the enemy and, except for the South Koreans, better fed. Butthere is little evidence that it was. By Korean standards the weather was rela-tively mild. Yet cold injury was distressingly common by any standards, exceptthose of the preceding year. The troops, especially newcomers brought in byrotation, showed little skill in protecting themselves. An Army winter environ-ment team found a lack of ingenuity in the construction of warming bunkers.The troops apparently were intimidated by winter weather, despite the fact thatgeography had granted them the south slopes of the hills. Some combat patrolswere so brief as to be ineffective. Except during enemy attacks, hospitals re-ceived a mere trickle of battle casualties, and medical problems dominated theirwork.*

Yet such generalities did not do justice to many a bitter action. Aidman Pfc.Bryant E. Womack of the 14th Infantry, 25th Division, was the only medic witha combat patrol that suddenly ran into superior enemy forces on the night of 12March 1952. While aiding the wounded, Womack himself was hit. As he workedon, a mortar burst tore off his right arm. Even now he directed others inadministering first aid to the wounded and was the last man to leave the scene.He soon collapsed from loss of blood and died a few minutes later in the arms ofhis comrades. Womack received the Medal of Honor posthumously, one ofmany who died in Korea’s no-man’s-land in actions little noticed by the world atlarge.^

Any hopes—millions entertained them—that the war might be nearing anend were dashed during these months. The Chinese and North Korean armieswere in part composed of men who were not committed to their own govern-ments, for the Chinese Army had absorbed many of its Nationalist opponentsduring the civil war of 1948-49 and the North Koreans had impressed bothanti-Communists and unwilling South Koreans into their own ranks. As a result.

'Rpt, Office of the Deputy Assistant Chief of Staff, DA, sub: Winter Combat Problems, Korea,December 1951-February 1952, Observations by Department of the Army Winter EnvironmentTeam, file 381 (Korea) F, 1951, Box 53, Accession no. 56A-179, RG 112, WNRC; Hermes, TruceTent and Fighting Front, pp. 178-86. On nutritional problems of the South Korean troops, seeChapter 11 of this volume.

^Committee on Veterans’ Affairs, Medal of Honor Recipients, p. 805.

THE MEDICS’ WAR

Aidmen Helping Casualties of a Patrol Mission

prisoners of war (POWs) held by the U.N. forces were sharply divided onwhether to return home in the event a truce was reached. The United Statesmoved reluctantly and with many hesitations to a position that only POWsvoluntarily seeking repatriation could be returned. Though the Communist na-tions tried by every means to avoid actually saying so, this was unacceptable tothem. Months of discussions during 1951 only served to sharpen the issue, andby January 1952 negotiations had reached a stalemate over a matter of sub-stance on which neither side was disposed to give way.

In consequence, new battles broke out of singular ferocity and little practicaleffect—images in miniature of the great, futile struggles of the Western Front inWorld War I, when the combatants fought like beasts with locked horns, unableeither to win or to let go. The fighting that began in May 1952 revolved aroundefforts of the 2d and 45th Infantry Divisions to gain and hold the heights calledOld Baldy and Porkchop Hill near Chorwon, at the southwestern apex of theIron Triangle. Here fighting was as savage as any since the war of movementhad ended.^

The following account is based on 2d and 45th Infantry Divisions, Annual Reports of MedicalService Activities, 1952, files 319.1-2 (2d Inf Div) and (45th Inf Div) Far East-1952, HRB.Quotations from 2d Division report, as follows: first, p. 6; second, p. 2; third, p. 5; fourth and fifth,p. 8. Another change of command occurred in May, when General Mark W, Clark replaced Ridgwayas U.N. commander in Tokyo.

STATIC WARFARE

199

Forward Aid Station Near Old Baldy

Evacuation took familiar forms. As usual, the helicopter proved to be invalu-able in evacuating the seriously wounded and the hemorrhagic fever cases thatcontinued to occur. The 45th Division surgeon strongly recommended incorpo-rating some “choppers” into the division’s medical battalion. Although thecorps surgeons favored the proposal, the small number of machines made itimpossible to carry out. Land vehicles continued to carry most of the wounded.Rail buses moved severe cases at night, and despite bad roads and heavy traffic,the wheeled ambulance remained the first reliance.

In contrast to earlier fights, improved forward treatment now had becomethe rule rather than the exception. In the 2d Division only a little over one-fourth of the battle casualties were evacuated out of the division area. Division-al facilities handled the rest and returned them to duty. The 2d Division surgeonidentified the reason for his improved capability as the “static tactical situation”that enabled the clearing and collecting stations to dig into more permanentsites and freed the physicians of the need to be constantly preparing for the nextmove. He also cited the obvious advantages of the new system in holding ontomanpower and saving the costs of evacuation.

One consequence of the forward buildup was a partial change in that mostbasic of Korean medical traditions, the primacy of transport. Encouraged by thestatic line that gave greater security to patients and medics alike, medical unitsmoved “close to the wire,” held their patients longer, and depended on the

THE MEDICS’ WAR

excellent roadnet the engineers were carving out in the forward areas to concen-trate casualties close behind the front. Battalions customarily maintained bothforward and rear aid stations. The forward station was good for the morale ofthe fighting men and also reduced the exhausting litter carries that were so hardon the wounded and the men who bore them.

Forward of the main line of resistance where roads vanished and enemy firewas heavy, the armored personnel carrier won praise as an ad hoc ambulance.When September brought both a fierce Chinese counterattack on Old Baldy andheavy autumnal rains, other vehicles took up the task as well. Bridges washedout and roads were several feet under water in a large part of the 2d Divisionsector. Even tracked vehicles were unable to move under such conditions, buttwo vehicles familiar from World War II—the Weasel and the DUKW—tookup the burden. Weasels were tracked cargo carriers that proved “rather ineffec-tive” as conditions worsened, and the division surgeon called upon the Navy forthe amphibious DUKWs. These craft “proved to be very effective,” both incarrying supplies into flooded areas and in bringing wounded out.

The psychology of position warfare reflected the conditions under which themen now lived and fought. Rotation brought in new and inexperienced soldiers,personnel turbulence was high, and men faced battle among strangers. All theseconditions afflicted the 2d Division during its July battle. Even though thedivision had been long in Korea, its troops, by and large, were new and untried.The division’s psychiatrist reported that in some units a “serious breakdown incommand” occurred due to combat losses and “poor leadership.” The ratio ofneuropsychiatric cases to battle casualties reached a 1952 high of 1 to 3.6.However, with forward psychiatry now well established and with proper for-ward holding facilities, 80 percent were returned to duty. The contrast wasstriking in the later, equally bitter fighting against Chinese counterattacks. Theratio sank to 1 to 17, comparing favorably with the professional and veteranFrench Battalion’s 1 to 14.

These figures might have given some comfort to those asking the painfulquestion of why Americans had so poor a record in enduring stress by compari-son with the U.N. forces they fought beside. The Americans alone were draftees,and the operations of the rotation system virtually destroyed esprit de corps, thecrucial feeling of identity with the unit that provided stable professional battal-ions much of their vitality and strength. Ironically, rotation came in during theautumn of 1951 just as the war was changing its character, a change confirmedas it settled into stalemate during 1952. Never had cohesive professional forma-tions been more in demand than during a fight whose only possible aim was torestore the status quo ante bellum; never had the Army been farther from suchstability. An important compensating factor was the advantage that the staticfront gave the maturing field medical service to repair some of the damage tomorale wrought by continuing turbulence.

From Battle Line to Hospital

On the western part of the line, evacuation continued during 1952 in well-established patterns. The main innovation was the approach of the railroads

Evacuation by Litter Toboggan

ever closer to the fighting. In the central mountains occupied by the X Corps’40th and 45th Infantry Divisions, which were federalized National Guard units,a precipitous landscape demanded greater ingenuity. Here a wounded manmight travel his first few hundred yards down the south slopes on tramways orlitter toboggans. Eighth Army ambulance companies provided transport fromclearing stations to holding units at the airstrip, for in X Corps almost allevacuation out of the corps area was by air. The seriously injured rode byhelicopter from battalion aid stations direct to the surgical hospitals, routinely(though not invariably) bypassing the collecting and clearing stations.Neurosurgical cases went to the 8209th MASH, where immediately they enteredthe specialized neurosurgical chain of evacuation. Though casualties of theRepublic of Korea (ROK) Army divisions usually moved by Eighth Army am-bulance or U.S. Army helicopter to their own hospitals (the ROK 6th MASHserved the X Corps also), cases too serious for the Korean system were takeninto U.S. hospitals instead."*

“'X Corps and 40th Infantry Division, Annual Reports of Medical Service Activities, 1952,especially p. 12 and p. 21, respectively, files 319.1-2 (X Corps) and (40th Inf Div) Far East-1952,HRB.

THE MEDICS’ WAR

The Eighth Army now sought to organize evacuation under a single head-quarters, the 52d Medical Battalion. Activated in 1949 at Fort Benning, Geor-gia, the battalion at the beginning of 1952 was a floating headquarters located inPusan with responsibility for medical regulating. It contained only two assignedunits plus an attached collecting company, hospital train, and ambulance com-pany. The train brought patients from the North; the ambulance companycarried them from the railhead to the various hospitals crowded in and aroundthe port city. The battalion also serviced the airstrip 9 miles outside the city,carrying patients to and from the planes and the hospital complex. But late inJanuary the battalion headquarters moved to Yongdung-po near Seoul, settingup offices in four permanent buildings while the troops pitched tents for hous-ing. Now the battalion began to grow like Topsy, acquiring fourteen new unitsduring February. In effect it became a medical group charged with the evacua-tion of casualties throughout Korea. From the division areas back to Pusan andthence to Japan, U.N., ROK, and U.S. casualties rode ambulances or trainscontrolled by the battalion headquarters.

The basic plan adopted by a small organization with such extensive responsi-bilities was to attach an ambulance company to each corps area. Other unitsremained under battalion control, to be used as the tactical situation demanded.The 52d Medical Battalion’s ambulance companies evacuated from divisionclearing stations to the MASHs; from the MASHs to the battalion clearingcompanies; and thence to railheads, where battalion trains took them on, or toair evacuation points. The hospital trains carried the wounded south to Taeguor Pusan where more of the battalion’s attached ambulances carried them eitherto hospital ships in Pusan harbor or to an airstrip for transport to Japan.

In August, when the Korean Communications Zone (KCOMZ) was set up,all units under the 5 2d Medical Battalion that were south of a lateral linethrough Wonju passed to the control of the zone. The area between the Wonjuline and the front remained under the battalion’s control. Later, in the spring of1953, the battalion itself would come under the control of the newly activated30th Medical Group, the first to operate in Korea. In the meantime, it served asa sort of Eighth Army medical command, relieving the Army surgeon of muchday-to-day operational responsibility for a melange of units and enabling him toconcentrate on his duties of setting policy and advising the Army commander.Its size and lack of an adequate headquarters, however, made it both lessindependent and less useful than it might have been. Its orders were cut at theEighth Army headquarters, and the Eighth Army surgeon apparently ran thebattalion with his left hand.^

Another innovation, dating in this case from 1951, was the organization ofrear medical units on an area basis. The Department of the Army ordered theEighth Army surgeon to conserve physicians by eliminating the medical detach-

*52d Medical Battalion (Separate), Annual Report of Medical Service Activities, 1952, sec. 2, file319.1-2 (52d Medical Bn, Sep) Far East-1952, HRB. See also Interv, Samuel Milner with ColRobert P. Campbell, MC (hereinafter cited as Campbell Interv), 18 Aug 66, AMEDD Oral Historyfile (Campbell), HRB.

203

merits of separate units in favor of local dispensaries. He turned to a skeletonunit, the 163d Medical Battalion, to coordinate a change that medics on thescene found more of a burden than a help. Unit commanders felt little responsi-bility for medics who no longer belonged to their organizations and failed toprovide for such needs as shelter, clothing, food, discipline, or personnel ser-vices. The battalion headquarters had little exact knowledge of the medicalneeds of a collection of engineer, ordnance, signal, and other specialized units,many operating in remote locations and constantly subdividing their personnelto carry out different tasks. Units moved; dispensaries stayed put. Fewer doc-tors met larger sick calls. Preventive medicine in units without organic medicalsupport was neglected. If designed to generate a good deal of petty ill-feeling, theplan was a success.

In the end the solution was to “go 360°,as a medical officer put it,attaching each dispensary to one of the units it served for administrative andlogistical support. In many cases the end result was not distinguishable in anypractical way from the organic medical support of times past, except that a greatdeal of diplomacy was required to define the rights and duties of commanders,medics, and the battalion headquarters. The primary advantage came in areaswith large troop concentrations, where a single big dispensary could do the workof many unit medics, conserving medical strength and making skilled personnelavailable for other assignments. Whether the advantage was worth the botherwas a question to which most officers involved still would have returned anegative answer.

Outside the control of the catchall battalions, the Eighth Army’s hospitalsalso registered the changing nature of the war. When the KCOMZ took over therear areas, many hospitals shifted to its control, including the 21st, 25th, and171st Evacuation Hospitals, Semimobile, and the Swedish Red Cross Hospital.In all, during 1952 the Eighth Army’s hospital resources shrank from sevenevacuation hospitals to two (counting the Swedish hospital in this category) andfrom three field hospitals to none. The effect on actual field operations was,however, less important than it appeared. The evacuation hospitals already hadacquired the functions of station hospitals supporting urban troop concentra-tions, and the field hospitals already were serving the POWs. The Eighth Armyretained the six American and one Norwegian surgical hospitals. The ItalianRed Cross Hospital, aiding the civilians of the Seoul-Yongdung-po area, kept itsforward location but passed administratively to the KCOMZ. Two evacuationhospitals the 121st and 11th, remained with the field army—not enough, ac-cording to General Ginn, the Eighth Army surgeon, to support a return to a fast-moving tactical situation if the nature of the war changed again. Evacuationhospitals in the army area, like those in the communications zone, tended moreand more to resemble station hospitals. Routine matters, including physicalexaminations and consultations, filled the wards and made the hospitals evenless mobile than before. MASHs as well were allowed to dig in and to construct

^Campbell Interv, 18 Aug 66, HRB. In 1953 the 163d Medical Battalion, like the 52d MedicalBattalion, joined the newly formed 30th Medical Group.

THE MEDICS’ WAR

Nurse at the Italian Red Cross Hospital bathing the injured foot of a

Korean child

temporary buildings. General Ginn remarked that “few, if any, individuals onduty in any of our hospitals at the present time have seen the unit[s] moved.

If medical organization under the Eighth Army appeared to parallel broadlythe developments in the KCOMZ, part of the reason was that evacuation fromEighth Army hospitals did not go automatically to the communications zone.Ginn wrote of “the two communications zones” that supported the field army,the KCOMZ and “Army Forces Far East, formerly the Japan Logistical Com-mand.” The Eighth Army surgeon saw little advantage in sending his mostserious cases to the KCOMZ. Instead, as in the past, his hospitals evacuated byair to Japan, which was closer in the sense that large cargo planes equipped tohandle the sick and wounded on return trips flew direct to Tokyo and otherJapanese cities. Hence, Ginn could write paradoxically that “due to their rela-tive inaccessibility the evacuation hospitals in KCOMZ have been utilized bythe Eighth Army primarily for the care of cases of disease and minor non-battleinjury, and the short-term convalescence of minor battle wounded. They cannotbe considered reasonably available for true evacuation hospital functions.” TheKCOMZ took the overflow of minor cases from the field army but, because ofthe ubiquity of air transport, never became a communications zone in the

TUSAK, Annual Report of Medical Service Activities, 1952, p. 5, file 319.1-2 (EUSAK) FarEast-1952, HRB.

World War II sense of a stage through which all serious casualties passed ontheir way to definitive care.®

The growing sophistication of the Eighth Army hospitals helped to make thesystem workable. The Eighth Army hospitals were as well equipped and staffedas those further to the rear in Korea. Specialization continued to make progress.A center for the treatment and rehabilitation of neuropsychiatric cases grew upon the outskirts of Seoul in a cluster of tents and quonset huts staffed by the212th Psychiatric Detachment and the 123d Medical Holding Company.Neurosurgical detachments worked at both the 8209th MASH and the 8063dMASH, serving respectively the eastern and the western parts of the front. InJuly a neurosurgical team under 1st Lt. Joseph C. Barnett, Jr., began to assist thefront-line ROK Army hospitals. The success of the neurosurgical units in Korealed to issuance of a table of organization and equipment (T/O&E) with slots forthree surgeons, a nurse, and three enlisted men, and for operating room equip-ment, a jeep, and a trailer. In other developments the 121st Evacuation Hospitalbecame a center for the treatment of eye injuries and the 11th EvacuationHospital, Semimobile, continued to work with kidney problems, notably lowernephron nephrosis resulting from blast injury. Research also continued in half adozen fields, including cold injury and hemorrhagic fever.

Kidney research at the 11th Evacuation Hospital, which was located atWonju, was the responsibility of the surgical research team. Working in a newlyestablished renal insufficiency center, the team in March 1952 introduced adevice new to Korea—the first artificial kidney machine at a forward hospital.Kidney dysfunctions often resulted from wounding, primarily as a consequenceof low blood pressure caused by bleeding. The inability of the kidneys to main-tain an adequate urinary output was associated with shock, through the severefailure treated by the kidney machine (oliguria or anuria) was rare. Both ameans of tiding over severe surgical cases and a tool for studying the generalproblem of kidney lesions in war casualties, the machine proved a useful tool.Though about two-thirds of the very serious cases who received dialysis died,more than 90 percent of similar cases had perished during World War II.^

The most outstanding forward-area clinical innovation of 1952 was the rapidimprovement in arterial repair.*® During World War II severely damaged pe-ripheral arteries normally were ligated (tied off). Both doctor and patient thenwaited to see whether smaller satellite vessels could supply blood to the limb insufficient quantity to preclude amputation.

^Quoted words from ibid., annex IV, p. 27, HRB. See also EUSAK, Report of ETMD, August1952, pp. 14-16, file 350.05 (EUSAK) 1951, HRB.

’Howard, Battle Casualties in Korea, 4:1-6, 42; EUSAK, Annual Report of Medical ServiceActivities, 1952, annex IV, pp. 11-13, HRB; Army Medical Service, Neurological Surgery of Trau-ma, pp. 18-19; 8086th Army Unit, Military History Detachment, “Surgical Hospital in Korea,”Ms no. 8-5.lA DN, RG 319, MMHB; 11thiEvacuation Hospital, Semimobile, Annual Report ofMedical Service Activities, 1952, pp. 18, 22, file 319.1-2 (11th Evacuation Hospital, Smbl) FarEast-1952, HRB. The 3d Neurosurgical Detachment was organized at the 8063d MASH in April1952. The 140th Neurosurgical Detachment, at the end of June, absorbed and expanded Meirow-sky’s team at the 8209th MASH. On the surgical research team, see below.

‘“Sources for the following section include: FEC and USAFFE, Annual Report of Medical ServiceActivities, 1952, p. 40, file 319.1-2 (FEC) Far East-1952, HRB; Report of Research Team forMedical Investigation in the Field, prepared by Fiorindo A. Simeone, M.D., et al., July 1951, Enel to

(Continued)

206 THE MEDICS’ WAR

Artificial Kidney Machine at the 11th Evacuation Hospital

But about half of all World War II arterial wounds of the extremities endedin loss of a limb. The situation in Korea appeared more hopeful, for the intro-duction of the helicopter opened new possibilities. Deterioration of the wound-ed limb was a function, among other things, of the time that elapsed betweenarterial injury and repair. Because such injuries received priority for helicopterevacuation, the average time dropped below a critical figure that most surgeonsset at about ten hours. Besides the helicopter, advances in surgical techniquealso had occurred since World War II, notably in the use of arterial segmentstaken from corpses that were preserved in an antibiotic solution and grafted into

(Continued)

Memo, Simeone et al. to Col William S. Stone, MC, Commandant, Army Medical Service School,27 Aug 51, sub: Report of Research Team for Medical Investigation in the Field, file 333 (Far EastCommand) AA, 1951-52, and Ltr, Maj Gen William E. Shambora, Chief Surgeon, Medical Section,FEC, to Maj Gen George E. Armstrong, Surgeon General, DA, 10 Jun 52, file 319.1 (Far EastCommand) AA, 1951-52, both in Box 69, Accession no. 56A-179, RG 112, WNRC; Carl W.Hughes, “Acute Vascular Trauma in Korean War Casualties,” Journal of Surgery, Gynecology, andObstetrics 99 (July 1954): 91-100; ibid., “Arterial Surgery During the Korean War,” Annals ofSurgery 147 (April 1958): 555-61; Edward J. Jahnke, “Late Structural and Functional Results ofArterial Injuries Primarily Repaired,” Surgery 43 (February 1958): 175-83; Frank C. Spencer andRoy V. Grewe, “The Management of Arterial Injuries in Battle Casualties,” Annals of Surgery 141(March 1955): 304-13; Noble S. R. Maluf, “Use of Veins in Surgery: A History,” Sudhoffs Archiv,Zeitschrift fuer Wissenschaftsgeschichte 61 (1983): 50-73.

207

large gaps. Both transport and surgery, therefore, promised advances on therecord of the previous war.

During 1950 and 1951, however, the surgeons failed to seize their opportuni-ty. In mid-1951 a field research team reported that wounds of arteries continuedto be “life-endangering as well as limb-endangering lesions.”" Apparently most,as before, were treated by ligation, with consequences much like those in timespast. Accurate information on the results of treatment, or even on the number ofcases, was hard to come by because of rapid evacuation, overwork, hasty record-keeping, and high personnel turnover. Efforts at the 8055th MASH to suture theends of severed arteries (end-to-end anastomosis) showed little improvementover ligation. Attempts to replace sections of damaged arteries with homologousgrafts from corpses, or with autogenous vein grafts from the patient’s own body,seemingly failed whenever tried. Because the patients arrived after a lapse, onaverage, of a little over nine hours since wounding, time was not the problem.What was needed was instruction in improved surgical technique. Beginning inApril 1952, this was supplied, notably by Lt. Col. Carl W. Hughes working at the8055th MASH, and by the surgical research team, which, under Capt. John M.Howard, was engaged in studying many of the complex bodily changes whichresulted from wounding. Maj. Edward J. Jahnke of the Medical Corps, sent toKorea from Walter Reed for thirty days, lingered twice as long to teach methodsof vascular repair.

In 1952-53 vascular surgery at the MASHs demonstrated the value of anas-tomosis when only short sections of arteries required repair, as wells as thesuperiority of autogenous vein grafts over homologous arterial grafts. BetweenApril 1952 and the end of the war 269 of 304 major arterial injuries wererepaired and only 35 ligated. The failure rate dropped to 15 percent, or less,though the final results were somewhat more difficult to summarize. Follow-upstudies showed lingering problems in the repair blood vessels, yet many limbsthat ligation would have left only partly useful regained full function. Overall,arterial repair after the spring of 1952 was one of the more striking successstories of military medicine in Korea, in Marine Corps as well as Army hospi-tals. Limbs that would have become gangrenous only a few years earlier weresaved from the knife.

Life on the Line

The maturing of the medical system took the most varied forms. For medicsin general, comfort and safety in their daily lives improved markedly. Com-pared to aidmen, litterbearers, and jeep ambulance drivers who continued toface danger in their jobs on the line, many medics—especially those in hospi-tals—encountered fewer risks. Statistics for 1952 indicated that no medicalofficers and only two Medical Service Corps officers were killed in action. Foodwas ample, with three hot meals a day served at company headquarters and

"Report of Research Team for Medical Investigation in the Field, Simeone et al., July 1951, Enelto Memo, Simeone et al. to Stone, 27 Aug 51, RG 112, WNRC.

THE MEDICS’ WAR

battalion aid stations. Most medical companies operated a PX. Unpleasantduties and heavy manual labor fell to Korean civilians hired for the task, or tothe Korean Service Corps personnel (KSCs). At the MASHs during late 1951and 1952 baseball diamonds appeared on level spots, horseshoes clanged, andvolleyball teams practiced. On summer days swimming parties visited “clearpools formed by mountain streams.” As danger lessened, the surgical hospitalsgained a reputation for insouciance bordering on wackiness. Liquor was abun-dant and cheap, and the MASH was normally the farthest point forward thatAmerican women got in Korea. Questioned about the nature of the hijinksduring off-duty hours, a MASH doctor later said tersely, “Oh, sex and liquor.What else is there?”

With such relaxation went, very often, an unmilitary slackness that reflectedboth the nature of the war and the outlook of doctor draftees. Inspections ofmedical installations in the X Corps during September 1952 showed that poorappearance and absence of spirit were the rule. “Mess halls and kitchens weredisorderly and unattractive. Equipment and supplies were poorly segregated,stored, and maintained. Police was poor. . . . There was no unit pride. . . .The standards usually expected of medical units and installations were not, ingeneral, being maintained.” The military, as opposed to the professional, train-ing of the medical officers was “generally poor.” Pulled from budding practicesand thrust by their lack of rank to forward stations in an uninviting land, youngdoctors displayed unconscious arrogance and a refusal to adapt to the necessi-ties of a life that they despised. Such men failed to understand their responsibili-ties in respect to “equipment, maintenance, supplies, records, reports, trainingof enlisted personnel, and other non-technical activities. ... A deep sense ofresponsibility toward the military service seems never to have been gained.”*^

As a result, even their professional skills sometimes showed poorly, in partbecause their enlisted subordinates either did not know or did not practice theirjobs. Enlisted men showed a lack of courtesy, looked unmilitary, maintainedequipment in a slipshod manner, and expected their failings to be overlooked orcondoned. In the X Corps aidmen handled casualties roughly, leaving themexposed to weather; litterbearers sometimes ran with patients or walked back-ward; and drivers operated their ambulances at excessive speeds. Officers andenlisted men alike were ignorant of, or indifferent to, basic administrative tasks.The corps surgeon blamed the emphasis on professional and technical subjectsto the detriment of field training. How much complaints of this nature reflectedan unbridgeable difference in style between civilian and military and how muchthey represented actual failings on the part of the former is impossible todetermine. Both elements were certainly present.

Judged by the only standard that ultimately mattered, the saving of lives, thedraftees did as well as their predecessors. The MASH of 1952 had become amatured practitioner of emergency medicine in a style that civilian practice was

'Tirst quotation from 8209th MASH, Annual Report of Medical Service Activities, 1951, p. 4,file 319.1-2 (MASH, 8209th Army Unit) Far East-1951, HRB. Second quotation from confidentialcommunication to author.

'^X Corps, Annual Report of Medical Service Activities, 1952, pp. 29-30, HRB.

209

Typical MASH Operating Room

not to see widely employed for another fifteen to twenty years. The total sys-tem—including attached helicopters, corpsmen to act as paramedics, and ad-vanced methods of treating shock—was the key to success. In August 1951 theMASHs had briefly experimented with special shock treatment sections, only toabandon them because the sections found too little to do between battles. (Suchdedicated units, however, existed in evacuation hospitals where the staff waslarger.) Instead, the MASH’s preoperative section prepared casualties for sur-gery, acted as a shock treatment unit, and in slack times ran an outpatient clinicas well.*'*

Amid technical innovations and changes of personnel, one thing that did notchange was the MASH’s basic function of performing what Capt. H. RichardHomberger of the 8055th later called “meatball surgery.” Speaking as RichardHooker, pseudonymous author of Af*^**S*//, he suggested that

meatball surgery is a specialty in itself We are not concerned with the ultimate recon-struction of the patient. We are concerned only with getting the kid out of here alive

‘‘‘8055th MASH, Annual Reports of Medical Service Activities, 1951 and 1952, pp. 3-4, 16-17and pp. 2-3, respectively, files 319.1-2 (MASH, 8055th Army Unit) Far East-1951 and 1952;8228th MASH, Annual Reports of Medical Service Activities, 1951 and 1952, p. 3 and p. 6,respectively, files 319.1-2 (MASH, 8228th Army Unit) Far East-1951 and 1952. Both in HRB. Seealso 8086th Army Unit, Military History Detachment, “The Regimental Medical Company inKorea,” Ms no. 8-5.1 A DO, RG 319, MMHB.

THE MEDICS’ WAR

enough for someone else to reconstruct him. Up to a point we are concerned with fingers,hands, arms and legs, but sometimes we deliberately sacrifice a leg in order to save a life,if the other wounds are more important. In fact, now and then we may lose a leg because,if we spent an extra hour trying to save it, another guy in the preop ward could die frombeing operated on too late. . . . Our general attitude around here is that we want to playpar surgery. Par is a live patient.**

On the operating table “par surgery” did not permit elegant technique. Insuturing the four layers of the bowel, a surgeon from Georgia was not “quite asdainty” as the replacement he was instructing. “I’ve got mucosa to mucosa,submucosa more or less to submucosa, muscularis pretty much to muscularisand serosa to serosa, and there ain’t any place where it’s gonna leak. It took y’alltwo hours, and it took me twenty minutes.” Despite growing stability andsophistication and a general decline in the proportion of wounded to sick,brusque and rapid lifesaving technique remained the primary function of theMASH. When battle wounded flooded in, the ability to work quickly was stillthe most basic of skills.’^

Men in Armor

During the fighting of 1952 new equipment of considerable medical signifi-cance appeared on the line. Small laboratories at the clearing companies furtherstrengthened divisional medical capabilities. Insulated casualty bags greatly in-creased the comfort and aided the survival of evacuees, especially as autumncame on and the weather turned colder. Among new items provided for winterwear were insulated footwear (“Mickey Mouse boots”), which proved to bevastly better than the shoepac. The boots were distributed, six thousand pairs toeach division, between November 1951 and February 1952 and won instantpopularity among the men who received them. The Jamesway, a weather-tightinsulated tent stretched over a semicylindrical frame, proved a rugged, easilyassembled means of housing the ill and wounded, cooler in summer than con-ventional tents and warmer in the winter.

But body armor was undoubtedly the premier innovation from the view-point of medic and front-line soldier alike. It transformed the medical statisticsof the war by making chest and abdominal wounds rarer, peripheral woundsproportionately more common. Its use was so closely interwoven with the defen-sive psychology of static warfare as to make it almost a symbol of the new GI,who, lacking the enthusiasm and clear objectives of World War II, calculated hisown victory in terms of personal survival.*’

Experiments with body armor had taken place during World War II, leadingto development of the “flak jacket” for fliers. Layers of fiberglass laminated bymeans of a resin formed a light, resistant material called doron. Though the new

‘^Hooker, M*A*S^H, p. 160.

’%id.,p. 159.

'^2d Infantry Division, Annual Report of Medical Service Activities, 1951, pp. 10-11, file319.1-2 (2d Inf Div) Far East-1951, HRB; Rpt, Office of the Deputy Assistant Chief of Staff, DA,sub: Winter Combat Problems, Korea, December 1951-February 1952, p. 59, RG 112, WNRC.

211

new armor proved highly effective inslowing missiles, commanders usuallyhad rejected it as burdensome andinefficient and fighting men had ridi-culed it. During June-October 1951,however, a joint Army-Navy medicalteam, headed by Lt. Col. Robert H.

Holmes of the Medical Corps, visitedKorea with a supply of 40 Navy ar-mored vests to test the reaction of thefront-line troops. The vests met an en-thusiastic reception among officersand men alike, and the team recom-mended adoption of body armor asregular organization equipment. Ex-tensive testing began the followingMarch. Each division subsequently re-ceived about 350 vests to equip unitsgoing on patrol. So encouraging werethe results that use among men on theline rapidly became as common as thenumber of available vests wouldallow. The marines were the first to be equipped, and the Army procured 25,000of the Navy type and only 5,000 of its own, in recognition of the Navy vest’sgreater stopping power and the consequent preferences of the troops. (The Navymodel provided a snug fit and doron plates covering the lower chest, back, andabdomen.)

Speculating on the reason for this change from World War II attitudesamong American fighting men, the Army’s 1952 body armor investigation teampointed out that “the action in Korea is unique in our military history in thatthe lack of specific battle goals and the prolonged truce talks [have] resulted in afeeling of caution in all combat echelons. Commanders, under these conditions,are not quite so ready to sacrifice personnel on the battlefield.” Of the practicaleffectiveness of the armor there was no doubt. Armor cut the number of chestand upper abdominal wounds by 60 to 70 percent, and reduced the severity ofone-fourth of those that did occur. Improved technology and Korean War psy-chology worked together to make the armored soldier, for the first time inAmerican wars, the battlefield norm. A historian noted that “next to his weap-ons, the most important item to the infantry soldier was his armored vest.”**

’^Quoted words from Carl M. Herget et al., “Wound Ballistics and Body Armor in Korea,” inWound Ballistics, Medical Department, United States Army, ed. James C. Beyer (Washington, D.C.:Office of the Surgeon General, Department of the Army, 1962), p. 743. See also Rpt, Joint Army-Navy Mission, Council of Medical Research and Development, OSG, sub: Medical Project—BodyArmor, Korea, 14 June to 13 October 1951, prepared by Lt Col Robert H. Holmes, MC, et al., file422.3 (Korea) F, 1951; Rpt, Body Armor Test Team, Office of the Assistant Chief of Staff, G-4, DA,sub: Report on the Use of Body Armor in Combat, Korea, February 1952-July 1952, prepared by LtCol William W. Cox, MC, et al., September 1952, file 422.3 (Korea) F, 1952; and Memo, DeputyChief, Medical Statistics Division, OSG, to Chief, Research and Development Division, OSG, 4

(Continued)

Infantry Soldiers inArmored Vests

MAPS

213

Back to the Battle

September and October brought new fighting as the two armies disputed forfavorable terrain. In several of these battles the ROK Army demonstrated a newmaturity, beating off heavy Chinese and North Korean assaults. American andU.N. units also were engaged. Enemy attacks, worst in the western and centralsectors {Map 5), spread to the east, provoking attempts by U.N. forces to regainthe initiative. Troops of the 31st Infantry of the 7th Infantry Division movedout in Operation Showdown to seize enemy positions in the bloody hills northof Kumhwa. Here a complex of heights and ridges centered on the triangularmass of Hill 598 formed the stronghold of crack Chinese troops of the 45thDivision, Fifteenth Army. Medical planning had to take into account the ene-my’s year-long efforts to fortify his position; the growth of enemy strength sincethe start of the armistice talks; and the powerful supporting fire of artillery andmortars. The landscape, as shown by aerial photos, was almost devoid oftrees—a stark, dissected pattern of skeletal ridges.*’

The 7th Division was similarly dug in, its battalion aid and regimentalcollecting stations in sheltered bunkers strengthened with sandbags and log roofsand walls. The 8063d MASH stood 9 miles to the rear of the 7th MedicalBattalion, considerably closer than in the recent past. During late 1951 and early1952 battle experience had compelled the medics to shift much basic surgeryforward to the clearing station. Now, reduced to a formula by General Ginn, thenew practice became a policy that received its first full test (and some importantmodifications) in Showdown.

Aiming to make the medical system more responsive to the needs of positionwarfare, Ginn decided that cases with minor wounds were either to be retainedin the division area or moved by ambulance direct to an airhead and then to theevacuation or the rear hospitals. The moderately wounded were to be givensupportive treatment in the clearing station and then evacuated from rail- orairhead to the evacuation hospital for definitive surgery. The critically woundedwere to go direct from the battalion aid station to the MASH, by helicopter ifpossible. MASHs were to work at a central location in each corps area, servingseveral divisions as before. They kept a variety of other functions, such asproviding primary hospitalization for nondivisional troops. For the time beingthey also retained their holding capacity of two hundred, with additional nursesand support personnel.^®

(Continued)

Dec 53, sub: Battle Casualty Data for Korea, file 704.1 (Korea) F, 1953. All in Box 54, Accession no.56A-179, RG 112, WNRC. See also Ltr, Maj Gen William E. Shambora, Chief Surgeon, MedicalSection, FEC, to Maj Gen George E. Armstrong, Surgeon General, DA, 22 Aug 52, file 319.1 (FarEast Command) AA, 1951-52, Box 69, Accession no. 56A-179, RG 112, WNRC. The develop-ments of the Navy vest is recounted in Bureau of Medicine and Surgery, History of the MedicalDepartment of the United States Navy, pp. 111-16.

‘’Evidently, some GIs saw a different landscape, for one of the heights involved in the fightingwas nicknamed Jane Russell.

“Surgeon’s Circular Letter 7, no. 1, Medical Section, FEC, 1 Jan 52, p. 3, file 300.5 (CircularLetters) FEC, HRB; 2d End, Headquarters, EUSAK, to Commanding General, FEC, 6 Dec 52, file

(Continued)

THE MEDICS’ WAR

Holding Ward in a Regimental Collecting Station

Elements of two battalions, each supported by its medical platoon, movedforward in simultaneous and coordinated assaults. The battalions were drawnfrom the 31st and 32d Infantry regiments, whose medical companies tookcharge of evacuation from the aid stations back to the collecting stations. Be-cause the attack was limited and distances short, aid stations, instead of advanc-ing with the troops, were dug into bunkers in two narrow defiles through whichassault troops would pass to attack the hill. Medics correctly anticipated that themost difficult leg of evacuation would be the first. They knew from hard experi-ence that casualties would be much heavier than Army doctrine anticipated, andthat the six litter squads authorized by each medical company’s T/O&E wouldhave to be supplemented by KSCs. Seven M39 armored personnel carriers(APCs) were obtained, to carry wounded back to the aid stations after bringingammunition and supplies forward. The 31st Infantry was able to weld externallitter racks on some of the APCs. (Even severely wounded men had to beremoved from their litters if enemy fire compelled them to be carried inside, for

(Continued)

300 (Administration Classified from 13 Aug 52), Box 3133 (Medical Section, FEC), RG 338,MMFB. General information on the H 598 battle, unless otherwise cited, is in 8086th Army Unit,Military History Detachment, “Medical Planning and Support of Attack on H 598, 14 to 25 October1952,” Ms no. 8-5.1 A DL, RG 319, MMHB. For a sharp critique of the new policy, see thecomments of Bolibaugh, attached to 8086th Army Unit, “Surgical Hospital in Korea,” RG 319,MMHB.

215

litters would not fit into the personnel carriers.) Helicopter landing sites wereestablished south and east of Kumhwa, beside the advanced collecting stations.With these resources, and with personnel shortages that amounted in the 31stInfantry’s medical company to 12 percent of the enlisted men, one doctor andfive Medical Service Corps officers, the medics prepared for the attack.

Farther to the rear, the new policy brought a separate organization, the 618thMedical Clearing Company, to the railhead to receive all casualties who did notrequire immediate surgery at the MASH. Four helicopters of the HelicopterDetachment, 8191st Army Unit, waited at the MASH. By sunrise on 14 Octoberthe double envelopment of Hill 598 was under way.

Almost at once trouble developed. The Chinese fought back fiercely, hurlinghand grenades, satchel charges, and pipe bombs down the slopes. On the highpoints that were won, heavy enemy counterattacks developed, intensifying afterHill 598 fell on the fifteenth. What had begun as a limited operation entrusted(in the original planning) to a single battalion, and later to parts of two, turnedinto a lengthy battle. As enemy artillery zeroed in, small arms and grenade-fragment wounds ceased to typify battle injuries. The massive tissue damageand extensive trauma of blast injury and shell fragments became common. Onthe first day of the attack, 3 percent of the approximately 330 casualties werecritically wounded; on the second, with about the same number of casualties, 15percent.

Company aidmen again proved themselves despite often inadequate train-ing. In Ginn’s opinion, the aidmen “can be credited with a greater salvage ofmanpower than the surgical hospital.”^* Notwithstanding Ginn’s efforts to re-lieve the MASH, it was crowded with patients waiting for surgery, obliging theEighth Army surgeon to order debridement to be done at the clearing stationand to add anesthesia equipment to its table of equipment. On 26 October,having beaten off the enemy attacks and gained its objectives, the 7th Divisionturned over Hill 598 to the ROK Army. Chinese attacks then promptly regainedthe height.

Twelve days of heavy fighting left over 1,400 men with battle wounds. Totalcasualties of all types totaled over 2,000. The two regimental medical companiesthemselves lost 4 killed and 50 wounded. After-action interviews revealed acomplex picture of failure and success, of courage and cowardice. In the begin-ning medics simply disregarded field manual predictions of 3 to 5 percentcasualties for small unit actions and prepared for 75 percent casualties in theassault units—a prediction amply confirmed when the 31st and 3 2d Infantryregiments together took 784 casualties out of about 1,000 men engaged. Veteransurgeons could compare such losses only to I wo Jima. The heavy casualties andthe harsh precipitous landscape combined to throw an intolerable burden on theenlisted litterbearers, for whom supplements were hard to find. Capt. Philip W.Heuman, regimental surgeon of the 32d Infantry, described how wounded,when they fell, “would often roll into deep ravines, some impossible to reach.”Those who were brought out had to be strapped to litters, while the litterbearersheld on and let them slide down the sloping ground. “It was a common occur-

^‘EUSAK, Annual Report of Medical Service Activities, 1952, annex IV, p. 20, HRB.

THE MEDICS’ WAR

Armored Personnel Carrier Evacuation to an aid station near Hill 598

rence for patients to arrive at an aid station on a litter filled with gravel androcks.” Such journeys were made under constant mortar and artillery fire.^^

Men able to handle a task so perilous and physically demanding were hard tocome by. Reliance on the KSCs usually was ill-placed. These men, rejects fromthe ROK Army, were understandably terrified by the experience of battle intowhich they were forced without armor. ‘T have seen them,” said a surgeon, “sentout under fire without any protection, not even metal helmets . . . controlledby soldiers who brandish their weapons” to force them on. Treated as outcasts,the KSCs responded accordingly. KATUSAs, on the other hand, treated withgreater respect and supplied armor, usually won praise for their performance. Inspite of these efforts, the medical system’s weakest link in its chain of evacua-tion was still the first. The problem of getting the casualty to the battalion aidstation had not yet been solved.

The overwhelming influx of wounded also astonished and disoriented inex-perienced junior surgeons. The first twenty-four hours of the battle found themat their worst. “They seemed,” said a regimental surgeon, “unable to performthe definitive forceful treatment required, but instead spent their time pid-dling.” Yet learning came quickly, and after the first day most were performing

^^Quotations in this and the following two paragraphs from 8086th Army Unit, “Medical Plan-ning and Support of Attack on H 598,” pp. 43, 75, 80, RG 319, MMHB.

217

Preparing a Casualty for Evacuation by Tramway

tasks of great importance to the patient: tracheotomies to open blocked airways;abdominal wall punctures to drain fluid; wound explorations to control majorarterial bleeding; and nerve blocks to suppress pain. Abundant supplies of wholeblood permitted massive transfusions in the later stages of the fighting.

At times the forward aid stations were scenes of half-controlled chaos. Sweat-ing Korean laborers hauled litters in at gunpoint. Stragglers and walking wound-ed wandered in by themselves and preempted litters needed for more seriouscases. Medics stripped the wounded, tossing clothes and armored vests alikeonto growing piles of ruined equipment. Sometimes they turned up grenadeswith half-pulled pins. At the collecting stations helicopters proved impossible tocall because enemy artillery had destroyed the phone lines, and only a few of thewounded were evacuated by chopper during the battle. As yet, the new medicalsystem had more problems than successes to report.

Germ Warfare

While the pattern of static warfare matured on the line, a new and bizarreelement appeared in the war of words between Communist and non-Communistblocs. The Chinese and North Koreans launched a massive effort to convincetheir own people and mankind at large that the United Nations Command was

THE MEDICS’ WAR

engaged in the widespread use of biological weapons. Except in its earliest days,the germ warfare campaign was not a purely medical story. Yet it originated in amedical emergency and retained to its end strong medical overtones.

Stories of combatants waging war by the deliberate dissemination of diseasehave appeared through much of recorded history. A medieval chronicler toldthe tale that the Black Death entered Europe in the fourteenth century afterTartars, besieging a city on the Black Sea, catapulted the corpses of plaguevictims over the walls. Fleeing Genoese seamen then carried the disease to Italy.Similar stories exist in American history of colonists or British soldiers givingthe blankets of smallpox victims to Indian tribes with malicious intent. Docu-menting such charges is far from easy. During World War II the only power toemploy germ warfare was Japan, whose forces in Manchuria apparently under-took “field trials” against the Chinese. In the American Army suspicion anddislike of biological weapons were rife in the Medical Department, thoughmedical officers were assigned to the installations of the Chemical WarfareService where such weapons were developed and tested. Reflecting on the war-time experiments carried out in the laboratories at Camp Detrick, Frederick,Maryland, and elsewhere. Brig. Gen. Stanhope Bayne-Jones of the MedicalCorps, who had observed the program, judged the results “all very interestingand as alarming as you want to make it, and as foolish as you want to makeit. . . . Nobody knew what actually was practical. . . . The philosophical andmoral problems were very difficult of solution.

The Japanese germ warfare experiments were of great importance not only inshaping the views of Asian Communists but also in raising early and durablesuspicions of Americans. At Pingfan, near Harbin, Manchuria, a unit of theKwantung Army under Lt. Gen. Shiro Ishii conducted experiments on prisonersthat were morally comparable to those in Nazi concentration camps, for whichGerman war criminals were tried and, in some cases, executed. However, deci-sions at a high level of the American government prevented similar actionagainst Ishii and his subordinates. In 1947 experts working for the State-War-Navy Coordinating Committee, which communicated American policy direc-tives to SCAP, termed the results of Ishii’s work “of great value in confirming,supplementing and complimenting several phases of U.S. research. . . .” Withthe aim of securing Ishii’s information and denying it to the Russians, Americanofficials failed to prosecute him for war crimes. Yet the story of the Pingfanexperiments came to light. At the war crimes trials in Khabarovsk the Russianstried and convicted a number of Japanese soldiers who had participated. Testi-

”Quoted words from Interv, Harlan B. Phillips with Stanhope Bayne-Jones, 1967, p. 520, Bayne-Jones Collection, National Library of Medicine, Bethesda, Md. The story summarized here has beentold at greater length and from a somewhat different viewpoint in Albert E. Cowdrey, “‘GermWarfare’ and Public Health in the Korean Conflict,” Journal of the History of Medicine and AlliedSciences 39 (April 1984): 153-72. See also Memo, Norbert H. Fell, Chief^ PP-E Division, CampDetrick, to Chief, Chemical Corps, 20 Jun 47, sub: Brief Summary of New Information AboutJapanese B.W. Activities, Biological Warfare Laboratory Collection, Fort Detrick Archives, Freder-ick, Md.; Msg, CINCFE C-52423 to WDGID, 6 May 47, file 107-0, Box 1519 (War Crimes Branch,International Affairs Division, JAG, 1944-49), Entry 143, RG 153, MMFB; John Norris, “East orWest? The Geographic Origin of the Black Death,” Bulletin of the History of Medicine 51 (Spring1977): 11; Materials on the Trial of Former Servicemen of the Japanese Army Charged WithManufacturing and Employing Bacteriological Weapons (Moscow: Foreign Languages PublishingHouse, 1950), p. 23.

219

mony about the Ishii unit and its use of insect vectors in biological warfare filledthe published record of the trials.^"*

At the time of the Korean War, accusations against Ishii and efforts to forceSCAP to bring him to trial formed a continuing theme of propaganda by AsianCommunists. Chinese, North Korean, and Russian newspapers repeatedlycalled attention to the Ishii episode. “During World War II,” reported Hsin-hua,the official Chinese news agency in 1951, “the Japanese army used bombs withbacteria of bubonic plague and typhus after their invasion of northern andcentral China. . . . After the defeat of Japan the war criminals enjoyed Mac-Arthur’s protection and were not punished.” From this it was not far to thefictional elaboration that “US authorities assigned Ishii Shiro, leading Japanesebacteriological warfare expert, to develop bacteriological weapons to be usedagainst us, instead of punishing him as a war criminal.

The bitter fighting in Korea soon raised the specter of germ warfare. Storiesalleging its use by the United Nations Command appeared in the press ofCommunist nations, randomly intermixed with other atrocity stories. Ameri-cans shared the climate of opinion with their adversaries. During October 1950men of the 7th Division saw two Koreans throw a “brownish powder” into astream in their bivouac area in North Korea. A release by the division’s publicinformation officer spread the story that “several fish rose to the surface,”presumably dead.^^ Some of the powder was secured and sent for analysis toJapan. There the medical laboratory found it to be plant debris, its only mi-crobes normal field contaminants. Apparently the powder was an herbal prepa-ration used by peasants to stun fish. Concern was sufficient, however, to bring aspecial technical intelligence team into the picture, to check this and similarallegations, and experiments with the brown powder continued for a time in theUnited States.

Later in the month, when U.N. troops entered the North Korean capital ofPyongyang, germ cultures from the Kim II Sung Medical College were subjectedto similar examination. Interrogators questioned personnel of this and otherNorth Korean laboratories, with an eye to discovering military influences on

^“Quoted words from Draft Rpt, E. Wetter and H. I. Stubblefield, sub: Interrogation of CertainJapanese by Russian Prosecutor, p. 2, Enel to Memo, Comdr J. B. Cresap, Secretary, State-War-Navy Coordinating Committee, to R. A. Fearey et al., 1 Jul 47, same sub, file 107-0 Box 1519 (WarCrimes Branch, International Affairs Division, JAG, 1944-49), Entry 143, RG 153, MMFB. Seealso Statements by Maj Gen Kiyoshi Kawashima and Maj Tomio Karasawa (Document nos. 9305,9309, 9306), Ends to Ltr, Chief, Legal Section, SCAP, to Civil Affairs Division, War CrimesBranch, DA, 30 Jun 47, sub: Transmittal of Affidavits, file Legal Section, SCAP, Admin Correspon-dence, Box 1 (Admin Correspondence, 1945 to 13 Jun 52), Entry 271, RG 331; and relatedinterrogations in file 330, Box 1736 (Investigation Reports, 1945-49), Entry 271, RG 331. All inMMFB. An American expert termed Japanese experiments with fleas “excellent.” See Memo, Fell toChief, Chemical Corps, 20 Jun 47, Fort Detrick Archives, Frederick, Md.

^Quoted words from Peking Jen-min Hih-pao, 7 Mar 51, and Hsin-hua report in PragueSvobodne Slavo, 24 Mar 51, both in Central Intelligence Agency (CIA), Foreign Documents Divi-sion, “A Report on Foreign Press Coverage of Anti-US CW (and BW) Propaganda,” 2 Jul 51, pp. 6and 18, Report no. U-1378, CIA Archives, Rosslyn, Va.

“Ltr, Lt Col R. L. Hullinghorst, MC, Commander, 406th Medical General Laboratory, to Sur-geon, Japan Logistical Command, 18 Oct 50, sub: Biological Warfare Agent, End to Ltr, Maj GenEdgar Erskine Hume, Chief Surgeon, FEC, to Surgeon, EUSAK, 20 Oct 50, sub: Report of Analysisof a Suspected Toxic Agent, file 312.3 (EUSAK Correspondence, 1-25 Oct 50), Box 3105 (MedicalSection, FEC, General Records, 1950), RG 338, MMFB.

THE MEDICS’ WAR

their work, possible Russian interest and assistance, and progress made inculturing plague and other pathogens. The only apparent positive finding was aremark by Dr. Yang Chang Fah that he could start an epidemic of Japanese Bencephalitis “if I had the mosquitoes.” One interrogator asked, “Do the Rus-sians know you could start an epidemic?” “Yes,” replied Dr. Fah, “they are veryinterested.” The investigation, however, led only to the conclusion that no basishad been found for suspecting germ warfare activity in North Korea. Despitethe appearance of some sensational stories in the Western press, the UnitedNations Command treated the matter as an intelligence question, to be decidedon a factual basis.^^

On the other side of the battlefront, the Communist press gave increasingcoverage to germ warfare stories in the months that followed. The reason for theheightened interest surely lay in the frightful conditions of Korea in the latewinter and the early spring of 1950-51. With epidemics out of hand, propagan-dists in search of atrocity stories gradually abandoned earlier charges of gaswarfare and began to focus on biological warfare instead. On 22 March 1951 aShanghai report had MacArthur buying bacterial “media” from the governmentof Japan for use against the North Korean Army and people. (The procurementof Japanese vaccines was probably the germ of truth, so to speak, in the story.) Afew days later a Canton newspaper quoted former Secretary of Defense LouisJohnson on the American budget for biological weapons, alleging that they wereintended for use in Korea. Echoes of these stories resounded in apparentlyrandom fashion through the Eastern bloc, for editors there resembled theirWestern counterparts in their habit of filling space by copying other newspapers.Soviet press reaction was slight.

In China, however, the line began to get more vigorous play, with someevidence of a high-level decision to push it. In the first week of May the ChineseRed Cross protested against American use of captured Chinese in germ warfareexperiments. The source of this charge was General Sams’ lab-equipped landingcraft in which he had visited the North Korean shore. The American magazineNewsweek published a story on the ship, and the Chinese seized upon the reportas evidence that plague was being, not investigated, but deliberately spread. InPoznan, Poland, a garbled report communicated the news that “General SamCrawford had been appointed to organize ‘centers for bacteriological experi-ments’ in Korea. . . . The American imperialists are so brazen that they nolonger strive to hide their crimes.” In Russia, Pravda and Izvestiya picked up thetheme. Though the sensational reports spread widely, signs of an integratedworldwide propaganda effort were few. Yet on 8 May 1951 the North Koreangovernment officially charged that the United States was engaged in biologicalwarfare in Korea.

^’Quoted words from Exhibit 2 of Technical Intelligence Report TB-1336-50, 13 Nov 50, sub:Bacterial Institute of North Korea, p. 9, file 000 (Biological Warfare), Box 3132 (Medical Section,1952), RG 338, MMFB. See also Technical Intelligence Report TB-1378-50, 1 Dec 50, sub:Cultures from Kim II Sung Medical College, file 000 (Biological Warfare), Box 3132 (MedicalSection, 1952), RG 338, MMFB.

^*CIA, “A Report on Foreign Press Coverage,” 2 Jul 51, pp. 4, 11, 26, CIA Archives, Rosslyn, Va.General Sams’ name was incorrectly reported in the Polish story.

221

In a note to the chairman of the United Nations Security Council, the NorthKorean foreign minister protested against the “heinous crime” of the UnitedStates in using smallpox as a weapon. Because smallpox was a serious problemat the time throughout Korea, due to lapsed immunizations and the movementof refugees, the choice of diseases was significant. The dissemination of small-pox germs by U.S. forces retreating from North Korea in December 1950 alleg-edly resulted in some thirty-five hundred cases, all among civilians. The NorthKorean government also demanded the trial of Generals Ridgway and MacAr-thur for using germ warfare. Though reported in the West, the charges apparent-ly gained little attention, for they seemed merely another part of the war ofwords that accompanied the fighting, no different in kind from the accusationsof gas warfare that preceded and accompanied them.^’

What practical success the Communist powers had in fighting disease amongthe North Korean population during the spring and summer of 1951 remainsunclear. Immunization efforts were sporadic, despite an influx of Russian vac-cines that the government administered widely among the people, and even toPOWs. In May 90 percent of the North Korean Army received a formidableRussian polyvaccine. American medical officer repatriated at the end of the warreported that typhus and smallpox vaccinations were given the POWs in August1951, using a common needle for every five men, which led to a hepatitisoutbreak.

The lot of the Communist armies, however, improved noticeably in the latesummer and fall. Food supplies were better for the troops on the line, providinga major boost for improved health, and despite continuing diarrhea and persis-tent malaria, the epidemics of the spring had ended. According to intelligencereports, typhus fell to less than 2 percent incidence, relapsing fever appeared in“only a few sporadic cases,’’and there was “no proven or even fairly reliablereport of an incidence of cholera in North Korea.” During August-December1951, reported Capt. Ralph M. Takami, the Far East Command’s medicalintelligence officer, “all [enemy] troops have . . . been reimmunized againsttyphus fever.” Like the U.N. forces across the line, the Communist powers tookadvantage of a static front and reduced fighting to improve the health of theirarmies. Midwinter found them with larger supplies of vaccines on hand, andthey began a determined drive to raise the health consciousness of the public, toenforce sanitary rules, and to administer a new round of mass immunizations.This drive coincided with a major escalation of the germ warfare campaign.^®

”Ibid., pp. 8, 12-13, CIA Archives. See also New York Times, 10 May 51.

“First and second quotations from Rpt, Capt Ralph M. Takami, MC, Medical IntelligenceOfficer, Medical Section, FEC, 31 Dec 51, sub; Disease Incidence in Enemy Troops, Enel to DF,W.E.S. [William E. Shambora], Medical Section, FEC, to G-2, FEC, Attn.: Maj Lovelace, 11 Jan 52,sub: Medical Intelligence, file 350.09 (Intelligence), Box 3087 (Medical Section, FEC, Decimal File,1952), RG 338, MMFB. Third quotation from Rpt, Takami, 12 Mar 52, sub: Biological WarfarePropaganda Broadcasts, Enel to Ltr, Maj Gen William E. Shambora, Chief Surgeon, MedicalSection, FEC, to The Surgeon General, DA, 19 Mar 52, sub: Communist Propaganda Re BiologicalWarfare, 319.1 (Far East Command) AA, 1951-52, Box 69, Accession no. 56A-179, RG 112,

(Continued)

THE MEDICS’ WAR

The Opening Barrage

In February 1952 General Dean saw firsthand the scope of the new inocula-tion campaign. “Everybody—soldiers, civilians, adults, and children—receivedfour separate inoculations and revaccination,” he wrote. “They were monstershots, and all of North Korea had fever and sore arms.” A North Korean officertold him, “We had national inoculation of the population. Nobody could moveon the roads without an inoculation card. We were ready for the germ bombswhen they came.”^^

In China, where the movement of armies toward Korea and the enlistmentof an already inadequate medical profession in the army also had increased thedanger of disease, a similar campaign began about the same time. “The presentPatriotic Health Movement,’’declared a writer in the Chinese Medical Journal,“launched early in 1952, is unique in its scope and breadth and is of specialimportance in our battle for health. It has in fact become the driving forcebehind our medical work throughout the country.” The people reportedly drewup “patriotic health pacts,” binding themselves to observe the rules of hygiene.In Tsingtao in April a Westerner saw hundreds of schoolchildren wearing facemasks and going about equipped with flyswatters and bottles. Thousands ofsoldiers were led out to collect insects, and for days the police directed people onsimilar hunts. In Harbin, mass inoculation, after considerable procrastinatingby local authorities, followed the opening of the new germ warfare campaign.^^

But now the campaign had wider purposes. A concerted drumbeat began inFebruary as Peking Radio and the People's Daily charged that since 28 JanuaryAmerican aircraft had repeatedly dropped large numbers of insects carryingcholera and other disease germs. The renewed vigor of the accusation probablyreflected some critical recent developments—the breakdown of the truce talksover the prisoner issue, the approaching Japanese peace treaty, and the embar-rassing decision of tens of thousands of Korean and Chinese prisoners to refuserepatriation. The new campaign accompanied increasing violence among Com-munist POWs in the camps at Pusan and on Koje, which may also have been aresponse to the impasse at Panmunjom.

The allegations rapidly broadened. On the Imjin River front American artil-lery units reportedly fired containers of spiders laden with cholera and typhusgerms. By the first weeks of March the Communists expanded their charges toinclude germ raids on China itself According to Chinese reports, infected ani-mals were dropped at Antung; at the mouth of the Yalu River, where thePeople’s Republic maintained a large base for Russian-built MIG fighters;at other sites near the river; and in Liaotung Province. In a formal statement

(Continued)

WNRC. See also Deane, I Was a Captive in Korea, pp. 170-71; Dean, General Dean’s Story, p. 264;Rpt, Maj Lee B. Grant, sub: Operation Big Switch: Medical Intelligence Processing, pp. 11-13, file383.6 (Operation “Big Switch”) 1953, HRB.

^‘Dean, General Dean’s Story, pp. 276-77.

^Tirst quotation from Shih-Shan Fang, “Effect of War on the Health of the People,” ChineseMedical Journal 71 (September-October 1953): 326-27. Second quotation from Office of CurrentIntelligence, CIA, Current Intelligence Digest, 7 Apr 52, CIA Archives, Rossyln, Va. See alsoInformation Report no. OO-B-55704, 4 Sep 52, CIA Archives.

223

Communist Charge of Germ Warfare. This cartoon, which appeared in theRussian magazine Krokodil in 1952, portrays an American soldier firing off testtubes of germs while Secretary of State Dean Acheson (left) and U.N. SecretaryTrygve Lie (right) mouth propaganda.

Foreign Minister Chou En-lai charged the United States with conducting germwarfare in Manchuria and demanded the punishment of American fliers.

Meanwhile, the germ warfare charge served the Communist powers well athome by stimulating the public health campaign aimed at preventing any recur-rence of the conditions of 1951. Monitored Chinese broadcasts reported thatPremier Kim II Sung had issued a decree placing his country in a virtual state ofemergency to combat bubonic plague. The National Extraordinary Anti-Epi-demic Committee, the Ministry of Public Health, and the army’s Medical Bu-reau were ordered to mobilize all forces to wipe out germ-carrying insects. “Thebacteriological warfare propaganda,” according to imprisoned American medi-cal officers following their release at war’s end, “was directed primarily towardthe civilian population. The town governments enforced clean-up programs.

224 THE MEDICS’ WAR

mass immunizations, boiling of clothes and in some cases dusting individualspresumably with a lousicide.””

In North Korea a spring antiepidemic campaign got under way with an Aprilradio broadcast by Hwang Jung Hyop, vice chief of the Sanitation and An-tiepidemic Bureau of the Ministry of Public Health. “The American imperialistmurderers,” he declared, “have recently been engaging openly in the villainousgerm warfare.” Aircraft were dropping flies to spread cholera, typhoid, andparatyphoid; fleas to carry plague germs; and a melange of rats, bedbugs, spi-ders, grasshoppers, ants, and crickets to disseminate “eruptive typhus,” Japa-nese encephalitis, malaria, and “other epidemic diseases of the tropical zone.”The “American cannibals” were attempting not only to murder people en masseat the front and in the rear area but also to annihilate cattle, fowl, and crops.The response to this apocalyptic threat was prosaic and rational: clean upprivies, exterminate rats, wash bodies and clothing frequently, avoid eating rawfood, kill flies, wash hands before eating, and boil water before using. Melodra-ma played its part in North Korea; so did minute organization. Six “big clean-updays” were ordered for every month, on the second, seventh, twelfth, seven-teenth, twenty-second, and twenty-seventh. Antiepidemic committees formed anew and comprehensive hierarchy, from the lowest to the highest administrativedivisions of the country. The committees carried out daily inspections andreported all cases of disease, a precaution fundamental to epidemic control herejustified as vigilance against an atrocious enemy. The Red Cross Association,the Democratic Youth League, and the Democratic Women’s League pitched in.Propaganda media were utilized “to fullest capacity.” In North as in SouthKorea, a still largely medieval nation headed perforce toward modern sanitationunder the stress of war.^^

American prisoners received similar treatment. The first inoculations of1952 were administered about a month after intensive germ warfare indoctrina-tion lectures began. Many POWs were told the shots would protect them fromdiseases that American planes were spreading. Inoculations were systematic,“given by the roster,” and an attempt was made to include everyone. During theyear shots were given for typhus, cholera, plague (twice), plus a combined serumsupposed to protect against cholera, typhoid, and paratyphoid. The Chineseevidently believed their own propaganda, searching for insects and forbiddingprisoners to swim in water that had supposedly been contaminated from the

Charge and Countercharge

The immediate American reaction to the germ warfare charge was less thancandid. In comparison to 1951, most evidence for 1952 pointed to improving

^Quoted words from Rpt, Grant, sub: Operation Big Switch, p. 21, HRB. See also New YorkTimes, 2, 4-5, 7-8 Mar 52.

^^Broadcast from Pyongyang, 15 Apr 52, in CIA Daily Report, Foreign Radio Broadcasts, no.78-1952, 18 Apr 52 (Foreign Broadcast Information Service), p. 2, CIA Archives, Rosslyn, Va.

”Rpt, Grant, sub: Operation Big Switch, p. 23, HRB.

225

health conditions in North Korea. YetAmerican officials took the facile linethat the intent of the Communistcharge was to cover up the existence ofreal epidemics. Both Secretary of StateDean Acheson and General MacAr-thur were unwise enough to cite plagueas one of the supposed epidemic dis-eases. This provided a mirror image tothe Communist story that the UnitedStates was attempting to spreadplague, and it further obscured the factthat the Black Death, though dreadedby both sides, apparently had neverbroken out at all.

However, the Western counter-charge that real epidemics were occur-ring was plausible, because of theevents of 1951 and the medieval dis-ease environment that prevailed inmost of China and North Korea. American officials deplored the failure ofCommunist governments to care for their people, ignoring the factors of povertyand overcrowding, of war and social upheaval, and of scientific backwardnessand entrenched tradition against which those governments struggled with littleto aid them but Russian vaccines, social regimentation, and the psychology ofwartime. Dialectically, the Communists were caught in a trap, obliged to claimthat they were victims of germ warfare yet to deny the existence of realepidemics and to refuse the offers of assistance that soon rolled in from theWorld Health Organization and the International Red Cross.^^

The Far East Command’s military intelligence officers, however, foundthemselves trying to dampen reports of enemy epidemics that they knew to befalse. Captain Takami warned that “epidemics of plague have never been re-ported from Korea.” Reports of cholera epidemics in North Korea had “neverbeen confirmed,” though he admitted the possibility of outbreaks among civil-ians. Maj. Gen. William E. Shambora, the chief surgeon, warned the surgeongeneral of the problems Shambora’s office might face if obliged to contradict apublic statement by General MacArthur that plague existed in North Korea.

Repeated interrogations of PsW [POWs] and refugees from North Korea together withinterviews of agents operating in enemy territory have failed to offer any evidence of thepresence of either plague or cholera in North Korea. However a press statement recentlygiven out inadvertently by the United Nations Commander to the effect that he hadevidence that plague was present in North Korea has made the publication of the abovestatement somewhat difficult. ... In view of the statement by the United Nations

Maj. Gen. William E. Shambora

“Office of Current Intelligence, CIA, Current Intelligence Digest, 24 Mar 52, CIA Archives,Rosslyn, Va.; New York Times, 9 Mar 52.

THE MEDICS’ WAR

Commander ... it is suggested that any statements from your office to the contraryindicate that they are based on evidence available to you and not be credited to me or myoffice.^^

Chinese fabrications followed American misstatements. Evading investiga-tion by the International Red Cross and the World Health Organization, Chinainstead called upon a variety of friendly witnesses. The most impressive groupwas the International Scientific Commission for the Investigation of the FactsConcerning Bacterial Warfare in Korea and China, made up of sympatheticWesterners plus the chief Soviet medical expert from the Khabarovsk trials. Thecommission viewed pathological studies of Koreans who had died of anthraxand reported finding the organism of plague in human fleas. Testimony byNorth Koreans and others connected the appearance of disease with overflightsby American warplanes. Intermediate between the two was an amazing varietyof supposed vectors—including spiders; nonbiting flies; other insects that haveno known role in spreading any illness; and small wild rodents, such as voles. Insome cases the commission itself queried the evidence, usually on the groundsthat the technique of germ warfare was not fully understood. At no time did thecommission consider the possibility that the evidence had been cut from thewhole cloth. A formidable illustrated volume of testimony, analysis, and conclu-sions resulted from the commission’s work, which, published in Peking in Au-gust 1952, became the chief theoretical support of the germ warfare campaign.^*

If the 1951 campaign seemed disjointed, the 1952 campaign—like the Mayuprising on Koje—had the look of a concerted effort to win a major propagandaadvantage. Taking up the cudgel, the Soviet Union carried the accusation beforethe United Nations Disarmament Commission, causing, if possible, an evendeeper freeze in relations with the United States than already existed. Thespectacular and intriguing nature of the charge won the Soviets a wide hearingin the world press, both Communist and non-Communist. However, the effectupon world opinion remained problematic. Studies of press and radio reactionby the Central Intelligence Agency indicated that many in non-Communist blocnations were skeptical. In Western Europe some distinguished intellectuals ac-cepted the Chinese evidence with little difficulty. Then and later, critics foundsome of the evidence irresistibly comic: “The dissemination systems and thevectors,” one recently concluded, “if not the agents, were almost all quitebizarre.”'’

One aspect of the campaign was not amusing, however. Downed Americanpilots were put under severe pressure—most commonly by sleeplessness, isola-tion, and threats of death—to confess to waging germ warfare. Airmen whoyielded were sometimes paraded from camp to camp to lecture other Americans

^Ttr, Shambora to The Surgeon General, 19 Mar 52, RG 112, WNRC.

^^Report of the International Scientific Commission for the Investigation of the Facts ConcerningBacterial Warfare in Korea and China (Peking: Foreign Languages Publishing House, 1952). Thevalidity of the charges is assessed in John Cookson and Judith Nottingham, A Survey of Chemicaland Biological Warfare (New York: Monthly Review Press, 1969), pp. 57-63 and 297-308; inStockholm International Peace Research Institute, The Problem of Chemical and Biological War-fare: The Prevention of CBW, 5 vols. (New York: Humanities Press, 1971-75), 5:238-58; and inCowdrey, ‘“Germ Warfare’ and Public Health in the Korean Conflict.”

^’Cookson and Nottingham, A Survey of Chemical and Biological Warfare, p. 307.

STATIC WARFARE

227

on the alleged crimes of their government. Once they had returned to the UnitedStates, all revoked their confessions on the grounds that they had been obtainedunder duress. The language used in some supposedly spontaneous state-ments—“‘Let us change the tune of the piper and dance to the tune of peace,’”said one, while another exclaimed, “‘Speak! Act! and your efforts for peace willbe blessed’”—was often unconvincing. But some fliers produced highly circum-stantial accounts that would be admissable as evidence, except that they wereembedded in the fabrications of the germ warfare campaign.^”

The campaign served many functions, chiefly in the fields of diplomacy andpropaganda. General Dean’s rather loose captivity during 1952 enabled him toobserve some of its practical military effects in North Korea. “The civil popula-tion,” he noted, “became so inflamed [by the germ warfare stories] that adowned airman had virtually no chance of getting away from his wrecked planeor parachute. Although Chinese and Korean intelligence officers always racedeach other for downed airmen, most of the captives were made by farmers orvillagers long before the military arrived.”^*

The type of warfare that developed in Korea after the stabilization of thefront was not without historical parallels. During World War I armies on theWestern Front dug in, besieging each other for years in a war that seemedunwinnable. At the same time, in their military frustration the combatantsfought a war of words to win support from noncommitted nations—most im-portant, to influence the policy of the United States. While precise analogies areimpossible in view of the intense ideological passions of the Cold War, suchdevelopments did share a common character with much that happened in Ko-rea. With the armies in deadlock the contenders sought to win the sympathy ofmankind—or, if not, to win the condemnation of their enemies in the court ofworld opinion. In this atmosphere the germ warfare campaign emerged as thefinest flower of ideological war. Beginning in local medical conditions, it spreadto affect, and in some respects to poison, the world of ideas. For a short time thecampaign was a touchstone by which believers in the two world systems coulddemonstrate their loyalty and affirm their support to the side they had chosen,or had felt compelled to choose. In the medical history of the Korean War theepisode remains an embarrassment for the chronicler, hard to assimilate, impos-sible to exclude. And the question of who won the controversy is as difficult toanswer as the question of who won the Korean War as a whole.

■“Quoted words from ibid., p. 306. Compare Office of Current Intelligence, CIA, Current Intelli-gence Digest, 14 Jul 52, OCI no. 6439, p. 10, and information from Foreign Documents or RadioBroadcasts, “Non-Communist Radio Comment on BW Charges,” 7 Feb-7 Apr 52, Report no.OO-F-229. Both in CIA Archives, Rossyln, Va. Also of use is the New York Times, 2-3 Apr 52, 4May 53, and 7 Sep 53. On pilots’ confessions, see transcript of Interv, Wilfred G. Burchett, Ce Soircorrespondent, with 1st Lt John Silas Quinn, 30 May 52, as detailed in DA Msg B 312317, 010515ZJun 52, file 470.6-2 (Korea) F, 1951-52, Box 50 (Geographic Files, 1951-53, 386.3 (Korea) F to721-End (Korea) F), Accession no. 56A-198, RG 112, WNRC. See also Depositions of NineteenCaptured U.S. Airmen on Their Participation in Germ Warfare in Korea, 1 Dec 53, and Statementsby Two American Air Force Officers, 16 May 53, both in Library of Congress, Washington, D.C.; andGeorge Winokur, “The Germ Warfare Statements: A Synthesis of a Method for the Extortion ofFalse Confessions,” Journal of Nervous and Mental Diseases 122 (July 1955): 65-72.

■"Dean, General Dean’s Story, p. 278.

CHAPTER 8

Medical Support Behind aStable Front

Prime gainers from the new kind of warfare were the Korean rear areas. Thestabilization of the front permitted rapid maturing of the medical support sys-tem. Command of the air allowed convoys to roll undisturbed, laden with allkinds of supplies. While the Chinese and North Koreans had to burrow under-ground, United Nations (U.N.) hospitals and depots could build in the open,free from attack. Under the Far East Air Forces’ umbrella the medical systemdeveloped in near ideal conditions. Despite the ruin of war, the poverty andmisery of many Koreans, and the sporadic fighting between South Koreantroops and guerillas, the rear areas slowly began to assume a more normalaspect.

Here, as at the front, rotation presented many difficulties for military com-manders and administrators. Together with the doctor draft and the generaldraft it meant near 100-percent turnover in many medical units during 1951,and continuing turbulence thereafter. The problems involved in continuousretraining meant that military medicine, from its simplest to its most profes-sional aspects, became an art that medics had not only to learn but also relearnas they worked with soldiers who themselves continuously came and wentthrough the doorway marked “Big R.” Rotation was one of the ways thatAmerica coped with the Korean conflict once it became apparent that the warwould not be a short one, and in this sense it, too, represented a maturing of thesystem that supported the battle.^

Organization of the Rear Areas

Within the Eighth United States Army, Korea (EUSAK), the 2d LogisticalCommand organized and controlled the rear areas. It provided direct support tothe Eighth Army, requisitioning supplies from the Japan Logistical Command(JLCOM) and overseeing storage and distribution. Its police duties includedsecurity in metropolitan Pusan, in Seoul-Inchon, and in other important mili-tary areas. The increasing burden of housekeeping chores led the Eighth Army

‘Civilian health and welfare is discussed in Chapter 10 of this volume.

229

surgeon to suggest making the command a JLCOM advance section. Instead, theFar East Command on 10 July 1952 established at Taegu a more weighty andcomplex structure—the Korean Communications Zone (KCOMZ).^

Under the new headquarters was a mixture of area commands and organi-zations having special functions. The major subordinate commands were theKorea Base Section, the United Nations Civil Assistance Command, Korea(UNCACK), and the Prisoner of War Command. Over the course of the yearthat followed, the 3d Transportation Military Railway Service and the TaeguMilitary Post were added, the first to control the increasingly heavy rail trafficthat supported the front and the second to provide services and security in andaround the KCOMZ headquarters. UNCACK, on the other hand, was abolishedon 1 July 1953 and replaced by the Korean Civil Assistance Command (KCAC),directly under the United Nations Command in Tokyo.

The KCOMZ headquarters reported to the Far East Command (FEC). Itsprimary functions were and remained advisory, with operations in the hands ofthe many specialized subordinate commands. Of these, the Korea Base Sectionwas simply the old 2d Logistical Command under a new title, but with broaderpowers. Its subordinate elements were the 6th Army Medical Depot, the Swed-ish Red Cross Hospital, and three evacuation hospitals, which were reorganizedas station hospitals in 1953. The field hospitals serving the vast prisoner popula-tion fell under the Prisoner of War Command, the medical trains under the 3dTransportation Military Railway Service. Beyond this, the KCOMZ on 1 August1951 assumed control of all major medical installations in Korea, except theMASHs and the 11th and 121st Evacuation Hospitals. Within its geographicalarea—mostly south of the 37th Parallel and about seven times the size of theregion under EUSAK—it controlled all medical service units except those fewinstallations, designated Class II, that remained under the Eighth Army. TheKCOMZ furnished medical logistical support to the fighting forces; handled railevacuation; provided medical, dental and veterinary care to all U.N. troops inits area, plus the prisoners of war (POWs); and, through UNCACK, directedU.N. medical services on behalf of the civilian population as well.^

A New Army

Trying to staff the Army hospitals and to fill the medical units was a frustrat-ing endeavor. The draft gave and rotation took away. The doctor draft, killed in1948 by the American Medical Association’s opposition, was revived with over-

^EUSAK, Annual Report of Medical Service Activities, 1951, pp. 15, 78, file 319.1-2 (EUSAK)Far East-1951, HRB; 8086th Army Unit, Military History Detachment, “Organization of theKorean Communications Zone,” vol. 1, pp. 1 and 4, Ms no. 8-5.1 A DJ, RG 319, MMFB; KoreanCommunications Zone (hereinafter cited as KCOMZ) and FEC and USAFFE, Annual Reports ofMedical Service Activities, 1952, pp. 1-2 and p. 72, respectively, files 319.1-2 (KCOMZ) and (FECand USAFFE) Far East-1952, HRB.

^8086th Army Unit, “Organization of the Korean Communications Zone,” vol. 1, pp. 1-2, andvol. 2, end. 10, RG 319, MMHB; EUSAK, Annual Report of Medical Service Activities, 1952, pp.3, 6 and annex IV, p. 3, file 319.1-2 (EUSAK) Far East-1952, HRB; 8086th Army Unit, MilitaryHistory Detachment, “Transportation of Supplies,” p. 24, Ms no. 8-5.1 A AA.B, RG 319, MMHB;

(Cominued)

THE MEDICS’ WAR

whelming congressional support after the opening of the Korean War. Both themedical association and the reserve medical officers now backed it, motivatedin part by a desire to satisfy the needs of the armed forces by placing in the firstpriority for the draft six thousand Army and Navy Specialized Training Pro-gram graduates (ASTPs and V-12s) who had not yet served. For their part thearmed services turned to the draft for the usual reason: Efforts to persuadephysicians to volunteer had no more success after the war began than before. Aspassed by the lawmakers in early September 1950, the draft legislation providedfor induction first of ASTPs and V-12s with less than ninety days of service;second, those with ninety days but less than twenty-one months of service; third,other doctors, dentists, and veterinarians with no military service since 1940.When these categories were exhausted, professional men with recent militaryservice were to be taken in inverse ratio to the length of their service.^

However, the inevitable delays in making the legislation work meant that nodrafted medical officers reached Korea until January 1951. Meanwhile, amidcomplaints from men whose lives were being disrupted and reminders from theunsympathetic that reserve service was voluntary, the medical reservists—mostof them veterans of World War II—continued to be called. Few men who wereliable to the draft volunteered for reserve commissions, despite the Army’sinitial hopes. During 1951 regular draft calls summoned medical professionalsinto the service. By the end of August the standard five-week course at theMedical Field Service School at Fort Sam Houston, Texas, had given sometwenty-five hundred medical, dental and Medical Service Corps officers theirinitial introduction to the Army and its ways. From that time forward the draftbecame increasingly important, and during 1952 over 90 percent of the medicalofficers required by the Army Medical Service in the Far East Command wereprocured through the doctor draft.^

In tandem with the general draft, the doctor draft brought a different kind ofmedical service into being in the Far East Command. The key to the rapidity ofthe change from an overwhelmingly volunteer to a largely conscript service wasthe rotation system. During 1950 the Medical Service had begun to rotatemedical and dental officers to Japan for professional refreshment, as well asnurses on grounds of their supposed inability to sustain the stress of front-lineservice. In March 1951 the Far East Command announced a general rotation

(Continued)

USAFFE and EUSAR, “Logistics in the Korean Operations,” vol. 1, p. 28, Ms no. 8-5.1 A AZ, RG319, MMHB. A useful account of the Korean Communications Zone is Gary Jennings, “TheKCOMZ Story,” Army Information Digest 8 (October 1953): 56-60.

“U.S. Congress, House, Congressional Record, 81st Cong., 2d sess., 30 Aug 50, vol. 96, pt. 10, pp.13855-870; Public Law no. 81-779, 9 Sep 50; Ltr, President Harry Truman to Secretary of Defense,9 Sep 50, in SG Conference Notes, 12 Sep 50; extract from Ltr, Col C. G. Blakeney, Chief ofLegislative Liaison, to Honorable Harold D. Donohue, House of Representatives, [circa August1950], HSF (Blakeney-1950), HRB; Weekend Letter no. 9, Maj Gen R. W. Bliss, Surgeon General,DA, to Maj Gen Edgar E. Hume, Chief Surgeon, FEC, 5 Sep 50, file 200 (Personnel Letters BetweenSGO and Medical Section, FEC), Box 3099 (Medical Section, FEC, General Records, 1950), RG338, MMFB. Most of this group of ASTPs and V-12s had escaped service because the programterminated while their education was incomplete.

^“Washington News,” Journal of the American Medical Association 144 (October 1950): 470;Historical Unit, U.S. Army Medical Service, History, Medical Service Activities, 1 Jul 50-30 Aug

231

policy covering all who served in Korea. The basic principle was to return suchmen and women to the zone of interior, beginning with those who had thelongest combat exposure. None, however, could leave the war zone until aqualified replacement had arrived to take his place. After some initial confusionthe commander-in-chief came up with a plan dividing the command into threezones. Those who served with combat units in Korea received constructivecredit of four months for each month served; those with noncombat units, two;those outside Korea, one. Troops were eligible for rotation after earning thirty-six months of credit, which translated into nine months of actual service forthose in forward areas.**

Clearly, such a system implied heavy demands for replacements, and whenthey initially failed to arrive on time much bitterness resulted among people onthe line. By the end of September, however, an influx of replacements, mostdrafted, permitted rotation of almost all the eligible medical and dental officers.A mass arrival of Medical Service Corps and warrant officers during thatmonth, producing a temporary surplus on the rolls, did not completely relievethe backlog of officers eligible for rotation, but by the end of October most haddeparted. The same period also saw the departure of other groups: residents whohad come to the Far East on five months of temporary duty (TDY) just beforethe war broke out; Navy doctors, who returned to their own service; and othermilitary and civilian residents, who went home to resume their interruptedstudies.

Adding normal losses for death and injury, illness or compassionate causes, anear revolution in staffing took place. Among those who departed was ColonelDo veil, the Eighth Army surgeon. In a month and a half—mid-August to 1October—the chief of every division in the Eighth Army’s Medical Sectionrotated, obliging Dovell’s replacement. Col. Thomas N. Page, to build up anentirely new staff. During 1951 the Far East Command saw the departure of itschief surgeon. General Hume; of its consultant in preventive medicine. Col.Arthur P. Long; of its psychiatric consultant. Colonel Glass; of its medicalconsultant. Col. Francis W. Pruitt; and of many others, both of high rank andlow.^

In the next year upheaval became institutionalized. In theory rotation shouldhave distributed the burden of service in Korea, built up a pool of trainedpersonnel, and avoided turbulence by integrating into units newcomers whocould learn from veterans and then teach others in their turn. But in practice theideal of regularly replacing a certain percent of the command each month wasunattainable. Ruled by the tactical situation, the coincidence of rotation dates,and the availability of replacements, the system moved by jerks and starts.Because every failure to meet the announced criteria brought bitter complaints

51, pp. 45-46, file 314.7-2 (Army Medical Service Activities, 1 Jul 50-30 Aug 51), HRB; FEC andUSAFFE, Annual Report of Medical Service Activities, 1952, p. 13, HRB.

‘FEC, Annual Report of Medical Service Activities, 1951, pp. 136-37, file 319.1-2 (FEC) FarEast-1951, HRB.

’EUSAK and FEC, Annual Reports of Medical Service Activities, 1951, pp. 81-82 and pp.25-26, 132-37, respectively, files 319.1-2 (EUSAK) and (FEC) Far East-1951; FEC, Report ofETMD, October 1951, p. 22, file 350.05 (FEC) 1951. All in HRB.

THE MEDICS’ WAR

A Contingent of Medical Officers. Left to right, front row: GeneralShambora; Surgeon General Armstrong; Brig. Gen. Yun Tchi Waang, surgeongeneral of the South Korean Army; Col. L. Holmes Ginn, Jr.; Brig. Gen. EarleStandlee, surgeon general of the Air Force; and Col. Thomas N. Page.

from men who had their thirty-six constructive months in hand, the Far EastCommand struggled to maintain morale, avoid congressional queries, and fendoff adverse press reaction by meeting rotation dates even when replacementswere not available. The result was that the command was soon understrength inevery corps of the Medical Service, except the Dental. Late in 1952 the criterionfor rotation was raised to thirty-eight months, but for the forward zone.®

During 1951 the massive turnover had ended in generally satisfactory staff-ing levels, for new people were available to replace the old. During 1952,however, nagging problems emerged as the draft and rotation interacted. Com-mand experience was at a premium as veterans departed, yet—ironically—anoversupply of some medical specialists developed. Nurses were too few. MedicalService Corps officers were abundant but short on experience, and trainedenlisted people were difficult to come by.

Washington tended to justify shortfalls by the drop-off in military activityalong the front. In 1952 the Office of the Surgeon General requested that the Far

*FEC and USAFFE, Annual Report of Medical Service Activities, 1952, p. 12, HRB.

233

East Command accept “a small calculated risk” in regard to the supply ofphysicians. Doctors were said to be too few in civilian life, casualties in thecommand were at a low level, and the surgeon general feared “criticism fromcivilian medicine that [the] Armed Forces are wasteful in utilization of physi-cians”—a familiar theme. In the event that full-scale hostilities were renewed,the “staffing level could be restored by airlift of medical officers.” In reply theFar East Command declined to agree to any decrease, pointing out that it wasalready taking a risk by operating with about 85 percent of its authorizedstrength under the tables of organization and equipment (T/O&Es) and tables ofdistribution. Combat divisions were functioning with thirty-two doctors eachinstead of forty-two, evacuation hospitals with twenty-four instead of twenty-nine, and MASHs with twelve instead of fourteen. In Japan itself the number ofphysicians at each of the four general hospitals was reduced from twenty-eightto eighteen, and “a proportionate decrease was effected in most of the otherhospitals.” In consequence, the rotation of doctors for the time being had almostcome to a halt.’

By this time the stabilization of the front and the opening of negotiationshad drastically changed the image of the war, from a crisis in the internationalconflict between the Communist and non-Communist powers to a purposelessstruggle in which victory was no longer possible, or at any rate no longerpursued. Most Americans who could avoid the war did so; those who servedsubmitted only as long as they must to a grim necessity. The declining activity inKorea reminded the Army of its obligations elsewhere in the world. A sign of thegeneral tendency to minimize the importance of Korea as far as possible was thecurtailment of battlefield promotions in August 1952. Time in grade began tocount for more than it had during the period of heavy combat. First lieutenantsin the Medical Corps and Dental Corps were promoted to captain upon comple-tion of twenty months of active duty; 2d lieutenants in the Medical ServiceCorps and Army Nurse Corps to 1st lieutenant after eighteen months. Promo-tions for enlisted men in medical units were cut back sharply, with the resultthat men of E-4 rank and below often filled slots tagged for E-5s to E-7s.*®

At the top of the medical tree, command jobs existed with no one to fillthem. At the end of 1952 the Eighth Army had 6 of its 11 authorized MedicalCorps colonels, 14 of 37 lieutenant colonels, and 15 of 90 majors. It possessed inall 36 field-grade officers against a T/O&E requirement of 139. Only three of itseight hospital commanders and only two of its six divisional medical battalioncommanders had had previous commands. Half the division surgeons lackedstaff experience. During the first six months of 1952 a shortage of well-trainedboard-qualified general surgeons developed, and by the latter part of the yearthe Far East Command was obliged to assign specialists to such slots instead ofthe major hospitals. Spot shortages also occurred in those speciali-ties—anesthesiology, orthopedics, urology, otolaryngology, neurosurgery—thathad experienced problems intermittently since the war began. By and large.

’Ibid., pp. 13-14, HRB. Quotation on p. 14.

‘“Extract from Ltr, Brig Gen William E. Shambora, Chief Surgeon, EEC, to Maj Gen George E.Armstrong, Surgeon General, DA, 12 Feb 52, HSF (Shambora-1952), HRB.

THE MEDICS’ WAR

however, professional expertise was common, command rank and experiencerare. Professionalization, the draft, and rotation were recreating in Korea thevery situation that had typified many World War II theaters."

Serious shortages developed as well among enlisted men and nurses. Theaterpersonnel offices filled first the requirements of the line units, restricting thesupply of aidmen and technicians, especially of those with prior training. Be-cause women still could not be drafted. Army nurses went to Korea on avoluntary basis, and the continuing shortage could not be met by denyingrotation to those who had served. A severe shortage of nurse anesthetists ap-peared in 1951 and, despite training in the hospitals, apparently continuedduring 1952. A gradual erosion of strength in the Army Nurse Corps—about 7percent from mid-1951 to the end of 1952—worsened the special problems ofthe Far East Command, and had to be met by a variety of expedients.

Army nurses were relieved of much of the routine work in hospitals, both inpatient care and administration, and enlisted personnel trained as practicalnurses. In 1951 the Office of the Surgeon General discussed again the questionof opening the Army Nurse Corps to male nurses, only to run into the bafflingtangle of legislation and sentiment that declared nursing to be women’s work.U.N. nurses helped to take up the slack; during the same year, 122 wom-en—Danish, Swedish, Thai, Norwegian, Italian, Turkish, French, Dutch, Bel-gian and Greek—served in the Far East Command. Japanese nurses, graduatesof Class A schools, worked in the hospitals in their homeland; Korean nursesfrom similar Korean schools in the prisoner-of-war hospitals. The stable tacticalsituation of 1952, the continued rapid evacuation, and the assignment of Armynurses to the hospitals with the heaviest work loads (rather than strictly byT/O&E) enabled the system to function, though shortages continued in both theKCOMZ and the Japan Logistical Command."

Training

High turnover implied training many newcomers. Skilled medical enlistedmen remained the major problem. “Rotation was the big news in the Far EastCommand about 1 March [1951],” said a report, “and the ‘Rotation Blues’ wasabout to be adopted as a theme song by the Medical Section, GHQ, FEC, sinceit was found that adequately trained personnel were not available. . . .” With abacklog of almost five thousand eligibles waiting impatiently to go home it was“fairly obvious” that a training program would have to be instituted."

“EUSAK and FEC and USAFFE, Annual Reports of Medical Service Activities, 1952, pp. 1-2,annex II, pp. 3-4 and p. 47, respectively, HRB.

'Tec, Annual Report of Medical Service Activities, 1951, p. 89; FEC and USAFFE, AnnualReport of Medical Service Activities, 1952, pp. 57-60; FEC, Report of ETMD, February 1952, file350.05 (FEC) 1952. All in HRB. See also Nursing Division, OSG, Summary of Major Activities, 9Sep 51-31 Dec 52, pp. 1-2, file 314.7-2 (Army Medical Service Activities, 9 Sep 51-31 Dec 52),HRB. The proportion of ANCs to total nurses in the Far East Command declined slightly during1952, but remained in the range of 83-88 percent.

'Tec, Annual Report of Medical Service Activities, 1951, p. 117, HRB.

235

At the behest of the FEC chief surgeon, that summer the Japan LogisticalCommand established the Far East Medical Service Specialist School at CampShinodayama, near Osaka. Early courses included four- to twelve-week sectionsfor X-ray, pharmacy, laboratory, and operating room technicians and for fieldmedical aidmen. Students sent by the command returned to their units aftertraining; men taken from the pipeline were assigned throughout the command,with first priority to the Eighth Army, which apparently received 80-90 percentof the graduates. After a brief exchange with the adjutant general, the 250 spacesallotted to the school by the Japan Replacement Depot were filled automatical-ly. Some question remained as to whether the Japan Logistical Command wasselecting the students at random. Studies showed that only 4.5 percent hadreceived medical basic, which corroborated the Medical Service’s suspicion thatthe command was sending infantry-, armor-, and artillery-trained men (whomade up 90 percent of the allotment) to become medics and medically trainedmen to line units.

Various problems continued to be apparent, some as old as the MedicalService, some as new as the rotation system. The Medical Replacement TrainingCenter at Fort Sam Houston, Texas, found that training divisions were sendingtheir worst men to be medics, just as line units had done since the AmericanRevolution. A second center was set up at Fort George G. Meade in March1951, drawing its 220 men per month direct from the induction centers. Ahigher caliber of personnel was noted at once. During 1951 the highly special-ized military occupational specialty (MOS) 1229—Medical Equipment Mainte-nance Technician—remained critical. Inferior applicants in the zone of interiorled to an excessive failure rate at the St. Louis Medical Depot, where 1229s weretrained; in Japan brief instruction left many incompetent at the job for whichthey were supposedly qualified. Meanwhile, medical equipment became evermore complex, often with intricate electronic components. Complaints to theOffice of the Surgeon General and much retraining resulted, but these measuresapparently did not solve the problem.

During 1952 the oddities of the rotation system also resulted in severeproblems with the supply of field medical aidmen. In May, after the CampShinodayama school was abolished, aidmen trained at the Eta Jima SpecialistSchool. Serving at the front in Korea, they earned the maximum constructiveservice time and consequently rotated in a fashion likely to cause vertigo in apersonnel officer. Too few trained men were coming from the zone of interior,but the quota set for the pipeline by the school was not met—could not be met,according to the Far East Command’s G-1 (personnel) section, because menwith combat MOSs could not be diverted and those with noncombat MOSswere too few. As a final note, the dangerous nature of the job meant high lossesby death, injury, and capture, further reducing the number of men on whom,when all was said and done, the whole medical superstructure rested. At the end

’^bid., pp. 117-19, HRB; Ltr, General Headquarters, FEC, AG 352 GC-TNG, 10 May 51, sub:Training of Medical Specialists, referenced in Japan Logistical Command (hereinafter cited asJLCOM), Report of ETMD, May 1951, p. 22; JLCOM, Reports of ETMD, July 1951, p. 3, andSeptember 1951, p. 53. ETMDs in file 350.05 (ETMD, Far East, JLCOM, 1951), Box 1 (ETMD,JLCOM, 1950-53 . . .), Entry 54B, RG 112, MMFB.

THE MEDICS’ WAR

Medical Equipment Maintenance Technicians at Work

of 1952 the command lacked twenty-four hundred of the more than eight thou-sand authorized aidmen. Though the shortage was nearing 30 percent, no solu-tion had appeared.*®

The Far East Command’s decision to terminate the Shinodayama schoolapparently was based upon assurances that greater numbers of qualified replace-ments would be received through the pipeline. The Japan Logistical Commandwas suspicious from the first and recommended that the school be retained.When it was abolished, the logistical command set up its own courses forphysical therapy technicians at the Kyoto Army Hospital and for medical equip-ment mechanics at the Japan Medical Depot. In Korea a chorus of complaintsindicated that new technicians received from the zone of interior were not livingup to their billing. According to the Eighth Army surgeon, the

caliber of laboratory technicians now being sent to this organization is far below mini-mum standards. The graduates of the Laboratory Technicians School at Fort Sam Hous-ton are universally unprepared to perform any of the routine procedures employed in the

’Tec, Annual Report of Medical Service Activities, 1951, pp. 139-40, HRB; JLCOM, Report ofETMD, May 1952, pp. 3-4, file 350.05 (ETMD, Far East, JLCOM, 1952), Box 1 (ETMD, JLCOM,1950-53 . . .), Entry 54B, RG 112, MMFB; FEC and USAFFE, Annual Report of Medical ServiceActivities, 1952, pp. 19 and 31, HRB; extract from TSG Notes no. 7, February 1954, pp. 5-6, HSF(TSG Notes-1954), HRB.

laboratory. . . . They are not particularly interested in laboratory work, but rather seemto regard their MOS as insurance against more rigorous and dangerous assignments.

Pointing out that the quality of medicine in any hospital depends in greatmeasure on the quality of the laboratory work, the report concluded that thehospitals must rely upon the few technicians who were both willing and able andupon the universal Army cure for defective preparation, on-the-job training.

Clinical training for doctors moved in familiar grooves, though greater ma-turity in the professionalization program was evident by comparison with thefirst year of the war. On arrival in Japan newly assigned physicians attendedorientation courses at the JLCOM hospitals, set up to give them some familiari-ty with Army ways. Dating from the earliest days of the war, the programapparently underwent little change except for location. By 1951 instruction wascarried out at installations in the Tokyo area to minimize transport and similarproblems. For newcomer and veteran alike, conferences and symposia increasedin number and sophistication. Radiologists, ophthalmologists, internists, andother specialists met at both regional and general conferences; dispensary physi-cians attended meetings on general medicine.

In the Eighth Army—and in the KCOMZ after its establishment— postgrad-uate courses were designed to utilize the talents of visiting consultants who,while remaining inspectors, became instructors as well. Such “courses” mightlast only a few days, for the students were busy people and the consultants’ visitsto any given area usually short. Most were concerned with imparting the newestwrinkles in one or another specialty to professionals who already knew thebasics, which they practiced every day. Refresher training was also provided forbattalion surgeons and for the Medical Service Corps officers serving as assis-tant battalion surgeons. In Korea the field and evacuation hospitals were usuallythe sites chosen. After the 8228th MASH had become a hemorrhagic fevercenter, however, lectures there informed both newcomers and veterans aboutKorea’s surprise contribution to American medical literature. A civilian consul-tant from Harvard spoke in Pusan on diseases of the chest; at some meetings,papers were presented, and physicians were encouraged to bring up interestingcases for discussion. Largely the work of General Ginn, who had succeeded Pageas Eighth Army surgeon, the development of these brief courses indicated thatmedical men in Korea now had time to study as well as to work on patients.*^

Both the rotation system and the ever-changing nature of modern medicinehelped to make continuous professional training a feature of the Korean scene.The end of the war of movement enabled personnel from the general hospitalsdown to the battalion level to train and work simultaneously. Informal but

•‘’Quoted words from EUSAK, Report of ETMD, October 1952, pp. 29-30, file 350.05 (EUSAK)1952, HRB. See also JLCOM, Reports of ETMD, April 1952, pp. 9-10, and March 1952, p. 32, file350.05 (ETMD, Far East, JLCOM, 1952), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B, RG112, MMFB; Japan Logistical Command General Order 67, 19 May 52, MMFB; JLCOM, AnnualReport of Medical Service Activities, 1952, pp. 67-68, file 319.1-2 (JLCOM) Far East-1952, HRB.

•’JLCOM, Report of ETMD, September 1951, pp. 49-50, RG 112, MMFB; FEC, Annual Reportof Medical Service Activities, 1951, pp. 104-05, HRB; JLCOM, Report of ETMD, July 1952, p. 27,file 350.05 (ETMD, Far East, JLCOM, 1952), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B,

(Continued)

THE MEDICS’ WAR

effective were sessions at the medical and dental societies that sprang up inKorea—the 38th Parallel Medical Society, the X Corps Medical Society, theMilitary Preventive Medicine Society of Korea, and the Korean Communica-tions Zone Medical and Dental Society. Despite all its faults the system accord-ed people with interest and ambition an unusual opportunity to learn, for a widerange of teaching was open to all. Classes were well attended, indicating thatmany used their chance to learn new skills and hone old ones in study as well aspractice.

Supply

While personnel fluctuated, supply became more dependable. Over thecourse of 1951-52 a steady influx of zone-of-interior materiel supplanted therapidly dwindling World War II stocks. In some areas—notably pharmaceuti-cals—the capacity of Japanese manufacturers increased. In time. Army unitswere able to utilize sturdier American products. This did not, however, imply aloss of business for all Japanese manufacturers, because the needs of Koreanrelief mounted as the reconstruction of the country began under U.N. supervi-sion. Additionally, supplies from all over the world arrived in the warehouses ofthe Japan Medical Depot, bound for the war-battered nation across the KoreaStrait.

Another burden on medical stocks, both in the Far East and in the UnitedStates, resulted from the presence of increasing numbers of troops sent by otherU.N. nations. Issues of medical supplies and equipment to U.N. forces in-creased in 1951 from about 3 percent of total issues in January to about 22percent in October. As issues to the Republic of Korea (ROK) Army did notincrease significantly, the diversion of supplies to other U.N. forces evidentlycaused the decrease in issues to U.S. troops from 94 to 75 percent during thesame period.’*

In 1951 medical supply operations divided into two phases, as the war did.Up to 10 July the war of movement, with continuous combat, meant high ratesof usage. The opening of armistice talks at Kaesong, signaling the period ofdigging in and limited combat actions, meant lower consumption and, becausemateriel arrived from the zone of interior uninterruptedly, rising stocks in mostgoods. Until May the 6th Army Medical Depot at Yongdung-po remained theonly supply organization in Korea itself; greatly overextended during the ad-vance in late 1950, its scattered advance platoons benefited from the contrac-tion of the front that followed the defeats of November and December. Subse-quent advances underlined the need for a more elaborate system, and in May1951 the 60th Medical Base Depot Company was activated at Pusan. In effect,the 6th and the 60th functioned as forward and rear support units, with the

(Continued)

RG 112, MMFB; FEC and USAFFE and EUSAK, Annual Reports of Medical Service Activities,1952, p. 48 and annex IV, pp. 7-8 and 14-17, respectively, HRB; Korean Communications Zone(hereinafter cited as KCOMZ), Report of ETMD, September 1952, p. 3, file 350.05 (KCOMZ) 1952,HRB.

**FEC, Report of ETMD, December 1951, p. 27, file 350.05 (FEC) 1951, HRB.

239

former serving the combat operations and the latter supplying the Pusan area,requisitioning from Japan, and operating as a transit depot. Located in smallwarehouses on the waterfront, the 60th by year’s end was in process of acquiringnewly constructed buildings for its work.^’

Also in May 1951, the Japan Medical Depot moved from its old quarters inYokohama, which the increasingly busy port authorities needed, to CampBenda, 60 miles northwest of Tokyo. While stocks rose with shipments from thezone of interior, dependence on the Japanese economy continued, particularlyfor support of the ROK Army and for U.N. forces other than Americans. Textiledeliveries for dressings were somewhat unsatisfactory, but Japan supplied manyother items with success.

Striking was the growth of Japanese sophistication in laboratory work andthe production of biologies. Early in the Occupation the Army had establishedtight quality controls over manufacturers to ensure high-quality productsneeded for civilian relief. In 1946 the civil government created a laboratorycontrol section in the Ministry of Health and Welfare to set and enforce stan-dards for the production of biologies. By May 1951, when Japan entered theWorld Health Organization, other Asian nations already were turning to theJapanese for advice and assistance in plant design and construction and forgeneral technical know-how. In vaccines, sera, antibiotics (except for some ofthe newest), and human blood products, Japan was by this time supplying itselfand a substantial part of the Korean civil assistance program as well. The FarEast Command called Japanese production of penicillin “one of the sagas of theoccupation.” From the little that was turned out in laboratories at the end of thewar, production on the islands rose to compete with the leading nations of theworld: By 1951 the Japanese were making 15 trillion units a year. One sign ofthe nation’s remarkable growth in expertise was the fact that the commandroutinely submitted drug supplies from U.N. nations to Japanese governmentlaboratories for assay before including them in medical assemblies or shippingthem to Korea for civilian relief.^®

Despite improvements in its sources of supply, the Japan Medical Depot wasnot without problems. By December 1951 the low level of combat had endedone nagging difficulty—there was at last an adequate supply of litters in the FarEast Command—but short supplies were noted at various times during 1951 ina number of basic items: nitrous oxide (for lack of containers), plasma, fielddressings, and blankets, among others. The tendency of medical supplies to leakaway into Korea’s civilian economy was a factor, notably in the case of blanketsand of items like antibiotics, which brought high prices on the black market.

’Tec, Annual Report of Medical Service Activities, 1951, pp. 142-43; Surgeon’s Circular Letter6, no. 7, Medical Section, EEC, 1 Jul 51, p. 125, file 461 (Circular Letters) EEC; EEC, Report ofETMD, August 1951, p. 24, file 350.05 (EEC) 1951. All in HRB.

^“Quoted words from EEC, Annual Report of Medical Service Activities, 1951, p. 207, HRB. Seealso ibid., pp. 200-12, HRB; JLCOM, Report of ETMD, June 1951, pp. 33-34, file 350.05 (ETMD,Ear East, JLCOM, 1951), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entiy 54B, RG 112, MMEB;Toyko Army Hospital, 8059th Army Unit, Annual Report of Medical Service Activities, 1951, p. 45,file 319.1-2 (Tokyo Army Hospital, 8059th Army Unit) Ear East-1951, HRB; EUSAK, AnnualReport of Medical Service Activities, 1951, p. 79, HRB; Civil Affairs/Military Government PublicHealth Activities, p. 688.

THE MEDICS’ WAR

“The many and varied uses to which some medical items may be misapplied""noted the EEC surgeon, “are too numerous to mention, and are usually quitewell known to all concerned.” Exactly where pilferage occurred—on the ships,in warehouses, on trains—is difficult to determine. On the whole, however,supply personnel were inclined to congratulate themselves on their success dur-ing the year that had seen a transition from the high usage rates and catch-as-catch-can methods of 1950 to a more sedate, elaborate, and well-ordered sys-tem. Few shortages lasted to the year’s end, and 1952 held out some promise ofputting the depots both in Japan and in Korea at last ahead of the game.^^

As the front stabilized, signs appeared of a typically American abundanceverging on excess. In this the medical supply situation was one aspect of a moregeneral trend. Partly the situation was geographic; supplies entered but rarelyleft the Korean cul-de-sac. More important was the changing character of thewar. Not only was combat less steady, but the American people sought tocompensate the few who bore the burden of the fight by attempting to reproducefor their benefit at least some of the comforts of home. Ice cream machines,snack bars, theaters, and PXs began to dot the landscape, often surprisingly farforward. (Every soldier and marine was supposed to receive at least one servingof ice cream a week.) American troops enthusiastically seconded this trend.Commanders and men alike gathered into bunkers, camps, and unit areas asmuch impedimenta as they could to improve the quality of life. Wherevermunicipal water supplies became available, flush toilets, sinks, and showerbaths followed. The official logistical history somewhat dourly warned that “it isthe exception rather than the rule [in war] to provide telephones, space heaters,and PX radios in every squad bunker, or thousands of rounds of artillery fire torepel local enemy attack.” Encased in body armor, longing for his rest andrecuperation (R&R) leave, and counting the days to his rotation date, the Amer-ican soldier comforted himself with consumer goods—a habit learned athome—while enduring an assignment that was still bleak and dangerousenough.^^

Transport reflected the new situation. The generally lower level of combatreduced the need for supplies, and its more predictable course meant that allmedical supplies except whole blood, vaccines, biologies, and goods needed tomeet sudden emergencies could be sent by sea. Transferred from the docks bytruck to the medical depot in Pusan, materiel moved direct from the depot toU.N. troops in the area; to ROK Army medical depots; to the 25th EvacuationHospital at Taegu, which supplied all U.N. units in that area; to the 171stEvacuation Hospital in Taejon, which filled the same role there; and to the 6thArmy Medical Depot for distribution to troops in the Seoul area and to theadvanced platoons at Uijongbu (I Corps), Chunchon (IX Corps), and Yanggu (X

^'Quoted words from Surgeon’s Letter 6, no. 7, Medical Section, FEC, 1 Jul 51, p. 125, HRB. Seealso FEC, Report of ETMD, September 1951, pp. 22, 25-28, file 350.05 (FEC) 1951; FEC, AnnualReport of Medical Service Activities, 1951, pp. 144-45; EUSAK, Annual Report of Medical ServiceActivities, 1952, annex V, p. 4. All in HRB.

^^USAFFE and EUSAR, “Logistics in the Korean Operations,” vol. 1, p. 11, RG 319, MMHB.See also FEC, Annual Report of Medical Service Activities, 1951, pp. 39, 74-75, HRB.

241

Corps). Supplies for UNCACK wereturned over to the Korean ForwardingCompany, a civilian concern, for ship-ment to another civilian establish-ment, the Korean Medical Company,a contractor with the South Koreangovernment’s Office of Supply.

From the Japan Medical Depot tothe forward platoons, integration andquality of service improved steadilyduring 1952. No critical shortages oc-curred. An agreement with the AirForce led to a mutually satisfactory al-location of medical supplies betweenthe two services in Japan. Procure-ment for the Army’s needs from civil-ian sources was in decline throughoutthe year as shipments from the zone ofinterior more closely approximatedneeds. In 1951 about 50 percent of ex-pendable supplies needed for the ROKArmy and for POWs had come fromJapan; in 1952 the percentage was reduced to 15. But civilian aid procurementsincreased, not only because the relief program was expanding but also becausethey were cheaper and of constantly improving quality. The Japan LogisticalCommand boasted of a “very healthy relationship” between the Medical Serviceand Japanese suppliers. Clearly, it was healthy for the manufacturers. By theend of September they had sold $4.5 million of goods, including $2.8 millionearmarked for Korean relief, to the Army for medical purposes alone.^'^

Of considerable importance from the medical angle was the improving quali-ty of food delivered to the troops in Korea. During much of the early fightingfield rations were in short supply, and to conserve canned rations against need,the quartermaster shipped in fresh foods. The soldiers’ taste for such items didnot dissipate with the stabilization of the front, particularly as supply becameeasier. Troops continued to demand two hot meals a day, battle permitting. Inthe spring of 1952 over half the dinners and suppers served on the line were saidto include some fresh meat. Some 20,000 tons of steaks, eggs in the shell, freshpotatoes, lettuce, and fresh fruit each month went northward from Pusan. Notonly the Japanese hydroponic gardens but also refrigerator ships from the zoneof interior brought the food in. Supplies were transferred to cold storage bargesin the Korean ports and sent to the front by “reefer” cars on the trains of the 3dTransportation Military Railway Service. Technical improvements made even

^^KCOMZ, Annual Report of Medical Service Activities, 1952, End 6, HRB. Relief activities aretreated in Chapter 11 of this volume.

^“Quoted words from JLCOM, Annual Report of Medical Service Activities, 1952, p. 60, HRB.See also EEC and USAFFE, Annual Report of Medical Service Activities, 1952, pp. 75-76, HRB.

Checking the 6th Army MedicalDepot Narcotics Supply

THE MEDICS’ WAR

the dehydrated and canned foods, familiar from World War II, more palatable.Though 10 to 15 percent of the food shipments was lost to pilferage, Americansoldiers probably ate better in Korea than even their own well-nourished prede-cessors during most of the Second World War.^^

Food supply was, of course, a Quartermaster responsibility, but members ofthe Veterinary Corps continued their accustomed work as food inspectors.(Their other duty, caring for Army animals, was minimal because the only onesin the command were 144 war dogs, of which 7 were in Korea at the end of1951; furthermore, the health of the dogs was very good.) Food inspection work,by contrast, was heavy. In one month taken at random—January 1952—nearly793 million pounds of food had to be inspected; over 850,000 pounds wererejected. Besides the imports from the United States a variety offood—including fruit, swordfish, vegetables, recombined milk, and icecream—was produced in Japan, though only the fruit and fish came fromJapanese sources. To carry out inspections, by the end of 1951 thirteen veteri-nary units operated in Japan and six in Korea.

The feeding of an international force presented unique challenges to allconcerned. The ROK Army ate only one large meal a day—an Oriental ration offish, kelp, rice, and beans—but snacked at other times, and exhibited a bound-less appetite for hot peppers. Inspectors baffled by Korean labels on cannedgoods sometimes found their Korean assistants as helpless as themselves; edu-cated under Japanese rule, they could read that tongue but not their own. Turkswould eat pork in battle or in camp, but in hospitals often felt religious qualmsand refused it. Greeks preferred their own food but would eat American rations,if pressed. (A request from a Greek Orthodox priest for “virgin” lambs forEaster was met with young male lambs, “which proved entirely satisfactory.Because many supplies, especially for the Koreans, came from Japanese sources,veterinary officers had to learn the names of Japanese fish, of which there werealtogether too many, and to accept the fact, difficult for American sensibilities,that the penicillin-like mold that grew on air-dried fish was harmless.

Though surprised by such variations in military service where standardiza-tion was the rule, the Army tried to meet the tastes of its allies as far as possible,obtaining from Japanese producers a porkless ration for Moslems and a stan-dard oriental ration that met ROK Army tastes. The chief questions remainingabout the latter were its nutritional value, and, after it passed out of Americanhands, its distribution to the troops on the line.^"^

The depletion of World War II stocks, increased zone-of-interior shipments,and the shift of local goods to the relief program reshaped the supply picture

^®Samuel Milner, “Time and Space,” ch. 5, p. 136, Ms no. 2-3.7B AA, RG 319, MMHB. Oncontinued veterinary food inspection work, see FEC, Annual Report of Medical Service Activities,1951, pp. 38-45, HRB.

^^JLCOM, Annual Report of Medical Service Activities, 1951, p. 115, HRB.

^Above paragraphs are based on ibid., pp. 112-16, HRB; FEC, Annual Report of MedicalService Activities, 1951, pp. 38, 41-45, HRB; Ltr, Headquarters, JLCOM, to Commander in Chief,FEC, sub: Organization of Veterinary Food Inspection Detachments, End to DF, Medical Section,JLCOM, to Staff Sections G-4, G-3, C/S, AG, JLCOM, 21 Nov 50, tab 2, document 14, MedicalSection, JLCOM, Command Report, 1-30 Nov 50, Narrative Summary [and Documents], file

243

during 1952. Reduced fighting, growing accumulations in the using units andthe maturing of the transport system changed the character of the soldier’sexperience. The lot of the fighter in any war is by definition harsh, but by thatlow standard American soldiers in Korea had passed from the chaos of mid-1950 to relative prosperity. The static front, control of the air, and the nature ofthe war itself had brought them to a “pampered” state that critics deplored butdid not offer to share. The medical system kept pace, delivering sophisticatedequipment like electrocardiograph machines to forward hospitals and maintain-ing a steady flow of all necessities to the front in a war that now had become,and seemingly might long remain, part of the order of things.

The Blood Program

No single medical item was more important than blood, and its supply was aspecialized program stretching from the zone of interior to the battlefield. Basicboth to its value and to many of the problems encountered in handling it wasthe fact that whole blood is a living tissue, obtainable only from human subjects.To be usable, blood had to be treated to prevent clotting, stored at 38°-42°F,and used within twenty-one days. During transport it had to be handled careful-ly to prevent the oxygen-carrying red cells from being destroyed. A part of thebody of the donor, and consequently reflecting his state of health, both wholeblood and plasma (the fluid part of the blood) had to be carefully controlled toprevent the spread of disease. Because the results of new tests revealed that thedanger of transmitting serum hepatitis was much greater than previously real-ized, the use of plasma during the Korean War tended to give way to serumalbumin and synthetic plasma expanders. The lifesaving qualities of wholeblood, however, were so remarkable that its use grew steadily, though no meansof sterilizing it were known.

The year 1951 saw the blood program established during the first months ofthe war grow and matured. In September the secretary of defense set up theArmed Forces Blood Donor Program, with centers at thirty-one major militaryinstallations across the country. The Red Cross rapidly increased its own capaci-ty to obtain and process blood. Plasma-processing plants were operating at fullcapacity. Blood collections continued high well into 1952, but fell off in May. InOctober, responding to the fierce fighting of that month, they rose again, only tofall thereafter in response to the general national disillusionment with the war.Throughout, the Red Cross supplied about three-fourths of the blood, the armedservices the rest. Besides obtaining blood the laboratories typed and otherwiseclassified it, and processors salvaged serum albumin from blood unsuitable for

AYUT-8000, Annex 24 (Medical Section, JLCOM, Nov 50), Box 4623 (JLCOM, AYUT-8000,Annexes 19-28, Nov 50), Entry 429, RG 407, MMFB.

^*This section is based upon the following sources: Kendrick, Blood Program in World War II, pp.713-806; copy of Article, Lt Col Spurgeon H. Neel, Jr., MC, Commander, 30th Medical Group,“Forward Distribution of Whole Blood,” HSF (Neel Articles), HRB; Supply Division, OSG, Sum-mary of Major Activities, 9 Sep 51-31 Dec 52, pp. 1-2, file 314.7-2 (Army Medical ServiceActivities, 9 Sep 51-31 Dec 52), HRB.

THE MEDICS’ WAR

plasma, from overage blood, and fromcontaminated plasma. From the zoneof interior. Type O blood, especiallythe low titer universal donor varie-ty—so called because it caused fewerproblems than other nonmatchedtypes when administered to Type Aand Type B recipients—was shippedto the Far East, most of it being senton from the 406th Medical GeneralLaboratory to Korea.

Once in Korea blood movedthrough the supply system much likeany other critical item, though medicalofficers often called for special treat-ment of a most unusual and fragilesubstance. In medical depots bloodwas stockpiled and the oldest that wasusable issued to the hospitals—a rea-sonable arrangement but one thattended to increase the age of the bloodby the time it got into the recipients’veins. With nine or ten usable days left for most when it reached Korea, theblood actually transfused was from nine to twenty days old.

Air transport was the key to the successful forward use of whole blood. Bloodwas flown by the Military Air Transport Service (MATS) to Travis Air ForceBase in Oakland, California. Here the Armed Forces Blood Processing Labora-tory examined and repacked it. MATS planes then carried it via Hawaii andWake Island to Tokyo. Again traveling by air to the depots at Pusan and Seoul,and by fixed-wing aircraft or helicopter to the forward depot platoons in thecorps areas, containers of blood completed the journey to the MASHs onmedevac helicopters, strapped into the pods like casualties. As with casualties,the two great advantages of air travel were speed and smoothness. Blood arrivedin time and in condition to be used, which was not always true after spendinghours or days in transit over the cocktail-shaker Korean roads. Though wastageoccurred, in considerable part because of the widely fluctuating needs of thefront once the static phase of the war began, the Far East Command judged theblood supply system on the whole an “extreme success” and a continuing key tothe remarkable survival rates in the hospitals of both Korea and Japan.^’

The problem of hepatitis in plasma proved, however, insoluble during theKorean War. Armed with new tests for detecting subclinical hepatitis, hospitalsin Korea found rates that reached 23 percent among men who received multipletransfusions of plasma and whole blood. Investigations by the Armed Forces

Medics AdministeringBlood Plasma

”FEC and USAFFE, Annual Report of Medical Service Activities, 1952, pp. 41-42, HRB.

245

Epidemiological Board and the National Research Council showed that ultravi-olet radiation did not destroy the virus in plasma. Unlike whole blood, plasmahad no oxygen-carrying ability and functioned in hemorrhaging patients merelyas a filler for the vascular system, preventing a disastrous fall in blood pressure.The problems with plasma turned the attention of investigators to other bloodsubstitutes that might accomplish the same goal with less risk. Serum albumin, anatural protein prepared from blood or plasma, proved to have marked advan-tages. It was not infectious and could be stored easily and used by medics in thefield to stabilize the wounded for their journey to a MASH, where whole bloodwas available. Another substitute was Dextran, a commercial product madefrom sugars that increased the fluid within the vascular system by drawing itfrom the surrounding tissues. Despite its dehydrating effect it too proved useful,especially to unit aidmen and in battalion aid stations. By such means theMedical Service attempted to minimize the problem of secondary infectionuntil a conclusive answer was found.

Preventive Medicine

Apart from the baffling mystery of serum hepatitis, spread by the verytransfusions that saved life, the record of the medics was generally one ofimproving control over the sources of disease, even hemorrhagic fever.^" Theother form of hepatitis—the infectious variety that was endemic in Ko-rea—reached near epidemic proportions during 1951. But change was on theway. The Army had developed an iodine water purification tablet shortly afterWorld War II but had hesitated to employ it because of fears that it might provetoxic. Tests showed, however, that ingestion of the amount needed was notharmful, and as a result Halazone tablets, long proved unsatisfactory afterstorage, were withdrawn and iodine tablets issued.

Chlorine also continued to have value in water purification. Troops locatednear municipalities increasingly drew their water from civilian supply systemsand adding chlorine provided a margin of safety. In the Eighth Army, thestandard field requirement rose from 1 to 5 parts per million. In response to thischange, and to the slackening of combat that enabled troops to drink treatedwater, the infectious hepatitis rate fell from 33 to 12 cases per 1,000 per annum.With canteen water disinfected, engineer water supply points multiplying, andmunicipal supplies hyperchlorinated, hepatitis and many enteric diseases as wellwere brought under better control during late 1951 and 1952 than at any timesince the outbreak of fighting.^*

Control of pests and disease vectors generally improved, though with one ortwo exceptions of note. Insect and rodent control in Korea was carried out byone preventive medicine company and a number of smaller units. The larger

“As a problem mainly of the forward areas, epidemic hemorrhagic fever is treated in Chapter 6of this volume.

^'FEC, Annual Report of Medical Service Activities, 1951, pp. 65-66; extract from TSG Notesno. 8, April 1954, p. 7, HSF (TSG Notes-1954). Both in HRB.

THE MEDICS’ WAR

Dusting for Mosquitoes with an improvised device

unit—designated the 37th Preventive Medicine Company after reaching the FarEast—was a new type of organization that quickly demonstrated its value.Serving with the IX Corps, the company provided one control section for eachdivision; its members conducted training sessions for the troops, mixed andprovided poisons, carried out field work, made sanitary inspections, and collect-ed water samples and insect specimens for testing. The company’s officers wereentomologists or sanitary engineers, and its enlisted men had received trainingin one or more phases of preventive medicine. The company proved so usefulan innovation that the Medical Service began to train a second in the zone ofinterior.^^

In cooperation with the Air Force, planes were used in what the Far EastCommand called the “largest military spray program ever conducted. UnderMaj. William M. Wilson, four aircraft began to fly missions in June 1951,spraying a 20-percent DDT emulsion over some 370,000 acres. Repeated flightswere necessary to supress insect (especially fly) populations, which tended torise quickly after each treatment. Major cities and airfields were the favoredtargets, with special missions to the Munsan peace conference area. As usual, it

^TEC, Annual Report of Medical Service Activities, 1951, pp. 60, 67, HRB; “New Type of ArmyMedical Company,” Military Surgeon 108 (January 1951): 65-66.

”FEC, Annual Report of Medical Service Activities, 1951, p. 67, HRB.

247

was difficult to separate the various factors influencing disease rates. Malaria,for example, peaked in early summer at a rate of only 18 cases per 1,000 troopsper annum, markedly lower that its maximum of 31 the year before. Possiblecauses included the fact that prophylaxis was more rigorously enforced, thatweather was unfavorable to mosquitoes, that ground sprayers were at work aswell, and that the new face of the war separated combatants from civilians morecompletely than before. Whatever the reason, diseases borne by insects andother arthropods were markedly less important than in the past. One seriousdisease, Japanese B encephalitis, almost disappeared.

Unfortunately, malaria became a problem in Japan as it ceased to be one inKorea, for returning personnel infected the local anophelines, which in turnattacked a population with little natural resistance. Troops returning to the zoneof interior also had frequent relapses on shipboard, a sharp reminder of the factthat chloroquine suppressed the symptoms of malaria but did not kill the para-sites. In December the new antimalarial primaquine came into use, a promisinginnovation because tests indicated that it killed the Plasmodia in the tissues ofvictims.^^

The environmental dangers of using broad-spectrum insecticides were littleappreciated at the time. Soon, however, it became apparent that body lice inKorea—probably because of immunity developed during earlier spray cam-paigns—were becoming DDT-resistant. At first medical personnel thought thatthe DDT in use must be old, and they obtained freshly made supplies. When thenew DDT also proved ineffective, search for another insecticide began, with thespecter of possible typhus epidemics to encourage speed. Experiments in Koreaduring the summer of 1951 included new reliance on an old standby, pyreth-rum, and trials of 1-percent lindane (benzene hexachloride), then in agriculturaluse in the United States. Lindane proved effective, and by the end of the yearthe 38 th Preventive Medicine Control Detachment reported that two applica-tions reduced the lice problem among some POWs—the worst afflicted group inKorea because of initial infestation, crowding, and restricted movement^—from92 to 0.9 percent. Meanwhile, studies in Japan showed again a highly specificresistance in lice to DDT, further evidence that the substance, for almost adecade the nuclear weapon of the war on noxious insects, was losing its punch.^^

Other diseases demanded quite different methods of control. In December1950 the surgeon general had warned of a possible influenza epidemic in Korea,and by January 1951 the case rate had risen in the Far East Command to 203per 1,000 troops. On 22 January the command ordered all U.N. troops immu-nized against influenza. Thereafter the disease fell off, though rates throughoutthe command remained higher than in 1950. Venereal disease (VD), as usual,showed an inverse relationship to the level of combat, rising in Korea as thefront stabilized and the intensity of fighting fell. Narcotic addiction was report-ed a problem in some parts of Korea, reflecting the ready availability of bothmarijuana and heroin. Poliomyelitis was relatively more common, the bulbarform in particular exhibiting a high mortality rate, and tuberculosis began to

^Ibid., pp. 51-52 and 67-68, HRB.

^®FEC, Annual Report of Medical Service Activities, 1951, pp. 69-72, HRB.

THE MEDICS’ WAR

rise among Americans in both Korea and Japan. Probably for genetic reasons,blacks were especially susceptible. No disease, however, was of major militaryimportance.^*^

Overall, the changes that appeared in the disease picture during 1951 re-flected, not medical innovations, but political and military events. The signingof the Japanese peace treaty meant more contacts between Americans andJapanese and consequent dangers to both. In Korea the stabilization of the frontdrastically altered the possibilities of preventive medicine and, as the rise in VDrates showed, increased the prevalence of some ills while enabling medics tosuppress others more effectively. The rotation system, R&R leave, and theintroduction of dependent travel to Japan all produced movements of peoplethat implied the spread of disease. When all was said and done, however, thepositive signs far outweighed the negative.^^

The following year saw many of these trends continue and intensify. Theactivation of the KCOMZ brought into being a headquarters where preventivemedicine throughout the rear areas was a matter of major concern. At the end of1952 the command reported that the health of the troops was, all things consid-ered, amazingly good. Systematic immunization, begun in 1950 and carried onthrough 1951 and 1952, was basic to the soldiers’ ability to resist the localdisease environment. Increasing numbers now were housed in permanent orsemipermanent quarters. Messing facilities were good, and the men themselveswere said to be showing considerable self-discipline in avoiding contaminatedwater and food, in great measure because their own rations were palatable andcommissary liquor was abundant and cheap.

Another key to success was the fact that the KCOMZ by this time had fourpreventive medicine units operating within its boundaries: the 38th, 152d, and154th Preventive Medicine Control Detachments, and the 219th PreventiveMedicine Survey Detachment. The 38th was assigned to the Prisoner of WarCommand and the 152d to the Korea Base Section. The 154th, headquarteredin Pusan, supplied groups of one to five technicians for special assignment tomeet local problems, and the 219th served the entire KCOMZ. Upon these unitsfell the responsibility of controlling what the command surgeon called the “‘en-tomological theater’” of Korea, performing work similar to that of the preven-tive medicine company in the forward areas.

The two great medical problems of the forward areas—hemorrhagic feverand cold injury—were nonexistent in the communications zone. The mainexceptions to the generally happy picture were infectious hepatitis—much re-duced by chlorination but still too high—and that traditional problem of thezone, venereal disease. The command surgeon traced the continued incidence ofhepatitis to three factors. Most, he noted, occurred in the Pusan area, a center ofthe drug traffic and drug addiction, and he raised the question of whether the

“EUSAK, Annual Report of Medical Service Activities, 1951, pp. 20-21, HRB.

^’FEC, Annual Report of Medical Service Activities, 1951, pp. 57-59; Ltr, Col C. C. B. Warden,Adjutant General, EEC, to Commanding General, JLCOM, et al., 11 Aug 52, sub: ReciprocalReporting of Communicable Diseases Between United States Armed Forces in Japan and JapaneseHealth Authorities, app. II, Preventive Medicine Division sec., FEC and USAFFE, Annual Reportof Medical Service Activities, 1952, HRB.

249

two might not be connected. Occasional slips in personal discipline, primarilyfrom drinking nonpotable water or eating seafood or fruit displayed in the streetstalls and markets, might also be a source. Finally, and seemingly most impor-tant in his eyes, he cited the large and increasing use of Korean food-handlers inmesses, clubs, snack bars, and railroad diners. Many surveys had shown thatKoreans of the laboring class were all parasitized in some degree; it seemedreasonable that such people might be a source of hepatitis as well.

As for venereal disease, rates were high and climbing, in 1952 jumpingbetween September and November from 176.8 cases per 1,000 troops per an-num to 202. The KCOMZ began to construct prophylactic stations in Koreancities, sought wider cooperation from South Korean authorities in treating thecivilian population, set up a Public Health Advisory Council composed ofmedical officers from its major commands, and began trials of oral penicillintherapy in hard-hit Taegu. The usual calls for “wholesome entertainment” forGIs were heard again. The zone surgeon found fundamental problems, however,in the extraordinary number of prostitutes, both registered and unregistered.Korean authorities followed traditional practice by informally licensing brothelsand inspecting their inmates; the U.S. Army’s policy of either breaking uphouses of prostitution or putting them off limits, Koreans pointed out, merelydrove women into the streets and put a premium on uncontrolled streetwalking.The Americans countered that actual Korean practice was extremely haphazard,with insufficient treatment of diseased women and poor contact tracing. Be-cause both accusations were probably true, and because the military and civilauthorities were at loggerheads over policy, the prospects for improvement inVD rates did not, at year’s end, appear to be very good. It was also true thatinfection on the average of one man out of five once a year did not, withantibiotic therapy, represent a very serious drain on job performance.^*

Psychiatry in the Korean rear areas showed trends which fitted in well withthe patterns of physical disease. Neuropsychiatric disorders in the KCOMZwere higher than in the American Army as a whole, though “not . . . exces-sive” in the judgment of the zone surgeon. Among causes he cited the “boredomof service in Korea,” which certainly had not been a difficulty during 1950.TDY to Japan came too seldom; places for sightseeing, given the continuingpresence of guerillas, were few. He noted, however, that the shortage of “hobbyshops, day rooms, special service activities and equipment, service clubs and thelike” was rapidly being corrected. The nature of the war was probably the rootproblem in that a sense of futility underlay many apparently superficial com-plaints. American soldiers simply did not feel any longer that they were part of asignificant endeavor. Against this background the erratic supply of replacementsand lack of promotions caused serious morale problems, for every revision inthe point score for rotation had “a shattering effect.” Such changes were, ofcourse, particularly noticeable in the rear areas, because the Far East Command,if faced with a shortage of replacements, would lengthen the time of service

Above paragraphs are based on KCOMZ, Annual Report of Medical Service Activities, 1952,end. 3, pp. 1-2 and 4-7, HRB. The hepatitis associated with drugs was actually serum hepatitisspread by infected needles.

THE MEDICS’ WAR

troops rather than that of men on the line. What the headquarters found tobe—and in fact was—reasonable and just often appeared to those affected as aheartless “manipulation” of rotation dates. Meanwhile, the well-nourished mo-notony of military life was surrounded by the “squalor, poverty, wretchedness,malnutrition and disease” of a wrecked and ravaged land—a comfortlessprospect.^’

Narcotic addiction raised minor furors in the press every few months,though the Far East Command judged the rate to be “not . . . anything alarm-ing.” However, heroin was cheap in Korea—between eighty and ninety cents forabout 65 milligrams—and was the most commonly used hard drug. A fairpercentage of users did not appear to be addicts but rather exhibited a socialpattern of indulgence, similar to the ordinary use of alcohol, which the com-mand found surprising. Use in Korea was spotty, “two or three persons in somecompanies with four or five hanger-ons [^/c].”Aside from suggesting that a fieldfor research might exist, the neuropsychiatric consultant apparently found nocause for concern in the phenomenon.'*”

Dental Care

The dental service reflected the tendency toward improved care. The armedforces had 2,358 dentists on 1 July 1950 and 5,729 one year later. In the FarEast Command the number of dentists, with few exceptions, was adequate; butfor a very few months. Eighth Army figures hovered within 5 percent of theauthorized strength. Replacements were sufficient in numbers, though some-times spasmodic in their arrivals. Normally, new men requested and receivedforward duty, often at division level, in order to earn rotation points as quicklyas possible and to finish their military tours in more agreeable locations thanKorea. Customary problems remained in the lack of adequately trained enlistedmen, especially well-qualified dental laboratory technicians. Replacements of-ten arrived at their assignments with long-neglected mouths that requiredlengthy work in the dental chair and prostheses. A survey in late 1952 onreplacements in a field artillery battalion showed that 6.5 percent needed emer-gency treatment, 15 percent prostheses, 43 percent immediate treatment ofadvanced dental conditions, 33 percent preventive or corrective action, andonly 16 percent no dental work at all. Such conditions, the result of personalreluctance to face the dentist as long as possible plus the Army’s failure tosurvey and treat men adequately before shipping them overseas, needlesslyburdened the Far East Command. They were, however, quite in line with theexperience of earlier years.'**

'’Ibid., p. 3, HRB.

’"First quotation from FEC and USAFFE, Annual Report of Medical Service Activities, 1952, p.89, HRB. Second quotation from MFR, Wayland L. Speer, Chief of Narcotic Control Bureau,Public Health and Welfare Division, Medical Section, SCAP, 26 Jun 51, sub: Staff Visit to Korea byChief, Narcotic Control Division, p. 3, file Korea-Narcotics, Box 3178 (Public Health and Welfare,Medical Section, FEC, Korea-Civil Affairs to Korea-Relief and Welfare), RG 338, MMFB. See alsoLtr, Speer to Commissioner H. J. Annslinger, Bureau of Narcotics, Treasury Department, 27 Jul 51,file 441.1 (Narcotics), Box 3171 (Public Health and Welfare, Medical Section, FEC, 1951), RG 338,MMFB.

““Extract from Office of the Secretary of Defense, Annual Report of the Armed Forces Medical

251

With the stabilization of the front,dentists began to do a great deal moredentistry and less emergency filling infor surgeons. The general tendencywas to increase dental staffing for-ward. During 1952 one oral surgeonwas attached to each of five MASHs togive added support to front-line units.

Each of the Eighth Army’s two evacua-tion hospitals had one dentist and oneoral surgeon. Evacuation hospitalsprovided some outpatient services,and the MASHs made their X-ray fa-cilities available for unit dental of-ficers in their areas. In the divisions ofthe Eighth Army all eighteen DentalCorps officers were assigned to themedical battalion but were attached tovarious units as the situation might re-quire. Usually, one dental officer wasneeded in each regimental collectingstation, in the replacement company, and in the division headquarters. Battal-ions serving in difficult or remote locations often received their own dentist,principally field artillery and antiaircraft units and combat engineers. The divi-sion dental clinic was an innovation that was proving itself in practice.

Additionally, the Eighth Army had in the 163d Medical Battalion an organi-zation that provided, among other functions, a dental service throughout theArmy area. The battalion controlled several dispensaries, eleven dental operat-ing detachments, and a dental prosthetic detachment. The battalion took up anyslack by sending help to needy units.

In the field the lot of the itinerant dentist was often difficult, strapped forshelter and for electric power to run his lights and drill. Dentists permanentlyattached to units showed considerable skill at digging in. Their tents wereframed and floored and usually set into the south slope of a hill, or against thedefilade of an east- and west-running ridge. Where possible, dental officers usedbunkers solidly constructed of logs, railroad ties, or bridge timbers. The framedsemicylindrical Jamesway tent (usually called “Janeway”) was, however, a darkplace when several sections were joined together, for the only windows were onthe ends. Except for the mobile prosthetic units that carried their own powersource, dentists were dependent on an outside source for electricity, or on smallportable generators that often worked poorly. With a chair, his dental field

Forward Dentistry

Policy Council to the Secretary of Defense, pp. 6-7, HSF (AFMPC-1951), and from ibid., sec. 13,tab 34, p. 168, file 334 (AFMPC, 30 Dec 49-1 Apr 53), Box 24, RG 112, MMFB; EUSAK, AnnualReports of Medical Service Activities, 1951 and 1952, p. 36 and annex IX, pp. 1-9, respectively,HRB.

THE MEDICS’ WAR

Interior of a Jamesway (“ Janeway”) Tent

operating chest, and electricity, the Dental Corps officer was ready for work, ofwhich there was seldom any lack/^

Dentists assigned to rear areas had little to report after 1950, except thefamiliar problems among replacements and dependents and ongoing improve-ment of facilities. In Japan, clinics and dispensaries tended to remain in oneplace for lengthy periods, adding to the increased sense of regularity and orderamong those who worked in them. The number of dentists was adequate, andthe rapidity of air evacuation from Korea enabled the dental consultant torecommend primary closure of maxillofacial wounds after temporary debride-ment—an important matter from a cosmetic standpoint because early woundclosure resulted in less scarring. Oral surgeons usually found wounds fresh anduninfected, and their own numbers were adequate to the lessened casualtyload.^^

■‘^EUSAK, Annual Report of Medical Service Activities, 1952, annex IX, pp. 1 and 6, HRB.“^JLCOM, Annual Report of Medical Service Activities, 1952, pp. 71-78, HRB.

MEDICAL SUPPORT BEHIND A STABLE FRONT

253

Military and Civilian Consultants. Left to right: Col. John M. Salyer, Lt.Col Haskell K. Ziperman, Dr. Edward D. Churchill, Brig. Gen. L. Holmes Ginn,Jr., Dr. Paul W. Sanger, Lt. Col William S. Cornell Col. Oral B. Bolibaugh, andCol Joseph R. Shaeffer.

Of Professional Interest

The work of the FEC consultants continued along familiar lines, interview-ing newcomers, recommending assignments in their own specialties, and carry-ing out tours of inspection. Instruction remained a basic duty, the consultant’slectures deriving much of their influence from his professional reputation, expe-rience, and expertise, rather than from his position in the military hierarchy.The consultant’s manner toward more junior physicians and surgeons was clear-ly derived from the tradition of ward rounds in teaching hospitals. The surgicalconsultant wrote in 1951 that

during visits to hospitals, professional ward rounds were made with members of thesurgical staffs. At all times the Consultant assumed the attitude of a friend and counselorwho was willing and desirous of being of help professionally. Suggestions were made indifficult or complicated cases. Mistakes . . . were brought to the attention of thoseresponsible, in a spirit of friendliness ... to the end that the Consultant (at least, so we

THE MEDICS’ WAR

sincerely hope) was looked upon, not as an inspector or fault finder, but as a colleaguehaving a paramount interest in the welfare of the patient and in the service.'”

Youth and inexperience in military surgery characterized most of the hugenumber of new men who arrived during 1951, obliging the consultant to dis-tribute the “sprinkling of Board eligible and Board certified officers ... as wellas possible throughout the Command.Whenever possible, new surgeons wereassigned to hospitals in the Japan Logistical Command before being sent toKorea. Here they could learn from both veteran soldiers and men returned fromthe battlefront and could observe at firsthand the consequences of proper andimproper procedure in forward hospitals. No consultants as such were assignedto the KCOMZ; specialists working there doubled as consultants. Frequentvisits from those in Japan provided an attraction for the monthly meetings ofthe Korean Communications Zone Medical and Dental Society, held at Pusan,Taegu, and Taejon.

Deficiencies in the supply of critical specialists continued, mitigated by thereduced work load. Rising numbers of orthopedic surgeons during 1951 com-bined with lessening combat activity to make a continuing shortage less acute.General surgeons were trained in orthopedic procedures and, reassigned to theMASHs, in many instances did outstanding work. Changes on the battlefieldand the rotation policy directly affected the nature and quality of surgical work.The advent of body armor noticeably reduced injuries to the trunk and in-creased proportionally the number of wounds to the extremities. Artillery duelsacross the entrenched lines meant increased injuries from shell fragments, alsomostly to the extremities, for even when fragments penetrated the armoredvests, the wounds were usually quite superficial. Chest injuries tended now to bethe result of crushing forces, such as the blast effect of nearby explosions, or theresult of direct impacts from high-velocity missiles. In October and November1952 a large number of men with infected wounds reached the hospitals inJapan. The reason was not only the increased combat during October but alsothe arrival in the Eighth Army and the KCOMZ of a large number of surgicalreplacements with hardly any experience in the treatment of massive traumas ina septic environment. The patients were inadequately debrided, and at least tworequired lower extremity amputations that should not have been necessary.Energetic activity by the FEC orthopedic consultant and the Eighth Army surgi-cal consultant—with frequent lectures and demonstrations—apparently endedthe problem by mid-November.

The general lessening of combat allowed patients to be held longer in thetheater and more elaborate procedures to be undertaken. Generally speaking,the duties of forward hospitals in handling wounds were to perform adequatedebridement, leaving most wounds open; to stop bleeding; to treat shock; and toprevent infection. In the KCOMZ every effort was made to close wounds as

'^FEC, Annual Report of Medical Service Activities, 1951, pp. 15-16, HRB. Quotation on p. 24.^*Ibid., p. 25, HRB.

Men at Work in a Surgical Research Team Laboratory

soon as possible after the fifth day. Physical therapists worked closely withorthopedists to restore function to injured limbs. Fracture victims could now beheld long enough for callus—a flexible tissue formed by the body as the firststage in healing a break—to form, avoiding complications caused by attempts tomove the patient prematurely. Nailing, or pinning, of broken long bones wasroutine. Though no attempt at elaborate reconstructive surgery was made in thetheater, treatment of chest wounds had become so effective that only occasionalevacuations to the zone of interior were necessary. For all wounded who reachedmedical installations, the mortality rate declined from World War IPs 4.5 per-cent to 2.1 percent in 1951 and again to 1.8 percent in 1952.'*^

Research teams continued to visit Korea, bringing and seeking new ideas,methods, and data. In 1951 the Office of the Surgeon General’s Research andDevelopment Board listed nine: in surgery, anesthesia, wound ballistics, coldinjury, field investigation, malaria, DDT-resistant lice, dysentery, and hepatitis.The malaria team’s primary function was to study primaquine; that of thehepatitis team was to study the hospital management of the patient. Studies bythe wound ballistics team led to more rigorous enforcement of the rule that steel

‘“Ibid., pp. 18, 25-26, HRB. See also ibid., 1952, pp. 38-39, HRB. Rates for 1950 do not appearin the records, due to the chaotic conditions of the time.

MEDICAL SUPPORT BEHIND A STABLE FRONT

255

THE MEDICS’ WAR

Litterbearers Carrying Casualties to a Hospital Train

helmets were to be worn by combat troops at all times. Methadone as a mor-phine substitute was still undergoing trials, which generated favorable reports.The field investigation team aimed to pinpoint important field medical andsurgical problems. A practical result of its efforts was the introduction in 1951of a new field dressing for wounds and bums.

The surgical research team was especially prolific in its studies of the clinicalmanagement of war casualties. Though research in combat theaters dated fromWorld War I, it was further systematized in Korea as a policy of the MedicalService and the Department of Defense. Under Dr. Fiorindo A. Simeone ofWestern Reserve University and later under Capt. John M. Howard, the teamfound a home at the 11th Evacuation Hospital on the relatively quiet easternsector of the front. Here and at the MASHs team members practiced and taughtarterial repair and also studied kidney and liver damage, bum treatment, andother types of wounds. Emphasizing the dynamic and pervasive effects ofwounding, Howard and his colleagues helped to make the Korean War alandmark in battlefield medicine.'*^

^TEC, Report of ETMD, June 1951, p. 29, file 350.05 (EEC) 1951, HRB; Medical Research andDevelopment Board, OSG, History of the Korean Conflict: Summary of Activities, 25 Jun 50-8 Sep51, p. 3, file 314.7-2 (Army Medical Service Activities, 25 Jun 50-8 Sep 51), HRB; Howard, BattleCasualties in Korea, 1:1-12. Accounts of some specific contributions by the team are given inChapters 6 and 7 of this volume.

257

The Flow of the Wounded

All these varied activities had meaning, of course, only in the flow andtreatment of the wounded. Though increasing numbers stayed in Korea, manycontinued to be carried by air or sea to Japan and the zone of interior. During1951-52 the railways remained the most important means of evacuation withinKorea, while movement out of the country became more dependent on airtransport than ever before.

Rail evacuation might begin as far forward as the clearing station, if trackswere nearby and the tactical situation permitted. When a line was available,ambulance buses were attached to the medical battalion. Fitted with additionalflanged wheels for travel on the rails, the buses also could move on the roads toand from the rail line in case of need. With the stabilization of the front, trackswere extended northward in the I Corps zone to within 8,000 yards of the frontline. By late 1951 sixty-two hospital ward cars were reported to be working inKorea. The standard train now consisted of thirteen cars—eight ward cars, akitchen, dining room, and pharmacy car, an officer personnel car, two orderlycars, and one utility car. Maintained and operated by Transportation Corpspersonnel and staffed by the Medical Service, the trains evidently had come along way from the rough early days of medical railroading in Korea. With theorganization of the KCOMZ, control of the railroads passed to the new head-quarters, but the Eighth Army reported at the end of 1952 that the ''evacuationsystem has changed very little during the year.” In terms of function and relativedependence upon the different modes of transport, the estimate seems fair.'**

Evacuation from the Army area into the KCOMZ was by train or plane.Ambulance convoys brought the wounded to railheads, where they passed intothe hands of the communications zone, or to airfields for flights to the zone orJapan. Assigning the wounded to the proper hospital continued to be the func-tion of the medical regulating officer at Pusan. In mid-1951 Lt. Col. Vincent J.Amato of the 52d Medical Battalion explained the medical regulating officer’sduties: He must be thoroughly familiar with the regulations, with the facilities,and with the specialties of the various hospitals; he must keep a list showing thelocation of special equipment (eye magnets for removing metal fragments, ironlungs, EKGs, to name a few); and he must know what languages were spoken inthe various hospitals so that, if possible, a U.N. soldier might find himself in aunit with nurses or at least an interpreter from his own country. Armed with thisinformation, the medical regulating officer confronted the inflow by train andplane. While the most serious cases were being unloaded first, the officer, usingadvance data on the makeup of a particular group of wounded, conferred withaccompanying doctors and nurses and began to make hospital assignments onthe basis of available bed strength and specialty.'*’

■“Quoted words from EUSAK, Annual Report of Medical Service Activities, 1952, p. 5, HRB.See also ibid., 1951 and 1952, pp. 6-9 and annex IV, pp. 6, 8-11, respectively; I Corps, AnnualReport of Medical Service Activities, 1951, p. 3, file 319.1-2 (I Corps) Far East-1951. All in HRB.“Surgeon’s Circular Letter 6, no. 7, Medical Section, EEC, 1 Jul 51, pp. 126-27, HRB.

THE MEDICS’ WAR

Rear area hospitals underwent considerable change in response to the lowerlevel of fighting. At the end of October 1951 the 21st and 22d EvacuationHospitals, Semimobile, replaced the 3d and 10th Station Hospitals, respective-ly, and the 25th Evacuation Hospital replaced the 4th Field Hospital. Ironically,during 1952 the rear area hospitals changed unmistakably into settled installa-tions providing area care. Though their titles suggested semimobile organiza-tions, part of a system of emergency medicine geared to quick evacuation, theirfunctions approximated more and more closely those of conventional stationhospitals.^®

As the MASHs had evolved into general-purpose forward hospitals, theevacuation hospitals in their turn grew as omnicompetent backup facilities.Lack of a medical field laboratory in EUSAK compelled hospitals to performmore elaborate tests than their T/O&Es contemplated and led to recommenda-tions for expanded laboratory facilities. Evacuation policy shifted frequently,but the long-range tendency was for the time limit to rise, and studies showedthat when it passed fourteen days a marked increase occurred in the demand fortests. But the basic factor in the elaboration of equipment and service was thestabilization of the rear areas during 1952. Here troops mainly were located in afew major concentrations around the urban areas and the ports. Disease and

*®EUSAK, Report of ETMD, October 1951, p. 8, file 350.05 (EUSAK) 1951, HRB.

Casualties on a Hospital Train Headed South

MEDICAL SUPPORT BEHIND A STABLE FRONT

259

nonbattle injuries dominated the admission rolls, especially during quiet peri-ods on the front. The evacuation hospitals also provided outpatient clinics anddiagnostic and consultant services. When battle casualties seemed likely toincrease, medical authorities attempted to “clean out” the lightly injured, onlyto find that few qualified for the term. Though complex equipment, such aselectrocardiographs and audiometers, had to be obtained by special authoriza-tion from Japan or the zone of interior, the hospitals were caring for substantialnumbers of patients with fairly serious nonbattle conditions. As support troopsgrew in number, and the fighting along the line remained sporadic, the propor-tion of such patients held by the evacuation hospitals could only grow.^^

With the creation of the KCOMZ, the 21st, 25th, and 171st EvacuationHospitals plus the Swedish Red Cross Hospital were transferred to the newcommand. The remaining step was evident, and in early 1953 the KCOMZevacuation hospitals again were reorganized and redesignated as station hospi-tals, with the added personnel, equipment, and bed strength of such installa-tions. The history of the evacuation hospitals in many ways symbolized thetransformation of the rear areas and, indeed, of the war itself

From the earliest days of the Korean fighting, hospital ships of the Britishand American navies—later supplemented by another from Denmark—servedfirst as seaborne ambulances and later as mobile hospitals. The original missionof such ships was to transport patients, giving care en route. However, Koreanconditions made them far more valuable as floating hospitals. Ships loadedpatients either by winching up litters directly from the docks, by lifting themfrom lighters at sea, or from helicopters landing on their decks. The first andthird methods were by far the best, and the advent of the medevac helicoptermeant that a hospital ship anchored off a port could receive patients with aslittle difficulty as one tied up to a pier. In evacuating to Japan, on the otherhand, movement by air was preferable because of the delay, possible danger,and need for several transfers that a sea voyage imposed on the wounded.Evacuation by ship was rare after mid-1951. As a British surgeon had noted inthe early days of the war, “One movement only is the ideal [for a woundedman]: direct from the field to a base hospital where he is able to remain forseveral weeks without interruption and . . . the sooner this movement fromthe time of injury takes place the better.

The result was what Rear Adm. Lamont Pugh called the “unique decision toleave the hospital ships in the Korean ports for considerable lengths of time.”The ships became a new kind of mobile hospital in Korea, for all moved fromplace to place: sometimes supporting the Inchon invasion (as the USS Consola-tion did), or doing service in Japan for a while, or aiding the Hungnam evacua-tion, or simply shifting about the Korean coast as needed. Up to the end ofSeptember 1952 admissions to the three U.S. Navy hospital ships totaled some40,662, about 35 percent battle casualties and the rest nonbattle injuries. Addi-

®‘EUSAK, Annual Report of Medical Service Activities, 1952, annex IV, pp. 11-13; FEC, AnnualReport of Medical Service Activities, 1951, pp. 129-30. Both in HRB.

”H. J. Bennett, “‘Maine’ Chance,” Journal of the Royal Naval Medical Service 37 (Winter 1951):

79.

THE MEDICS’ WAR

Caring for Casualties on Board the USS Consolation

tionally, a large number of outpatients were treated, possibly equal to the totalcared for aboard ship, for a ship at its pier could conduct a clinic just as capablyas a conventional hospital could. With the early service of the HMHS Maineand the later arrival of the Danish Jutlandia, five such ships in all provided anunusual and successful addition to rear area medical resources, and anotherexample of military hospitals whose function Korean conditions hadtransformed.^^

Such were a few of the salient points in the evolution of the Korean rearareas as the war shifted from one of movement to one of static confrontation.The improvisations of 1950 yielded to a stable, complex system designed tosupport a war of low casualties in which victory was not sought and for which noend could be foreseen. The KCOMZ assumed the form and many of the func-tions of the advance section of a World War II communications zone, whileJapan continued to serve in a manner reminiscent of the British Isles during thecampaigns of the European theater. In Japan lay the largest, most complexhospitals, and from the Japanese airports Air Force planes carried the mostseverely injured to definitive care at home.

”Lamont Pugh, “Mercy Is Their Mission,” Army Information Digest 8 (August 1953): 58.

CHAPTER 9

Definitive Care

War, rotation, and the natural transcience of military life combined to bringmany changes to the Far East Command (FEC), its logistical arm, the JLCOM,and the elaborate system of general and station hospitals in Japan. New facesappeared in top jobs during 1951. In August General Hays, the JLCOM sur-geon, was reassigned to the zone of interior to become deputy surgeon general.On 16 October General Hume, the controversial chief surgeon of the Far EastCommand, returned to the United States for retirement. Replacing him wasBrig. Gen. William E. Shambora, a capable, domineering man who was at leastas much soldier as doctor. A graduate of Georgetown University, Shambora hadserved as surgeon of the Army Ground Forces and the Ninth Army duringWorld War II, and since then of the First and Second Armies and the UnitedStates Army Forces, Pacific. Despite this major change, and the departure of themedical consultant and the Supply and Fiscal Division chief, the Medical Sec-tion staff remained fairly stable through the year, in part because the deputysurgeon. Col. Richard H. Eckhardt, the executive officer. Col. Robert E. Selwyn,and most of the division chiefs and consultants continued in their posts. Noupheaval like that in the Eighth Army staff occurred.^

The biggest changes for American forces in Japan were at SCAP, triggered bythe approaching peace treaty. General Sams departed for the zone of interior,and on 1 July his Public Health and Welfare Section was discontinued after abrief interim in which Col. Cecil S. Mollohan, Sams’ Harvard-trained deputy,replaced his former chief. The section’s records and most of its personnel nowshifted to Far East Command’s Medical Section. The change portended nothingless than SCAP’s approaching dissolution. Until his own departure GeneralHume took over as chief surgeon of SCAP without relinquishing his FEC role.For the time being, a rump section in SCAP advised the supreme commanderon civilian health programs in Korea and Japan, while laboring to speed thetransfer of full responsibility for public health and welfare in Japan to civilianagencies.^

'Surgeon’s Circular Letter 6, no. 11, Medical Section, FEC, 1 Nov 51, pp. 221-22, file 461(Circular Letters) FEC; JLCOM and FEC, Annual Reports of Medical Service Activities, 1951, p. 13and pp. 4-13, respectively, files 319.1-2 (JLCOM) and (FEC) Far East-1951. All in HRB.

Tec, Annual Report of Medical Service Activities, 1951, p. 148, HRB. See also Surgeon’sCircular Letter 6, no. 6, Medical Section, FEC, 1 Jun 51, p. Ill, file 461 (Circular Letters) FEC,HRB. The peace treaty was signed on 8 September 1951 and became effective on 28 April 1952.

THE MEDICS’ WAR

The reshuffling continued—indeed intensified—as the peace treaty wentinto effect in the spring of 1952. SCAP was abolished at the end of April. Thedesignation General Headquarters was dropped by the United Nations and FarEast Commands. In October the long-moribund paper command called UnitedStates Army Forces, Far East (USAFFE), sprang to life as the major Armyheadquarters under the Far East Command in Japan. Concurrently, the JapanLogistical Command was abolished and its missions and functions transferredto USAFFE. The Far East Command’s Medical Section also shifted to USAFFE,with General Shambora designated as chief surgeon of both commands. Themergers saved some thirty-three spaces—a matter of some importance as theKorean struggle steadily lost ground in the worldwide competition for person-nel. The net result was a simplified structure focused on the military, which hadabandoned its onetime proconsular role as ruler of Japan.^

Medical functions likewise changed with the signing of the Japanese peacetreaty. Because the treaty and the accompanying adminstrative agreement be-tween the United States and Japan failed to specify answers to a number ofmedical questions—there were no provisions for controlling health problemsresulting from the movement of Americans to and from Japan, no provision foranimal and plant quarantine, and no provision for reciprocal exchange of infor-mation on communicable diseases—the preventive medicine officer began ne-gotiations on such issues with the Japanese government. The Japanese also tookcontrol of the railroads, compelling the military to coordinate the movement ofhospital cars with them. With reduced numbers the headquarters medics hadplenty to do. Having both policymaking and operational duties, the MedicalSection directed work in USAFFE, supervised the medical activities of Armyunits in the United Nations Command, and managed the joint medical regula-tion of all patients in the Far East Command. The list was impressive and madethe Medical Section all-powerful in controlling the movement of the woundedback from the Korean battlefields and their treatment in the Army hospitals ofJapan."*

Evacuation: The First Leg

The stream of injured human bodies pouring out of Korea reached Japaneither by air transport or by water. Evacuation, like the war itself, developedthrough several well-marked phases. Though aircraft played a role almost fromthe beginning—even in July 1950, C-47s and C-54s were carrying patientsfrom the 8054th Evacuation Hospital in Pusan to the 118th Station Hospital inFukuoka, Japan—they were at first far less important than ships in the number

^United Nations Command General Order no. 53, 10 Dec 52; Far East Command General Orderno. 108, 23 Apr 52, and General Order no. 169, 10 Dec 52; United States Army Forces, Far East,General Order no. 2, 10 Oct 52, and General Order no. 46, 19 Dec 52. All in MMFB.

‘‘USAFFE, Annual Report of Medical Service Activities, 1953, pp. 1-2, file 319.1-2 (USAFFE)Far East-1953, HRB; JLCOM and FEC and USAFFE, Annual Reports of Medical Service Activi-ties, 1952, p. 19 and pp. 1-2, files 319.1-2 (JLCOM) and (FEC) Far East-1952, HRB; Far EastCommand General Order no. 123, 13 Oct 52, MMFB; FEC, Report of ETMD, September 1952, p.7, file 350.05 (FEC) 1952, HRB.

DEFINITIVE CARE

263

of wounded they carried. The prime function of airplanes during the tumultuousearly weeks of the war was emergency evacuation, often direct from divisionclearing stations, as the only alternative to abandoning wounded men to anadvancing enemy. Once the casualties were in Japan, the medical regulatingofficer. Eighth Army (later Japan Logistical Command), determined their fur-ther movements. In theory, casualties who were expected to recover withintwenty-one days should have been held in Korea. In practice, however, thetactical situation and the available bed space determined who was evacuatedand when. Because the war was going badly and few beds were on hand, thestream of evacuees became a torrent.

Frantic haste was the norm. Almost anything that floated was pressed intoservice. At the outbreak of the fighting the Royal Navy’s HMHS Maine was atKobe supporting elements of the British fleet in the Far East. The fifth such shipto bear the name, the Maine for her Korean service was to become the onlyhospital ship in British history to win a naval battle honor. Immediately offeredto the United Nations (U.N.) forces, she arrived on 14 July in Pusan—a “hot,parched, swirling dust-bowl”—to aid the evacuation of the wounded to Japan.For the next two months the small ship, a captured Italian liner never intendedfor such work, carried 1,849 casualties, almost all Americans, to Fukuoka,Osaka, and Yokohama. Overburdened, with only one air-conditioned ward andtemperatures in the lower decks rising above 100°F, the Maine saved livesprimarily through the untiring efforts of her small professional staff. Among herpatients were some who should not have been aboard at all, includingpsychoneurotics whose symptoms miraculously disappeared as Korea droppedastern and men whose only malady was their broken eyeglasses or dental plates.Though typical of the early days of the war, such cases were far outweighed bypatients with severe, often appalling wounds and by neuropsychiatric casualtieswhose derangement was only too real.^

In the sweltering wards of the Maine, in the troop carriers USNS Sgt. GeorgeD. Keathley and Sgt. Andrew Miller, in tossing LSTs, and by some accounts inChinese junks, the wounded endured a tedious journey that mocked the frenzyin which it had begun. Much more fortunate were those taken aboard the USSConsolation, which reached Korea in August. Over 500 feet long and displacing15,000 tons, the ship bore distinctive markings; the hull was painted white witha horizontal green stripe and red crosses blazoned the deck, funnel and helicop-ter pad. More important, it was spotlessly clean within, well-equipped anddesigned for its task, with the machinery separated from the ward areas and theoperating room located at the ship’s center where rolling was least. The Consola-tion was one of six such ships built on the East Coast during World War II andknown collectively as the Haven class. Among her sister ships, the USS Benevo-lence, newly fitted for Korean service, sank in a fog-shrouded channel off SanFrancisco. But the namesake USS Haven served at Inchon during 1950, atPusan in 1951, and returned for a second tour during 1952; the USS Repose saw

*Bennett, “‘Maine’ Chance,” pp. 72-86 (quoted words from this source); John H. Plumridge,Hospital Ships and Ambulance Trains (London: Seeley, 1975), p. 71. In August, evacuation policyfor Korea was increased to thirty days.

THE MEDICS’ WAR

USS Repose at Inchon

similar service. However, hospital ships rapidly turned from evacuation vehiclesto floating hospitals in Korean waters, and their contribution to the movementof wounded was correspondingly limited.*^

Critical to the early phase of evacuation was the month of September 1950.The invasion at Inchon, the enemy’s Great Naktong Offensive, and the EighthArmy’s breakout from the Pusan Perimeter swamped every type of transport.The number of casualties received from the combat zone reached its first peak,as did evacuations from Japan to the zone of interior. At the same time thecharacter of the traffic changed. Air evacuations from Korea jumped almosttwenty-fold, from 335 in August to 5,890 in September, while the number of seaevacuations fell from 4,459 to 2,171. Thereafter the air won out steadily, untilby the end of 1951 water evacuation had almost ceased, except for a fewpatients who could not tolerate altitude. The overwhelming majority returned to

Tugh, “Mercy Is Their Mission,” pp. 53-59; extract from Ltr, Maj Gen Edgar Erskine Hume,Chief Surgeon, Medical Section, EEC, to Maj Gen Raymond W. Bliss, Surgeon General, DA, 11 Dec50, HSF (Hume-1950), HRB; Weekend Letter no. 8, Col R. H. Eckhardt, Deputy Surgeon, MedicalSection, EEC, to Maj Gen Raymond W. Bliss, Surgeon General, DA, 8 Nov 50, file 200 (PersonnelLetters Between SGO and Medical Section, EEC), Box 3099 (Medical Section, EEC, GeneralRecords, 1950), RG 338, MMEB; extract from Msg, SECSTATE 183 to SCAP for USPOLAD, 2Aug 50, HSF (SECSTATE-1950), HRB. See also E. B. Coyl, “Hospital Ships in Korea,” MilitarySurgeon 112 (May 1953): 342-44.

Pyongyang

MAP 6

100 150 KILOMETERS

THE MEDICS’ WAR

Air Force Flight Nurse Aiding Evacuee

Japan in the transport planes that droned at all hours into Air Force fields onthe islands of Kyushu and Honshu {see Map 6)f

Initially, nearly all the evacuees landed on Kyushu, where ships tied up at theport of Kokura and planes landed at Itazuki Air Base, Fukuoka. Medical treat-ment followed at the 118th Station Hospital. The closeness to Korea of Japan’ssouthernmost and westernmost large island made its use a necessity for manysmaller planes. As a result, a 15-hour train ride to Osaka or a 27-hour journey toTokyo followed for general hospital patients. In January 1951, however, a “tri-entry” system was introduced after enough C-54s had entered the airlift to bringthe metropolitan areas of Honshu within flying range. Thereafter, casualtieswere divided on a 40-40-20 basis between Itazuki Air Base, Itami Air Base at

Above paragraph is based on the following: Headquarters, JLCOM, Command Report, 1-31 Jan51, Narrative Summary, pp. 75, 78, 80, file AYUT-8000 (JLCOM, Command Report w/SupportingDocuments, Jan 51), Box 4840 (JLCOM, AYUT-8000, Narrative w/General Staff Sections, Jan 51),Entry 429, RG 407, MMFB; EUSAK, Annual Report of Medical Service Activities, 1950, pp. 7-8,file 319.1-2 (EUSAK) Far East-1950, HRB; JLCOM, Report of ETMD, September 1950, p. 1, file350.05 (ETMD, Far East, JLCOM, 1950), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B, RG112, MMFB; FEC, Report of ETMD, July 1950, p. 25, file 350.05 (FEC) 1950, HRB; JLCOM,Annual Report of Medical Service Activities, 1950, p. 9, file 319.1-2 (JLCOM) Far East-1950,HRB; EUSAK, Report of ETMD, August-September 1950, p. 6, file 350.05 (EUSAK) 1950, HRB;N. M. Kater, “Air Evacuation of Casualties in the Korean War,” Medical Journal of Australia 2 (July1953): 94.

267

Unloading an Ambulance Bus at Tokyo Army Hospital

Osaka, and Tachikawa Air Base west of Tokyo, where the 376th Station Hospi-tal received the wounded.*

An Air Force nurse described a round-trip flight from Japan to a forwardairstrip in Korea during the winter of 1952. Outbound her plane carried mail.After off-loading in Korea it flew on over “the barren, rugged, desolate terrainnow so familiar, once so frightening.” The twisting dirt roads below were whitewith snow. At a forward airstrip MASH patients began to arrive while the nurseand a medical technician swept out the plane and unrolled the litter straps. Asthe casualties were carried aboard, their litter poles were buckled into the heavyweb straps that ran from floor to ceiling, forming a rigid structure. The patients’injuries determined where they were put:

head injury up front, in the position third from the top, so you can give him oxygen orplasma easily; paraplegic opposite him, so that his drainage will function properly; a manwhose left leg is amputated ... on the floor, so there is enough room for the large roundhoop holding the skin traction in place; ... a man with hepatitis in the top position,since he won’t need much nursing during the flight; and so on until you have all 30patients on board.’

“Headquarters, JLCOM, Command Report, 1-31 Jan 51, Narrative Summary, p. 75, RG 407,MMFB. See also sources in previous footnote.

This and the following paragraphs are based on Janice Albert, “Air Evacuation From Korea—A

(Continued)

THE MEDICS’ WAR

Among the young patients, many of whom had never flown before, reassur-ance was as essential as clinical skill. The nurse calmed a frightened private,dressed a wounded man’s colostomy, gave oxygen to a Turk with a penetratingchest wound, a narcotic to the amputee who was still not fully aware of theabsence of his left leg—“a smile here, a gentle hand there, and soon the tensionof the cabin is lessened, at least for the moment.” And so to the airport in Japan,where ambulances were waiting.

Once arrived, patients at Tachikawa and Itami passed into the hands ofmedical holding detachments for a brief respite, examination, and triage. Thoseclearly destined for the zone of interior were sent to Osaka or Tokyo ArmyHospitals for preparatory treatment, to make sure they could survive the longMilitary Air Transport Service (MATS) flight across the Pacific. For them, thenext stop would be Midway Island. Those who remained in Japan were a mixedbag. Included were men too seriously wounded to remain in Korea but whoserecovery was anticipated within the limit set by the current FEC evacuationpolicy—during much of the war, men who presumably would recover in morethan 30 but less than 120 days—and others whom triage officers had judged tobe in no condition to be sent to the zone of interior without stabilizing treat-ment. During the busiest months the men who stayed in Japan were simplythose for whom beds happened to be available. Even the lightly wounded wereshunted on across the Pacific, if the hospitals were full.

Within Japan a system of evacuation already existed at the time the warbegan, necessarily a somewhat complex one, for it served an island nation.Outlying units were reached by air, ambulance and rail; short trips were byambulance. Emergency service was the province of the Far East Air Forces’ AirSea Rescue Squadron in Tokyo. When the outbreak of war stripped Japan ofmany of its ambulances, the Japan Logistical Command converted ordinary 32-passenger buses into 10-litter ambulances, modeling them after American vehi-cles already in the command. Because the hospital cars that the Eighth Armystationed throughout the islands were now too few, the Transportation MilitaryRailway Service, at the command’s behest, converted regular Japanese cars,which were rapidly pressed into service as the workmen finished thern.^®

The main influence on changing work loads and evacuation policies was theconstantly shifting course of events on the Korean battlefields. As the NorthKorean Army collapsed in the fall of 1950, the influx of casualties plunged. On22 September the JLCOM hospitals held 9,300 casualties, but on 25 Octo-ber—when the first Chinese attack began—only 5,301. The FEC evacuationpolicy, after falling to 60 days, was changed back to 120 days during October.Then a new influx began—not only combat casualties but also the wave of coldinjuries, the victims of General Winter. Between late November and late De-cember 9,982 Army casualties were evacuated from Korea, of whom about3,500 were wounded and the rest the victims of nonbattle injuries and disease,primarily frostbite. On 3 December the 120-day policy was again reduced to 60

(Continued)

Typical Flight,” Military Surgeon 112 (April 1953): 256-59. All quotations from the article appearon p. 258.

‘TEC, Report of ETMD, October 1950, p. 12, file 350.05 (FEC) 1950, JLCOM, Annual Reportof Medical Service Activities, 1950, pp. 24-27. Both in HRB.

269

days. For all concerned, December was a busy month, the trains carrying some8,900 hospital patients, 90 percent of them from the ports to the hospitals, onlyabout 10 percent from the hospitals to duty."

By January 1951 the construction of new hospitals and greater specializationin those that existed began to change this thermometer-like response to theupheavals of the battlefield. On the nineteenth the 120-day policy was againreestablished, this time in the hope that any new surge could be accommodatedwithout further change. Casualties airlifted from Korea now were divided intothree groups: Patients with head, chest, and eye injuries went direct to theTokyo area for specialized surgery; those with frostbite and hepatitis were flownto Osaka, where treatment centers for these ills had been established; and allother types were distributed according to available bed space throughout Japan.The tri-entry system went into effect at the same time, and by the end of themonth the JLCOM surgeon judged it “about ninety percent effective.” Patientsreceived less handling and more rapid evacuation, the amount of interhospitaltraffic was less, and the load on hospital workers decreased. Even the springCommunist offensive did not compel any new change in the evacuation policy.

By this time all the major elements of the evacuation system had emerged.Minor adjustments remained. During 1951 new hospitals opened in the Osakaarea, making Itami Air Base for a time the preferred point of entry. Fluctuationsin the number of patients continued during the spring and early summer, follow-ing the tide of battle. By early summer six hospitals were preparing patients forevacuation to the zone of interior, with the JLCOM medical regulating officerreceiving their daily tallies and arranging transport from Itami Air Base and theMATS terminal at Tokyo’s Haneda International Airport. Throughout the yearthe number of patients carried from Korea by water remained comparativelysmall, dropping to zero in September. Aggregates of battle and nonbattle casual-ties fell slowly from the highs of April until August, rising again with the autumnoffensives. On average about six thousand patients a month arrived in Japanduring the first half of the year.^^

After the hard fighting of the autumn, falling casualties and expanded capac-ity relieved pressure on the evacuation system and the hospitals as well. InJanuary 1952 only about two planeloads of patients a day arrived in Japan.Evacuation by water continued to decline. Unusual was the experience of somepatients on the USS Repose, which docked in Yokosuka on its way to the zoneof interior. Only thirty-nine of the forty-six wounded who were aboard required

"Headquarters, JLCOM, Command Report, December 1950, Narrative Summary, p. 30, fileAYUT-8000 (JLCOM, Command Report, Dec 50), Box 4624 (JLCOM, AYUT-8000, Narrativew/encls., Dec 50), Entry 429, RG 407, MMFB; JLCOM, Report of ETMD, December 1950, p. 20,file 350.05 (ETMD, Far East, JLCOM, 1950), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B,RG 112, MMFB; JLCOM, Annual Report of Medical Service Activities, 1950, p. 12, HRB.

'^Medical Section, JLCOM, Command Report, 1-31 Jan 51, Supporting Documents (Annex 24),pp. 4-6, file AYUT-8000 (JLCOM, Staff Sections, Jan 51), Box 4842 (JLCOM, AYUT-8000, StaffSections, J.A. to trans, Jan 51), Entry 429, RG 407, MMFB; JLCOM, Reports of ETMD, January1951, p. 4, and February 1951, p. 3, file 350.05 (ETMD, Far East, JLCOM, 1951), Box 1 (ETMD,JLCOM, 1950-53 . . .), Entry 54B, RG 112, MMFB; EUSAK, Report of ETMD, January 1951, p.5, file 350.05 (EUSAK) 1951, HRB.

’"EUSAK, Report of ETMD, September 1951, pp. 7-8, file 350.05 (EUSAK) 1951, HRB;JLCOM, Reports of ETMD, June 1951, app. 8, pt. 2, pp. 19-20, and September 1951, p. 48, file

(Continued)

THE MEDICS’ WAR

treatment in the Japanese hospitals, and because the airlift was working welland no backlog of evacuees existed, the ship went on with its seven remainingpatients in a condition approaching solitary splendor, voyagers on a 15,000-tonvessel where the staff outnumbered them many times over. In the beginning thepatients had overwhelmed the system. By 1952, increasingly, the system wasmore than adequate for the patients.^'*

The Hospitals of Japan

Built for a peaceful occupation, the hospitals of Japan at first were swampedby the demands of war. Then, absorbing new personnel and constructing newfacilities, they grew to maturity just about the time that the armistice talkscaused the patient load to fall. Such an ironic capsule history, however, does notdo justice to the system’s achievements in meeting the emergency of 1950, to itscontinuing clinical excellence, or to its success in making the most of limitedmanpower resources even after the early tide of casualties had subsided.Throughout much of World War II the most persistent complaint of the medicalprofession against the military was that hospitals were overstaffed and doctorsunderused. Few such complaints surfaced during the early part of the KoreanWar, when with rare exceptions the Medical Service used improved transportand heightened professional skills to make much of little.

The frenzy of August and early September 1950, when there was enough ofnothing except the wounded, tended to conceal the excellent foundation thatexisted in the prewar medical system. At the opening of the war thirteen hospi-tals were operating in Japan, with a normal capacity of about thirty-five hun-dred beds and an emergency capability of over fifty-three hundred. The auxilia-ry buildings to house the overflow patients, however, were not well suited to thepurpose and were poorly equipped. Skilled foot-dragging by Eighth Army medi-cal officers had prevented hasty execution of the surgeon general’s orders toreduce the number of hospitals, and abundant stocks of World War II equip-ment were at hand. The true weakness of the FEC medical system lay in its lackof field units, whose formation stripped the hospitals of both professional andnonprofessional staff at the moment when the first waves of casualties werearriving from the front.

The influx of new personnel from the zone of interior combined with franticimprovisation to bring about the first major expansion. Fortunately, the peopleof the Far East Command were by and large healthy before the war so that manyvacant beds existed. Nevertheless, August 1950 saw the number of patients riseto the extreme limit of the hospitals’ emergency strength. By the thirty-first the

(Continued)

350.05 (ETMD, Far East, JLCOM, 1951), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B, RG112, MMFB. See also other JLCOM, Reports of ETMD, for 1951.

'"JLCOM, Report of ETMD, January 1952, pp. 27-28, file 350.05 (ETMD, Far East, JLCOM,1952), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B, RG 112, MMFB.

‘*JLCOM, Annual Report of Medical Service Activities, 1950, p. 6, HRB.

271

Tokyo Army Hospital

conversion of many camp, post, and station buildings into care units met theneeds of about 6,700. Still the bed space was not enough, for the singularintensity of the Korean battlegrounds was to raise the average daily count ofwounded past 8,000 in September and, after the autumn lull, to nearly 11,000during one week of December. A civilian consultant reported:

I was amazed at the number of casualties [in Japan]. . . . There were 1400 alone inTokyo. There were many psychiatric casualties and strangely enough they were boys whohad been in Okinawa, Anzio, etc., but they couldn’t take this battle. As a matter of fact,between 10% and 15% of the casualties are NP. All the boys felt they were terriblyoutnumbered. One patient remarked to me that ‘we were out-numbered a thousand toone.’*^

Visitors from the States found improvisation the rule. At a general hospitalan ophthalmologist ran the orthopedic section during August. Doctors workedall night. Only one neurosurgeon in the Far East Command was fully qualifiedto operate on head and spine cases, and men whose injuries required treatmentwithin twenty-four hours waited for days to be admitted to the operating room.

'^Quoted words from SG Conference Notes, 16 Aug 50, Medical Collection, HRB. See alsoJLCOM, Annual Report of Medical Service Activities, 1950, p. 14a; Surgeon’s Circular Letter 6, no.3, Medical Section, FEC, 1 Mar 51, pp. 52-53, file 461 (Circular Letters) FEC. Both in HRB.

THE MEDICS’ WAR

Centralizing the treatment of specific injuries in one or two hospitals andconcentrating the specialists was an obvious way to meet the shortage of skilledpersonnel. Such juggling, however, could carry the command only so far. Gener-al Weible, the JLCOM commander, warned that both people and facilities werebeing used to the absolute limit and demanded more doctors and nurses, moremoney, and a construction program aimed at giving Japan the capacity to hold24,000 patients. Meanwhile, evacuation to the zone of interior took the surplus:of 11,870 patients received during August, almost 1,300 were sent home.^”^

The October lull allowed General Hays and the hospital staffs to draw breathand assess the situation. Both the influx of casualties and the buildup of medicalpersonnel for Korea had slowed. Evacuation to the zone of interior fell by 59percent. Fewer new medical units were formed, and the 162 units alreadyrequested were canceled. Plans for an expanded hospital system, however, wereheld in abeyance, on a well-justified belief that the battlefield situation had notimproved enough to warrant cancelation. Work continued to convert one campto a hospital and to build one new facility. But clearly the pressure had abated;the number of occupied beds declined by 3,300 in mid-November and, for thefirst time since the coming of the war, the number of medical specialists wasadequate. As 1950 drew to a close, shortages no longer plagued most clinicalspecialities. **

Specialization of the hospitals also had advanced. The two big installationsat Tokyo and Osaka provided the most sophisticated care available in the FarEast Command. All head and chest surgery cases went to the Tokyo ArmyHospital. In November, as cold injuries proliferated, a center for the study andtreatment of frostbite was set up at the Osaka Army Hospital, also the site of amajor point for evacuation to the zone of interior. Wounded Britons receivedtreatment at Osaka, but other U.N. casualties were sent to the Tokyo installa-tion or the 361st Station Hospital because embassy personnel were available inthe capital to act as interpreters. In addition to performing their usual duties,the station hospitals became more specialized: the 118th, as a receiving hospitaland triage point; the 361st, as a neuropsychiatric center that also treated Japa-nese B encephalitis and as an evacuation hospital to the zone of interior; and the35th, as a hepatitis center. The hospitals relied upon the 406th Medical GeneralLaboratory for an array of technical services—tests, pathological studies, andresearch on viral and bacterial agents.

”Ltr, Maj Gen Walter L. Weible, Commanding General, JLCOM, to Commander in Chief, FEC,[20 Sep 50], sub: Hospitalization, tab 6, before document 1, Medical Section, JLCOM, ActivitiesReport, 25 Aug to 30 Sep 50, file AYUT-8000, Annex 24 (Medical Section, JLCOM, 25 Aug-30 Sep50), Box 4613 (JLCOM, AYUT-8000, Annexes 20-25, Aug-Sep 50), Entry 429, RG 407, MMFB;FEC, Report of ETMD, July 1950, p. 38, HRB; JLCOM, Report of ETMD, August 1950, p. 3, file350.05 (ETMD, Far East, JLCOM, 1950), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B,RG 112, MMFB.

‘^Headquarters, JLCOM, Command Report, October 1950, Narrative Summary, pp. 28-31, fileAYUT-8000 (JLCOM, Command Report, Oct 50), Box 4614 (JLCOM, AYUT-8000, Narrativew/encls. 1-9, Oct 50), Entry 54B, RG 407; JLCOM, Report of ETMD, October 1950, pp. 51-52, file350.05 (ETMD, Far East, JLCOM, 1950), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B,RG 112. Both in MMFB.

273

Osaka Army Hospital

With the onset of intense new fighting in late November, the drama ofhospital expansion was replayed. Closed annexes reopened, plans were laid forlowering the evacuation policy when the JLCOM hospitals approached satura-tion, and the complex processes of renovating facilities—obtaining funds, seek-ing bids, and awarding contracts—resumed. In place of canceled requisitionsthe Japan Logistical Command now submitted new requests for three generalhospitals. Meanwhile, the command pressed all its existing hospitals into ser-vice; in December, even the 161st Station Hospital, on the northernmost islandof Hokkaido, took 73 evacuees from Korea. During that month one project wascompleted—rehabilitation of buildings in Kyoto intended as a convalescentcenter—and other contracts let. As daily admissions soared to 1,182, the evacu-ation policy fell to 60 days. Though bulging with more than 10,000 occupiedbeds, the hospitals by such expedients got past the second critical period of1950. Intensified fighting in the spring and fall of 1951 and again in the autumnof 1952 brought new spurts in the influx of wounded, but after 1950 the mosttrying periods were past. The hospitals remained busy and some personnelshortages—notably in Army nurses and trained enlisted men—grew worse. Thecrisis, however, had ended.

’’Beginning in November, British Commonwealth troops were sent to the British Command ofForces General Hospital at Kure, Japan, as soon as they became transportable. On topics treated in

(Continued)

THE MEDICS’ WAR

Throughout the war American and Japanese civilians were important in theJLCOM hospitals. As early as the end of 1950 a total of 653 Ameri-cans—including 18 doctors, 155 nurses, 308 clinical workers, and 102 attend-ants—were at work, relieving uniformed personnel for service elsewhere. Thou-sands of Japanese continued to work for the Medical Service in many capacities,as they had during the peaceful years of the Occupation. Japanese nurses servedas nurse’s aides, outnumbering the American civilian nurses in some hospitals;Osaka Army Hospital, for example, had 2 civilian nurses but 18 Japanesenurse’s aides. U.N. nurses also appeared during 1950, 16 Thai nurses beingamong the first to serve in Japan.^”

During 1951 the buildup of medical units was steady. Three new generalhospitals—the 279th, 382d, and 343d—arrived, as well as the 2d MASH. Thebattered 171st Evacuation and 64th Field Hospitals returned from Korea andwere ordered to refit and prepare to reenter the battle zone. In the permanentplants renovation and new construction continued, both to expand existinghospitals and to provide buildings for the newly arrived general hospitals. Neworganizations and increased bed strength enabled the Far East Command tohandle the casualties of the Communists’ February counteroffensive withoutchanging the 120-day policy. Similarly, the Japan Logistical Command report-ed that enemy attacks during May did not cause any appreciable increase in thepatient census of the hospitals under its control. Indeed, orders received fromWashington in late March led to a cutback in the command’s medical comple-ment and the inactivation of several hospitals and dispensaries. If one event hadto be selected as marking the attainment by the hospital system of sufficientstrength to handle the demands of the front, it might well be the completion on15 March at Camp Drew of a plant intended for the 343d General Hospital. Atthis time 81 percent of admissions in Japan originated in Korea. But bedoccupancy was declining, a sufficient number of beds were on hand to accom-modate a moderate increase in the patient load, and the command wanted onehospital unit in reserve. Consequently, the 343d’s equipment was packed up as aunit assembly and the outfit itself, in reserve status, served as a pool of replace-ments for others. The newly completed plant passed into the hands of the AirForce.^*

(Continued)

these paragraphs, see JLCOM, Reports of ETMD, 1950-52, file 350.05, Box 1 (ETMD, JLCOM,1950-53 . . .), Entry 54B, RG 112, MMFB; JLCOM, Command Reports, 1950-52, filesAYUT-8000, Boxes 4608-27, 4840-4900, 5592-5630 (JLCOM, AYUT-8000, Command Reports,1950-52), Entry 429, RG 407, MMFB; Surgeon’s Circular Letter 5, no. 12, Medical Section, FEC, p.3, file 300.5 (Circular Letters) FEC, HRB; JLCOM, Annual Report of Medical Service Activities,1950, p. 16; 406th Medical General Laboratory, Annual Reports of Medical Service Activities,Professional Sections (Annual Historical Reports), 1950-53, files 319.1-2 (406th Medical GeneralLaboratory) Far East-1950, -1951, -1952, -1953, HRB.

^“JLCOM, Report of ETMD, December 1950, p. 22, RG 112, MMFB; Osaka Army Hospital,Annual Report of Medical Service Activities, 1950, p. 93, file 319.1-2 (Osaka Army Hospital) FarEast-1950, HRB.

’‘Above paragraph is based on: FEC, Annual Report of Medical Service Activities, 1951, p. 89,HRB; JLCOM, Reports of ETMD, January 1951, pp. 3 and 6-7, February 1951, p. 3, March 1951,pp. 3-4, and May 1951, p. 1, file 350.05 (ETMD, Far East, JLCOM, 1951), Box 1 (ETMD, JLCOM,1950-53 . . .), Entry 54B, RG 112, MMFB; Medical Section, JLCOM, Command Report, 1-31 Jan51, Supporting Documents (Annex 24), pp. 7-8, RG 407, MMFB; Chart, “Proposed Hospital

275

In consequence, patient losses—usually by return to duty—about balancedgains until December, when beds were emptying faster than new casualtiescould fill them. Some organizational changes occurred. The Air Force tookcontrol of facilities at its headquarters command and at two air bases. Armyhospitals endured another round of redesignation, this time in accordance witha scheme that gave each an army unit number. For example, the 118th StationHospital became the United States Army Hospital, 8162d Army Unit; the 35thStation Hospital, the United States Army Hospital, 8164th Army Unit; and soon. Specialization also increased; in particular, the psychiatric service reachedmaturity. Psychiatric centers functioned at the 361st Station Hospital, at theTokyo and Osaka Army Hospitals, and at the 141st General Hospital. By theend of the year the centers had closed-ward facilities and sophisticated equip-ment, including electroencephalograph machines. Neuropsychiatric casualtieswere triaged at the airports like other patients according to the seriousness oftheir condition and sent on to the proper facility.

The early months of 1952 saw a stalemated tactical situation in Korea.Despite inadequate cold weather discipline along the front, troops suffered farless than in the winter past, for the weather was relatively mild. In turn, the roleof the hospitals in Japan diminished. Through 1952 hospital staffs and facilitieswere maintained at the highest authorized levels; however, the tempo of thefighting was such that this medical potential did not have to be tapped. Occa-sional flare-ups on the front, bringing a flurry of activity to one or more hospi-tals, subsided almost as soon as they began. In many ways the hospital systemmight be compared to an athlete who reaches the peak of training and capacityonly to be told that the game has been called off. In November 1951 some 97percent of operating—that is, fully staffed and equipped—beds were occupied.Weekly thereafter the total fell, hitting 50 percent by the end of January and 38percent by May. What the JLCOM surgeon called “a milestone” came on 20April when, for the first time since early August 1950, the number of occupiedbeds dropped below the four thousand mark.”

Hospital services responded to the tide of battle in varied ways. The surgicalservice reacted quickly to events in Korea, notably, during 1952, to the fightingfor Old Baldy. Then the demand on a few hospitals was very great, even thoughno general inundation of wounded occurred. The work of the medical servicevaried with the seasons, heavy during the first three months of the year butfairly constant and predictable thereafter. Personnel problems continued, with

Reorganization Scheme To Meet Required Over-All Spaces Allotted,” document 11, Medical Sec-tion, JLCOM, Command Report, 1-30 Apr 51, Supporting Documents, file AYUT-8000 (JLCOM,Staff Sections, Apr 51), Box 4857 (JLCOM, AYUT-8000, Staff Sections, IG to Ord, Apr 51), Entry429, RG 407, MMFB; JLCOM, Annual Report of Medical Service Activities, 1951, pp. 7, 23, 54,HRB. The 343d General Hospital was not put into operation as a unit until September, and thenagainst the Japan Logistical Command’s wishes.

■^Surgeon’s Circular Letter 6, no. 11, Medical Section, EEC, 1 Nov 51, p. 228, HRB; EEC andJLCOM, Annual Reports of Medical Service Activities, 1951, pp. 29, 34-35 and pp. 8, 18, respec-tively, HRB; JLCOM, Report of ETMD, September 1951, p. 46, RG 112, MMEB. Technically, thestation hospitals were inactivated and the army units organized to replace them.

“JLCOM, Reports of ETMD, January 1952, p. 24, and April 1952, p. 13, file 350.05 (ETMD,Far East, JLCOM, 1952), Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B, RG 112, MMFB.Quoted words from April report, p. 2.

THE MEDICS’ WAR

major shortages among the nurses resulting in demands for better quarters andtreatment and for training of enlisted personnel to perform basic nursing tasks.Because of a continuous shortfall of nurse anesthetists, specialized courses wereopened in the general hospitals. Meanwhile, civilian consultants continued topass through, conducting teaching rounds for the medical officers and givingboth formal and informal instruction in their specialties. Through the opera-tions of the draft the number of doctors, including formerly scarce specialistslike orthopedists, was adequate in relation to the number of patients.^'*

Improvements in the treatment of bum victims, of neuropsychiatric casual-ties, and of hemorrhagic fever cases, the very high quality of surgery, andcontinued functioning of the blood program all contributed to the record of thehospitals in saving lives and returning men to duty. Hospital deaths during mostof 1952 ran at only 1.1 per 1,000 troops per annum throughout the Far EastCommand. A seven-month study indicated that 89 percent of those returned toduty by the JLCOM hospitals were fit for general military service. From itsroots in the impossible conditions of August 1950 the hospitals of Japan hadprogressed to a happy situation in which almost all factors conspired to aid boththe staffs and the men they treated. The numbers told their own story, in workwhere the bottom line was life.^®

On the Wards

A hospital was a military unit, a physical plant, and a shifting yet oddlystable society of the sick and the well. Physically, the Army hospitals of Japancame in many shapes and sizes. Some were complexes, medical hamlets ineffect, attached to bases or centered in large cities. The Osaka Army Hospitalwas a former Japanese Red Cross installation located in the metropolis ofsouthern Honshu. Covering more than 14 acres, its compound held about fif-teen structures. The main plant consisted of three connected five-story build-ings, but behind its tree-shaded wall, the tall stacks of the power plant and thelow peaked roofs of satellite buildings also could be seen. The Tokyo ArmyHospital stood near the center of the capital, with an annex located about a mileaway. A seven-story concrete building constructed by Christian missionaries,the main hospital was marked by a tower topped by a cross. On the SumidaRiver a few miles from central Tokyo stood the 361st Station Hospital, a prewarJapanese establishment taken over by the Army. The 155th Station Hospital indowntown Yokohama was a former department store, the Matsuya, convertedinto wards and clinics; it was a handsome brick and stone structure with someseventy satellite buildings of much less prepossessing design. The 118th Station

“FEC and USAFFE, Annual Report of Medical Service Activities, 1952, pp. 35-36, 47, 63; FEC,Report of ETMD, July 1952, file 350.05 (FEC) 1952. Both in HRB. Doctors were 21 percent belowauthorization and nurses 45 percent below. In December 1952 nurse authorizations were reduced tothe number actually present in the command.

“FEC, Reports of ETMD, May 1952, pp. 8, 10, and July 1952, p. 3, file 350.05 (FEC) 1952,

HRB.

277

Hospital in Fukuoka, the main entry and triage point in the early days of thewar, was again the typical solid reinforced-concrete structure most appropriateto earthquake-prone Japan. Seventy-one buildings surrounded the main hospi-tal. Finally, the 376th Station Hospital at an air base west of Tokyo representedthe pavillion-type hospital, with low wards in separate buildings connected bycovered walkways. By and large, the main hospital buildings were durable struc-tures, sometimes attractive but more often grimly functional, many with thelook of industrial plants.^*^

The events of mid-1950 meant a drastic upheaval for the Tokyo and OsakaArmy Hospitals and for many who worked there. Before the fighting started, liferevolved around the usual concerns of work, quarters, and recreation. To someextent self-contained communities, both hospitals provided movies, clubs, andsports teams for their staffs. Both published newsletters. The Host at Osaka andThe Tower at Tokyo.^^

Such routine concerns hardly prepared the hospital staffs for the events thatfollowed 25 June. Stripped of their professional—especially surgical—personnelduring July, both the Tokyo and Osaka Army Hospitals began at about the sametime to receive the first Korean casualties. Abandoning elective procedures andousting some dependents, they struggled to accommodate the influx. For a shorttime, Tokyo had only eleven doctors for its thousand-bed facility. At Osaka,proportions of 1 medical officer to 90-110 seriously injured patients were notunusual.^*

For the new patients, beds were set up in hallways, lobbies, and recreationrooms. To control patient loads, those who required only minor care began to betransferred to convalescent centers—for Tokyo, the 128th Station Hospital andCamp King. Designated to receive U.N. casualties, Tokyo treated over 800during 1950, including Turks, Frenchmen, Britons, Indians, Canadians, Aus-tralians, Swedes, Thais, Dutch, Filipinos, and South Koreans. As the number ofbattle casualties soared during August, the hospital set up three large ward tentsjust outside the walls as an admission and disposition section. Here hospitalpersonnel. Red Cross workers, laboratory technicians, and volunteers carriedout initial examinations, prepared paperwork, and sent the patients on to propertreatment inside. With the coming of winter a hastily constructed temporarybuilding replaced the tents that had served so well in warm weather.

Treatment at the Tokyo Army Hospital emphasized conservative handlingof two very common afflictions, burns and frostbite. Abandoning the traditionaltreatment of bums with vaseline gauze dressings, the surgical service adopted anArmy-pioneered method in which, after initial debridement under antisepticconditions, the wound was simply exposed to the air while the patient receivedantibiotics to prevent infection. Over the bum body fluids formed a natural

^‘See photos in annex to JLCOM, Annual Report of Medical Service Activities, 1950, HRB. Seealso reports of cited hospitals, same location.

”See, for example, Osaka Army Hospital, Annual Report of Medical Service Activities, 1950, pp.24-30, HRB.

^*Chart 1, “Strength, Gains and Losses: Japanese and Foreign National Personnel, 1 Jan 51 to 31Dec 51,” follows p. 22 of ibid.; Tokyo Army Hospital, Annual Report of Medical Service Activities,1950, p. 64, file 319.1-2 (Tokyo Army Hospital) Far East-1950, HRB.

THE MEDICS’ WAR

crust that was dry, free of odor, and relatively painless. Where the skin was onlypartly destroyed, the crust after a few weeks separated naturally, revealingnormal but slightly reddened healing beneath; where deep burning had oc-curred, surgeons removed the crust about the twentieth day and grafted newskin over the site. In the opposite case—cold injury—the hospital favored gentlecleansing and bed rest, exposing the injured extremities to the air, and delayingamputations as long as possible. Toes that had become black and appearedgangrenous would often spontaneously shed the dead superficial layer to reveala “pink but complete and functional digit underneath.” By avoiding amputa-tions, except where necessary, and by emphasizing supportive treatment thehospital not only obtained excellent clinical results but also sharply reduceddemands upon the time of overworked doctors and nurses.^’

Dental care in the Japanese hospitals was heavily dependent upon civilianassistance. Typical was the Osaka Army Hospital. Here, as in the field, dentalofficers sometimes were called upon to assist in busy operating rooms, especiallyduring 1950. At other times a staff of five American and six Japanese dentistsworked at a dozen chairs, assisted by five enlisted and seven Japanese techni-cians. All had the benefit during 1950 of an amenity that only came to the fieldlater, a dental X-ray machine. With a large clientele of hospital patients andpersonnel, plus an outpatient service for units in the area, the clinic boasted a“most complete” service. Its laboratory not only made dental plates but alsoserved other needs as well, making splints for fracture cases and turning outplastic eyes.^®

Like other parts of the Japan Logistical Command, the dental service spentthe last half of 1950 frantically shuffling officers in an attempt to meet the needsof the units in Korea while maintaining service in the Japanese hospitals. Thefield came first, and by December the 124 dentists available in June had shrunkto 70. In this setting the policy of hiring Japanese dentists and technicians,begun in 1949, proved its worth fully. Graduates of recognized colleges in Japanentered the Army hospitals as operators, technicians, oral hygienists, chair as-sistants, dental laboratory mechanics, and X-ray technicians. By the time thewar began, many of these skilled people already had eighteen months of experi-ence and were well versed in Army methods.

With their mixed military and civilian staff the dental facilities of the com-mand attempted to take on the duties of a communications zone. Troops pass-ing through on their way to Korea were examined at the Medical ReplacementTraining Center, and prostheses made on the spot, so that soldiers arriving atthe front would have as few dental problems as possible. For troops stationed inJapan, divisional dentists provided all care except prostheses. Logistical unitswere in constant turmoil with new people arriving and those in Japan movingout. Dental surveys were difficult, not only for this reason but also because newrecruits arrived from the zone of interior with mouths that seemed to have

^’Edwin J. Pulaski et al, “Evaluation of the Exposure Method in the Treatment of Bums,”Surgical Forum: Proceedings of the 37th Clinical Congress of the American College of Surgeons (SanFrancisco, 1951), pp. 518-23.

“Osaka Army Hospital, Annual Report of Medical Service Activities, 1950, p. 104, HRB.

279

received no attention whatever. As replacements moved toward the front,wounded men arrived back in the hospitals with injuries of the mouth and jaws,many, because of air evacuation, only a few hours old.^^

One such case was, ironically, that of a 28-year-old dental officer shot in themouth during an ambush in North Korea on 8 December 1950. His lower jawwas broken, his upper damaged, his lip, tongue, and right cheek badly tom. Afield hospital sutured the wounds—MASHs at this time had no assigned den-tists or oral surgeons—and the patient was evacuated to a station hospital inJapan. There surgeons removed fourteen broken teeth and noted that thewounds had become infected. Eight days after being shot in the field the patientwas in the Tokyo Army Hospital. Here an oral surgeon and the surgical consult-ant worked together on the case. Whisked away almost at once to the operatingroom, the patient underwent a complex stabilizing treatment. The surgeonsdebrided his tongue, drew the healthy tissue together and sutured it. Exploring asuppurating wound in his right cheek, they found the cause of infection—theembedded crown of a smashed molar. The lip was debrided and closed. The lossof so many lower teeth, however, caused it to turn inward. Technicians hadshaped an acrylic splint to replace the shattered dental arch and immobilize thebroken lower jaw. Its insertion also filled out the lower part of his face, leavinghim entirely presentable, though clearly a man who had undergone an unpleas-ant experience.

Two weeks after the operation all wounds appeared to be healing. Thepatient, however, was a long way from the end of his journey, in any sense. Thedestmction of the lower jaw was too extensive to be met by a denture, and boththe complexity of the reconstmctive work to be done and the length of convales-cence that would be required pointed to the hospitals of the zone of interior. On30 December the young dentist left for home.^^

Surgeons in Japan, like their opposite numbers in the field, encounteredconditions for which their training had not prepared them. As MASH surgeonshad already noted, the Korean, Turkish, and Filipino soldiers were full ofparasites, and the long roundworms called ascarides proved as mobile as ever,occasionally working their way through suture lines in the intestines and migrat-ing through abdominal incisions, spreading infection and creating fistulas. Self-mutilation was a problem not limited by nationality. A large number of self-inflicted gunshot wounds of the left hand and left foot showed up during themonths of retreat, often destroying bones, tendons, and soft tissue. Patientsstoutly maintained that the North Koreans or Chinese had shot them. Thesurgical service reported caustically that “the consistency in location and scopeof these wounds is a tribute to the marksmanship and perversity of theenemy.

Crowding the wards were not only medics and wounded but also a stream ofmore or less distinguished visitors. The civilian consultants who came to lectureand conduct ward rounds proved a mixed bag: Two were praised for inspiring

^'JLCOM, Annual Report of Medical Service Activities, 1950, pp. 79-83, HRB.

^Tokyo Army Hospital, Annual Report of Medical Service Activities, 1950, pp. 54-55, HRB.”Ibid., pp. 17-19, 47, 52, HRB. Quoted words on p. 17 of this source.

THE MEDICS’ WAR

Joe DiMaggio (right) and Lefty O’Doul (left) touring ward at TokyoArmy Hospital

work and teaching, while the others, in the opinion of the hospital’s command-er, “might very well have remained in the United States.” Entertainers whotoured the hospital wards ranged from local talent, such as Japanese Geishas,dancing groups, children’s orchestras, judo acts, men’s choral groups, andcarolers, to world-class stars like Bob Hope and A1 Jolson, Joe DiMaggio andLefty O’DouL Japanese civilians gave flowers, souvenirs, dolls, and books, andArmy and civilian clubs contributed a variety of personal items, from matchesto electric razors, to ease the time U.N. troops spent in the hospital.

At Osaka, wartime upheavals were even more pronounced than at Tokyo.While Tokyo saw thirteen changes of command during 1950, Osaka at the endof the year was left with only one of the officers who had been there at thebeginning. Amid this chaos, treatment of the wounded somehow proceeded. Asat Tokyo, the largest single contributor to the vastly increased volume of surgeryconsisted in the debridement and secondary closure of shell fragment wounds.Though most were treated in Korea, during the Chinese attack some men withabdominal wounds were flown directly from the battlefield without preliminarysurgery. Perforating wounds of the intestines were common, and both hospitalslabored to impress upon field surgeons the importance of the proximal colosto-

""Ibid., pp. 40, 58, 79, HRB.

281

Fracture Ward at Tokyo Army Hospital

my—that is, creating an artificial anus close to the site of an intestinal wound todivert the fecal stream and prevent infection.

Orthopedic injuries also were common. In prewar days, when more time wasavailable, compound fractures were treated in Japan. Except in rare cases, fewsuch open reductions and internal fixations were performed once the fightinghad begun. Orthopedic surgeons now were content to immobilize compoundfractures and evacuate the victims as early as possible for definitive treatment inthe zone of interior. In the treatment of frostbite cases Osaka—after Novemberdesignated the center for such work in Japan—apparently was quicker to use theknife than Tokyo. In its operating rooms a “master table” was set up, withinstruments and drapes constantly resupplied. Instead of laying out the specialrequirements of each individual operation, the scrub nurse, using sterile forceps,drew from the master table whatever was needed for the operation next in line.

Cited at Osaka during 1950 was an ever-increasing load of cases with gasgangrene. An extremely serious infection, clostridial myositis gained its com-mon name from the bubbles of gas formed in the wound by bacterial action.Anaerobic organisms typically infected deep wounds in large muscles (the thighsand buttocks were particularly susceptible) that had only small openings todrain and admit air. The danger of spreading the infection was so acute that inKorea such cases were sometimes operated on in the hallways of the MASH toavoid contaminating the operating room. At Osaka the busy operating rooms.

THE MEDICS’ WAR

impossible to vacate after each gas gangrene case, were scrubbed down to pre-vent cross-infection. A typical victim died at Osaka on 2 December 1950—asergeant wounded in both legs by shrapnel (such fragments always caused moreseptic wounds than small arms ammunition). Gas gangrene developed in the leftleg, and the invasion of the bloodstream by bacterial toxins brought death.

Most unusual was a single case of tetanus, a wound infection from whichimmunized U.N. soldiers were ordinarily free. Wound cultures showed thepresence of anaerobes and the patient had trouble opening his mouth. A wound-ed hand was amputated; then, as the toxin took hold, treatment for tetanusbegan. Surgeons performed a tracheotomy and paralyzed the victim with curareto prevent the violent, sometimes spinebreaking convulsions typical of the in-fection. Kept alive in a respirator, and injected with massive doses of antitoxinand antibiotics, the patient was fed by tube through two weeks of round-the-clock nursing, frequent spasms, and occasional moderately severe convulsions.Suffocation, despite the respirator, appeared to threaten at least twice. Afterthree weeks the patient began to take solid food again, though his ordeal had lefthim acutely depressed and at times disoriented. Held in a closed ward underobservation, he was dispatched to the zone of interior, lucky to be alive after anexperience that might make any soldier glad to take his shots.

Many of those who did not go to the United States for their treatmentreceived physical therapy in Japan. For men who had suffered a variety ofinjuries—burns, wounds with impairment of the peripheral nerves, neuro-psychiatric cases with psychosomatic symptoms—therapy was an essential partof treatment. When any part of the body was immobilized for a long time, orwhen moving it caused immediate pain, the patient compensated as far aspossible by using other muscles, forgetting the use of the injured limb or mus-cles. Therapists traced out the tendon or muscle on his body, explained itsproper function, and assigned exercises that gradually restored normal use.Wartime brought physical therapists many patients—men with chest injurieswho must, in a measure, relearn the art of breathing; frostbite victims whoseexercises were designed to restore circulation and prevent joints from becomingrigid; bum patients needing hydrotherapy to prevent contractures and restorefunction to damaged extremities; plastic surgery cases; and amputees who mustlearn a new and initially difficult means of getting about and performing ordina-ry activities.

Because the desperately ill commanded all available bed space, efforts wereunder way at Osaka, as well as at Tokyo, to find additional facilities for theconvalescing who still required medical attention. Osaka had operated an enlist-ed medical technicians school during early 1950; in August this was redesignat-ed Annex 1 and opened as a hospital with 220 beds, which quickly doubled.Without elevators and short on latrines this former high school, a U-shapedfour-story building of modem but undistinguished design, was a fine example ofa stmcture that should not have been a hospital. Soon a still odder building hadto be pressed into use: the Osaka Stock Exchange, which had seven floors andtwo elevators, both too small to hold a litter. At the end of November thisbuilding became the frostbite center and remained as such until the end of the

283

Turning a Paraplegic in a Stryker Frame

year. As Annex 2 it became a busy hospital in its own right under the commandof Lt. Col. Kenneth D. Orr, who was later to coauthor many of the basic studiesin cold injury prevention and treatment that came out of the Korean War.Incomparably the largest single cause of admissions to the medical service atOsaka, frostbite—often complicated by other wounds or by disease—became itsmost distinctive concern. In all, over two thousand cases of cold injury wereadmitted to the hospital during 1950.^^

In October 1951 Osaka underwent another major increase in work loadwhen the JLCOM surgeon designated it, along with Tokyo’s 361st Station Hos-pital, a center for epidemic hemorrhagic fever. At the end of the year over threehundred cases of the illness were concentrated at Osaka for study and treatment.The requirements for careful nursing and a prolonged convalescence burdenedits facilities to such an extent that many enlisted patients were shifted elsewherefor care after the acute period of the disease had passed. Seven hemorrhagicfever victims died. In 1952, with the establishment of the 8228th MASH inKorea as the center for handling and studying the disease, fewer cases reachedJapan. Stabilization of the front had enabled another rear-area function to shiftforward to the Eighth Army area.

Above paragraphs are based on Osaka Army Hospital, Annual Report of Medical ServiceActivities, 1950, pp. 47, 57-60, 67-68, 71-72, 79-80, 86, 89, HRB.

THE MEDICS’ WAR

Study and treatment of cold injury, however, continued on a seasonal basisin Japan as well. In May 1951 the cold injury section closed and its staff movedto Fort Knox, Kentucky, taking with them a number of frostbite patients forfurther study. Here the basic research was done that made the Korean War adecisive event in medical understanding of the phenomenon. Contact with theFar East continued, for Korea remained overwhelmingly the place where thepatients were. At the end of November 1951 the cold injury section was reestab-lished in Annex 2, and an interservice team of Army, Navy, Air Force andPublic Health Service medical officers carried on the work under the Depart-ment of Defense. During the ensuing six months 370 cases were admitted, allevacuees from Korea. When the section closed for a second time in April 1952,the Army contingent returned to Fort Knox as the Japan division of the ArmyMedical Research Laboratory.

By and large, work at Osaka had become so standardized as to lack majorsurprises. Statistical quirks appeared as the influx of cold injuries during Janu-ary 1951, and hemorrhagic fever cases in October caused the ratio of surgicalcases to the total patient census to sink to the lowest point of the year. Surgerycontinued to be primarily concerned with Korean evacuees; the most seriouscases—patients with colostomies, with chronic empyema (accumulation of pus)in the chest, with large tom wounds of the muscles, with nerve injuries, or withextensive bums—were returned to the zone of interior as soon as they weretransportable. This practice was in accord with the evacuation policy, for suchinjuries probably would require more than 120 days of treatment before returnto full duty status. Unlike the first year, wounds were clean and well debridedand wound infections few.

Overall, the general drift in the hospital was toward reduced strength, thoughsubject always to the vagaries of the war. The seasonal closing of the cold injurysection always brought with it a fall in bed strength. During mid-1952 thedecline in battlefield action enabled the surgical staff to clear beds from corri-dors, alcoves and dayrooms, breaking them down and returning them to storage.In October some had to be reassembled as casualties began to increase again.With the signing of the Japanese peace treaty, several of the buildings previouslyused as convalescent annexes had to be emptied and turned back to civilianowners.^^

The larger station hospitals, especially those in major cities, approximatedthe army hospitals and general hospitals in size and in the variety and complexi-ty of the cases they treated. During 1950 the 361st Station Hospital on theSumida River in Tokyo underwent the usual experiences, losing much of itsstaff to field units while its patient load rapidly increased from a normal100-120 to over 500. As South Korean, Turkish, Filipino, and other U.N.soldiers appeared on the wards, where they “behaved in a most comradelyfashion,”^^ baffled medics labored to take histories in many tongues.

“Above paragraphs are based on ibid., 1951, pp. 40-41, 44, 67, and 1952, pp. 8-9, 37, and annexXI, pp. 5-6, 47-48, files 319.1-2 (Osaka Army Hospital) Far East-1951 and -1952, HRB.

^’361st Station Hospital, Annual Report of Medical Service Activities, 1950, p. 10, file 319.1-2(361st Station Hospital) Far East-1950, HRB.

285

In 1951 the hospital continued to provide a complex array of services,including station hospital and outpatient care for its immediate area; specializedcare for infectious diseases of the central nervous system, primarily encephalitisand polio; and centralized care for dermatologic, neuropsychiatric, and hemor-rhagic fever cases. The main building was surrounded by the nurses quarters, afour-story annex housed in a onetime high school, and by utility buildings,gymnasium, and theater. Enclosed runways connected the nurses quarters to themain building. A prison ward provided care not only for jailed Americans butalso for Japanese war criminals from the Sugamo Prison; the latter were said toreceive “the same courteous and capable treatment”as the others. Contempo-rary photographs show a clean, solid, well-equipped hospital of conventionalstyle, with two-bed cubicles in the long enlisted wards, and floors of polishedtitle in the surgery, therapy, and mess areas. In the occupational therapy sectionwere hand looms, painting equipment, and other customary devices for restor-ing manual skills while passing time.

The 361st Station Hospital (renamed in 1951 the United States Army Hospi-tal, 8167th Army Unit) was the facility at which many an incoming psychiatristbegan his service in the Far East, learning the ropes before being sent to forwardposts. After rising sharply with the war neuropsychiatric casualties showed theusual pattern of decline, falling over 44 percent from 1951 to 1952. Psychiatristsattributed the drop not only to lower combat activity but also to the increasedfacilities in Korea and the general shift to outpatient treatment of the lessseriously disturbed in both Korea and Japan. Psychotic disorders, on the otherhand, tended to occur with small regard to environmental conditions. The risingproportion of psychotics among the total number of neuropsychiatric casualtiesindicated, therefore, that the combat fatigue cases were retained in Korea. By1952 the neuropsychiatric service reported that significantly fewer nonpsychot-ics were evacuated to the zone of interior, which more and more was theprerogative of the seriously and perhaps permanently ill.^*

The 35th Station Hospital in Kyoto was apparently a fairly sleepy installa-tion of three hundred beds when the war began. Within a few months bedstrength rose to two thousand and the actual patient census to 1,950. In Augustthe FEC medical consultant made the hospital a hepatitis center, to providecentralized treatment for one of Korea’s most common endemic ills. By the endof December the hospital and one of its new annexes held 552 hepatitis patients.Compared to battle casualties or hemorrhagic fever victims, such cases requiredlittle active nursing. Listless and sometimes without appetite, they needed to bewarehoused and monitored while their sometimes dangerous disease, its causeas yet unknown, ran its course.^^

In 1951, however, a hepatitis center was set up at Kyoto Army Hospital, andthe hepatitis study team, organized during the spring in the zone of interior,arrived in September for a year of work. Systematic study and follow-up of 461

^*United States Army Hospital, 8167th Army Unit, Annual Report of Medical Service Activities,1951, pp. 1-2, 6-7, 17, 31, file 319.1-2 (U.S. Army Hospital, 8167th Army Unit) Far East-1951,HRB.

^’35th Station Hospital, Annual Report of Medical Service Activities, 1950, p. 5, file 319.1-2(35th Station Hospital) Far East-1950, HRB.

THE MEDICS’ WAR

of the 4,000-odd patients who passed through the center resulted in the conclu-sions that an enriched diet aided recovery and that the patient could moveabout the ward, even safely take part in vigorous exercise during convalescence.Following their patients through reconditioning at the Camp Nara convalescentcenter on Honshu, the team gained an overview of the course of the disease thatbrought significant changes in its clinical management.'*®

Under the pressures of war such convalescent centers had emerged in late1950 as an important aid to the Japan Logistical Command’s effort to handle itshuge patient load with deficient resources. The centers quickly proved a boon topatients as well. From an administrator’s viewpoint much smaller medical staffscould handle recovering patients at such centers, freeing bed space for incomingwounded and seriously ill. But the centers developed an atmosphere and synergyall their own. Different kinds of patients—recovering wounded, neuro-psychiatric cases, the physically injured who manifested a reluctance to getwell—helped to heal one another. Lt. Col. John L. Mothershead of the MedicalCorps summed up the mission of the Camp Nara center: “Hold the patient untilnature heals the injured part, keep the soldier patient’s general physical andmental condition to as high a level as possible, and bring the effected [5/c] partback to normal or as near normal as possible.

The program aimed in part to make patients well by encouraging (or, ifnecessary, compelling) them to act well. Patients not confined to bed woreuniforms, lived in barracks, made formations, and stood inspections. Tradition-al therapies were modified. In place of the lengthy bed rest then prescribed forhepatitis victims, Nara emphasized early ambulation. Former hemorrhagic fe-ver patients displayed a sometimes alarming array of symptoms as sequelae oftheir disease. All symptoms tended to disappear during conditioning, though thepatients’ urine had to be carefully monitored to ensure that their kidneys werereturning to full function.'*^

For neuropsychiatric casualties, centers like Nara proved especially suitable.Such men mixed into the general population of recovering wounded. Often theconventional hospital was far too comfortable a place to convince the psycho-neurotic that he should seek to rejoin the world of ordinary people. Here psychi-atric patients found little sympathy for their symptoms, and the daily round ofexercise and normal unit activities, among men wearing fatigues not pajamas,brought many out of the world their fears had created. Even their attitudetoward psychiatrists improved. In an ordinary hospital the patients tended toregard their doctors as obstacles to evacuation; in the more bracing atmosphereof convalescent centers they sought them out as friends.

The convalescent hospital at Camp King, Omiya, Honshu, began its exis-tence as the 8079th Evacuation Hospital, Semimobile, apparently bound for

‘*®Thomas C. Chalmers et al., “The Treatment of Acute Infectious Hepatitis: Controlled Studiesof the Effects of Diet, Rest, and Physical Reconditioning on the Acute Course of the Disease and onthe Incidence of Relapses and Residual Abnormalities,” Journal of Clinical Investigation 34 (July1955, pt. 2): 1163-235.

'"United States Army Hospital, 8040th Army Unit, Annual Report of Medical Service Activities,1952, p. 2, file 319.1-2 (U.S. Army Hospital, 8040th Army Unit) Far East-1952, HRB.

^Tbid., pp. 3-4, HRB.

287

field service. Instead in December 1950 the organization was redesignated asStation Hospital, 8079th Army Unit, with the mission of operating a convales-cent center. The unit took over a group of large concrete industrial buildings, aformer lens and instrument factory, which most recently had served as barracksfor the 1st Cavalry Division. While reconstruction went on, the 8079th receivedits first group of salvageable patients whom it was to guide back to duty status.Among them were surgical, medical, and neuropsychiatric cases. At year’s endnone of these patients had to be evacuated to the zone of interior, and only fourneuropsychiatric cases had proved refractory.

During the two years that followed, uncommonly complete reports gave adetailed picture—literally, for the reports were illustrated by snapshots—of aconvalescent center at work. A walled-in compound of about 100 acres, Omiyaprovided its ambulatory patients bathing and latrine facilities which were de-scribed as “adequate on an austere basis.”"^ Apparently life there could becharacterized in similar terms. Despite its industrial origin the site was pleasant-ly landscaped, with lawns and shrubbery and a 15-acre turfed field for athleticsand drill, of which there was a great deal. As the commander’s formal orienta-tion lecture candidly declared, the center stood midway between a hospital anda rerun of basic training, with the daily schedule a round of calisthenics, ther-apy, lectures, and drill.

Patients were divided into four classes, from those still in bed to those readyto return to duty. Therapy and exercise were geared to each group’s capabilities.Included for the nearly well were road marches of up to 8 miles through what areport termed the “rural picturesque environs of the post”; such marches werealleged to be “enjoyable as well as essential to military conditioning.”'*^ Repeatedphysical exams monitored the patient’s progress, and a final one at his departureassigned him a physical profile that helped to determine his future assignments.Among the men who passed through Omiya were soldiers of all the U.N. con-tingents, except those of the British Commonwealth and South Korea. Thirty-nine hundred patients were admitted in 1952. More than thirty-five hundredwere Americans; the rest were Belgian, Colombian, Ethiopian, French, Greek,Dutch, Filipino, Thai, and Turkish fighting men.

As might be expected, recovered vigor created some problems of its own.Much of the commander’s lecture to newcomers dealt with venereal disease.“Failing [abstinence],” which was evidently regarded as unlikely, the soldier wasurged not to ''mix liquor and women because you could then better remember touse a rubber from beginning to end of each act, to take a Prophylaxis afterward,and to lubricate your rubber with some of the ‘pro jelly’ to lessen it’s chanceof breaking.”'*^ Such adjurations at any rate indicated a rapid return to normalon the part of many convalescents.

Such were the two roads followed by most casualties entering Japan: evacua-tion to the zone of interior or, via the convalescent centers, back to duty within

'‘^United States Army Hospital, 8079th Army Unit, Annual Report of Medical Service Activities,1951, p. 2, file 319.1-2 (U.S. Army Hospital, 8079th Army Unit) Far East-1951, HRB.

‘^“Handling of Convalescent Patients at Convalescent and Rehabiltation [^/c] Center UnitedStates Army Hospital 8079th Army Unit, Omiya, Japan,” p. 31, attached to ibid.

^*Ibid., end. 3, p. 4, HRB.

288 THE MEDICS’ WAR

the Far East Command. It would be satisfying to report that all followed eitherone course or the other. Obviously, they did not.

Official reports hide more than they reveal of any patient’s experience, hissuffering, the alternations of hope and despondency, and the labors and occa-sional failures of the medics. Case reports are at least suggestive of this inneraspect of a history that otherwise must appear formal and remote from the smellof real events. On 8 July 1951 in Korea a twenty-year-old soldier was woundedin the side and groin by shell fragments. That same day the 8076th MASHoperated, excised a part of his small intestine, and repaired some small perfora-tions in the gut. At first all went well. When the patient reached the 279thGeneral Hospital in Japan, his incision was already well healed. But on hissecond day in the hospital he suddenly felt a severe pain in the groin and upperthigh. Physical examination showed nothing. He continued to complain, now ofpain in his side radiating to the groin. He began to run a low temperature andhis white blood count rose. A soft mass could be felt under the skin of his flank.

X-rays revealed a small ragged bit of metal lying near the spine. Testsshowed the red blood cell count to be down, despite the transfusion of a unit ofwhole blood. Clearly, the soldier was bleeding internally. The question waswhere.

He was taken to the operating room. As the surgeon thrust a knife into hisflank “there resulted an outpouring and gushing of bright red blood.Thedoctors now knew that a large artery, probably the abdominal aorta, had beeninjured and was leaking. But any exploration might bring on a fatal hemorrhage,and the shock of surgery was a danger in itself. While the doctors hesitated, thesoldier received more whole blood and for a few hours showed no change. Thenhis blood pressure dropped suddenly, his pulse rose, and the bloody drainagefrom his side increased. The staff scrambled to find and match enough blood tokeep him alive under the impending operation. On reentering his side thesurgeon found the site of the hemorrhage hidden by masses of clotted bloodbehind the peritoneum. When the aorta was exposed, a sudden spurt of bloodfollowed, which the surgeon controlled by pressing with his fingers. Ligatureswere tried in various places, but the bleeding stopped only when the aorta itselfwas tied.

After five and a half hours the operating room team still had not located thesite of the bleeding. The boy’s blood pressure was dangerously low, his breathingshallow and rapid, despite the administration of whole blood. He died within anhour of the trauma of surgery, the only alternative to dying of slow internalhemorrhage. On the autopsy table a pathologist at last found the rent in theabdominal aorta, just above the point where it divides to form the iliac arteries,a little below the level of the navel. Immediately behind the injury was the metalfragment, which was about two centimeters (eight-tenths of an inch) at itsgreatest diameter. “No, ’tis not so deep as a well,” said Shakespeare’s Mercutioof his own fatal wound, “nor so wide as a church-door; but ’tis enough, ’twillserve. . .

^279th General Hospital, Annual Report of Medical Service Activities, 1951, p. 44, file 319.1-2(279th General Hospital) Far East-1951, HRB.

'’’Ibid., pp. 44-45, HRB. Quoted words from Romeo and Juliet, act 3, scene 1.

289

The hospitals stood between the battlefronts and the peaceful urban world ofthe Japanese cities, in contact with both. The harshest evidence of war and thenormal ways of peace mingled in the wards and halls; acrobats and comediansperformed among the burned and battered, while newly arrived staff memberstrailed veteran physicians on the ward rounds. On pass, convalescents testedtheir returning strength in old-fashioned hell-raising. But the wounded wereeverywhere, in hospitals and annexes, their beds crowding schoolrooms andcorridors, the centerpiece of all the activity, inescapable reminders of the warforty minutes away beyond the Korea Strait and the Sea of Japan.

The Way Home

Even before the war the Army regularly evacuated from Japan to the zone ofinterior patients whose hospitalization was expected to last longer than 120days. During the first six months of 1950 the number of evacuations averaged223 a month, 91 percent of them by air. With the onset of war the number beganto rise dramatically: 513 in July, 1,269 in August, and 5,014 in September. Theswamping of the hospitals during late August and early September compelledthe Japan Logistical Command to jettison its traditional policy and evacuatepurely in order to reduce the hospital census to a manageable level. The usualprocedure of having each evacuee approved by a medical board was dispensedwith. During September, for the only time that year, a large number of pa-tients—almost 1,400—were moved by ship, as emergency measures took prece-dence over a Department of Defense policy in effect since September 1949 thatplanes normally should be used for moving military patients.^^

Efforts to regularize the evacuation process had strictly limited success. Byearly December the Japan Logistical Command’s standard operating procedure(SOP) was in place. An evacuation officer in the office of the JLCOM surgeoncoordinated movement of patients to the zone of interior under the restored120-day policy. During the wild days of September the command had allowed anumber of hospitals, including station hospitals, to process evacuees. Now evac-uation took place only through the Tokyo and Osaka Army Hospitals and the361st Station Hospital at Tokyo, where disposition boards sat regularly to passon cases requiring long-term care in the United States. Patients embarked atHaneda International Airport in Tokyo or Itami Air Base in Osaka, passing withtheir records into the hands of MATS’ 1453d Medical Air Evacuation Squad-ron. Regulations provided for complex bureaucratic procedures—records wereto be delivered at least twelve hours before the estimated time of departure, forexample, and were to include “sixteen (16) copies of the evacuation order for

■“JLCOM, Annual Report of Medical Service Activities, 1950, p. 31b, HRB; End, 30 Nov 50,sub: Medical, p. 6, tab 4, document 3, Medical Section, JLCOM, Command Report, 1-30 Nov 50,Narrative Summary [and Documents], file AYUT-8000, Annex 24 (Medical Section, JLCOM, Nov50), Box 4623 (JLCOM, AYUT-8000, Annexes 19-28, Nov 50), Entry 429, RG 407, MMFB;JLCOM, Report of ETMD, September 1950, p. 5, file 350.05 (ETMD, Far East, JLCOM, 1950),Box 1 (ETMD, JLCOM, 1950-53 . . .), Entry 54B, RG 112, MMFB. On Department of Defensepolicy, see U.S. Department of Defense, Semiannual Report of the Secretary of Defense . . . , 1 Julyto 31 December 1949 (Washington, D.C.: Government Printing Office, 1950), p. 119.

THE MEDICS’ WAR

each patient,” plus an array of clinical and service documentation. This SOPbore the date 5 December. During that same week admissions to the hospitals inJapan quintupled—7,224 new patients in seven days. Such variations could notbe predicted, a fact which alone precluded careful scheduling, and by the end ofthe year the command admitted that projections for more than two weeks aheadwere without much value. The evacuation policy had to be lowered again, andfour more hospitals were designated to process patients. In December—the peakmonth for 1950 and the war—6,401 casualties were evacuated from Japan tothe United States.'*’

Predictability increased markedly during 1951 and even more in the yearthat followed. Though spurts could still occur in response to sharp actions onthe battlefield, the level of combat had been so lowered and the capacity of thehospitals in Japan so increased that evacuation policy remained constant andthe demands on MATS well within its normal capabilities. Sea evacuationremained a small fraction of the total—about 2.6 percent during 1951 and eight-tenths of 1 percent during the first seven months of 1952.

U.N. patients in American care presented a special case. British Air Forceplanes evacuated British, South African, Indian, Australian, and New Zealandsoldiers from the British Command of Forces hospital at Kure to Hong Kong,the first stop on the men’s journey home. In April 1951 the United Statesoffered a converted troopship, the USNS General J. H. McRae, as a hospitalvessel to carry other U.N. patients. Staffed professionally by U.N. medicalpersonnel, the ship bore 200 litter and 500 ambulatory cases to their homes inThailand, Turkey, Greece, France, and Holland. Later, other ships were used forthe same task. In mid-1952, for example, the USNS General LeRoy Eltingeevacuated 67 U.N. patients. Space on American ships was provided during 1952on a reimbursable basis, and such vessels departed periodically from Yokoha-ma, eliminating a backlog that had developed when only one ship was available.American ships carried the vast majority of U.N. wounded, though Britishaircraft or commercial vessels carried a few, and the Danish hospital shipJutlandia, on its return to Copenhagen in April 1952, bore a load of U.N.patients to their various homelands.^®

While the Military Sea Transportation Service handled the European andNear Eastern soldiers, and the British took care of their own. Western Hemi-sphere casualties entered the MATS system. Canadians were carried by plane tothe United States for later transfer to hospitals of their own nation; Colombiansto Brooke Army Hospital for transportation home; and soldiers of the Philip-pines, if seriously wounded, to Clark Air Base for disposition.

For Americans, naturally, the question of greatest interest was the transfer oftheir own wounded. For many an injured man, an Army or Navy hospital of thezone of interior was his final destination within the military medical system, theplace where medical science would make its final, most sophisticated effort to

“’Quoted words from Headquarters, JLCOM, Command Report, December 1950, NarrativeSummary, p. 86, RG 407, MMFB. See also JLCOM, Annual Report of Medical Service Activities,1950, pp. 28-30, HRB. The latter source elsewhere gives the December evacuation total as 6,382.

*®FEC and USAFFE, Annual Report of Medical Service Activities, 1952, p. 30, HRB; FEC,Report of ETMD, July 1952, p. 3, HRB; Headquarters, JLCOM, Command Report, 1-30 Apr 51,Narrative Summary, pp. 71-73, 76, file AYUT-8000 (JLCOM, Command Report w/Supporting

291

Off-loading a MATS Plane at Hickam Air Force Base

discharge him in condition to live out the remainder of his life in reasonablehealth.^^

Zone-of-Interior Hospitals

After a brief rest stop and a hot meal at Midway Island, MATS evacuationplanes flew nonstop to Hickam Air Force Base, Hawaii. Here litter patients wereunloaded into bus ambulances for the short drive up Moanalua ridge to the 375-acre reservation of sprawling Tripler Army Hospital. Occupying one of the mostbeautiful sites of any military hospital, most of Tripler’s rooms had lanais andviews of the ocean. Tripler showed the effects of unification—Army, Navy, andAir Force personnel staffed it—and of the usual personnel shortages, intensifiedby the war. After August 1950 civilian orderlies relieved service people of muchbasic work, and civilian laborers unloaded the litters of evacuees from the buses.

When they arrived, at any hour of the day or night, patients were checked bythe appropriate chief of service or his representative and then assisted to the airevacuation wards. During 1950 alone, more than 11,400 battle casualties passedthrough these wards. Here the patient was put to bed, fed a hot meal, and

Documents, Apr 51), Box 4853 (JLCOM, AYUT-8000, Narrative w/encls, Apr 51), Entry 429, RG407, MMFB.

** JLCOM, Annual Report of Medical Service Activities, 1952, p. 20, HRB.

THE MEDICS’ WAR

Ambulance Buses En Route to Tripler Army Hospital

bathed. All hospital services—medical, surgical, and psychiatric—pitched in totreat any who needed help before resuming the flight to the zone of interior.Problems that had developed or worsened in flight were attended to, as theorthopedists checked and cut casts, psychiatrists observed the neuropsychiatriccases, and so forth. As in Japan local entertainers appeared; pretty girls drapedleis over the foolish grins of pajama-clad soldiers and marines; on holidays, localhotels invited the ambulatory to their parties; and the Red Cross Gray Ladies,as ever, were on hand to provide small comforts. Celebrities came andwent—President Truman during 1950, Vice President Alben Barkley in 1951,plus many of the same entertainers who played the camps and hospitals ofJapan and Korea. As a first taste of home, Tripler had its charms and its seriousfunctions as well.

After a stay averaging between twenty-four and forty-eight hours, the patientwas ready for the next leg of his journey. If he was a Westerner, he flew to TravisAir Force Base north of San Francisco; if an Easterner, to Lackland Air ForceBase in Texas. In either case his next stop was the Air Force hospital serving thebase, where his presence and condition were reported to the Armed ServicesMedical Regulating Office in Washington, D.C. Here the hospital nearest hishome that could serve his particular needs was selected as the site for hisdefinitive treatment.^^

^Tripler Army Hospital, Annual Reports of Medical Service Activities, 1950, app. XIII, and1951, p. 89, files 319.1-2 (Tripler Army Hospital) Far East-1950 and-1951, HRB.

293

War had hit the Army hospital sys-tem hard. Years of contracting budgetsand manpower difficulties hadculminated, in early 1950, in the clos-ing of four general hospi-tals—Murphy, Oliver, Valley Forge,and Percy Jones. In consequence, thedouble pressure to meet the needs ofan expanding Army while caring forthe most serious and long-term Kore-an casualties could not be met. Fortu-nately, Korea was largely an Armywar, and among the other services on-ly the Marine Corps sustained largenumbers of casualties. The availabilityof beds in Navy hospitals provided anearly key to meeting the burden im-posed by heavily wounded men whorequired much special handling andskilled treatment. In October 1950 theJoint Chiefs of Staff set up the ArmedServices Medical Regulating Office under the chief of staff of the Army toperform the basic function of matching patient to bed on an interservice basis.By this time 1,875 Army battle casualties were already in non-Army hospitals,as against 1,796 in Army installations. Thereafter, the reopening of three of theclosed hospitals (Murphy, Valley Forge, and Percy Jones) and the redesignationof others as specialized treatment facilities rapidly improved the prospects fortreating Army patients in Army beds. The number of soldiers in Navy hospitalsfell to only 165 in August 1951. Nevertheless, the Army owed much to its sisterservice for its aid in handling the 13,000-plus evacuees who had flooded induring the first year of the war.^^

The zone-of-interior hospitals exhibited familiar problems in staffing. Typi-cal of the conditions of 1950 was the Fitzsimons Army Hospital, 10 miles east ofDenver. Ordered to reduce its civilian work force in April, the installation byJune had abolished 156 jobs and made 127 reassignments to meet its quota.Then came the war. In July the hospital experienced a “drastic swing fromcontraction ... to rush expansion” when civilian replacements were autho-rized for about 450 military personnel. By the end of the year stability hadreturned and about five hundred new civilian employees were on the payroll.During 1951, when the shortage of nurses became acute, new patient careprocedures supplemented more customary expedients. Patients, according totheir illness, were divided between “hospital” wards and “clinic” wards. Thehospital wards were for those who needed close attention and care by the

"Resources Analysis Division, OSG, Summary of Activities, 25 Jun 50-8 Sep 51, p. 1, file314.7-2 (Army Medical Service Activities, 25 Jun 50-8 Sep 51); Charter of the Armed ServicesMedical Regulating Office in SG Conference Notes, 25 Oct 50. Both in HRB. See also Byron L.Steger and Donald E. Domina, “Armed Services Medical Regulating Office,” United States ArmedForces Medical Journal 2 (July 1951): 1101-04; Speech, Maj Gen George E. Armstrong, Deputy

(Continued)

Comforts of Home at Tripler

THE MEDICS’ WAR

available professional staff, whereas the clinic wards were for those who re-quired minimum attention—in some cases by enlisted personnel only (“and,”noted a report, “by the minimum possible number of those”).^'*

As in Japan a rapid growth of facilities accompanied a declining influx ofpatients. The swelling of the Army, and the consequent need to provide medicalservice at new or expanded training camps, justified an expansion that contin-ued until the middle of 1952. Thereafter, allocations began to fall, the Armylosing 2,500 bed authorizations as the new fiscal year began and the Navy 2,200,with further reductions to come in January 1953. The uncertainty of the negoti-ations in Korea, the potential for a renewed outbreak of fighting, and thepossibility of a widened war that burdened all official thinking meant that asubstantial number of reserve beds had to be maintained. But the trend wasclearly enough in the other direction that the expanded hospital system took asevere cutback in mid-1953, when the number of beds available throughout themilitary hospital system was reduced from about 113,000 to a little over 95,000.At the time about 54,000 of these were occupied, 46,000 by military patientsand the rest by dependents. Meanwhile, construction of new hospitals was to beheld to a minimum, as the events of spring and early summer clearly foretoldthe end of the war.^®

Selected Hospitals

Many men of Western origins underwent definitive treatment at the Fitzsi-mons Army Hospital. The huge 2,300-bed hospital, employing over three thou-sand military and civilian workers, provided sophisticated care in all fields,though it was known particularly as a tuberculosis center. Standing some 5,300feet above sea level in the foothills of the rockies, with abundant sunshine andlow humidity, it offered an attractive setting both to staff and patients. Like thelarge hospitals in Japan, Fitzsimons was to some extent a community in itself,with clubs and sports teams, library and theater, music room and greenhouse,hobby shop and nursery, chapels, and even its own radio station, KFG. Celebri-ties visited and showmen performed. The hospital staff arranged trips for con-valescent patients to sports events, concerts, and rodeos, and the patients didsome entertaining of their own, addressing Denver clubs and veterans’ groupson patriotic themes, urging blood donations and support for the men in Korea,and telling war stories.

(Continued)

Surgeon General, DA, to Indiana State Hospital Association, French Lick, Ind., 23 May 51, “evacu-ation and Hospitalization in the Korean War,” in George Armstrong Papers, Book 4, Box 2, MedicalHistorical Unit Collection, Archives, U.S. Army Military History Institute, Carlisle, Penn.

®^Fitzsimons Army Hospital, Annual Reports of Medical Service Activities, 1950, pp. 18-20, and1951, pp. 81-84, files 319.1-2 (Fitzsimons Army Hospital) Far East-1950 and -1951, HRB.

of DtitriSQ, Semiannual Report of the Secretary of Defense . . . , 1 January to30 June 1952 (Washington, D.C.: Government Printing Office, 1952), p. 27; Thirty-second Meetingof the Armed Forces Medical Policy Council, 21 Jul 52, file 334 (AFMPC), Box 32, Accession no.58A-1095, RG 112, WNRC; Resources Analysis Division, OSG, History of the Korean Conflict,September 1951-January 1953, pp. 1-2, file 314.7-2 (Army Medical Service Activities, 9 Sep 51-3151),Semiannual Report of the Secretary of Defense . . . , 1January to 30 June 1953 (Washington, D.C.: Government Printing Office, 1953), p. 32.

295

Korea impacted on the hospital in many ways. Veterans’ Administrationpatients were the big losers, for all except a few under treatment for tuberculosiswere moved out of Fitzsimons. With their departure the need for beds on themedical wards fell drastically. The surgical service expanded. The obstetricaland gynecological service had particular problems, many of its staff departingfor service in the Far East Command that presumably would include morebullets and fewer babies. Fitzsimons was a teaching hospital with residents totrain; their number fluctuated during 1950, rising as other teaching hospitalsclosed, falling again as residents were sent to the Far East to replace the ArmySpecialized Training Program graduates, and still further with the advent ofwar. Personnel turbulence was the rule among the military as among the civil-ians, though for different reasons. By the second year of the war the problemwith enlisted people was not a lack of bodies but the rapid replacement of thetrained by the untrained, the veteran by the newcomer.

In the surgical service, where most of the wartime action was, cases of greatcomplexity were common. For many a patient this was the last link in the chainof evacuation, the place of final resort for care and healing. The most commoninjuries included severe vascular and nerve cases; large soft-tissue wounds, withmuch flesh destroyed; wide and deep burns; and embedded missies and frag-ments. Multiple wounds often were seen. A single patient might have a chestwound, clotted blood and pus in his chest cavity, fragments in his lungs, andlesser wounds in the abdomen, arms, and legs. Close cooperation among thedifferent surgical specialists was essential, because the same man might haveorthopedic, thoracic, and urologic injuries. Standard procedure, however, wentbeyond such technical cooperation in attempting to treat the whole man.

When a wounded man reached Fitzsimons, he not only had serious injuriesbut also had traveled far. On the average, he had lost about 20 pounds of bodyweight and the habit of eating as well. He often was confused, disoriented, anddepressed, his will to live sapped by pain, tedium, and the infantile state ofphysical helplessness to which he had been reduced. His first need was nourish-ment and reassurance, his second to get moving as soon as possible and as muchas possible. He must learn to do as many things for himself as he could; he mustwalk if he could manage it. The sense of dependency was an integral part of theapathetic state that obstructed recovery.

Then came the surgical centerpiece, the “correction of the primary defect.With the time and equipment to do thorough explorations, surgeons could oftenfind the source of baffling problems. In persistently draining sinuses, for exam-ple, they might find osteomyelitis (bone infection), sometimes caused by amissile fragment lodged at some distance from an original maxillofacial wound.Other procedures were the final step in a long series of surgical interventionsthat had begun in Asia. Patients with colostomies, as part of learning to care forthemselves, were taught to clean the opening through which their bowelsdrained. Then, after any injuries to the buttocks and perineum were healed,surgeons opened the patient’s belly, cut the exteriorized section of the bowel,and sutured the severed ends of the intestine (end-to-end anastomosis), restor-

“Fitzsimons Army Hospital, Annual Report of Medical Service Activities, 1950, p. 107, HRB.

THE MEDICS’ WAR

ing normal function. The influence of the Far East Command surgeons was feltat every step during work in the zone-of-interior hospitals. Orthopedic surgeonsfound their work lightened by the excellent care given in Korea and Japan,where medics had applied casts on broken limbs competently, set fracturescarefully and firmly, and accomplished amputations properly. On the whole,one gains the impression that the purely surgical work, demanding as it was inall aspects of knowledge and technique, was the least uncertain part of theprocess of restoration and recovery.

The last phase was as important as those that went before it. By therapy andexercise the staff aimed to rehabilitate the patient to the point where he felt,looked, and thought of himself as a complete and healthy man. Clearly, in viewof some of the injuries they faced, this could only have been an ideal; but as anideal it was by no means a poor one. Only when the process was judged ascomplete as possible did the former patient receive his proper reward, convales-cent leave or a furlough home.^"^

Some injuries were so massive that little could be done to dispel the cloudthat hung over the victim’s future, Murphy, for example, recorded a surgicalattempt to relieve persistent urinary problems in a paraplegic who had also lostthree limbs. Percy Jones during 1951 had at least one quadruple amputee,whose state the Office of the Surgeon General did not want to see “publicizedany more than necessary,” presumably to shield the public from uncomfortabletruths about the fighting in Korea. For patients requiring long-term care andexpert rehabilitation the hospitals of the Veterans’ Administration usually werethe next step after they left the Army hospitals.^* **

Not all the damage of the war was so severe, and not all was physical. In theBrooke Army Hospital at Fort Sam Houston, Texas, one of the psychiatricpatients was a twelve-year veteran, a former master sergeant broken to corporalfor striking an officer who had sent him on a disastrous patrol in Korea. He hadserved in combat throughout the months of fighting in 1950; he exhibited astable and pleasing demeanor; and, in short, he was not the usual neuro-psychiatric casualty. His chief symptom was an inability to speak above awhisper—a significant one in a man whose work had consisted so largely ingiving voice commands. No physical cause could be found, and he was evacuat-ed first to Japan and then to the zone of interior. During a lengthy interviewunder pentothal he finally ceased to be as guarded about his feelings as inprevious treatment, freely describing his resentment over the failings of thecombat units in Korea and his sense of guilt over several brothers who had diedin World War II. Within an hour he had begun to speak normally, and when lastheard from by the staff a few months later, he was having no further difficulty.^’

*Jbid., 1950, pp. 2, 62-63, 67, 71, 82, 106-08, 113, and 1951, pp. 76, 117, HRB. See also ibid.,1952, pp. 78-79, file 319.1-2 (Fitzsimons Army Hospital) Far East-1952, HRB.

**Quoted words from SG Conference Notes, 12 Jan 51, HRB. See also Memo for the President,sub: Utilization of Beds in Veterans’ Administration Hospitals for Armed Forces Casualties, inibid., following entry of 19 Jan 51, HRB.

^’Brooke Army Hospital, Annual Report of Medical Service Activities, 1951, pp. 65c-66c, file319.1-2 (Brooke Army Hospital) ZI-1951, HRB.

DEFINITIVE CARE

297

Among the eastern hospitals, Washington’s major center at Walter Reedreceived a heavy influx of Korean casualties. At least in general outline, how-ever, its problems—with staffing, the increase in the number of surgical beds,and the need for a convalescent annex (in this case at Forest Glen, Mary-land)—closely resembled those of Fitzsimons. Special problems did arise in thehospitals that were closed in the spring of 1950 only to be reopened in the fall toaccommodate the needs of an increased Army and the Korean wounded. Mur-phy Army Hospital, 12 miles east of Boston, was one of these. Standing on 93acres of elevated land, the hospital consisted of forty-four brick buildings in asimplified Georgian design. Though short a gym and swimming pool, it was inother respects a typical hospital complex, and a well-equipped one prior to itsinactivation on 1 May 1950. At its rededication on 1 November bands played.Deputy Surgeon General Armstrong spoke, tea was served at a reception in themess hall, and forty-six guests repaired later to the 1775 House restaurant inLexington for a dinner party.

By this time Col. James B. Stapleton, the new commander, knew that condi-tions in the hospital were less than perfect. In fact, the six months of deactiva-tion proved disastrous. The standby crew of caretakers were selected for theirjobs because they lived nearby, not because they were experienced or compe-tent. Complex machines were stored improperly and required extensive repair;the clubs and officers quarters were stripped of furniture and equipment forother Army posts; and the medical library was without books. What remainedwas anything that “neighboring installations did not want or could not use.”Stock records showed supplies that were not there. Funds were short, and manyof the new complement, especially among the enlisted people, inexperienced. Bythe end of 1950 Murphy was back in business, treating, among many others,Korean cold injury victims. But the effects of deactivation were yet to be fullyrepaired.^®

At another one of the hospitals that also was closed and then reopened—thePercy Jones Army Hospital in Battle Creek, Michigan—occurred a case thatmay serve as the conclusion to this chapter. With every technique that medicinecould offer, recovery still depended at the last on the ability of the patient toendure much, including many setbacks, and often to face at the end of his ordeala lasting handicap. In June 1951 a 21-year-old serviceman—there is no way totell from the report whether he was a soldier, though this seems likely—sufferedin his right shinbone one of the crushed and shattered open fractures that wereso typical of the war. A month later he arrived at Percy Jones from anotherzone-of-interior hospital for an amputation, for which surely he must haveappeared a likely candidate. From his half-healed wound, oozing foul-smellingpus, two fragments of shattered bone protruded; X-rays showed that 8 inches ofthe tibia were crushed and the fragments dispersed.

“Quoted words from Murphy Army Hospital, Annual Report of Medical Service Activities,1950, p. 5, file 319.1-2 (Murphy Army Hospital) ZI-1950, HRB. See also ibid., pp. 3-6, HRB;Walter Reed Army Hospital, Annual Report of Medical Service Activities, pp. 116-17 and 253, file319.1-2 (Walter Reed Army Hospital) ZI-1950, HRB.

THE MEDICS’ WAR

Nevertheless, the surgeons decided not to amputate. They debrided thewound and put the leg in a long cast. By September, the young man had begunto feel sensation in his foot for the first time since he was wounded. But inOctober he developed serum hepatitis, which ran its course. In November doc-tors found evidence of a bony union of the tibia. Sensation steadily returned,and in February 1952 surgeons covered the remaining wound with a skin graft.However, the patient’s toes still had no sensation and in May he burned themagainst a heater. The bums healed. By the next month—it was a year since hisinjury—sensation had returned throughout the whole foot, and the break hadhealed sufficiently that the orthopedists could put him into a brace instead of acast. The injured leg was about an inch shorter than the other, and the flexion ofthe knee was imperfect. But by year’s end he still had his leg, and he waswalking.^^*

To those who traveled the long way home through the medical evacuationsystem, definitive care could mean many things. To the worst injured it mightmean little more than the dubious prolongation of a burdensome existence. Formany it meant complete—or almost complete—recovery, an opportunity toresume intermpted lives and to pursue careers that had seemed lost. To others itmeant a tolerable compromise with defects that could have been far worse. Tothe hospitals themselves it meant, especially for the surgical staffs, an opportu-nity to learn as well as to treat; to practice and refine skills; to develop newtechniques and expand medical knowledge of the many faces of trauma. At theirbest the hospitals provided a setting where the patient’s fortitude and the heal-ing art could meet to the lasting benefit of both.

“Percy Jones Army Hospital, Annual Report of Medical Service Activities, 1952, p. 191, file319.1-2 (Percy Jones Army Hospital) ZI-1952, HRB.

CHAPTER 10

Victims of War

The United Nations Command wrote much of the medical story in Korea byresponding to the needs of prisoners of war (POWs), refugees, and the plainpeople of the embattled South Korean nation. Across the lines, meanwhile,imprisoned medical personnel attempted to aid their fellow POWs in Commu-nist camps. In both cases, medics had to deal with the fact that in Korea the warcontinued behind barbed wire.

The lot of POWs seldom has been happy. Incarceration does not usuallybring out the best in either prisoners or guards, and when the two are bydefinition enemies, good treatment of captives becomes even less likely. Im-proved conditions for prisoners date in Western history from the late seven-teenth century, when professional armies began to emerge out of the chaos ofthe religious wars. The eighteenth century saw leading thinkers of the Enlighten-ment begin to work out a code, which—further elaborated in the next centuryand ultimately written into international treaties—defined the prisoner of waras a man who was out of the battle, entitled to decent treatment, and in somecases to exchange. Even in the often barbarous Second World War, Westernnations generally attempted to observe the provisions of the various internation-al accords with respect to each others’ captives, though atrocities did occur.Treatment of other peoples was another matter. The Germans, in dealing withSlavic POWs, complied the worst record of the entire war.^

Asiatic nations appeared to regard prisoners much as Westerners did beforethe Enlightenment—as enemies disarmed but still hostile, to be ransomed,killed, or enslaved at the pleasure of their captors. In the Pacific war the Japa-nese demonstrated gross brutality and neglect in their treatment of POWs,resulting in extraordinary death rates. The record of the Pacific fighting prom-ised a hard fate for those who fell into North Korean (or South Korean) hands,for the bitterness of civil strife and competing ideologies further inflamed thepassions of wartime. Neither Korean nation was a signatory to the GenevaConventions of 1949, which embodied the most recent statement of prisoners’rights, nor was the People’s Republic of China, after it intervened. The UnitedStates had signed the accords but had not yet ratified them.

‘Howard S. Levie, Prisoners of War in International Armed Conflict, International Law Studies,vol. 59 (Newport, R.I.: U.S. Naval War College Press, [1978]), p. 5.

THE MEDICS’ WAR

In the event, all participants followed their own customs and ideals. TheUnited States generally upheld the spirit of the conventions and establishedWestern traditions. China and, to some extent. North Korea behaved as theirexperiences in revolutionary war and the theories of communism demanded.Meanwhile, casual brutality too often reigned at the level where the armedsoldier lorded it over the helpless prisoner. At no time did one side or the othermonopolize cruelty. ‘T think,” said Colonel Do veil, “that I can say with impuni-ty that all cats look the same in the dark. I say this because when it came tocruelty to the other side there was no difference between the North Korean andthe South Korean.”^

U.N. Prisoners: The First Phase

In almost every way, Americans captured during the summer of 1950 werethe most unfortunate of all. Apparently North Korea had no policy for dealingwith American prisoners in the early days of the war, simply because it had notanticipated encountering any. For South Koreans capture meant—if they wereassociated with the government—imprisonment and often execution; if not, andif they were males of military age, it usually meant impressment into the invad-ing army. American prisoners, on the other hand, were customarily robbed andsometimes stripped of clothing and shoes and their wrists bound with telephonewire or their own shoelaces. What happened then seemed to depend on theimpulse of their captors. In a few instances mutilated bodies recovered later byadvancing United Nations (U.N.) troops proved death by torture. Many prison-ers were driven toward the rear under conditions that would not have seemedstrange to a Chinese poet who had written eleven hundred years before:

The captives from the western tribes

Were driven into Ch’ing with ears pierced, faces broken. . . .

Bodies thick with wounds, faces bruised with sores

Sick to death they traveled a post length each day.^

When Philip Deane was captured, he was stripped to his shorts, his handswere bound, and with other prisoners he was driven north along the roads, fedlittle, permitted to drink from rice paddies, and at Korean villages beaten andkicked by the residents. A North Korean officer told him later that at first there“had been no policy” regarding war prisoners. Then the policy was enunciated

^Quoted words from Dovell Interv, 21 Sep 66, p. 12, Personal Interviews file (Dovell), HRB. Seealso Levie, Prisoners of War, pp. 507-10; Cohen and Copper, Follow-up Study of World War IIPrisoners, pp. 15-24. Communist allegations of atrocities against prisoners by Americans form asubstantial body of material whose evidentiary value seems impossible to assess. See, for example.Out of Their Own Mouths: Revelations and Confessions of Torture, Rape, Arson, Looting, and Cold-Blooded Murder of Defenceless Civilians and Prisoners of War in Korea (Peking, 1952) and variouspublications by Wilfred G. Burchett, including Koje Unscreened (Peking, 1953).

To Chu-i (772-846 A.D.), “Captives From the Western Tribes,” in Robert Payne, ed., TheWhite Pony (New York: New American Library, 1960), p. 211. The captives were Tartars. A postlength was about 20 miles.

301

that they were to be “treated kindly.”

Deane, as a newsman of some celebri-ty, suddenly found himself clothed, of-fered medical treatment, and fed eggsand other delicacies. Some Americansoldiers who survived their initialordeal appear to have gone through asimilar period of somewhat bettertreatment. Capt. Alexander Boysen, abattalion surgeon of the 24th InfantryDivision captured near Chochiwon,lived first on rice balls and water andsaw many fellow prisoners whoseshoes had been stolen. In Seoul andlater at Pyongyang, however, his grouphad more food and some medicalcare."*

The change in policy reflected anenduring fact of the Korean War, itsideological character. As potentialsources of propaganda the prisonershad an intrinsic worth denied them in many earlier wars. Furthermore, commu-nism was an ideology that professed humanitarian concerns and aspired touniversality. The prisoner was therefore a potential convert, and the practice inthe Chinese and North Korean armies of impressing captured opponents intotheir ranks may have deluded their leaders into believing that Americans andother U.N. troops could be transformed from enemies into allies. The fact thatthe rhetoric of peasant revolutionaries merely would bore, or baffle, most West-ern prisoners apparently was never really understood or accepted.

The early phase of relative good treatment was short-lived, in cases where itexisted at all. The collapse of the North Korean Army during September 1950and the simultaneous approach of winter boded ill for the prisoners. Drivennorth to prevent liberation by U.N. forces, they endured cold and renewedprivation. Several massacres occurred when recapture seemed imminent. Asdiscipline dissolved in the remaining North Korean units, the stage was set foracts of individual cruelty by guards who stole prisoners’ clothing in bitter weath-er, denied medicine to the sick, and administered random beatings. Both Deaneand Boysen fell into the power of a security policeman called the Tiger. During aten-day death march soldiers and civilian internees, men, women and children,walked 75 miles and eighty-one died. They moved at night, in Siberian windsacross the northern mountains, ill-clothed and starving, racked by dysentery.

“Quoted words from Deane, / fVas a Captive in Korea, p. 88. See also ibid., pp. 86-87; Rpt,Grant, Operation Big Switch, pp. 11-13, file 383.6 (Operation “Big Switch”) 1953, HRB. Prison-ers’ experiences varied greatly; not all benefited from a period of improved treatment.

THE MEDICS’ WAR

often executed summarily if they fell by the roadside or stopped to defecate. Theliving stripped the dead, leaving them naked.®

The condition of prisoners rescued during the rapid U.N. advance called forquick medical aid. Col. Wayne S. Hume, surgeon of the 1st Cavalry Division,encountered at Pyongyang a prison camp with thousands of South Koreans“literally rotting away with untreated wounds.” The 8055th MASH providedhelp. While Army engineers piped water into the compound from the TaedongRiver, medics treated the worst cases and the evacuation of the rest began byair. The main burden fell upon the division’s clearing company, and upon theEighth Army hospitals. Moving the victims out was the only practical possibili-ty, for the prison area was grossly contaminated. After testing a barrel of rainwa-ter intended for drinking, a medical officer remarked, “‘Can’t you feel thoseamoebic cysts just crunching in your teeth?’”*^

Americans also were liberated. On 17 August Capt. Oree Gregory noted inher diary, “Our first American prisoners of war. Sad, happy, hungry, wounded,sick, lousy, cold—and very much afraid . . . even of fellow Americans. We didwhat we could.” The men were flown to Japan as soon as they could travel. Herea battery of medical tests revealed that most were in better condition thanexpected, though all suffered from malnutrition (their diet had consisted largelyof rice balls and barley), and almost all had sore feet, for their captors had stolentheir shoes soon after capture and they had marched many miles. The codename Enoch Arden was adopted for orders and correspondence dealing withthe returnees and a repatriated allied military personnel center was establishedat Camp Zama. By the end of November 1950 the number of recovered prison-ers totaled 251—15 officers and 236 enlisted men."^

For those survivors of the atrocities not fortunate enough to be liberated, aharsh time began in the makeshift prison camps—actually depopulated peasantvillages—of extreme northern Korea. The winter was severe, even for thatregion; food was scarce; and the Chinese intervention had made their captorsconfident of victory without restoring order or reviving the policy of goodtreatment. “This was a phase,” wrote five medical officers who survived, “ofprofound deprivation of all the necessities of life.”* Food was grossly inade-quate. The Thanksgiving dinner for one group of five hundred men that No-vember was one millet ball each and soup prepared by boiling nine heads of

*Deane, / fVas a Captive in Korea, pp. 78-136; War Crimes Division, Judge Advocate Section,Korean Communications Zone, Extract of Interim Historical Report, Cumulative to 30 June 1953,pp. 11-26, LIB; Rpt, Grant, Operation Big Switch, p. 13, HRB; Albert D. Biderman, March toCalumny: The Story of American POW’s in the Korean War (New York: Macmillan, 1963), pp.104-05; Clarence L. Anderson et al., “Medical Experiences in Communist POW Camps in Korea:Experiences and Observations of Five Medical Officers Who Were Prisoners,” Journal of theAmerican Medical Association 156 (September 1954): 120.

‘Hume Interv, 19 May 66, HRB. First quotation on p. 13; second quotation on p. 14.

’Quoted words from Gregory, “An Army Nurse’s Diary,” 17 Aug 50, file 211 (Nurses) Korea,HRB. See also Headquarters, JLCOM, Command Report, November 1950, Narrative Summary,pp. 23-24, file AYUT-8000 (JLCOM, Command Report, Nov 50), Box 4619 (Narrative w/encls.1-7, Nov 50), Entry 429, RG 407; Ltr, Maj Robert C. Buehrig, MC, Commander, 128th StationHospital, to Surgeon, JLCOM, 21 Oct 50, sub: Summary Regarding UN POWs, in JLCOM, Reportof ETMD, October 1950, pp. 45-46, file 350.05 (ETMD, Far East, JLCOM, 1950), Box 1 (ETMD,JLCOM, 1950-53 . . .), Entry 54B, RG 112. Both in MMFB.

‘Anderson et al., “Medical Experiences in POW Camps,” p. 121.

303

cabbage in water. Sanitation was nonexistent, as the men were crowded intosmall, unheated, verminous farmhouses. No clothing was issued until July 1951.

Medical conditions beggared description. The lack of food and especially ofanimal protein combined with crowding and extreme cold to produce a newwave of deaths. At first most occurred among the wounded; then many whowere uninjured died either from pneumonia or dysentery, or a combination ofthe two. Some who survived the first five or six months of captivity died later ofdeficiency diseases, mostly pellagra and beriberi. Testimony as to whetherAmerican doctors were permitted to treat fellow prisoners varies; some were,but many were not. Often enlisted men without medical training were obliged tocare for each other and to perform such operations as pulling teeth with the aidof wires or wooden toothbrush handles. (Prisoners suffered severely with dentalproblems throughout their captivity.) “Hospitals” were simply huts where themoribund were confined to die, the most dismal of spots in a grim world,unheated, filled with dying men who sat in their own excrement, awaitingrelease. Occasional epidemics of typhus broke out among prisoners. Such condi-tions reflected to a great degree those existing among Chinese and North Koreantroops, whose medical service was primitive and whose diet was sparse. But theenemy soldiers, armed and free to move about, got more of what little food wasavailable in that devastated land.’

The spring of 1951 saw the most acute phase of the food shortage, someprisoners boiling weeds to provide additional sustenance. North Korea at thistime was a veritable medical museum, with epidemics raging among the Com-munist forces and the population at large. At the same time, an influx began ofRussian medicines, of health workers from China and other Communist na-tions, and a major public health effort by the North Korean government gotunder way. By midsummer the approach of peace talks seemed to hold out thehope of an early end to the war. The lot of the POWs improved as more andmore of them were transferred into Chinese hands. They received new clothingand a more ample diet. The Chinese adopted a policy aimed at using and, ifpossible, at converting the prisoners to communism rather than allowing themto perish.

Not all the changes were for the better. During that summer and fall Britishand American doctors gradually found themselves crowded out by Chinesephysicians who “exhibited a wide range of medical incompetence”; such doctorsapparently held important posts because of their political reliability rather thanmedical expertise. The Chinese used some techniques, such as acupunture, thatwere strange to their prisoners; immunized without the benefit of sterilizedneedles; and tried out such current Russian medical fads as implanting chickenlivers beneath the skin. (A special high-protein diet brought quick recovery tomany experimental subjects, who sloughed the implants. All then witnessed“another miracle of soviet medical science.”)*"

’Medical Corps, OSG, U.S. Army, 1 Dec 53, sub: Report of Conference With RepatriatedP.O.W. Personnel, Document no. LD 1192897 F, Box 584, Accession no. 59A801, DIA Archives,Washington, D.C.

’’Anderson et al., “Medical Experiences in POW Camps,” pp. 121-22.

THE MEDICS’ WAR

The mental state of the POWs reflected their changing fortunes at the handsof their captors. During the months of most severe privation their reactions rana gamut from hostility to numbness and dogged survival. Acts of great altruismoccurred in the camps, but so did acts of cruelty by the prisoners against oneanother. Because the men had begun to feel that any sickness would be fatal, theill were sometimes forsaken when care might have saved them. Philip Deanecited GIs who stole their comrades’ food or stripped the dying hours beforedeath. He also took note of a “ginger-headed teen-ager” who, after survivingpneumonia and dysentery, volunteered for duty in the hut called the dysenteryhospital. There he made sure that the patients at least got food, worked tirelesslyto save them, and somehow remained cheerful, liked even by the guards, underconditions at which the imagination quails. “Letting a G.I. die in my hospital issomething I won’t do,” he told Deane. They did die, of course, but less quicklythan in the other “hospitals.”"

Under these stresses American soldiers often did not show up well by com-parison with marines, or with men from the professional military units sent toKorea by other U.N. nations. Many soldiers had become POWs shortly aftertheir arrival. Almost none had strong feelings of belonging to any unit. Theenemy’s practice of shuffling men back and forth from camp to camp and hisdeliberate policy of breaking down structures of loyalty and command amongthe prisoners increased each man’s isolation. Escape from intolerable conditionsthrough fantasy was common, aided by the widespread smoking of hemp (Can-nabis). So was apathy. Cases were seen of men who apparently willed themselvesto die. “The people who died,” recalled a doctor, “would first become despon-dent, then would lie down or cover their heads with their blankets, then wantedice water to drink with their food, eventually no food only water andeventually—death.”"

Doctors found—as others had in dealing with similar cases in Japaneseprison camps during World War II—that making the patient angry was one wayto restore his will to live, and they coined the term “give-up-itis” as an irritant.The syndrome affected few healthy prisoners, and survivors of the camps em-phasized that “every prisoner of war in Korea who died had suffered frommalnutrition, exposure to cold, and continued harassment by the Communists.Contributing causes to the majority of deaths were prolonged cases of respirato-ry infection and diarrhea.” Despair did not develop except in response to condi-tions that—one could very well argue—made dying a rational response thoughone the medics struggled against. There appears to be no reason to credit thepostwar legend that prisoners in good condition died from mere lack of spirit.The 38-percent mortality among prisoners in North Korea was comparable tothe 37.2 percent who died in Japanese prison camps. The chief determinant ofmortality was how long the individual prisoner stayed in the hands of theenemy, which also followed World War II experience."

"Deane, / Was a Captive in Korea, p. 150.

"Medical Corps, OSG, 1 Dec 53, sub: Report of Conference With Repatriated P.O.W. Personnel,p. 24, DIA.

"Anderson et al., “Medical Experiences in POW Camps,” p. 122. See also Effects of Malnutritionand Other Hardships on the Mortality and Morbidity of Former United States Prisoners of War and

305

Once camp conditions had improved and the Chinese had taken over themanagement of most prisoners (a process substantially complete by October1951), the chief psychological pressure on POWs was the relentless program ofindoctrination. How the prisoner was treated, how much cold or hunger hesuffered, came to depend in considerable measure on his apparent progress inadopting the political outlook of his captors and in some cases supplying themwith propaganda material. Under these conditions some prisoners became“progressives,” who went along with their captors’ desires and in a few casesdemonstrated apparently sincere enthusiasm for their doctrines. At the otherextreme a small number resisted every blandishment and threat, often payingwith prolonged mistreatment or brutal torture. (Psychiatrists later noted thatsome of these men were admirable examples of mature, integrated personalities,while others were pathologically hostile to all authority. Communist or other-wise.) The great majority, in the phrase of the time, “played it cool”—gave whatlip service they must and otherwise attempted to remain as inconspicuous aspossible.

In sharp contrast to the supposed psychological subtlety of Chinese methods(a legend that spread with the popularity of stories about “brainwashing”) mostprisoners developed intense, though hidden, hostility toward their captors. Thecoercion, the hypocrisy into which they were forced in order to survive, and thesheer boredom of the endless lectures and self-criticism sessions all contributedto this, as did feelings of guilt over every concession they made to the interro-gators. As in all prisons, status among the prisoners was the reverse of thatamong the jailers. Those whom the Chinese called progressives were “rats” totheir fellows, and the “reactionaries” were admired, subject to some doubtsabout their sanity if they resisted to the point of endangering their lives.

Overall, from the Communist viewpoint the program of indoctrinationseems to have paid poor dividends, considering the investment of time andeffort it entailed. Some propaganda advantages undoubtedly were won, but atthe war’s end only 347 U.N. prisoners, including 21 Americans, declined repa-triation as against 22,000 North Koreans and Chinese. The Communist pro-gram also revealed something about the provincialism and naivete of the Chi-nese and North Koreans. They were convinced that they possessed a universaltruth to which all people could be brought in time, yet even their communismconsisted largely of parroting the works of Mao Tse-tung. Sophisticated GIs whoknew something of Marx and Lenin found many of their indoctrinators easy to

Civilian Internees of World War II: An Appraisal of Current Information, House Document no. 296,84th Cong., 2d sess., 12 January 1956, p. 33. The melodramatic postwar allegations against Ameri-can POWs were refuted by Biderman, March to Calumny, passim, and “Dangers of NegativePatriotism,” Harvard Business Review 40 (November-December 1963): 93-99. Cases of fatal de-pression among POWs were recorded during the Civil War. See Albert J. Glass, “Military Psychiatryin Korea,” ch. 1, p. 12, CHA.

‘'‘Quoted words from Robert J. Lifton, “Home by Ship: Reaction Patterns of American Prisonersof War Repatriated From North Korea,” American Journal of Psychiatry 110 (April 1954): 737. Seealso Henry A. Segal, “Observations on Prisoners of War Immediately Following Their Release,”Recent Advances in Medicine and Surgery, 2:403-21; Edgar A. Schein, “Some Observations on theChinese Indoctrination Program for Prisoners of War,” Study for the Army Medical Service Gradu-ate School, 1955, p. 33, file 383.6 Prisoners of War (Some Observations . . .) 1955, HRB.

THE MEDICS’ WAR

Dusting a Chinese Captive

overcome in argument. Whether, by giving the POWs value in the eyes of theircaptors, the program prevented more suffering than it caused is a question thatmust remain unanswered.

Communist Prisoners: The First Phase

The United States adhered to the principles of the Geneva Conventions, andits medical service was more expert and better supplied than those of theCommunist powers. Because of this—and the proven ability of Chinese andNorth Korean prisoners to survive under difficult conditions—the latter, oncesafely incarcerated in prison camps, had considerably better chances than U.N.prisoners to maintain their life and health. The greatest initial medical problemresulted from the soldiers’ poor condition before capture, neglect of theirwounds and diseases by their own armies, and the overwhelming numbers whoswamped the U.N. forces during September and October 1950. The physicalcondition of the average prisoner was that of the Asian peasant suffering fromthe complications of wartime deprivation and stress. As the Korean Communi-cations Zone’s Prisoner of War Command reported in 1953, the newly capturedprisoner exhibited “debilitation, gastrointestinal anomalies, body vermin, [and]

'*Heraies, Truce Tent and Fighting Front, p. 515.

307

respiratory infections. ...” His igno-rance of, and indifference to, Westernnotions of personal hygiene was vast.

His most common illness was tubercu-losis, arguably the chief plague of theOrient, which his military service oft-en had aggravated.*^

The condition of the wounded usu-ally was deplorable, but especially soin 1950. Infection was rampant, mag-gots infested many wounds, dressingsof leaves or paper intensified sepsis,and lack of immunization produced afairly large number of tetanus cases.

Men so seriously wounded and inphysically poor condition imposed aheavy burden on Medical Service fa-cilities. The first POWs were taken inJuly, but the great surge in numbersoccurred after the Inchon landing. Be-cause the South Korean governmentwas unlikely to assure humanitariantreatment, the United States on 26September took sole responsibility for custody of the POWs, though the SouthKorean Army’s military policemen continued to make up the majority of prisonguards. The prisoners numbered 224 in July; 2,688 in early September; 116,882in October; and 127,459 in November.

Unprepared for this inundation, the United Nations Command improvisedmedical care for the POWs on the spot. The 3d Logistical Command originallywas scheduled to take over base medical units in the X Corps area, but the corpsheadquarters retained control of its units in anticipation of the coming invasionof North Korea. As a result, the logistical command’s Medical Section was leftwith little to do but run dispensaries and organize care for the POWs—a fortu-nate happenstance. As large numbers arrived at the enclosure near Inchon, theonly medical aid came at first from two South Korean doctors, one of whom wasa former prisoner of the Communists. With medical supplies hard to obtaineven for U.N. troops, POWs at first had almost nothing. Capt. Gunnar Bohman,then serving with the 2d Engineer Special Brigade, was apparently the firstAmerican medical officer to assist the POWs. He secured additional space forthem and saw to it that the injured had clean, DDT-dusted straw mats to lieupon. Then a surgical team from the 121st Evacuation Hospital contributedthree days work, followed by two others from the 1st MASH. Meanwhile, hiredSouth Korean doctors, nurses, and nurse’s aides had begun work. Following aWorld War II practice, medical personnel among the POWs themselves werecalled upon to assist. American doctors continued to come on loan to work for a

‘‘Prisoner of War Command, Annual Report of Medical Service Activities, 1953, pp. 5-6, file319.1-2 (Prisoner of War Command) Far East-1953, HRB. Quoted words on p. 5 of this source.

Maj. Gen. Edgar Erskine Hume(right) and Surgeon General Bliss(center background) with prisoner ofwar at the 1st MASH

THE MEDICS’ WAR

few days at a time, though two physicians from the 4th Field Hospital servedfrom late October until all the patients had departed and the hospital had closedon 7 December.’^

From reports by these officers a precise picture of the Inchon camp emerges.The four separate compounds were located a few miles southeast of the city.Headquarters for the medics was Compound 1, a former Japanese prison withstone buildings inside an enclosing wall; here was the main dispensary, thecontagious ward, and the morgue. Other dispensaries were located in Com-pound 2, a tent city; in Compound 3, fenced-in factory buildings heavily dam-aged by shellfire and bombs; and in Compound 4, subterranean rooms andtunnels where the Japanese had stored ammunition. In these surroundings med-ics worked over men who were suffering from every type of gunshot and frag-ment wound and bum. The physical condition of the POWs was paradoxical.Patients were weak and mn down, their wounds healed slowly, and manyexhibited large absesses that had no apparent cause. Yet they showed a tena-cious grip on life.

Some 85,000 POWs passed through the Inchon camps, a river of dirty, lice-infested men plus about 250 women and 15 children. All had to be dusted andvaccinated. (Apparently, DDT killed the lice in about 149 out of 150 cases,leaving the resistant strains to multiply.) Diarrhea was common, and campsanitation difficult to impose, all the more so because of the fluctuating popula-tion. Infectious hepatitis was common, and cases of erysipelas, a fulminatingwound infection, turned up as well. There were forty-five cases of tetanus andthree each of smallpox, typhus, meningitis, and relapsing fever. The expectedhigh rates of tuberculosis were seen as well, and hardly a day passed without atleast one death from the disease. A medical museum, the camp dispensariesreflected only too well the conditions of the whole Korean nation at the end of1950—except that here the ills were treated.**

Many other hospitals received POWs who were on their way either to Inchonor to Pusan. Treating prisoners was for a time the chief duty of the 171stEvacuation Hospital at Taegu. In the lingering humid heat of the end of summerdoctors and nurses confronted a ceaseless flow of pain-racked and fear-crazedpatients whose language they did not speak, and whose time in the hospital wasusually twenty-four hours or less. Work went on in tents pitched beside thehospital’s quarters and in the four long wooden buildings of the teachers college.To convince the POWs that the operating room was not a torture chamber,hospital personnel hit on the device of returning postoperative cases to the tentfrom which they had come. A South Korean interpreter explained the dialoguethat followed:

‘What did they do to you?’

‘They fixed my leg.’

‘Are you sure you have a leg underneath that white rock [the cast]?’

‘Of course I have a leg. I can feel it, can’t I?’

’’3d Logistical Command, Annual Report of Medical Service Activities, 1950, pp. 1-2, file319.1-2 (3d Logistical Command) Far East-1950, HRB.

’*4th Field Hospital, Annual Report of Medical Service Activities, 1950, Appendix on Medical

309

Operating on a Chinese Patient at the 64th Field Hospital

Convinced at last, POWs began asserting their right to be taken in the orderof their arrival. When a worse-injured comrade went before them, some poutedlike children. “This about face of the North Koreans,” said a nurse, “was ourmost surprising contact with the enemy.”*’

The initial housing of POWs was wherever they could be put. Water wasperpetually short in many of the makeshift prison pens; the prisoners wereentirely innocent of notions of sanitation, as were their South Korean guards.The U.N. armies had outrun their own supply lines in many cases and, as aresult, food for prisoners was often inadequate. Surveys turned up evidence ofprotein deficiency. Prisoners taken during the warm weather were unequippedfor the cold, and surplus clothing had to be rustled up for them. Some evidenceexists that the tragedy of the U.N. prisoners during the North Korean retreatwas repeated in milder form among Communist prisoners during the withdraw-al of the U.N. forces in the winter of 1950. With the onset of colder weather andthe movement of large groups of POWs from the enclosures at Inchon and

Activities of the POW Inclosure, Inchon, Korea, 21 October-7 December 1950, file 319.1-2 (4thField Hospital) Far East-1950, HRB.

’’Quoted words from Surgeon’s Circular Letter 6, no. 2, Medical Section, FEC, 1 Feb 51, pp.24-25, file 461 (Circular Letters) FEC, HRB. See also 8086th Army Unit, Military History Detach-ment, “Logistical Support to Prisoners of War,” pp. 2, 5, 32, Ms no. 8-5.1 A AA.C, RG 319, MMHB.

THE MEDICS’ WAR

Pyongyang to Pusan, “the condition [with respect to housing, heating, andclothing] became acute,” reported the Eighth Army surgeon. “There wereno . . . facilities available for heating tents.

Around Pusan developed the first of the huge complexes of prisoner-of-warcamps whose management was to burden and bedevil the United Nations Com-mand for the rest of the war. What was to become a vast medical establishmentbegan unobtrusively about 1 August as a dispensary of the 8054th EvacuationHospital, which served a small number of prisoners captured during the earlyfighting. In mid-September the 1st Prisoner of War Field Hospital (Provisional)was set up by the Eighth Army, still drawing its personnel on detached servicefrom the 8054th. By the end of the month, as U.N. casualties decreased. Hospi-talization Unit 1 of the 64th Field Hospital became available to work with theburgeoning prisoner population. The unit, which had aided both U.N. andprisoner-of-war wounded at the Pusan Middle Girls School, now set up a prison-er-of-war hospital in buildings vacated by the Eighth Army, Rear, headquarters.Within a few days over 2,000 patients were admitted. In mid-October the 64thturned over its wards to the 14th Field Hospital (Provisional) and moved toTaejon to rejoin the rest of its unit. The 64th, however, was by no meansfinished with prisoner-of-war affairs.^*

In December the 3d Field Hospital replaced the 1st Prisoner of War Hospi-tal. The commander of the 14th Field Hospital assumed command of both,forming what was in fact a large general hospital with the double mission oftreating prisoner-of-war casualties direct from the line and caring for injuredand sick among the existing body of inmates. In combination, the units maywell have formed the largest hospital in the world. A visitor in late 1950 report-ed some 3,000 patients housed in tents. By March 1951 the patient census hadreached 10,800, before subsiding to a monthly average of 7,500 to 8,000. At thehigh point in March, according to an Australian medical officer, about half thepatients were surgical cases and half medical; about 2,000 had orthopedic inju-ries, chiefly gunshot wounds of the limbs; and several hundred, at the end of thewinter’s fighting, were suffering from frostbite with gangrene.^^

Here, as at Inchon, the wards were a “walking pathological museum” withevery sort of wound; with a throng of tuberculosis patients and cold weathercases of lobar pneumonia; and with exotic cases, including four lepers. Yet inDecember 1950 a civilian consultant found that the hospital grounds were cleandespite the difficulty of compelling inmates to use “the largest latrine in theworld ... an imposing open affair containing over 200 holes covered withwooden lids.” A loudspeaker system insistently broadcast simple rules of hy-giene in the Korean tongue. In stark contrast was a South Korean hospital in

“EUSAK, Annual Report of Medical Service Activities, 1950, pp. 43, 47, file 319.1-2 (EUSAK)Far East-1950, HRB. Quoted words on p. 43 of this source.

^‘3d and 64th Field Hospitals, Annual Reports of Medical Service Activities, 1950, pp. 1-2 andp. 7, respectively, files 319.1-2 (3d Field Hospital) and (64th Field Hospital) Far East-1950, HRB.

M. Kater, “Some Experiences in a Korean Prisoner-of-War Camp Hospital,” MedicalJournal of Australia 1 (March 1953): 409; 3d and 14th Field Hospitals, Annual Report of MedicalService Activities, 1951, p. 1, file 319.1-2 (3d and 14th Field Hospitals) Far East-1951, HRB.

VICTIMS OF WAR

311

Medic Administering Blood to Chinese Patient on Koje

downtown Pusan. Here wounded lay on the floor on thin rice mats. Many werenaked. The hospital stank of rotting straw, urine, feces, and dead air, “almostsomething out of Hogarth. . . . Our enemies were receiving much better care atour hands than were our allies at the hands of their own people.””

Outside the hospital, general conditions in the Pusan prison enclosures couldbe termed good only by comparison with those endured by U.N. prisoners inNorth Korea. The concentration of the POWs had evident dangers as well asadvantages. With the Chinese advancing and U.N. forces anticipating the possi-bility of being pushed into the sea, prisoners did not enjoy a very high priorityfor any sort of supplies. Sanitation was the big loser in the camps. Dysenteryand respiratory diseases were rife. Space was inadequate, heating and housingdeficient, and the water supply at Camp No. 3, with a population of 39,370, wasonly one-half gallon a day per capita as against an estimated minimum require-ment of 10 gallons. This was an extreme case—Camp No. 1, the best off,averaged 13 gallons a day, and none of the others had less than two—but itpointed to a fundamental deficiency. Bathing, washing, and laundry were not to

”Rpt, Howard D. Fabing, M.D., 30 Dec 50, sub: Recent Trip to Far East Command, pp. 6-7, file730 Neuropsychiatry (Consultants Visits) Far East 1950-51, HRB. The reference is to Hogarth’sportrayals of the underside of life in eighteenth-century London.

THE MEDICS’ WAR

be thought of among a vast population of lice-ridden men (and some women)whose vermin now were often DDT-resistant. Tents were unheated; both tentsand stoves were in short supply; and only construction of mud huts by theprisoners themselves alleviated overcrowding.

Improvement was slow, a matter of expedients. Surplus clothing finally metthe need created by cold weather. Bedding was simply rice bags placed on theground, and blankets were furnished, two for each prisoner and three for eachhospital patient. Sewage was managed through use of pit or pail latrines. Despiteoutbreaks of dysentery, however, no serious epidemics occurred. Like the U.N.forces, the prisoner-of-war camps squeaked past the crisis period of the winter,and during the following year satisfactory medical control was established.^'*Meanwhile, on 28 January 1951 the first POWs arrived on mountainousKoje {Map 7), an island off the southwest coast in the Korea Strait. The result ofa hurried decision forced by the pressure of an advancing enemy, the movepresented serious logistical and medical problems. The command structure onKoje was still more fortuitous than that which had developed at the Inchonenclosure. The 3d Logistical Command bucked responsibility down to the 60thGeneral Depot, which had lost its function of supplying X Corps when the latterwas absorbed by Eighth Army during late December. Actual planning fell to aphysician and a Medical Service Corps officer from the command. As the firstparty of 2,500 POWs arrived in a cold, rainswept region enclosed by almosttreeless hills, frantic improvisations began to house, guard and care for them. Atthe end of January only a dispensary existed, and any who became seriously illhad to be evacuated on pitching LCTs, or similar light landing craft, back to themainland. During February incessant rain and “extremely poor living condi-tions” helped to ensure that such evacuations would be frequent.^^

Gradually the medical staff on Koje increased, drawing personnel from the3d and 14th Field Hospitals at Pusan. For a time the medical unit on the islandwas called the 3d Field Hospital Annex. The first true hospital, wrecked by atyphoon, was rebuilt and reopened in tents during March. It rapidly expandedto twenty-three hundred beds and by summer reached three thousand. As on themainland. South Korean civilians and prisoners helped to staff it. As moresupplies became available, all but the most serious cases were retained. By theend of April the 64th Field Hospital, newly assigned to help with the POWs,began to arrive on Koje from Japan. The provisional hospital now was phasedout. The depot command became the United Nations Prisoner of War CampNo. 1. As Army engineers developed the camps into livable sites and the guardsorganized the POWs for many purposes—to clean latrines, gather kelp for food,construct adobe huts, and make furniture to fill them—the sordid and miserableearly phase of life on the island ended.

^TUSAK and 3d Field Hospital, Annual Reports of Medical Service Activities, 1950, pp. 42-44and p. 4, respectively, HRB. See also FEC, Annual Report of Medical Service Activities, 1950, p. 50,file 319.1-2 (FEC) Far East-1950, HRB.

“United Nations Prisoner of War Camp Number 1 (Headquarters, Military Police Group,8137th Army Unit), Annual Report of Medical Service Activities, 1951, pp. 4-5, file 319.1-2 (U.N.Prisoner of War Camp No. 1) Far East-1951, HRB. Quotation on p. 5.

MAP 7

THE MEDICS’ WAR

Now POWs were better fed, housed, clothed, and cared for. After muchexperimentation, lindane proved effective against the resistant lice, and duringDecember 1951 infestation declined both on the mainland and on Koje to 3percent or less. Improved sanitation, including engineer-built sewer lines,helped to control enteric diseases after a major epidemic had swept through thecamps in the spring. Systematic immunization of newcomers ended the threat ofsmallpox. Typhoid was a useful index to the general health situation: By thesummer of 1951 intestinal perforation caused by the disease had dropped spec-tacularly, probably because of immunization.

In the course of the year teams from the United States Fleet EpidemicControl Unit, the Armed Forces Epidemiological Board, and the Office of theSurgeon General visited Koje to study dysentery and tuberculosis. Dentistsamong the prisoners were allowed to work under the supervision of an Ameri-can dental officer. Both on the island and on the mainland, hospitals wentbeyond the treatment of existing trauma to perform reconstructive and plasticsurgery. A shop for manufacturing artificial limbs for POWs was set up atPusan. Though the endemic diseases proved tenacious and hard to tackle, prog-ress was recorded in almost every phase of preventive and clinical medicine.^*^

The Riots and After

Improved control of disease did not, unfortunately, imply adequate controlof the POWs themselves. In the prison camps of North Korea the Chinese wereattempting to wage revolutionary war by converting their captives to commu-nism. In the camps near Pusan and on Koje the United Nations Commandworked in another set of cultural blinders created by “current directives, thearticles of the Geneva Convention, and . . . the highest principles of medicalethics and humanitarian policies.” Typically, a commander of the 3d and 14thField Hospitals grossly misinterpreted the happiness of many POWs when theydiscovered they were not to be tortured and killed, concluding that “once thesepatients realize that the effort here is no longer toward destruction but rathertoward reconstruction, they become very cooperative. . . . The patients in gen-eral are quite grateful and many . . . have become quite valuable as helpersdue to their cooperative attitude.

In itself decent treatment for captives was not a fatuous policy. But appar-ently too little consideration was given to the active and committed Commu-nists among the prisoners, who assumed that they were still part of the armedstruggle, with a special mission to foment trouble behind enemy lines. Even alerthospital personnel were frustrated by their patients’ cleverness and overwhelm-

^*64th Field Hospital, Annual Report of Medical Service Activities, 1951, pp. 7-8, file 319.1-2(64th Field Hospital) Far East-1951, HRB. See also EUSAK and FEC, Annual Reports of MedicalService Activities, 1951, pp. 25-26, 57-59 and pp. 21-22, 27-28, respectively, files 319.1-2(EUSAK) and (FEC) Far East-1951, HRB.

^Tirst quotation from 8086th Army Unit, “Logistical Support to Prisoners of War,” p. 101, RG319, MMHB. Second quotation from Surgeon’s Circular Letter 6, no. 6, Medical Section, FEC, 1Jun 51, file 461 (Circular Letters) FEC, HRB.

315

Raiding a Prisoner-of-War Compound on Koje

ing numbers. As the impasse developed over prisoner exchange and the trucetalks faltered, the Communist high command seemingly pursued a deliberatepolicy of encouraging disorder in the prison camps to distract world attentionfrom the very large number of their soldiers who had decided not to returnhome. Sabotage extended even to deliberate blocking of the newly installedsewer lines.

American and South Korean Army guards were insufficient in number, oftenpoorly trained, and occasionally trigger-happy. Food supplies from the SouthKorean government were at best erratic. These pressures combined with thework of agitators to heighten tension in the crowded camps, giving Red leadersreal as well as imagined grievances to exploit. During late 1951 and early 1952,incidents of prisoner-of-war insubordination grew in number and severity. Bymid-1952 some two hundred outbreaks, including riots and some deaths, hadoccurred.^*

^*EUSAK, Report of ETMD, March 1952, p. 34, file 350.05 (EUSAK) 1952, HRB, Staff Study,2d Logistical Command, 31 May 1952, sub: Factual Summary of Situation in United NationsPrisoner of War Camp Number 1, Koje-do, Korea, and Enel 11, Ltr, Commanding General, 2dLogistical Command, to Commanding General, EUSAK, 18 Sep 51, sub: Security of Prisoners ofWar, in vol. 2 of 2d Logistical Command Monthly Command Report, file LOGC-2 (SupportingDocuments, 2d Logistical Command, May 52), Box 6189 (Nonorganic Units, 2d Logistical Com-mand, LOGC-2, Narrative w/vols. 2 and 3, May 52), Entry 429, RG 407, MMFB.

THE MEDICS’ WAR

The prison hospitals were especially vulnerable to disorder, for a variety ofreasons. Obliged to deal with some eighty-eight hundred occupied beds, theirpersonnel were too few, most were unarmed, and some apparently were hobbledin meeting security needs by their professional ethics and humanitarian ideolo-gy. The facilities were compelled to employ POWs as doctors, nurses, and wardattendants to eke out their staffs of uniformed Americans and South Koreancivilians—a continuation of a policy that had worked well during World War II.Once inside the hospital compounds, POWs found themselves in a situationwhere “security . . . was practically non-existant [5/c].” Tough and determinedmen found the conditions a pushover. On Koje the 64th Field Hospital becamea Communist communications center, as its commander admitted. At Pusan theend result was what 1st Lt. Stanley Weintraub, a Medical Service Corps officer,called “war in the wards.

A young admissions officer, Weintraub recorded in his diary the “minusculeconfrontation between Communist and Western minds” that he saw as theessence of the bizarre happening. By the spring of 1952 the combined 3d and14th Field Hospitals formed the center of a complex that not only provideddefinitive care for POWs but also, after a medical examination, funneled newlyarrived prisoners to the camps offshore. A mammoth general hospital despite itsofficial designation, the facility consisted of a two-storied white-stuccoed schoolbuilding enclosed by the wards, a “dreary collection of huts and tents” inbarbed-wire compounds. Other compounds housed the healthy POWs whoworked in the hospital. Beyond stretched a vista of “dusty villages and fecallyaromatic rice paddies.” Fierce ideological passions seethed among a patientpopulation that included Reds, impressed South Koreans, and Chinese who hadfought for Chiang Kai-shek. Communist kangaroo courts operated freely. Atdaybreak, corpses left at the compound gates frequently exhibited signs of exe-cution by blunt instrument or hanging.^®

Throughout April 1952 the United Nations Command was at work in thecamps, screening prisoners to determine who would forcibly resist repatriationand moving those who said they would away from Koje. On the island the 64thField Hospital was in the thick of things, treating tortured prisoners who hadsurvived the kangaroo courts. Some prisoners were not so fortunate; tied downand beaten along the back from neck to lower legs with tent poles, whichcrushed the subcutaneous tissues, they died from pulmonary fatty embolismfour to eight hours later.

As events moved to a climax in May 1952 the Communists kidnaped Brig.Gen. Francis T. Dodd, the camp commandant, at the gate of Compound 76,directly in front of the hospital. Surrounded by some eighty thousand hostileprisoners and connected to the headquarters by one narrow road between thecompounds, the 64th Field Hospital evacuated its female nurses. For three days

”First quotation from 64th Field Hospital, Annual Report of Medical Service Activities, 1951, p.22, HRB. Second quotation from title of Stanley Weintraub’s The War in the Wards: Korea’sUnknown Battle in a Prisoner-of-WarHospital Camp (New York: Doubleday, 1964).

“Weintraub, War in the Wards. First quotation on p. 179; second, third, and fourth quotationson p. 8.

317

active treatment of POWs perforce ended, though food and medications contin-ued to be distributed daily for their use. The situation grew worse as Dodd’ssuccessor, Brig. Gen. Charles F. Colson, won his predecessor’s release by givingthe POWs a statement that proved to be a propaganda godsend for the Commu-nists. (For this action both officers were broken to the rank of colonel.)

Then Maj. Gen. Hay don L. Boatner was appointed commandant. Paratroop-ers of the 187th Regimental Combat Team, flown in from Japan, reassertedcontrol. Striking prisoner-of-war hospital personnel were first denied food, thenremoved forcibly from the positions they had exploited and replaced by SouthKorean civilians. Their lives threatened, the civilians went “over the hill,”compelling American military personnel to feed and care for 1,900 patients andto stand duty twenty-four hours a day in order to do so. Then the paratroopersinvaded and broke up the most rebellious compound by force. The hospitalreceived 122 wounded and 41 dead POWs. Eleven Americans suffered spearthrusts and 1 died from a misaimed concussion grenade.^^

During the standoff many wounded POWs from Koje overflowed the 64thField Hospital and were sent on to the 3d and 14th Field Hospitals at Pusan.Violence also broke out on the mainland. On 11 May, when the military policeofficer who commanded Compound 10—the pens surrounding the 3d and 14thfacility—announced that nonpatients would be separated from patients andscreened, three compounds refused to obey, and the confrontation was on.Mobs of tuberculosis patients and amputees on crutches marched and shoutedslogans under the leadership of Red honchos. Notable among the leaders wereprisoner-of-war attendants and doctors, regardless of the fact that most of thelatter seemed “as little committed to Communism as they are to medicine.”American doctors were in a strange situation, confronted by patients who werealso enemies, uncertain whether to halt food and treatment in hopes of restoringorder or to follow their ingrained professional instincts to minimize sufferingand loss of life despite all provocations. As troops gathered to suppress theoutbreaks for good, Weintraub one night recorded a scene that unforgettablyfroze this strange moment in the war:

As we jeep along, the tangled barbed wire and squat ROK guard towers twist themoonli^t into strange shadows. The Korean tower sentries now stand silently in the coolair, now thump their boots on the wooden platforms to keep warm—their syncopateddrum taps are the only sounds in the night to compare with the droning vehicle motors.We pass tanks and jeeps on the slow pace of regular patrol, half-tracks with 50-calibermachine guns perched on rocky prominences, pointing their ‘quad-fifties’ toward thequiet hospital.^^

^'64th Field Hospital, Annual Report of Medical Service Activities, 1952, pp. 1-7, file 319.1-2(64th Field Hospital) Far East-1952, HRB; 187th Airborne Regimental Combat Team CommandReport, June 1952, file 311-INF (187) (Command Report, 187th Airborne Regimental CombatTeam, 11th Airborne Div, Jun 52), Box 3460 (11th Airborne Div, 311-INF (187), Jun 52), and 2dLogistical Command Monthly Command Report, May 1952, file LOGC-2 (Command Report, 2dLogistical Command, May 52), Box 6188 (Nonorganic Units, 2d Logistical Command, LOGC-2,Narrative w/vol. 1, May 52), both in Entry 429, RG 407, MMFB. See also Hermes, Truce Tent andFighting Front, pp. 243-55; Goulden, Korea, pp. 596-98.

^^Weintraub, War in the Wards. First quotation on p. 58; second quotation on p. 71.

THE MEDICS’ WAR

The days were raucous. Loudspeakers blared at the prisoners, urging submis-sion. Tanks rumbled up to the wire, planes buzzed the compound, and infan-trymen ostentaciously practiced with flamethrowers in full view of the prison-ers. Meanwhile, POWs defiantly scaled the roofs of their barracks and wavedred flags dyed in the blood of executed anti-Communists. There was a brief lullwhile the International Red Cross interviewed prisoner representatives. Onecompound submitted peacefully, but the others remained defiant. On 20 Mayinfantrymen cut the wire and invaded with bayonets, tear gas, and concussiongrenades. POWs fought back with makeshift javelins, honed from aluminumlitter poles or whittled from tent supports; with knives; and with flails of barbedwire. Almost unbelievable episodes occurred:

A bilateral amputee crawls out of his [tear] gas-filled hut on his stumps, leans against theside of his hut for support, and aims a sharpened litter pole at a passing GI, who sees himjust in time. Clobbered over the head with a rifle butt, the PW tumbles into a muddydrainage ditch, the spear bouncing in after him. GI medics following behind pull himout, but leave the spear stuck crazily in the ditch bank.”

Amid the wrecked huts, the crackle of burning red flags and propagandabanners, and the fumes of tear gas, hospital personnel began the task of policingup, resuming treatments that had been interrupted in some cases for a month ormore. Only one prisoner was dead and twenty-nine wounded, a tribute to thesteadiness of the infantrymen who fired no shots. Screening proceeded. Hard-core Communists were shipped to Koje; anti-Communists were segregated andprotected. For one loss there was no real answer, however. The rioters haddestroyed most of their own records, and names. X-rays, and case histories haddisappeared forever.^'*

The wonderful tenacity and all but indestructible toughness of their soldiershad yielded the Communist states important propaganda advantages, to saynothing of influencing military operations by diverting American combat troopsfrom other duties. The lax administrative practices of the hospitals, founded inan attitude of mind that exalted humanitarian and professional considerationsto the neglect of security, had contributed to the severity of the outbreaks. Thesewere the harsh reverse sides of policies from which few Americans of the timewould have dissented—decent treatment for sick and wounded POWs, andrefusal to compel anti-Communist prisoners to return to their homelandsagainst their will. In the event, a fifth of all prisoners faced acute personaldanger to refuse repatriation, and the U.N. forces incurred tens of thousands ofadditional casualties to maintain the principle that allowed them to do so.^*

”Ibid., p. 164.

’^Ibid., p. 166; 3d and 14th Field Hospitals, Annual Report of Medical Service Activities, 1952,p. 6, file 319.1-2 (3d and 14th Field Hospitals) Far East-1952, HRB; 2d Logistical CommandMonthly Command Report, May 1952, pp. 56-61, RG 407, MMFB; Haydon L. Boatner, “How ICrushed the Reds on Koje Island,” fVar Stories (Summer 1964): especially 21; Hermes, Truce Tentand Fighting Front, pp. 236 and 255-57.

^*8086th Army Unit, “Logistical Support to Prisoners of War,” pp. 89-90, RG 319, MMHB;Hermes, Truce Tent and Fighting Front, p. 515.

319

Removing Wounded POWs After the Koje Riots

With order restored, the hospitals were transferred in August 1952 to thecontrol of the Korean Communications Zone. The 2d Logistical Commandhanded over its responsibilities to the Prisoner of War Command. Some fea-tures of the old regime continued in the new. Medical training was given asbefore to POWs whose assistance was still essential for the understaffed hospi-tals, and American doctors held regular sick call, aided by prisoner-of-warattendants and doctors. A few post-riot reforms, however, were implemented.The prisoner population was broken up into smaller enclosures. This in turnrequired each compound to have a holding ward where short-term cases couldbe treated in a manner similar to infirmaries. But POWs had tenacious diseasesand injuries requiring long-term treatment so that large numbers still had to behospitalized, a continuing danger to those who cared for them. Tuberculosisremained the most important cause of lengthy hospitalization, and medicalpersonnel made slow progress, treating moderately advanced cases with bed restand additional diet, severe cases with antibiotics. Dysentery remained a prob-lem, a persistent cause of a large, constantly fluctuating patient census.^^

^EUSAK and KCOMZ, Annual Reports of Medical Service Activities, 1952, p. 12 of annex 4and p. 3 of end. 1, respectively, files 319.1-2 (EUSAK) and (KCOMZ) Far East-1952; KCOMZ,Report of ETMD, November 1952, p. 4, file 350.05 (KCOMZ) 1952. All in HRB.

THE MEDICS’ WAR

From the beginning, nutrition had posed special difficulties in the camps. Inall probability the POWs’ food was insufficient during the crises of late 1950and early 1951. Thereafter, an improved diet may have contributed to theunrest, not only because the more nutritious food made the POWs physicallybetter able to resist but also because the organization of POWs for food gather-ing, as for other purposes, enhanced the internal autonomy of the camps. Sup-plies purchased largely from oriental sources gave prisoners a diet that was bothfamiliar and, according to early nutritional surveys, adequate—between 2,200and 2,850 calories a day during 1951, for example. The survey teams thatvisited individual messes to determine whether food rations actually werereaching the prisoners concluded that they were. The POWs were, of course, fullof worms and bore in their bodies all the consequences of a lifetime of inade-quate diet. Continuing high sick call rates were attributed in part to malingeringand in part to general debility.

In early 1953, however, the International Red Cross complained that thePOWs were not receiving sufficient food. General Mark Clark requested anutrition survey team to investigate. Meanwhile, persistent press reports ofmalnutrition among soldiers of the Republic of Korea (ROK) Army had made areexamination of their rations desirable as well. As a result, the surgeon generaldispatched Col. H. D. Sandstead and Lt. Col. Carl J. Koehn to survey nutritionamong prisoners, the ROK Army, and the Korean Service Corps. In contrast toearlier surveys, Sandstead and Koehn did not confine themselves to caloricestimates but thoroughly examined the questions of vitamin and protein intakeas well. They concluded that the POWs were in fair nutritional state, with theNorth Koreans in better condition than the Chinese. Principal deficiencies werein vitamins A, B2, and C. They recommended treatment with brewer’s yeast,replacement of lima by soybeans in the ration, and substitution of canned beefand pork for dried fish and of green for root vegetables. Monitoring by theMedical Service evidently was less than rigorous, though the deficiencies maywell have resulted in large measure from the prisoners’ own dietarypreferences.^^

By March 1953 the exchange of sick and wounded prisoners was approach-ing, but the POWs’ resistance continued and intensified. The increasing dangeronce again caused the removal in February 1953 of all American female nursesfrom the wards of the 64th Field Hospital and their replacement by corpsmenand Korean nurses. By early March the situation was sufficiently perilous that a“buddy” system had to be set up in the hospital compounds, medical personnel

^’'EUSAK, Annual Report of Medical Service Activities, 1951, p. 69; KCOMZ, Report of ETMD,September 1951, p. 24, file 350.05 (KCOMZ) 1951; KCOMZ and USAFFE, Annual Reports ofMedical Service Activities, 1953, p. 9 and p. 68, respectively, files 319.1-2 (KCOMZ) and(USAFFE) Far East-1953. All in HRB. See also 8086th Army Unit, “Logistical Support to Prisonersof War,” pp. 18-19, 23-24, 27, 31, RG 319, MMFB. Menus for POW patients can be foundattached to 64th Field Hospital, Annual Report of Medical Service Activities, 1951, HRB. Forsurvey report, see Summary of Significant Findings and Recommendations of the Report to theChief Surgeon, United States Army Forces, Far East, 20 Jul 53, sub: Report of Nutrition Survey ofROKA, KSC, and PsW, attached to DF, Col R. G. Prentiss, Jr., MC, Executive Officer, OSG, to ColArthur P. Long, MC, Acting Chief, Preventive Medicine Division, OSG, 24 Aug 1953, and torelated correspondence on same subject, file 720.1 (Korea) F, 1953, Box 54, Accession no. 56A-179,RG 112, WNRC.

321

doubling up to perform all tasks while roving patrols circulated. The increasingdisorder was related to the crisis in the truce talks which signaled the approach-ing end of the war. To medical personnel the trouble underlined their need forstill more men at the habitually understaffed hospitals. But the prisoner ex-change and the phaseout of the 64th occurred before higher headquarters couldact on the hospital’s request for additional staffing.^*

All in all, the experience with the Communist POWs was a remarkable one,without real precedent in American military history. Accustomed to subdued,easily controlled enemy prisoners during World War II, Americans of the 2dLogistical Command and its successor found themselves facing organized, de-termined men, ideologically motivated, who continued the war as prisoners withscant regard for the pieties of the Geneva Conventions. Of all Americans, themedical personnel were probably the most thoroughly imbued with the spiritrepresented by the accords and the least ready to meet the requirements of thesituation. Hospitals faced with rebellion among their patients learned to theircost that when security failed treatment ended as well.

Yet the riots tended to conceal the fundamental success of the policy of goodtreatment. Whatever their basic motivation in refusing repatriation, it is diffi-cult to believe that starved or abused POWs would have chosen in so manycases not to return home. The United Nations Command followed a policydictated by American and West European cultural norms and by internationalobligations emanating from membership in the United Nations and from themoral authority of the Geneva Conventions. Medics followed, even more thanpolicy or orders, the imperatives of their professional consciences. Even withthe riots, the results tended to vindicate the practical value of those ideals. Onecould reasonably argue that the United Nations Command won its strangestvictory behind its own lines.

The Refugee Problem

Immensely greater in numbers than the prisoners were the refugees, thesecond element in the huge medical problem that developed behind the bat-tlefront. According to available estimates, which varied in their totals, aboutone-seventh of the total population of South Korea were refugees at one time oranother during the fighting. Refugees came in two great waves {see Map 8),following the initial invasion and the Chinese intervention, but the condition ofhomelessness and dependence became chronic for many whose villages weredestroyed, or else occupied by the fighting forces during the long period of staticwarfare. Both victims and carriers of disease, subject to epidemics and in needof everything—a military, social, and medical problem of the first impor-tance—the refugees also became the objects of a program of civil assistancethrough the United Nations Command that grew to embrace every aspect ofreconstruction in Korea.

“8086th Army Unit, “Logistical Support to Prisoners of War,” p. 108, RG 319, MMFB.

MAPS

VICTIMS OF WAR

323

In the dark days of July 1950 U.N. commanders viewed refugees largely as agrave military problem. North Korean soldiers covered their uniforms with thetraditional white garb of the Korean peasant and mingled with the fleeingcolumns. But the refugees were too many for U.N. troops to screen and search.One woman who appeared to be pregnant was found to be carrying a radiounder her clothing. Men were observed changing from civil to North Koreanmilitary garb and back again. Even innocent refugees obstructed roads andimpeded troop movements. As they crowded into the Pusan Perimeter, bothmedical and supply problems confronted the United Nations Command. Toprotect its troops and to prevent unrest, the refugees had to be fed, instructed inbasic sanitation, immunized, and provided care when sick. The emergencyphase of civil assistance had begun.^’

First to be tasked with the problem, about 1 August, was SCAP’s PublicHealth and Welfare Section under General Sams. Sams arrived in Pusan withfour members of his staff and began to survey the needs of the people crowdedinto the Pusan Perimeter. He assigned an advisory team to the South Koreangovernment’s central relief committee and others to advise the two survivingprovincial governments at Pusan and Taegu. The Americans’ job was essentiallyto get supplies, to ensure their proper distribution, and to give the benefit of theprofessional knowledge and experience they had gained in Japan to the Koreanauthorities. Problems were severe. Some three hundred thousand refugees werethen living in the river bottoms in summer heat among multiplying insects andimpure water. Cases of typhus, typhoid, and diphtheria had appeared amongthem. Civilian hospitals no longer operated in Pusan, for the ROK Army hadseized the existing facilities.

A mass program of immunization, delousing, and sanitation began. In thelarge refugee camps, teams were organized among the inmates to police thegrounds, to clean the wells, to chlorinate water supplies, and to instruct theircompatriots in principles of basic hygiene, which they had newly learned them-selves. Volunteer teams fanned out to the villages, spreading the word. Millionsreceived shots. An intensive DDT dusting program took aim at the vectors ofthe Korean summer. By good fortune all the water supply plants in the PusanPerimeter, except three in the North Kyongsang Province, continued to func-tion. South Korean health and sanitation officials cooperated with the effort.Despite the usual difficulties in persuading or forcing people to change thehabits of a lifetime—peasants still tended to regard any unoccupied square yardof ground as a proper spot for defecation—sufficient control was achieved toprevent the outbreak of epidemics. Under the conditions of the perimeter, thatwas a remarkable accomplishment.'*®

^’Ist Cavalry Division War Diary, 24 Jul 50, file 901 (War Diary, 1st Cav Div, 25 Jun-Jul 50),Box 4405 (1st Cav Div War Diary w/G-2 and G-3 Sections, Jul 50), Entry 429, RG 407, MMFB;Military History Section, EEC, “History of the Korean War,” vol. 3, pt. 5, “Civil Affairs/CivilAssistance Problems,” pp. 27-28, Ms No. 8.5-lA AA.F, RG 319, MMHB.

““FEC, Annual Report of Medical Service Activities, 1951, pp. 177-81; extract from Presenta-tion, Brig Gen Crawford F. Sams, MC, to Brig Gen Earle Standlee, MC, OSD, et al., 8 Jun 51, sub:Disease and Hospital Conditions in Korea, HSF (Sams-1951). Both in HRB.

THE MEDICS’ WAR

Korean Refugees Near Chunju

Organization of the effort went apace. Arriving in Seoul at the end of Sep-tember, Sams’ groups found Colonel Mollohan, Sams’ Public Health and Wel-fare Section deputy, awaiting them. Two U.N. civilians from the InternationalRelief Organization joined the team. Though Mac Arthur’s G-4 (logistics) sec-tion still coordinated various aspects of the program, the Eighth Army head-quarters had responsibility for organizing the work and, in consequence, set up aCivil Assistance Section. For the time being the personnel remained the same,drawn mostly from Sams’ staff. Funds came from various sources, includingEconomic Cooperation Administration money originally intended for economicdevelopment. Civil assistance teams advanced with the fighting line. UnderMacArthur’s orders, they moved into North Korea to provide similar help to thepeople there, launching the usual immunization and delousing programs.

The growing importance of the work caused the Eighth Army to organize afield operating unit called Headquarters, Civil Assistance, Eighth Army.Meantime, another bureaucracy began to develop under the United NationsCommission for the Unification and Rehabilitation of Korea {Chart 2) and itsexecutive arm, the United Nations Korean Reconstruction Agency (UNKRA).UNKRA loaned personnel and experts to the United Nations Command andoffered policy advice to the South Korean government. Advisory teams took onan international flavor. General Sams noted on 18 December that “at presentwe have Americans, British, Dutch, Norwegians, Peruvians, Swedes and

| United NationsGeneral Assembly                  | —   |  |
|-------------------------------------------------|-----|--|
| U.S. Government & 1

Department of the Army |
| 1 .                                             |

UNKRA

Advisory

Committee

United Nations Commissionfor the Unification andRehabilitation of Korea

| L-_. | UNKRA                 | ✓   | Tokyo     | N | —1

United Nations   |
|------|-----------------------|-----|-----------|---|----------------------|
|      | Tokyo Office          |     | Joint     |   | Command              |
|      | Planning Liaison Team |     | Committee |   | Tokyo                |

United Nations KoreanReconstruction Agency(UNKRA)

Washington Office

Zone-of-Interior

Ports

| UNKRA        |  | Korea Joint |  | Eighth |
|--------------|--|-------------|--|--------|
| Korea Office |  | Committee   |  | Army   |

Planning Liaison Team

L_

Republic of Korea

United Nations

H Civil Assistance |“‘

Command, Korea

A AiiAA

Corps CivilAssistance

Command   Policy

Coordination  Membership

Working Teams in Field

Advice and authority as to whereand with whom to operate

Japan LogisticalCommand(Supply)

T

Ports &Depots

|  | 2d LogisticalCommand |
|--|----------------------|
|  |
|  |

Division CivilAssistance Teams

Unified Command.

L)cated at the United Nations. Affairs Actmiies in Korea, June 1952, p. x, LIB.

source: G-5. Headquaners. Far East Command and United Nations Command, Unite a ion

CHART 3-OrO*N,ZAT,ON OF T„B Un.TFD Nat.ONS Cv.b

Assistance Command. Korea. November 1952

Source: G-5, Headquarters, Far East Command

and United Nations Command, United Nations Civil Affairs Activities

in Korea, November 1952, p. ix, LIB.

325

Canadians which is, you will agree, quite a hodgepodge. . . Though militarypersonnel under Colonel Mollohan had gone into Inchon, worldwide recruit-ment for civilian public health experts continued, and substantial civilian in-volvement in the work became the rule, despite overall military control.

Stimulated by the influx of new personnel, both military and civilian, civilassistance offices multiplied to cover every province by the end of the year,except the extreme southern one of Cholla-Namdo. In the region near thefighting front such duties fell to civil assistance officers and enlisted men withthe divisions and corps. A chaotic period followed when the Chinese surgedsouth, recreating the scenes of July against a backdrop of plummeting coldinstead of breathless heat. As new waves of refugees, including many NorthKoreans, fled the Chinese, the United Nations Command sought to channelthem into peninsulas and onto islands out of harm’s way and the Army’s. SouthKorean police struggled to keep the main roads clear. As the fighting began tostabilize again, efforts got under way to exploit the refugees for labor, to resettlethem out of the danger zone, and to diffuse them among the settled populationin hopes of reviving the nation’s shattered economy.'*^

The Japan Logistical Command, meanwhile, shipped medical supplies forrelief in basic medical units modeled on the standardized medical maintenanceunits used by the Army—medicines and supplies to serve ten thousand peoplefor one month. Small, forty-bed hospital assemblies were also sent, enablingwar-ravaged civilian hospitals to reopen, or new ones to be established. Vac-cines were procured almost entirely in Japan, another boost for the rapidlygrowing Japanese industry in high-quality biologies. Donated supplies fromU.N. nations arrived in Yokohama to be sample-tested, stored, and shipped toKorea when requisitioned by the Eighth Army. On 11 January 1951 the Head-quarters, Civil Assistance, Eighth Army, was renamed the United Nations CivilAssistance Command, Korea (UNCACK). Its duties, as before, were to requisi-tion and distribute supplies and to plan, in conjunction with the South Koreangovernment, for their proper use. UNCACK represented the maturing of thecivil assistance structure in a form it was to retain, with only minor changes,until July \952> {Chart 3).^^

The winter of 1950-51 was a bad time, only a little less so for settledKoreans than for refugees. The weather was harsh. Bandits and guerillas ravagedthe hill districts, and police and army units waged an intermittent war ofextermination against them. Stress and hunger lowered resistance to disease,and two large groups lacking immunization had joined the popula-tion—refugees from the North, now scattered over the southern provinces, andbabies bom since the outbreak of war. In December rural areas experiencedoutbreaks of smallpox, which continued through the winter and into the spring

'"Extract of Ltr, Brig Gen Crawford F. Sams, Chief, Public Health and Welfare Section, SCAP, toCharles C. Furman, Chief, Recruitment Branch, Overseas Affairs Section, DA, 18 Dec 50, HSF(Sams-1950), HRB.

"^Military History Section, FEC, “Civil Affairs/Civil Assistance Problems,” pp. 1-2, 5-7, 9-14,38, RG319, MMHB.

“^Ibid., pp. 6-7, RG 319, MMHB; JLCOM, Annual Report of Medical Service Activities, 1950,file 319.1-2 (JLCOM) Far East-1950, HRB.

THE MEDICS’ WAR

months, hitting hardest in regions where fighting made disease control impossi-ble. Forces entering reconquered provinces near the 38th Parallel found thatwidespread typhus epidemics had occurred. The first six months of the new yearsaw thirty-eight thousand reported cases of typhus, forty-seven thousand ofsmallpox, and eighty-eight thousand of typhoid, the last a sure sign of pollutedwater supplies and inadequate sanitation. UNCACK faced not only the prob-lems of a brief crisis but also the continuing ones of a poor and backward nationutterly without resources to meet the devastation of war.'*^

In May 1951 UNCACK estimated that almost 4.5 million displaced personswere in South Korea. An unknown number lived north of the Han River; nearly1.3 million lived south of the Han, in Kyonggi Province alone. Some 60,000were relocated from the mainland to the large island of Cheju in the KoreaStrait, while 78,000 on Koje provided an element of volatility to the mountain-ous isle that was shortly to receive the main body of enemy prisoners as well.Carrying their belongings in A-frames, leaning often on sticks, wearing (if theywere fortunate) quilted coats over pajama-like suits with baggy pants tied at theankles, the refugees formed an almost indistinguishable mass, their individualstories of fear and flight known to few but themselves. To feed and clothe them,to dust and inoculate them, to shelter the orphaned, and to provide at least tenthospitals for the sick remained the foremost concerns of civil assistancepersonnel.

Civil assistance efforts also helped another group, the civilian laborers,whose services had become essential to the U.N. army. They carried supplies ontheir backs over rough terrain, built roads, repaired damaged bridges and rail-roads, worked at supply points and ammunition dumps, and so forth. Heavyconcentrations of such labor immediately behind the fighting lines and aroundthe port of Pusan created new needs for food, clothing, blankets, shoes, andmedical supplies—all contributed through the civil assistance program. UN-CACK estimated that about one hundred thousand men were involved, dividedabout equally between the corps and division areas forward and the logisticalcommand areas to the rear.

Medical support extended beyond these special groups to the entire civilpopulation. A systematic program got under way to immunize all citizensagainst typhus, typhoid, and smallpox in response to the epidemics. People incoastal areas and port cities received shots against cholera as well. As UNCACKpersonnel increased in numbers, supervision and assistance for Koreans partici-pating in the public health and information programs became more thorough.Training courses were held for provincial and city civil assistance teams andlocal sanitation workers. Villagers received instruction in the basics of publichealth, and cleanup campaigns began at the village level. Hospitals and dispen-saries increased in number, providing free care to about half the population.Funding came from a variety of sources, the Congress of the United States beingthe largest contributor under a program known as Civil Relief in Korea (CRIK).CRIK funds went for food, clothing, shelter, fuel, medical supplies, and recon-struction materials. At the end of 1951 SCAP reported that a “sound, expertly

“^FEC, Annual Report of Medical Service Activities, 1951, pp. 173-76, HRB.

327

planned, well conducted, highly successful environmental sanitation program”existed in Korea. Further, Koreans were doing much of the hands-on work,which implied a permanent gain in national understanding of basic publichealth."*^

The following year saw more progress in stabilizing the rear areas. Rehabili-tation of water systems continued on a routine basis, with inspections andsurveys by UNCACK sanitary engineers to ensure proper construction anddisinfection. The payoff for years of effort appeared as rates of illness respondedto the programs of environmental control and immunization. Striking declineswere registered in the diseases most closely associated with the disruption ofwar. Cases of typhoid, according to UNCACK, declined from about 69,000 to2,400; of typhus, from 31,000 to 721; and of smallpox, from 40,000 to 885.Recalling some of the earliest triumphs of modem medicine, control of thesediseases rested upon the classical methods of improved sanitation, vector con-trol, and immunization. In 1951 the three diseases claimed over twenty-fourthousand lives in South Korea; in 1952, fewer than six hundred.^^

Of great importance, though less publicized, was the program of improvingthe health of Korea’s food and draft animals. CRIK funds supplied and madepossible the rehabilitation of national and provincial veterinary laboratories.Vaccines from the same source made possible nationwide programs of immuni-zation against hog cholera; Newcastle disease, which affects chickens; and ra-bies. In a nation that depended heavily on animal muscle, and among a peoplechronically short of protein, such improvements had direct implications forhuman health and the national economy.

Success was not, of course, universal. Tuberculosis continued as the greatestand most baffling problem. In December 1952 the South Korean Ministry^ ofHealth reported that 1.3 million Koreans suffered from the disease—some 6.5percent of the population, most of them younger people. An intensive programof tuberculin testing to locate victims began during 1952, aimed especially atchildren. UNCACK personnel supervised, while Korean doctors and nursescarried out the effort. But many doctors had been drafted into the ROK Army,and the government’s health budget could not support its part of the program.New momentum was gained in 1953, when some four hundred thousand testswere administered, but reporting remained slow. Tuberculosis proved itself inKorea, as it had in Japan, a most resistant menace. Other difficulties showedduring the spring of 1952 in a renewed rise in smallpox, mostly among nonvac-cinated children, though in this case improved reporting procedures may havecreated the illusion of a rise over 1952.'*’^

Most basic to Korean health then and in the future were the country’s ownresources in hospital plants and especially in professional skill. The former

"*Ibid., pp. 176, 181 (source of quotation), 225-29, HRB. See also Orlando Ward, Civil Assis-tance in Korea (FEC Printing Plant, 1951).

^KCOMZ, Report of ETMD, September 1952, p. 21, file 350.05 (KCOMZ) 1952, HRB; J-5,Headquarters, Far East Command, United Nations Command (hereinafter cited as FEC/UNC),United Nations Command Civil Assistance and Economic Affairs—Korea, 1 July 1952-30 June 1953,p. 15, LIB.

^’FEC/UNC, Civil Assistance and Economic Affairs, pp. 15-17, LIB.

THE MEDICS’ WAR

former proved far easier to increasethan the latter. By late 1951 civil assis-tance had made possible the openingof all hospitals where damage was notbeyond repair. At the end of June1952 government agencies were run-ning 97 hospitals and almost 500 dis-pensaries, with a total bed capacity inexcess of 9,000. Missionary hospitalsprovided another 200 beds and pri-vate hospitals almost 1,300. A year lat-er government bed capacity had in-creased to 9,700 and missionary to550. The ROK Army was, of course,operating its own system.

A deficient supply of trained doc-tors remained the chief weakness inthe system and in the efforts of civilassistance to provide an adequatehealth program for the nation. Koreandoctors were divided into three cate-gories: those who had graduated fromapproved medical schools; those who had passed government examinationsafter a little formal training; and those whose training was limited to an appren-ticeship. In early 1953 the number of physicians in all three categories to serve apopulation of about 20 million totaled 5,237. One doctor, often of dubiouscredentials, for every 3,800 persons was a statistic that would have horrified theAmerican Medical Association, for the poorest American states counted no lessthan 1 to 2,200 during the height of the Second World War. But not all theKorean doctors were available for the general population; 1,350 were in theROK Army, and others were out of the country or were government officials orteaching in government schools. Many Koreans no doubt continued to dependfor most of their medical problems on the 5,000 herb doctors who, as in timespast, practiced Chinese medicine, passing on its lore to their apprentices."**

As a result, UNCACK estimated that fewer than 800 doctors were in privatepractice in the whole Republic of Korea, and “most of these [were] either in ornear major cities.”"*^ Early in 1952 the command converted a truck into anexperimental mobile clinic, which began operation in the refugee-crowdedSouth Chungchong Province. Success was immediate. UNKRA agreed to fur-nish four more mobile clinics, supplying the necessary drugs and training Kore-an staffs. All five facilities were in operation under UNCACK by early 1953,when the United Nations Command supplied a sixth clinic to operate on thelarge island of Cheju, also crowded with refugees. With the clinics maintained

‘“Ibid., pp. 17-18, LIB; Fishbein, Doctors at War, p. 83.“’FEC/UNC, Civil Assistance and Economic Affairs, p. 18, LIB.

War Orphan SufferingFrom Malnutrition

329

by the government, by missionaries, and by voluntary agencies, the mobile unitsbrought at least the rudiments of care while they sought out medical data on themasses of Koreans who otherwise would not have seen any doctors at all.

The time, cost, and technical expertise required to train doctors was a formi-dable stumbling block, one that endured until long after the war’s end. Themilitary pitched in, however. The Korean Communications Zone (KCOMZ)adopted a policy of aiding Korean medical education. American and other U.N.medical officers served as part-time instructors at medical colleges in the com-munications zone, and the KCOMZ surgeon frequently lectured to the faculty ofTaegu Medical College. U.S. Army instructional films were loaned to the col-leges to assist teaching. The language barrier was particularly great in communi-cating technical subjects. Whether, as some officers believed, speaking slowlyand distinctly aided comprehension is doubtful. Yet many Koreans were pick-ing up a smattering of English, and lectures were mimeographed and distributedthree to seven days before they were delivered to enable students (and faculty)time to puzzle them out.^®

In many ways the broadest contribution of the American forces came afterthe armistice. In July 1953 UNCACK was reorganized as the Korean CivilAssistance Command. With no more battlefield casualties to treat, militarydoctors and health facilities provided greater aid to the civilian population. Themission of maintaining and improving public health during wartime shifted intoa program of rehabilitation and reconstruction, to which the Korean govern-ment as well now could devote a larger proportion of its meager resources.These developments lie outside the scope of this chapter; however, the trendsthat were to make South Korea a modem nation in health care during thegeneration that followed the war apparently rose from a foundation laid in thedarkest days of the nation’s recent history.

Korean Soldiers and Laborers

Though the demands of the ROK Army drained civilian doctors from anation that had few enough to begin with, the program of health training in thearmy to which the United Nations Command contributed had clear long-rangeimplications for the improved care of all Koreans. Health workers in armyschools received instmction in arts they later would apply in civilian life. TheROK Army’s health discipline transmitted the message of basic public healthand sanitation to soldiers, many of whom had lived until the war in conditionsapproximating the Middle Ages in the West. At the same time, U.N. hospitalsand dispensaries served the needs not only of Koreans drafted into the Ameri-can divisions to augment their strength (KATUSAs) but also to members of theKorean Service Corps (KSCs) who supplied unskilled labor to the fightingforces. One of the evacuation hospitals, the 171st, served the Korean ServiceCorps alone, and evacuation was entirely through American channels.

*®KCOMZ, Annual Report of Medical Service Activities, 1952, end. 1, p. 4, HRB.

THE MEDICS’ WAR

Building up the ROK Army’s medical capability to serve its own troops wasa frustrating and arduous endeavor. According to the available evidence, thearmy received comparatively little help during 1950, except for medical suppliesand random training of its medical and dental officers by their American coun-terparts. Many descriptions of ROK Army hospitals in this period were hair-raising because of—in the words of Colonel Dovell—“amputating geniuses” atwork on the patients, fighting infection with the knife as American militarysurgeons had done during the Civil War. The ROK Army medical serviceremained autonomous, operating, even in corps areas, Class II installations forthe evacuation of its own soldiers who were wounded while serving in Koreandivisions under U.S. command.

The channel for providing American guidance and assistance to the ROKArmy was the United States Military Advisory Group to the Republic of Korea(KMAG). Its headquarters in Taegu also included the senior medical adviserand staff that served in the Office of the Surgeon General, ROK Army. Theincomparably greater resources in materiel and skill in American medical facili-ties made KMAG a frequent recipient of offers of assistance, for anything thatserved to increase the efficiency of the ROK Army was of evident value to theforces that served beside them. During 1952 considerable help was given inevacuation. Air evacuation was beyond the ROK Army’s capability, and consol-idation of ambulance and rail hauls reduced the burden on Korea’s transportsystem. American surgeons were loaned to work on ROK Army patients whenpossible.®*

In general, however, the ROK Army’s medical organization and channelsdeveloped as mirror images of the U.N. system. Its tables of organization andequipment were less complex than for equivalent American units, and U.S.supply officers tried to keep them simple in order to reduce the strain on theirstocks. Basically, the 60th Medical Depot received supplies and issued them tothe ROK Army Medical Depot in Pusan, which then answered requisitions fromits three forward platoons at Taegu, Seoul, and Chunchon. Shipments fromJapan and the zone of interior, which went beyond the surpluses available in theKorean depots, met the needs of the ROK Army expansion during 1952. AtKMAG three medical supply advisers on the staff of the senior medical adviserstruggled to bring the ROK Army expansion during 1952. At KMAG threemedical supply advisers on the staff of the senior medical adviser struggled tobring the wishes of Korean officers into line with their actual needs and with theavailable materiel. Establishing adequate control of supplies was difficult, andinefficiency and confusion were common.®^

Maj. Anthony J. Zolenas, Jr., a Medical Service Corps officer, served as aKMAG medical adviser to the South Koreans while the first American effortswere getting under way during 1950-51. He accounted the time “the best part of

*'EUSAK, Report of ETMD, June 1951, p. 51, file 350.05 (EUSAK) 1951; EUSAK andKCOMZ, Annual Reports of Medical Service Activities, 1952, p. 13 of annex IV and pp. 1, 3-4 ofend. 1, respectively. All in HRB.

“EUSAK, Annual Report of Medical Service Activities, 1952, annex V, p. 7, HRB. See also EECand USAFFE, Annual Report of Medical Service Activities, 1952, p. 76, file 319.1-2 (FEC) FarEast-1952, HRB.

331

his experience in Korea,” though it could not have been easy. His effort toreform their hospitals and medical supply system was assisted by two Koreansnamed Kim, an enlisted bodyguard and a Western-trained physician. Trainingmanuals from Zolenas’ footlocker were translated, and a Korean practitioner oftraditional Oriental medicine, with an energetic aide who was Western-educat-ed, began using the materials to train medical technicians.^^

In early 1951 the Koreans got their first hospital assemblies from Japan, andZolenas worked with them to develop supply and resupply procedures. Tech-niques had to be worked out gradually for dealing with people who were proud,intelligent, and wedded to a medical tradition whose complex lore formed partof their inherited culture. Colonel Dovell had selected an Edinburgh-trainedboard-certified obstetrician as surgeon general of the ROK Army, and throughhim elderly officers devoted to herb medicine were gradually shunted into jobsthat were full of honor but deficient in the power to make mischief. For exam-ple, Zolenas’ assistant. Colonel Kim, learned about “a certain hospital com-mander [who] didn’t believe in operating or giving blood transfusions. . . .’’Insuch a case there was only one thing to do: “send him to an induction center toexamine recruits, or put him in charge of a despensary [5/c] where his oldfashioned medical ideas wouldn’t do much harm.”^^

Liking the Koreans, Zolenas lived with them, ate their food, learned “neverto appear to be imposing [your] ideas on them, but rather to let them mill [sic]over what you had to tell them and let them work the right answers out forthemselves.” Correct as it was in essence, this diplomatic approach causedproblems in meeting the brusque demands of war, for inadequate medical su-pervision was quite dangerous at any level, including the induction center.Another problem was that Korean resourcefulness, praised by Zolenas, alsoapplied to theft. Maj. John B. Moore, the Eighth Army medical supply officerunder General Ginn, later had many a tale to tell of the “horrible pilferage rate”in both American and South Korean medical stores. “No matter how much theROK’s were issued, they were always complaining that they needed more.” TheROK Army medical warehouses falsified inventories to cover up thefts, asAmericans discovered in the summer of 1953 when they staged surprise raids ontheir ally’s stores. But in a poor and long-exploited land, theft was almosthonorable. It was the traditional medicine for poverty.^^

In September 1952 the ROK Army Medical Field Service School reopened atMasan under KMAG, commanded by an American Medical Service Corpsofficer. The school since its original founding in 1949 had a checkered history,marked by persistent poverty. The new school copied the methods of its coun-terpart at Fort Sam Houston, Texas, drawing instructors from the faculty of theinstitution and following its curriculum. Officer and enlisted student quotaswere set by the ROK Army surgeon general, and Korean medical and medicalservice corps officers who had graduated from American service schools were in

“Interv, Samuel Milner with Col (Ret.) Anthony J. Zolenas, MSC (hereinafter cited as ZolenasInterv), 13 Jul 66, p. 11, AMEDD Oral History Collection, HRB.

*"Ibid.,p. 17, HRB.

**First quotation from ibid., p. 15. Second quotation from Moore Interv, 28 Jul 66, p. 2. Thirdquotation from ibid., p. 7. All in HRB.

THE MEDICS’ WAR

demand for their fluent command of English as well as their clinical and mili-tary knowledge. Instruction was in Korean, but knowledge of English technicalterms was required of all students, who included doctors, administrators,nurses, and enlisted men. Courses combined lectures and demonstrations withfield exercises. The area near Masan had seen some of the deadliest fighting ofthe Pusan Perimeter, and descriptions of the region mention not only the heavi-ly wooded area with parade grounds, where the school was located, but also atraining area in a nearby mountain pass, where field evacuation and first aidcould be studied under conditions of simulated combat. Through their schoolmen and women of improved skill and practical experience began to filter backinto the ROK Army and, conducting unit programs on environmental sanita-tion and individual hygiene, to affect the outlook of masses of young Koreans.^^

Yet when all is said and done, ROK Army medicine by the end of the warwas good only by comparison with that of other Asian armies and its own grimpast. In the spring of 1953 American press reports raised questions about theefficiency of the South Korean medical service in treating its wounded men. TheOffice of the Surgeon General checked into the situation. Analysis showed thatthe ratio of killed in action to wounded in action was 1 to 3.14 in the ROKArmy as against 1 to 5 for the U.S. Army, implying that less adequate evacua-tion resulted in more deaths among seriously wounded South Koreans. Of thewounded who reached medical channels, however, only 1.55 percent died, fewerthan in the American Army. The reason may well have been the same: thearrival of a smaller number of seriously wounded to swell the death total. Thefact that many serious cases were evacuated through American channels alsomay have contributed in part to the figures, reflecting the ROK Army’s continu-ing problems in handling evacuation.

Overall, Surgeon General Armstrong judged that the ROK Army medicalservice was probably the best in Asia, comparing favorably with that of the U.S.Army in the early twentieth century. South Korean medics had improved since1950 in striking fashion; in no equal period of time had their U.S. counterpartsmade a similar advance. By 1953 a South Korean neurosurgical team washandling casualties in professional fashion. “If, as alleged,” wrote Armstrongtartly, “twice as many wounded South Korean soldiers are dying after reachingSouth Korean medical channels, as compared with our current record, the SouthKorean Medical Service is to be congratulated. I question whether they haveattained this standard since it would compare with our own in World War II.”^^

Exhibiting a mixture of defensiveness and optimism, like a parent with aslightly backward child, Armstrong refuted in a similar vein press complaintsabout the way the ROK Army was fed.^* Again relying (as in the case of the

“See Arthur D. Sullivan, “The Training of Korean Army Medical Service Personnel,” and HunChan Yoon, “Preventive Medicine in a Korean Division,” both in Medical Bulletin of the U. S.Army Far East 11 (October 1953): 187-89 and 190-91, respectively. See also Philip J. Buckler, “AnIntroduction to the Medical Field Service School, Republic of Korea Army,” [1952].

*’Memos, Maj Gen George E. Armstrong, Surgeon General, DA, to Secretary of the Army, 24 and27 Feb 53, subs: Medical Service of the ROK Army, file 333.5 (Far East Command) AA, 1953, Box69, Accession no. 56A-179, RG 112, WNRC.

“The following section is based on Summary of Significant Findings and Recommendations ofthe Report to the Chief Surgeon, United States Army Forces, Far East, 20 Jul 53, sub: Report of

VICTIMS OF WAR

333

POWs) on analyses of the caloric value of the official ration, the surgeon generalconcluded that the feeding of the South Korean Army was adequate, with 3,800calories a day for front-line troops and 3,100 for those in the rear. Malnutrition,he pointed out, accounted for less than 1 percent of admissions to ROK Armyhospitals.

The fact that all the calories for men at the rear came from rice might in itselfhave raised some questions about this easy reply. Here the matter rested, how-ever, until the Sandstead-Koehn team reported in early summer. Their accountmade dismal reading. “[It is] estimated that approximately fifty percent of themen inducted into [the] ROKA failed to reach front lines because of malnutri-tion. Effectiveness of those reaching front lines is impaired because of malnutri-tion. New ROKA inductees were found to be in marginal nutritional state. Ineach successive stage of training, progressive deterioration in this nutritionalstate was noted.” Excessive work—a sixteen-hour training day supplemented byhard labor on roads and construction projects—without a compensating dietwas the apparent cause. The herb doctors who watched over their health appar-ently saw nothing wrong. The end result was an army that suffered from almostevery form of physical debility associated with inadequate food: weight loss andprotein and vitamin deficiencies, especially in A, B, B2, and C. Men in forwardareas, guarding the line, exhibited nutritional edema as well as emaciation andweakness. The deficiencies were “of serious nature undoubtedly inimicable [5/c]to the effectiveness and stamina of the ROKA.”

The team recommended immediate reduction of the training schedule toeight hours a day, excusing combat trainees from labor battalion work, evacua-tion of men with “definite debilitating malnutrition” from the line to restcamps, and a ration supplement of brewer’s yeast for all. Long-range improve-ment would require modifying the basic ROK Army rotation, abandoning thepractice of paying troops a stipend to enable them to buy part of their own food,and issuing rations under rigid control at large breakdown points. (The reportdid not make clear whether the purpose of this reform was to maintain qualityor reduce graft.) Similarly, the rations of the KSCs should be raised in caloricvalue and improved with vitamin supplements, especially A and C. The teamurged action on the diplomatic level to appoint an American nutritional consult-ant to the United States Army Forces, Far East, specifically to advise the SouthKorean government on how to feed its troops.

In all, this startling analysis, coming just at the end of the fighting (it wascirculated to top U.S. officials during July 1953) raised serious questions aboutthe causes and consequences of malnutrition in Syngman Rhee’s army. Did theconditions under which young men were better fed in a war-shattered civilianeconomy than in their nation’s army result from sheer nutritional ignorance,official venality, or the practice of allowing South Korean soldiers in part to feedthemselves, again ignorantly, with a small allowance of money? The ROK Armyoften had performed in disappointing fashion during the war. To what extentcould this be attributed to starvation? Though the fact was not mentioned in the

Nutrition Survey of ROKA, KSC, and PsW, attached to DF, Prentiss to Long, 24 Aug 53, and torelated correspondence on same subject, RG 112, WNRC. All quotations therein from this source.

THE MEDICS’ WAR

summary report, Vitamin A deficiency can cause night blindness, a most unde-sirable condition in a war where enemy attacks usually were launched afterdark.

The question of the American Medical Service’s own responsibility alsoarose. Clearly it had no official duty to oversee the feeding of the ROK Army.Yet its contacts with that army were intimate, and the existence of widespreadnutritional edema and cachexia among front-line troops probably would havebeen a matter of some interest to the United Nations Command. Because theMedical Service was quick to take a due measure of credit for advances in ROKArmy medicine, it might well be charged with regrettable lack of alertness inspotting a serious and fundamental failing in an army over which an Americanheadquarters exercised command, and upon which all U.N. forces in Koreadepended for the defense of wide sectors of the line.

As a theater of tragedy, melodrama, and occasional gross comedy, the Kore-an rear areas yielded nothing to the battle line. Indeed, there were times whenthe sharpest battles were at the rear. For all its failings, the United NationsCommand followed medical policies that were humane in principle if some-times deficient in practice. The lot of POWs and the much-battered Koreanpeople was bettered, major diseases suppressed, and at least minimal carebrought to many whose normal state in time of peace was to live and diewithout any medical attention at all. Of the four classes of South Koreansconsidered here—refugees, soldiers, KATUSAs, and KSCs—those under themost direct control of the American medics did best. Ironically, this meant thatthe ROK Army troops on the line, depending as they did primarily on theirgovernment and their own nascent medical service, in many ways did worst ofall. Throughout South Korea, the most typical medical endeavor continued tobe a holding action against great odds. So it would remain, despite some promis-ing efforts, until peace made possible a new beginning for all the victims of thewar.

Chart 4—Organization of the Medical Section

United States Army Forces, Far East, December 1953

I Radiology Medical Library |

Laboratory & Pathology [

Source:Vna.a States Army Forces, Far East, Anrtual Report of Medical Service Activities,1953, p. 4, file 319.1-2 (USAFFE) Far East-1953, HRB.

CHAPTER 11

The End of the Fighting

Nineteen fifty-three began with the war, the fighting front, and the relationsof the contending powers all in a state of deep freeze. Routine patrol activityand a few unsuccessful attacks on strongpoints by the Communist forces occu-pied the men on the line. From the United States Army Forces, Far East(USAFFE), headquarters to the forward bunkers habit ruled a conflict that hadsettled into routine. On the world scene harbingers of change appeared with theinauguration of Dwight D. Eisenhower as president of the United States inJanuary and with the death of Russia’s dictator, Joseph Stalin, in March. Butthe early months of the year gave small indication of the events to come.

The Medical Picture

The Medical Section, USAFFE, had reached full development {Chart 4). Itsmajor functions had matured but changed little from 1952. In evacuation, airstill predominated, both for carrying casualties from Korea to Japan and fromJapan to the zone of interior, though naval hospital ships occasionally played apart when rotating back from assignments in the war zone. The 801st (laterredesignated the 6481st) Medical Air Evacuation Squadron was chiefly respon-sible for moving patients within Japan and from Korea to Japan. The 1453dMedical Air Evacuation Squadron of the Military Air Transport Service carriedevacuees from Japan and the Ryukyus Command to the United States. Armymedical regulating officers operated at Seoul for the Eighth Army, at Pusan forthe Korean Communications Zone (KCOMZ), and at Camp Zama for the FarEast Command. Typically, a hospital would report on patients ready for evacua-tion to the appropriate medical regulating officer, who would then contact the6481st at Tachikawa Air Base to provide transport. The officer at Camp Zama,upon notification from Korea, designated the hospitals in Japan that were toreceive the evacuees. All services were involved, for liaison officers from the AirForce and Navy coordinated use of their own services’ hospitals. U.N. personnelwere hospitalized in the Tokyo area. Though as a rule each service cared for itsown people, hospitalization was primarily on an area not a service basis, and in

336 THE MEDICS’ WAR

consequence individual American wounded or sick might find themselves inany convenient facility/

Throughout, the customary evacuation policies ruled—30 days for Koreaand 120 for Japan. On return to the United States evacuees received theirhospital assignments from the Armed Services Medical Regulating Office inWashington, D.C., with most Army patients going to the large general hospitalsfor specialized care. What had once been a flood, however, had fallen by theearly months of 1953 to a relative trickle. For all three armed services, a total ofabout two thousand battle casualties and fourteen hundred others were receivedfrom Korea during the first six months of 1953. The Army had slightly morecasualties than the Marine Corps, while the Air Force, with only eight wounded,exhibited almost a peacetime pattern.^

Within Korea the fact that the KCOMZ still had no clearly defined missionto provide medical support for the Eighth Army caused some difficulties. Bedrequirements and staffing in the communications zone had to be justified on thebasis of its troop strength alone. Only the lack of activity on the front preventedthe deficiency from having serious consequences. The problems of evacuatingU.N. patients through American channels were likewise of little practical impor-tance. Over the years the situation had grown familiar, and linguistic difficultiescontinued to be minimal, even with tongues like Amharic (Ethiopian), whichalmost no Americans spoke. Units still provided their own medical personnel atthe lower echelons, and the Ethiopian surgeon, by good fortune, was an English-speaking European versed in a number of languages. The commander of theEthiopian unit found that the system of evacuating through American channels“works very satisfactorily. We don’t think any changes in the present arrange-ments are necessary.”^

Supply similarly had become standardized and remained virtually un-changed through 1953. Lack of fighting in the early part of the year enabled theinventories at medical depots to reach their most satisfactory condition sincethe beginning of the conflict, with materiel on hand that proved very usefulwhen the final enemy assaults began in the summer. The source of supply was,as before, the Japan Medical Depot, shipping to the 60th Medical Depot in theKCOMZ. In turn the communications zone depot supplied the Eighth Armythrough the 6th Army Medical Depot, the Republic of Korea (ROK) Armythrough its medical depot, and the units of the zone directly. The Eighth Armyand the ROK Army together took about three-fourths of the materiel issued,while the KCOMZ absorbed the rest. As before, the 60th Medical Depot operat-ed under KCOMZ’S subordinate command, the Korea Base Section. One oddityof the early part of the year was the reluctance of depot personnel in Japan tomaintain stocks at a high level. Rotation and the draft had by now eliminated allworkers with experience of heavy combat, and as a result medical supply people

'USAFFE, Annual Report of Medical Service Activities, 1953, pp. 80-93, file 319.1-2(USAFFE) Far East-1953, HRB.

^Armed Services Medical Regulating Office, Summary of Major Events and Problems, 1 Jan53-30 Jun 53, pp. 2-3, file 314.7-2 (Army Medical Service Activities, 1 Jan-30 Jun 53), Box 2, RG112, MMFB.

^Quoted words from Military History Section, FEC, “History of the Korean War,” vol. 3, pt. 2,sec. B, “Inter-Allied Co-operation During Combat Operations,” Ms no. 8-5.1 A AI VI, RG 319,

337

found it hard to believe that the levels established by their predecessors had anyrelevance to things as they now were. Fortunately, General Ginn knew better,and supplies to meet the last attack were either on hand or on the way when theneed arose."*

The personnel picture in USAFFE continued to resemble the familiar imageof a revolving door. The problem was not only the old one of rotation—which aslate as September was still calculated on the basis of constructive months ofservice—but of special early-out provisions that began to emanate from theDepartment of the Army following the first breakthroughs toward peace in theearly spring. “What the public may regard as overstaffing,” wrote the surgeongeneral to General Shambora, “in fact, is not such. However, we already havebegun to receive a trickle of letters originated by individuals in oversea[s]commands and coming to us through various channels including members ofcongress. I anticipate that this trickle will grow into a fair size stream andrefutation of the allegations [of overstaffing] is most difficult without breakingsecurity.” Unpredictable changes in policy made advance planning and requisi-tioning of replacements as baffling a problem as the physical turnover itself. Notuntil October did a fixed-tour requirement for service in the Far East Commandfinally promise a return to order. Meanwhile, under pressure from civilianmedicine, the Army rushed to release its physicians upon the mere promise ofpeace.^

Doctors in the Far East Command continued to be young, professionallyable, and short on field experience. Reflecting the obsessive specialization ofAmerican medicine as well as the Army’s own deliberate policy, too manymedical officers were trained in specialities and too few in general practice.Because of the shortage of general practitioners, who were needed most, thespecialists had to fill slots for which they overqualified. Men of sophisticatedtraining had to go forward into field assignments that provided them muchphysical discomfort and little professional excitement. Meanwhile, the lack ofexperienced officers to fill command positions brought older specialists intojobs as division surgeons and hospital commanders, rather than allowing themto use their clinical skills. The problem of finding officers who combined mili-tary experience, administrative knowledge, and board certification was not easi-ly solved, and, on the whole, experience continued to be at a greater premiumthan clinical expertise. Shortages became more pronounced in units that werecloser to the sound of gunfire. The Eighth Army complained of a “continuingshortage” throughout the year, extending to all grades, but critical in field-gradeofficers. Of 130 field-grade Medical Corps officers authorized, only 43 actuallywere assigned at the end of 1953; only 6 had previous command experience and

MMHB. See also KCOMZ, Annual Report of Medical Service Activities, 1953, p. 3, file 319.1-2(KCOMZ) Far East-1953, HRB.

'‘USAFFE and KCOMZ, Annual Reports of Medical Service Activities, 1953, pp. 94-96 and pp.3-4, respectively, HRB.

^Quoted words from Ltr, Maj Gen George E. Armstrong, Surgeon General, DA, to Maj GenWilliam E. Shambora, Chief Surgeon, Medical Section, FEC, 16 May 52, p. 2, 319.1 (Far EastCommand) AA, 1951-52, Box 69, Accession no. 56A-179, RG 112, WNRC. See also references toPublic Law no. 83-84, 29 Jun 53, and Department of the Army Msg no. 415370, 30 Apr 53, andMsg no. 438420, 24 Jul 53, cited in USAFFE, Annual Report of Medical Service Activities, 1953,pp. 6-7, HRB.

THE MEDICS’ WAR

only 3 of the 6 division surgeons hadstaff experience.

Veteran Medical Service Corps of-ficers were likewise in short supply, di-minishing a source of compensatingstrength. Because they were so oftenpulled into Medical Corps administra-tive slots, their usual role in trainingmedical units for combat was less easyto perform. Nurses were at about 70percent of authorized strength. In theArmy as a whole, the sharpest drop inany category during 1953 was in Medi-cal Service enlisted men. Falling draftquotas at home in the first six monthsof the year were reflected in a declinefrom about eighty thousand to sixty-four thousand—a 20 percent drop-off.But the Far East Command apparentlywas not affected before the armistice.^Preventive medicine, best performed under conditions of stability and care-ful routine, reached a high level of competence and success despite the problemsof the command. At division and corps headquarters general medical officerswho had taken a short preventive medicine course at the Medical Field ServiceSchool in Texas but who had no lengthy experience in the field usually filledavailable slots. Or nonmedical officers with a background in civilian public ^health might take on the job. The competence displayed by the latter groupindicated that very elaborate training was not a practical necessity for the workin Korea. (At major headquarters, however, fully qualified medical officers,sanitary engineers, and entomologists were the rule.) One preventive medicinecontrol detachment served with each division, carrying out the work of sanitaryinspection, insect and rodent control, and so forth. Technical supervision fromthe Office of the Surgeon, Eighth Army, supplemented the knowledge of thedivision surgeons but led to some grumbling about interference from above. Byyear’s end, however, the units were still attached to the divisions but underArmy control.^

Health discipline for the troops had reached its highest level of development.Every man had to shower once in five days; at the battalion shower point he alsoreceived a complete change of clothing. During cold weather he spent severalhours in a warming bunker every three to four days. In effect, this bunker was a

Care of the Feet

‘Sources for the above paragraphs include: EUSAK, Annual Report of Medical Service Activi-ties, 1953, especially pp. 2-3, file 319.1-2 (EUSAK) Far East-1953; Personnel Division, OSG,Summary of Major Events and Problems, in Source Material for Summary of Medical ServiceActivities, 1 Jan 53-30 Jun 53, p. 13, file 314.7-2 (Army Medical Service Activities, 1 Jan 53-30Jun 53). Both in HRB.

’USAFFE, Annual Report of Medical Service Activities, 1953, p. 69, HRB.

339

dayroom where he read, wrote letters, washed his clothes, and received a hair-cut. Rest periods in a rear area were allotted on a rotating basis, and, as in thepast, each man received a five-day rest and recuperation leave in Japan at sometime during his service in Korea. Whether or not combat was occurring, thecompany aidman remained the key to maintaining health in his unit, especiallywhile it was on the line. Each man had to change his socks daily as a precautionagainst trenchfoot, and one duty of the aidman was to inspect the feet of allmembers of his unit every day. The aidman also sprayed bunkers with disinfec-tant once a month and spread rat poison to control the rodent population. Hechecked the chlorination of water, distributed chloroquine weekly by roster,gave first aid, and kept an eye on latrine and mess facilities. He was, as usual,indispensable.®

No important new health problems developed during 1953. In the springhemorrhagic fever repeated its by now familiar seasonal pattern. Despite inten-sive study by epidemiologists and ceaseless work in medical laboratories, theagent was not isolated, the vector was not found, and the natural reservoir wasnot identified. No therapeutic agent appeared. On the reasonable assumptionthat a virus caused the disease, that its reservoir was among wild rodents and itsvector a chigger or mite, an extensive mite control program continued, withquartermaster laundries routinely soaking newly washed outer clothing in miti-cide. During the April to September season medics could congratulate them-selves that only 148 cases were reported, as against 487 for the same period in1952. Unfortunately, during the fall season 279 cases occurred, a few more thanin the 1952 autumnal outbreak. Was the mite control program wrong in princi-ple (as later proved), or was it improperly carried out? A carefully supervisedprogram for an entire division was planned for 1954; however, the war endedwith the mystery of hemorrhagic fever still unsolved and, more to the point,with even the pragmatic methods of field control in doubt.

Among other diseases, a few cases of smallpox surprisingly occurred amongArmy personnel, about one a month from December 1952 to March 1953. Allwere in the Pusan area, and all reflected unsuccessful vaccinations. Hepatitisdeclined throughout the Far East Command, with the greatest change noted inthe Eighth Army area. With only 2.5 cases per 1,000 troops per annum, theforward areas were benefiting from the improved water, better mess discipline,and enforced lack of contact with infected civilians. More rigorous medicaltesting of civilian employees in rear areas, where they were widely employed,revealed that 4 percent of those who had passed earlier testing had activetuberculosis. The use of routine X-rays thus provided a new means of guardingtroops against one of the commonest of local ills. Malaria control was even moreeffective in 1953 than in earlier years. In Korea the reported incidence of 8.4 per1,000 troops per annum in 1951 had declined to 3.2 in 1952 and dropped againto 1.9 in the last year of the war. Primaquine treatment of Korean veteransreturning to the United States appeared to be successful, with a resulting drop inthe cases among rotated Army personnel. More than 10,000 such cases were

*Samuel Hurewitz, “S.O.P. for Aid Men of Infantry Companies,” Medical Technical Bulletin 4(May-June 1953): 85-86; Hermes, Truce Tent and Fighting Front, p. 374.

THE MEDICS’ WAR

reported in 1952, but only 848 came to light in 1953. Checking for toxic sideeffects of primaquine continued to be a tiresome chore for GIs and medics alike,for men taking the drug were supposed to report to the dispensary for fourteendays afterward. Nevertheless, primaquine appeared to destroy malaria parasites,rather than merely suppressing the clinical symptoms like earlier antimalarials,both natural and synthetic.

In Korea cold injuries declined with improved discipline and the low level offighting. Aerial spraying of insecticides continued during warm weather, carriedout jointly by the Fifth Air Force and Eighth Army. Vector control details wereset up in every company and battery, or separate unit, and their memberstrained by the preventive medicine units. A newly established PreventiveMedicine Association of Korea, which held regular monthly meetings, proved avaluable educational tool, especially because so many of the people engaged inthe effort were to some extent amateurs. Every meeting was built around alecture by a visiting consultant, or other expert, and all personnel involved inthe work were encouraged to attend.

Prevention of disease extended to Koreans, both civilian and military. In thelate summer and early autumn an epidemic of Japanese encephalitis swept thecountry, though few cases were reported among American troops. However, theneeds of the local population and the ROK Army got increasing attentionduring the lull in the winter and spring and again after the signing of thearmistice. The Preventive Medicine Association served as adviser to the KoreanSchool of Public Health, giving assistance in planning curricula and providinglecturers from its own members and its visiting experts. A preventive medicinesection was set up within the United States Military Advisory Group to assistthe ROK Army. Members of the Korean Service Corps were surveyed in somedivisions for tuberculosis, though the results at year’s end were termed inconclu-sive. The prevalence of rabies in Korea’s animal population—rabid animals hadbitten about a hundred U.S. soldiers during 1953—led to an intensive programto immunize pets acquired by military personnel. Efforts to improve animalhealth apparently were due largely to civil assistance officers. Work with and forthe Koreans would increase greatly after the armistice, but the final months ofthe fighting demonstrated concern and helped to lay a basis for future efforts.^

On the Line

In the forward areas the major innovation in organizing Eighth Army medi-cal care was the activation of the 30th Medical Group on 25 March 1953. Byearly June this subordinate command had taken charge of the surgical hospitals,the separate medical battalions, the 1 st Medical Field Laboratory, and an arrayof small units of company, dispensary, and detachment size. Its fundamentalmission was to coordinate the operations of units providing third-echelon sup-

’USAFFE, KCOMZ, and EUSAK, Annual Reports of Medical Service Activities, 1953, pp.62-79, pp. 5-6, and pp. 3-6, respectively, HRB.

port to the Eighth Army, and this comprehended evacuation; initial hospitaliza-tion; and area medical service, including dental care.’®

As the largest medical field command ever assembled by the Army, up to theKorean War, the 30th Medical Group unified under a single headquarters evac-uation and area medical service, previously the domain of the 163d MedicalBattalion. Fixed-wing aircraft and the two Eighth Army evacuation hospitalsremained outside its jurisdiction. Like the 52d Medical Battalion, which wasattached to the medical group, the 30th’s function was not to fix policy—thatremained the concern of the Eighth Army surgeon. General Ginn—but to act ashis executive agency, a sort of Eighth Army medical command. The grouprepresented the third stage in defining the relationship between the Eighth Armysurgeon and the field units. Colonel Do veil, patching together his jerry-builtservice in the early days of the war, had simply run everything himself, as far aspossible. Colonel Page, a somewhat shadowy figure between Dovell and Ginn,apparently made few changes. But the increasing number of diverse units com-pelled action, and Ginn gave the 5 2d the functions of a group while he em-barked on the bureaucratic ordeal of getting the larger headquarters he neededonto his troop list. Whether, with the creation of the KCOMZ and the windingdown of the war, the group was as necessary in mid-1953 as it had been a yearearlier is another question. Fully functional for only seven weeks before thearmistice, the group saw plenty of action, for its brief wartime span coincidedwith almost continuous enemy assaults.

Under the group another new unit appeared in June with the creation of the1 St Helicopter Ambulance Company (Provisional) to provide a command struc-ture for the isolated medevac detachments. This innovation completed a pro-cess begun in December 1952, when the 49th, 50th, and 52d Medical Detach-ments (Helicopter Ambulance) replaced the three functioning helicopterevacuation units. With this change the helicopter evacuation detachments for-mally became medical outfits, a part of the medical troop list, under tables oforganization and equipment (T/O&Es). In February 1953 the three detachmentswere combined with a fourth unit, the 37th Medical Detachment (HelicopterAmbulance) and two paper units, the 54th and 56th, to form the new provision-al company. Beyond all question, dedicated medical aircraft were now a reality,though proposals to bring small fixed-wing planes into the company did notmaterialize. Because training of Medical Service Corps officers as helicopterpilots had begun the previous autumn in the United States, the future of themedevac chopper as a true ambulance staffed and controlled by trainedparamedics was clearly indicated, though no Medical Service Corps officer flewa helicopter in Korea before the end of the war."

By now both the power and the current limitations of the helicopter hadbecome fairly clear. Though the figures are at best uncertain, it appears thatmedevac helicopters carried 5,040 casualties during the first twelve months of

‘“EUSAK, Annual Report of Medical Service Activities, 1953, p. 1, HRB. See also ibid., annex I,30th Medical Group, Annual Report of Medical Service Activities, 1953, p. 2, HRB.

"8086th Army Unit, Military History Detachment, “Helicopters in Korea,” pp. 5-6, Ms no.8-5.1 A AJ, RG 319, MMHB.

THE MEDICS’ WAR

operation (January-December 1951); 7,923 during the second year (Janu-ary-December 1952); and 4,735 during the last seven months of the war. As-suming that the twelve assigned machines were available throughout, a statisti-cal convenience in view of the shortage of helicopters and the maintenanceproblems that put them into the shops six hours for every one in the air, eachcraft carried an average of about 1.5 casualties per day. During 1951, a year forwhich total hours of flying time are available, the medevac helicopter was in theair about one hour and fifteen minutes on an average day. Recognizing thatnonmedical machines carried many patients unrecorded, the available figuressuggest that medical helicopters carried between 3.5 and 4 percent of the443,163 hospital admissions recorded for all causes.*^

Of the helicopter’s effectiveness in saving the lives of the seriously wounded,no more needs to be said here. A specialized vehicle of high cost and limitedeffectiveness, the medevac chopper won its fame as an evacuation vehicle underconditions that were unique to the Korean War. As a wealthy nation thatadmired technical innovation and placed a high value on individual life, theUnited States was well fitted to finance such a pioneering effort. Preexistingmedical skills of a high order were necessary to make the trial a success, for onlya medical service of great sophistication could have dealt competently with themassive and near fatal injuries that were the helicopter’s specialty. The endeav-or was not militarily significant, but it boosted morale by demonstrating that,against all purely material considerations, the nation intended to save everypossible life. The typically high-cost, low-yield experimental period during theKorean War proved the potential of a vehicle whose future impact on allemergency medicine, both military and civilian, would be great indeed.*^

Meanwhile, the helicopter’s partner, the MASH, assumed its final form ofthe war, becoming at last the sixty-bed T/O&E surgical hospital of the manuals.The long-delayed troop list for fiscal 1953, received in January, authorized thechangeover from the table of distribution strength to T/O&E size and makeupfor the surgical hospitals. In the following months the MASHs underwent twochanges in nomenclature as well. On 2 February, for example, the 8225thMASH was formally discontinued and the 47th Mobile Army Surgical Hospitalactivated, only to be redesignated on 25 March as the 47th Surgical Hospital(Mobile Army). Despite these vicissitudes, everyone continued to call the surgi-cal hospital a MASH.

Yet the changeover did not go unchallenged. The USAFFE surgical consult-ant, for one, bitterly opposed General Ginn’s plan on the grounds that theclearing stations were unequipped to perform surgery. But in the end the Eighth

'^Ibid., pp. 36-37, RG 319, MMHB. See also Lt Col Spurgeon H. Neel, Jr., “Medical Considera-tions in Helicopter Evacuation,” Address before the Medical Field Service School, Fort Sam Hous-ton, Texas, 25 Jun 53, in ibid., p. 153, RG 319, MMFB, and Table 3, “Numbers of Casualties andHours Involved in Transportation by Army Evacuation Helicopters, Korean War, 1952-July 1953,”in Dorland, “Army Air Ambulance Evacuation,” ch. 2, p. 17.1, in fldr 20, box 2 of Dust OffBackground Materials, RG 319, WNRC, which gives a grand total of 15,595 patients.

'^See William G. Baxt and Peggy Moody, “The Impact of a Rotorcraft Aeromedical EmergencyCare Service on Trauma Mortality,” and the Editorial, “Helicopters in Emergency Trauma Care,”both in Journal of the American Medical Association 249 (June 1983): 3047-51 and 3074,respectively.

343

Medics at the 47th Surgical Hospital Fitting a Cast

Army surgeon had his way. Already in the fall of 1952 the MASHs supportingOperation Showdown had begun to receive only nontransportable cases. InFebruary 1953 Ginn issued a standard operating procedure defining the types ofsurgery to be performed in the clearing stations—in essence, minor operationsthat did not involve fractures of the long bones, penetrating wounds of theperitoneal or pleural cavities, major nerves, or the brain. He defined surgicalprinciples and techniques for clearing stations and surgical and evacuationhospitals in order to standardize, as far as possible, what each level wouldcontribute to the care of the patient.

For several reasons, however, the surgical hospital still was not locatedadjacent to the clearing station but rather 1,000 to 20,000 yards in the rear,depending on local terrain and the road net. The helicopter and improvedground transport combined to make this possible, but rotation made it desir-able. MASH personnel received credit for only two constructive months insteadof three, as they would have in division areas, an essential move to slow theturnover among their often decimated staffs.*'*

“'8086th Army Unit, Military History Detachment, “Surgical Hospital in Korea,” pp. 7-8 and19, Ms no. 8-5.1 A DN, RG 319, MMHB; 8225th MASH, Annual Report of Medical ServiceActivities, 1953, p. 1, file 319.1-2 (MASH, 8225th Army Unit) Far East-1953, HRB; L. HolmesGinn, Jr., and H. Haskell Ziperman, “Surgery in Division Clearing Stations,” Military Surgeon 113(December 1953): 443-47. On rotation points, see comments of Col Dean Schamber, Inspector

(Continued)

THE MEDICS’ WAR

In divisional medical battalions the old pattern continued of rotating off theline to rest areas, back on the line to replace another unit. Customary com-plaints followed any move. The new location, if previously occupied by anotherunit, usually was described as a mess. As cleanup and beautification proceeded,a rise in morale was recorded. Medical work was partly traditional, partly acreation of Ginn’s new policies. In the clearing station, seasonal diseases cameand went like the flowers of spring: upper respiratory infections during coldweather and hemorrhagic fever in its familiar two-humped pattern. Typical for1953 was the experience of the 3d Medical Battalion, 3d Infantry Division.Beginning the year in reserve, the division relieved the 25th Infantry Divisionlate in January and the medical battalion moved forward a few days later. Inline with Ginn’s policy it operated a consolidated clearing station with a 55-bedmedical ward and 25-bed surgical ward, plus an admissions and dispositionssection. It evacuated to the 44th Surgical Hospital (Mobile Army). Seasonalmaladies brought a sharp rise in admissions during April, including 8 cases ofsuspected hemorrhagic fever. In June patrolling and probing gave way to fiercefighting as the enemy attacked the division sector. A total of 918 battle casual-ties flooded in, and the clearing station recorded 198 surgical procedures.*^

The 115th Medical Battalion, 40th Infantry Division, encountered heavyaction during enemy attacks in May and June, not only supporting its owndivision but aiding the overtaxed medics of the ROK 12th Division. During thecrisis the 45th Surgical Hospital (Mobile Army) sent a surgical team, which setup in a hospital tent about a mile south of the clearing station. Facing aug-mented responsibilities, an increased number of units to support, and an enemyassault, the battalion operated at about 75 percent of its assigned strength; onlytwo of its three clearing platoons could be manned, and the ambulance companydid not have enough drivers to use all the vehicles. The unit traded support withother battalions. The 115th took care of the 3d Division artillery that was firingin support of the 40th Division, while, for a time during June, some casualtieswere evacuated to the clearing station of the 45th Infantry Division to save anhour’s ride. Despite the pressure, the medical battalions seem to have liked theadditional responsibility they had acquired under Ginn’s system. A medicalbattalion,” noted the commander of the 115th, “is capable of rendering medicalservice far beyond its designed capacity . . . without overtaxing its facilities ordisrupting its operation.”*^^

Ironically, the quickening combat signaled the approaching end of the war.Trying to gain as much ground as possible before peace came, the enemy hitTurkish and American outposts at the end of May and June. The unrelentingpressure forced minor withdrawals of U.N. forces. In June the main enemy

(Conlinued)

General, Medical Section, USAFFE, attached to 8086th Army Unit, “Surgical Hospital in Korea,”RG319, MMHB.

'®3d Medical Battalion Command Reports, January-September 1953, files 303-MED (Com-mand Reports, 3d Medical Bn, 3d Inf Div, Jan-Apr and May-Sep 53), Box 3082 (3d Inf Div,303-MED to 303-SIG, Jan-Sep 53), Entry 429, RG 407, MMFB.

“115th Medical Battalion Command Reports, May-September 1953, file 340-MED (CommandReports, 115th Medical Bn, 40th Inf Div, May-Sep 53), Box 4222 (40th Inf Div, 340-MED to340-REP, May-Sep 53), Entry 429, RG 407, MMFB.

345

drive shifted to the ROK Army lines in the east, with the 3d Division receivingits share of the fighting. Then on 18 June President Rhee of South Korea, in anattempt to disrupt armistice negotiations that threatened to leave his nationpermanently divided, ordered his forces guarding nonrepatriate prisoners of war(POWs) to allow a mass escape. Now the Chinese prepared a massive assaultseemingly aimed at convincing the South Koreans that they could not hope tofight on alone. Meanwhile, other attacks on U.S. held salients enabled theChinese to improve their position at severe cost. The last attacks in mid-Julypierced the ROK Army lines and compelled the United Nations Command tomove forces from Japan to bolster the Koreans.*^

Thus the battalions, the hospitals, and the medical group had ample oppor-tunity to gain new combat experience. As the ROK Army medical servicebecame overburdened, evacuees were diverted into American channels. A newkind of helicopter evacuation played its part during the last battle. The long-desired Army H-19 cargo helicopters had arrived in Korea during the spring of1953. Large machines intended to provide short-haul transport for men andsupplies, the H-19s were under the control of transportation companies butcarried wounded on return flights. Despite the fact that evacuation was only asecondary mission, the 6th Transportation Company carried 701 casualtiesbetween March and the end of the fighting in July, and the 13th TransportationCompany 1,547. In the June fighting the large helicopters proved their value,both coming to and going from the line. Their great advantage lay in the factthat the wounded could receive medical attention in flight, which was difficultat best in the little H-13s where patients were carried outside on litter racks.This was an innovation whose significance to future medevac missions tran-scended its brief use in Korea.**

Operation LITTLE SWITCH

The most important activity of 1953 in Korea took place at Panmunjom,where major international changes began to register in a series of breakthroughstoward peace. In the United States a new administration warned of severeconsequences, including the possible use of nuclear weapons, if the Communistnations did not agree to end the conflict. In the Soviet Union the death ofJoseph Stalin in March signaled a power struggle over the succession. Under thecircumstances the burden of Korea was one that none of the parties to the war,except some of the Koreans themselves, wished to bear any longer.*^

The first breakthrough was one in which medics were particularly interested:the decision announced by the Chinese and North Koreans on 28 March toagree to U.N. proposals for the exchange of sick and wounded POWs. Asworked out between the negotiators, the United Nations was to return 700Chinese and 5,100 Koreans, or 4.5 percent of the 132,000 prisoners then in its

‘’Copy of Article, Lt Col Spurgeon H. Neel, Jr., “The 30th Medical Group in Korea,” HSF (NeelArticles), HRB; Hermes, Truce Tent and Fighting Front, pp. 459-76.

‘*8086th Army Unit, “Helicopters in Korea,” pp. 39-40, 48, 155, RG 319, MMHB.

‘’Goulden, Korea, pp. 548-650.

THE MEDICS’ WAR

Ward 236 at Tokyo Army Hospital Annex, where staff and ward attendantsawait returnees

custody, and the Communists 450 Korean and 150 non-Korean POWs, or 5percent of the 12,000 men whom they held. The agreement provided for theexchange to take place at Panmunjom and allowed the Communists to move thewounded to the front in well-marked convoys over designated routes.^®

Planning by the United Nations for the exchange had begun too early and,perhaps in consequence, became far too elaborate. The start of peace talks inmid-1951 provoked the first efforts. The Far East Command had decided thento evacuate all prisoners to Japan through medical channels and, after process-ing, by airlift to the United States. The subsequent course of the truce talks didlittle to encourage hopes that either plans or planes would soon be needed. Thefirst look at the problem did, however, identify the basic aims of the medicalprocessing: to detect the prisoners’ physical problems in order to provide propertreatment; to prevent the spread of communicable diseases from former POWsto others in Japan and the United States; to accumulate medical data for futureanalysis; and to provide a permanent record of the individual returnee’s medicalcondition for his own and the government’s future protection in event of claims.Plans were, according to the command “drafted, revised and redrafted” and

^“On the general story of Little Switch, see Hermes, Truce Tent and Fighting Front, pp.412-19.

347

Leaving Freedom Village on an H-19 Helicopter

conferences were held “at which myriad problems were discussed.” How muchall this bureaucratic buzzing had to do with the ultimate welfare of the prisonersremains unclear.^*

Activity continued during 1952. Despite the lack of any clear idea of howmany prisoners might still be alive in Communist hands, analyses continued onsuch questions as how many spaces on airlift planes should be allotted to them.A detailed plan based on the 1951 discussions was prepared, submitted, andapproved. International Red Cross teams joined in devising schemes for proper-ly feeding the returnees, and the round of conferences on the subject continuedat the Far East Command among its staff sections, the technical services, the AirForce, various medical services, the Plans and Operations Division, and theMedical Section’s Preventive Medicine Division. Under these circumstancesthe extremely small numbers of returnees promised by the Communists—mostU.N. POWs had been captured between July 1950 and July 1951 and most ofthe wounded had either recovered or died—gave the operation dubbed LittleSwitch the look of a barrage of organized compassion aimed at a mouse. Some

^'Quoted words from FEC, Annual Report of Medical Service Activities, 1951, p. 119, file319.1-2 (FEC) Far East-1951, HRB. See also ibid., pp. 120-23, HRB; JLCOM, Report of ETMD,December 1951, pp. 28-29 and end. 10, file 350.05 (ETMD, Far East, JLCOM, 1951), Box 1(ETMD, JLCOM, 1950-53 . . .), Entry 54B, RG 112, MMFB.

THE MEDICS’ WAR

2,248 quarts of reconstituted milk were flown in to provide milkshakes, and the45th Surgical and 121st Evacuation Hospitals set up to treat the wounded. InJapan the Tokyo Army Hospital and the United States Army Hospital, 8167thArmy Unit, were designated to receive the non-Koreans. The H-19 cargo heli-copters stood by to fly the POWs from the reception point. Freedom Village atMunsan, to the airport at Seoul. A horde of interrogators and counterintel-ligence agents waited, with a larger horde of newsmen.^^

By 20 April, the day fixed for the opening of Little Switch, the followingsituation existed. A KCOMZ medical team waited at Panmunjom. Three ambu-lance companies were ready to evacuate the first POWs to Freedom Village, 15miles down the Munsan road, where a processing center staffed by marines wasset up, with a Navy surgeon in attendance. Nearby, the 45th Surgical Hospital,with two H-13 helicopters, stood in readiness for emergency cases. On a landingpad at the south end of the hospital the first H-19 helicopter waited to carrypatients onward to the 121st Evacuation Hospital at Yongdung-po, whereguards, litterbearers, and ambulances stood ready to rush patients to treatment.At Yongdung-po, as at Freedom Village, adjutant general personnel prepared toprocess the returned soldiers and counterintelligence agents to screen them fromunauthorized contacts with the press, to fingerprint them, and to confirm theiridentities.

Into this situation walked, or were carried, the first “packet” of fifty prison-ers at 0600. Processing and loading at Panmunjom took about forty-five min-utes. Because their condition was better than expected, the medical team at theexchange site took only the litter patients, four in number, and placed a call forthe H-13s to pick them up. Eight ambulances left for Freedom Village with therest. In Munsan the ambulances carrying ROK Army patients turned off to theROK 5th MASH, while the others moved on to the U.N. processing center.

At the 45th Surgical Hospital an array of brass—Generals Clark and Ginnand the Eighth Army commander. General Maxwell D. Taylor—were on handto meet each helicopter with the litter patients. Other dignitaries from USAFFEand the Eighth Army command milled about as well. After arriving at theFreedom Village processing center, returnees who could walk had their firstphysicals and then had their identities verified. Chaplains provided spiritualcomfort. When they passed on to the 45th, the men filled out new medical formsand underwent thorough physicals. They then were led in sixes to the landingpad, where they boarded helicopters, and twenty-two minutes later they arrivedat the 121st Evacuation Hospital. The men already had changed clothes once,from new attire the Communists had issued them in anticipation of their releaseto fresh dress uniforms (ODs). Now they doffed their ODs, put on pajamas, andtook another physical. Adjutant general and counterintelligence personnel tookover again, doing new records checks and reconfirming identities. A few return-ees had had brief interviews with the press at Freedom Village, but most wereheld incommunicado to prevent leaks of any useful information they might haveabout the enemy. In some cases agents went so far as to accompany them to

^^Daily Journal, Plans and Operations Division, Medical Section, FEC, 4 Jan 52, sub: Air LiftBricks, pt. 2, item 6, Staff Section Report, Medical Section, FEC, 1-31 Jan 52, file January 1952,Box 3488 (Medical Section, Unit History, Military History Section, FEC, 1952), RG 338, MMFB;EUSAK, Annual Report of Medical Service Activities, 1953, p. 7, HRB.

349

the showers. Even their diet gave evi-dence of a somewhat excessive con-cern, for it was served without salt,apparently in the belief that salt wouldincrease the nutritional edema thatthey were expected to have. Fortunate-ly, most appear to have spent onlythirty-six hours in processing beforetheir planes left for Japan.

In plain fact, the medical aspect ofLittle Switch was a dull affair. Ev-erything went smoothly, and even giv-ing the men three physicals and forc-ing sequential changes of attire uponthem did not suffice to keep the medi-cal personnel busy. Initial evaluationsshowed the POWs to be in bettershape than expected, and the work re-solved itself into routine poking andprodding and the filling out of forms.

The process was tedious, and somesurgeons, finding nothing to do, departed. The emergency team at Panmunjomwas almost without a job. In the midst of this overproduced affair the prisonersthemselves impressed most of their interviewers as stolid, except for their en-thusiasm for food. The curiously “flattened” personalities of those imprisonedfor an extended period were noted; these men answered when spoken to, volun-teered nothing, and showed little emotion. Men more recently captured retainedtheir natural spontaneity, reacting emotionally to the sudden release of tensionafter doubts that had continued almost up to the last moment as to whether ornot their captors actually would release them. The old hands continued to act asthey had learned to do in order to survive, going through the routine likesleepwalkers not yet awakened.

In Tokyo the interrogations got serious. With no medical personnel amongthe returnees, medical intelligence was necessarily limited. The Far East Com-mand’s G-2 (intelligence), however, had many questions. Sessions ran frombefore breakfast until after supper during the returnees’ whole stay in Tokyo.Different intelligence teams had failed to coordinate their questions, and as aresult the men were asked many of the same questions over and over. Thesimilarity between this process and what the men had experienced during theircaptivity provoked resentment, increasing uncommunicativeness, and suspicionas the process wore on. At the same time, new and even more thorough medicaltesting proceeded for the seven to ten days that they lingered in the Japanesecapital. The 147 Americans who passed through this gauntlet showed, on thewhole, surprisingly good health. Weight loss was great, ranging from 18 to 46pounds depending on build, and about 38 percent had parasites of one kind or

Another Change of Clothes

”8086th Army Unit, Military History Detachment, “Operation Little Switch,” vol. 2, “Medi-cal Processing and Evaluation of Repatriated Prisoners,” Ms no. 8-5.1 A DQ, RG 319, MMHB.

THE MEDICS’ WAR

Greeting a Little Switch Returnee at Tachikawa Air Base

another. But few had tuberculosis or malaria, and 8 out of 10 were rated asshowing good mental health and morale. Only about 1 percent was diagnosedpsychotic. As with recovered prisoners of the Japanese during World War II, thestresses of captivity would show up for many only after a lapse of time.^"*

The contrary movement of Communist POWs from the hospitals toPanmunjom was a far noisier and more exciting affair for all concerned. Toquell new demonstrations as they broke out, guards warned the POWs that theywould lose their chance of repatriation. Prisoners riding from the island campsto landing craft for transport to the mainland threw away their rations of soapand tooth powder and tossed away cigarette packs containing hand-printedmessages that accused the United Nations Command of “‘babarous acts.’” Somewent on hunger strikes; many mutilated their clothing to make themselves lookmaltreated. On the whole, the command—and especially the prison hospi-tals—benefited by the departure of the 6,670 sick and wounded prisoners. Thegain of 684 assorted U.N. POWs in return may have saved some lives, but theexchange was most important as the first firm step on the road to peace.^^

^'‘Reister, Battle Casualties and Medical Statistics, pp. 87-91; USAFFE, Annual Report of Medi-cal Service Activities, 1953, pp. 62-79, HRB.

^Hermes, Truce Tent and Fighting Front, pp. 415-16 and 419. Both sides turned up additionalsick and wounded in the process of exchange, and both returned more than originally promised.

351

Operation BIG SWITCH

In accepting the United Nation’scall for an exchange of woundedPOWs, the enemy also had suggestedthat the larger prisoner-of-war issuemight be resolved. A few days after the28 March breakthrough, Chinese For-eign Minister Chou En-lai amplifiedhis first delphic proposal by suggestingthat nonrepatriates be turned over fora time to a neutral state to ensure thatcoercion played no part in their deci-sion not to return home. The negotia-tions, which had lapsed in October1952, began again on 26 April 1953.

By the middle of June—when negotia-tors had ironed out all essential dis-agreements, when the neutrals had for-warded their acceptances, and whenstaff officers had defined the limits ofthe Demilitarized Zone that was to separate the armies {see Map 9)—the Chi-nese launched their last offensive.

The objectives of the Chinese were to strengthen the Communist positions;to give the impression of a victory for their side; and, after Rhee had releasedthe Korean nonrepatriates, to sound a warning to the South Korean govern-ment. Thus almost until the last moment, the armies exchanged blows andwounded flowed as before through the medical system. Only in the week beforethe armistice was signed on 27 July did the fighting wind down. Then followed agreat movement of prisoners—repatriates toward home and nonrepatriates to-ward the Demilitarized Zone for the period of internment and second thoughtsallowed by the armistice document. Americans called the return of their ownmen Operation Big Switch.

Modeled on Operation Little Switch, the new exchange went about assmoothly and with considerably less disproportion between the numbers ofreturnees and of those assembled to receive them. The H-19s, having provedthemselves, were called upon once again and performed excellently, movingnine times as many people in seven times as many hours as before. All thereturned prisoners were bathed, deloused, and vaccinated against smallpox. Onething that immediately became clear was that not all the sick and wounded hadreturned during Little Switch. Some new returnees arrived with such patentconditions as chronic coughs, amputations, amebiasis, mental illness, epilepsy,cold injury, and malaria. Some of them believed that the Communists hadchosen the “progressives,” whether sick or well, to go first.^*^

'‘Rpt, Grant, sub: Operation Big Switch, file 383.6 (Operation “Big Switch”) 1953, HRB. In all,1,132 Americans of the 3,596 included in Big Switch returned home in patient status, but this

(Continued)

Enemy Captives Going Home

MAP 9

353

The stream of men divided, thehealthy parting from the sick. Ameri-can POWs who were well enough wereflown by helicopter to Inchon, wherethey boarded ships for home. Thosewho required emergency treatmentwere flown to Japan, where they un-derwent a week to ten days of medicalprocessing like that of the LittleSwitch returnees. A total of 438POWs, of whom 345 were soldiers,were judged in sufficiently seriouscondition to warrant immediate re-turn to the zone of interior. The restjoined other returning ex-prisonersand rotating troops on troopships orhospital ships. (On the former, pa-tients were treated in sick bay.) Ac-companying the returnees wereUSAFFE medical teams—sixteen of-ficers and sixty-two enlisted men for atroopship, eight officers and twenty-six men for a hospital ship—that were to care for them, finish their processing,observe the psychiatric cases, and extract medical intelligence.

On shipboard the former POWs tended to keep together, believing that thosewho had not undergone their experiences would not understand them. But thefactions of the prison camps endured also, the “progressives” keeping them-selves apart while providing interested psychiatrists with voluble explanationsof their conduct. There were some fistfights between those who had gone too faralong the road marked out by former captors and those who had resisted, butapparently no very serious clashes.

As the process went forward, interrogators recorded in casual fashion a crosssection of the varied POW experience. Many men named as their chief physicalproblem during captivity the pervasive dysentery and gastric complaints causedby coarse and unfamiliar food. “Stomach trouble right along,” said one, “roughchow had tore my insides.” Most had received medical care from their captors,though it was often crude and unskillfully applied. Of those who were treatedwith acupuncture, a few seemed uncertain whether this was a form of medicineor an oriental torture.) Exercise and recreation had been surprisingly abundant

Big Switch Returnees ArrivingAT Freedom Village

(Continued)

status was not always deserved. See extract from Medical Plans and Operations Division, OSG,Annual Historical Report, 1 Jul 53-30 Jun 54, tab N, “Summation of Recap-K Operation,” HSF(Recap-K Operation), HRB.

THE MEDICS’ WAR

in the camps. An Air Force staff sergeant recalled “cards, ping pong, basketball,volleyball, softball, chess pieces made by PWs—All male square dances.

But many also had harsh memories of interrogation and abuse. A Mexican-American sergeant first class was hung from the ceiling by his arms for ninehours and put to hard labor because of his “hostile attitude toward the ChinesePeoples Volunteers.” Those who attempted escape spent months in “the Hole,”typically a cold bare room with “unplaned knotted floor.” A young airmanrecalled that “the most common form of punishment for breaking camp ruleswas standing at attention for hours. In the winter time punishment might bestanding at attention in your bare feet upon a cake of ice and holding a snow-ball in each hand.”

Some appeared to have gone through their ordeal without injury and withlittle inner turmoil, like the sergeant who “made no escape attempts, got into nofights and had no special punishments.” In this case indoctrination “went in oneear and out the other.” A black GI underwent “considerable indoctrination” butsaid the appeals emphasizing American racism had little influence on himbecause he was “pissed off’ at the treatment he had received from the Chinese.Men of the most varied experiences, however, reported one reaction in com-mon: Many had cried at Freedom Village.

Once in the United States, patients needing immediate specialized treatmentfollowed men from Little Switch into Army hospitals. As many as possiblewere placed on leave. Those neither in a dangerous condition nor well enough tovisit their homes at once were sent to the hospital nearest home, where theirfamilies and friends could visit them. Hawaiians went to the Tripler ArmyHospital, Filipinos to Manila, and Canadians to the Madigan Army Hospital fortransfer to their own country. Of the Big Switch returnees 4 percent showedsigns of tuberculosis, about 2 percent had malaria, 16 percent were sufferingfrom malnutrition, and less than 3 percent were neuropsychiatric casualties.None had any other major infectious diseases, for which the systematic inocula-tions introduced by the Chinese in 1952 probably must be credited. The lack ofserious malnutrition cases reflected the better diet that most had received dur-ing 1953. The overall physical condition of the U.N. POWs who survived can besummed up as not too bad, everything considered.^*

The worst consequences of captivity for most surfaced only after a lapse oftime. Though the concept of posttraumatic stress disorder had not yet receivedclinical formulation, the experiences of many former Korean POWs resembledthose of World War II survivors of Japanese prison camps. In some respectsthey were worse. For years after the war former prisoners showed higher death

^Quoted words in this and the following two paragraphs from Repatriated POW PsychiatricSurveys, August-September 1953, Ends to Ltr, Capt William B. Fowlkes, Administrative Officer,Joint Intelligence Processing Board, USAFFE, 1 Oct 53, sub: Reports of Repatriated POW Psychiat-ric Surveys and Medical Intelligence, file 383.6 (Far East Command) AA, 1953, Box 72, and 6004thAir Intelligence Service Squad, Air Intelligence Information Report nos. RPW 3022B, RPW 3024A,RPW 3522A, RPW 4502, RPW 4516-2, RPW 4523, all 8 Sep 53, file 350.05 (Korea) F, 1953, Box53. Both Accession no. 56A-179, RG 112, WNRC.

^*USAFFE, Annual Report of Medical Service Activities, 1953, pp. 9-11; Preventive MedicineDivision, OSG, Summary of Major Events and Problems, 1 Jul 53-30 Jun 54, pp. 159-60, file314.7-2 (Army Medical Service Activities, 1 Jul 53-30 Jun 54). Both in HRB.

355

rates than other veterans of the fighting. The degree of stress during imprison-ment directly correlated to later death, which resulted most commonly fromaccident, suicide, or homicide. Persistent psychiatric sequelae were noted, in-cluding schizophrenia. Nutritional deficiencies endured during captivityshowed up later as an apparently permanent susceptibility to tuberculosis and toother infectious and parasitic disorders.

Complicating a difficult homecoming for POWs were attacks by their owncountrymen. Arguing that Americans had become too soft and slack to meet thechallenge of Communist aggression, energetic charlatans of many stripes spreadthe legend that American prisoners during the Korean War had been uniquelyspiritless, dying without cause and yielding without reason to enemy pressures.Men who already had suffered much faced an ordeal at the hands of some fellowAmericans, which contrasted sharply with the lavish care that had attendedtheir release.^’

After the Battle

As the guns fell silent, peace came to the Medical Service in varied andsometimes paradoxical ways. At the hospitals of the 30th Medical Group only atemporary decrease in admissions was noted. Instead of hurriedly giving emer-gency treatment and evacuating the wounded, the surgeons at the forward hospi-tals screened personnel in the units they served to locate those who were in needof elective procedures—correction of hernias or hemorrhoids, circumcisions,and so forth. In the more relaxed atmosphere of the postwar hospitals, patientsalready on hand also were treated for retained foreign bodies and the like.Hence, the impact of peace showed most noticeably in reduced evacuationsrather than in a declining hospital census. In the 2d Infantry Division, MedicalCorps officers moved out of the aid stations, which Medical Service Corpsofficers now could handle adequately. Training increased, with refresher coursestaking the place of the wartime influx of wounded in reminding Medical Servicepersonnel of the basics of their profession.^®

A major innovation for improving the skills of enlisted medics was theestablishment under the 30th Medical Group of the Eighth Army MedicalTraining Center, located immediately to the rear of the IX Corps area atChongpyong-ni. The first class opened on 26 October 1953 and soon specializedtraining was under way on a three- to four-week cycle for aidmen, corpsmen,and technicians of various types. Classes were small, most of the instructorsmedical officers from the 30th Medical Group, though two Medical ServiceCorps officers and two Army nurses were on the faculty. Bivouac and unit

”Biderman, March to Calumny, passim; M. D, Nefzger, “Follow-up Studies of World War II andKorean War Prisoners, I: Study Plan and Mortality Findings,” American Journal of Epidemiology 9 \(February 1970): 123-38; G. W. Beebe, “Follow-up Studies of World War II and Korean WarPrisoners, II: Mortality, Disability, and Maladjustments,” American Journal of Epidemiology 101(May 1975): 400-22. An interesting recent study of the general topic is Richard H. Rake and EllenGenender, “Adaptation to and Recovery From Captivity Stress,” Military Medicine 148 (July 1983):577-85.

^30th Medical Group, Annual Report of Medical Service Activities, 1953, pp. 4-5, Annex I toEUSAK, same report, 1953, HRB. See also 2d Infantry Division, Annual Report of Medical ServiceActivities, pp. 2-3, file 319.1-2 (2d Inf Div) Far East-1953, HRB.

356 THE MEDICS’WAR

training accompanied classwork, providing a well-rounded curriculum of theo-retical and field instruction.^*

Other signs of the times included a construction program during the secondhalf of the year aimed at replacing tents with semipermanent buildings, both inhospitals and in troop quarters. Men and women who still had to live in winter-ized tents, however, found the 1953-54 season relatively mild. The troops faredwell, and no particular problems arose in keeping them healthy through the coldseason. To care for nonrepatriated POWs in the Demilitarized Zone pendingtheir final disposition, the KCOMZ transferred four medical units to the EighthArmy—one field hospital, one clearing company, one veterinary food inspec-tion detachment, and one ambulance detachment. Meanwhile, the Prisoner ofWar Command closed up shop, shifting its dispensaries to Korea Base Sectionand inactivating the remainder if its units. As in the forward areas, trainingactivities increased to fill empty time and keep a cutting edge on the skills of thetroops.^^

Organized aid to the Koreans as they sought to reconstruct their countrydeveloped during the same period under the Armed Forces Assistance to KoreaProgram. Eighth Army medical units sponsored construction projects and sentArmy medical personnel into Korean civil and military hospitals to assist in thecare of patients and to aid in the training of doctors and nurses. At the sametime, under orders from USAFFE headquarters, Korean health personnel werebrought into Eighth Army hospitals for training and civilian patients admittedfor treatment. One evacuation hospital reported that it was aiding about athousand civilians a month in various ways and that its personnel additionallywere providing aid and support to an orphanage for refugee children. At Christ-mas 1953 a Santa Claus from the hospital staff presented gifts: ten bags of rice,75 pounds of fish, a supply of seaweed, and a truckload of firewood. A pair ofsocks and rubber shoes went to every child, plus games,- candy, dolls, andballoons. Two days later the orphans reciprocated, presenting a dance andmusic show at the hospital for patients and staff that earned the small entertain-ers candy and oranges, and for all the children new gifts sent by the fire depart-ment of Spokane, Washington. Typical of many such efforts by American units,the work of the 11th Evacuation Hospital was practical and useful, but theoranges and gifts probably remained longest in the memories of the children.^^

At higher headquarters, signs of the changeover to peace were varied: in-creased indiscipline and violence among idle troops; a temporary overstrengthin doctors, which, in a fashion made familiar by the aftermath of World War II,soon changed to a deficiency; hospital closings; and plans for the departure of

^‘Briefing, Lt Col Spurgeon H. Neel, Jr., MC, Commander, 30th Medical Group, to Gen MaxwellD. Taylor, Commander, EUSAK, 10 Nov 53, sub: The Eighth Army Medical Training Center, HSF(Neel-1953), HRB.

”EUSAK and KCOMZ, Annual Reports of Medical Service Activities, 1953, pp. 1-2 and p. 2,respectively, HRB.

”llth Evacuation Hospital, Semimobile, Annual Report of Medical Service Activities, 1953, p.8, Annex II to EUSAK, same report, 1953, HRB. Other useful reports for 1953 are those of theKCOMZ and the 121st Evacuation Hospital, Semimobile, both at HRB. See also Msg no. EX 24164,CG USAFFE to CG EUSAK, 14 Oct 53, file 701 (Far East Command) AA, 1953, Box 73, Accessionno. 56A-179, RG 112, WNRC.

357

major units from the Far East Command. Like the planning for the prisonerexchange, plans for the postwar drawdown went back to the days of 1951, whenthe truce talks were new and peace had seemed close at hand. Planning contin-ued in more elaborate fashion during 1952 and became a large part of the workof the Plans and Operations Division at USAFFE in the following year. Thoughthe nature of the armistice inclined the cautious to delay major deploymentsuntil the completion of a less tentative settlement, readjustments began at theend of the summer. One convalescent hospital was closed, operating beds werereduced from a bit over ten thousands to about eighty-six hundred throughoutthe command, and a portion of the Tokyo Army Hospital was shut down.However, the armed peace that had come to Korea did not encourage hastyaction, and USAFFE did not contemplate reducing the hospitals available to themilitary in Korea, where they might be needed at any time. The Korean CivilAssistance Command, the Republic of Korea, and the Japanese government allhad their eyes on American military hospitals, but no general transfer of facili-ties occurred in 1953, and the year ended with the medical establishment largelyin a holding pattem.^“

Overall, the post-Korean War Medical Service began to show a markedsimilarity to the earlier postwar period of 1945-50, though maintenance of thegeneral draft ensured that personnel levels would not again sink so low. Thedoctor draft resulted in an overstrength in medical officers during the Ju-ly-September quarter in 1953. The American Medical Association complained,and the old problem of underuse of doctors again alarmed the Office of theSurgeon General. Similarly, the influx of many board-qualified or board-certi-fied specialists raised the usual difficulties in assigning them to posts that weresuitable to their skills. Personnel losses in the Medical Service Corps and ArmyNurse Corps resulted in a lower authorization from the Army’s G-1 (personnel),with line officer benefiting from the transfer of two hundred to three hundredslots that the Medical Service could not fill anyway. Analysis suggested thatabout one-third of the Medical Service Corps would turn over during fiscal1954, and hospital commanders in the zone of interior were urged to “get anyreally capable warrant officer or enlisted man” to apply for a commission,because civilian college graduates who agreed to join probably would leave afterfulfilling their minimum time of service. In searching for nurses the old litany ofexpedients was drawn up again, with complaints from nurses already servingabout work load, nonprofessional duties, and, above all, the length of overseastours and the wish of many to marry and accompany husbands. While standingfirm against commissioning male nurses in the Regular Army, the surgeongeneral backed the notion of offering such men reserve commissions, but theyear ended with Congress’ views still uncertain.

^USAFFE, Annual Report of Medical Service Activities, 1953, pp. 80-86; JLCOM, AnnualReport of Medical Service Activities, 1952, pp. 97-99, file 319.1-2 (JLCOM) Far East-1952. Bothin HRB.

^Summary of Presentations and Discussions at the Conference of Army Surgeons and Class IIHospital Commanders, Held in the Office of the Surgeon General (Room 3601, Main Navy Build-ing, Washington, D.C.), 5-6 Nov 53, p. 85, file 337 (Army Surgeons and Class II Commanders) 5-6Nov 53, HRB.

THE MEDICS’ WAR

As the draft calls fell and the emergency passed into the uneasy peace of thecentral Cold War, the problem of getting sufficient doctors for the Army againappeared, with all its customary train of subsidies, appeals, and administrativetours de force. Plans for scholarships, affiliated units, hiring of contract physi-cians, and the use of civilian consultants as emissaries to the civil profession ofmedicine all continued as in the past, or resumed shortly. Existing RegularArmy slots could not be filled; about two-thirds of the Medical Corps consistedof draftees who had accepted reserve commissions for a two-year tour of duty.At the end of 1955 an officer briefing the surgeon general spoke like an echo ofthe past: “One of the most serious matters facing the Army today is the problemof providing an adequate medical service. The crux of this problem is thecritical shortage of Medical Corps officers.”^^^

Another difficulty resulted from a decision of the secretary of defense in May1953 to prescribe a ceiling for the armed forces of 3 doctors per 1,000 troopstrength. This rigid requirement did not become fully operative until mid-1954and thus did not affect the Korean War. It was, however, a new source of oldwoes thereafter, especially for the Navy, which had the highest existing ratio(about 4 doctors per 1,000 troops, as compared to the Army’s 3.5). The numberof units and their makeup and distribution, the number of dependents, and thenumber of hospitals and their size were some of the elements that determinedthe true needs of the services. The new rule, which the Department of Defenseadopted in response to pressure emanating from the White House, may properlybe termed a political decision. In setting up the doctor draft. Congress hadprovided for the creation of a Health Resources Advisory Committee in theExecutive Office of the President to enable civil medicine to influence draftpolicy. At a time when the president of the American Medical Associationwarned that the United States had “25% more practicing physicians in propor-tion to population than any other country in the world,” and that physicianswere increasing faster than the population, the advisory committee wrote apresidential assistant to ask that the number of military physicians be reduced.The ''continuing withdrawal of physicians for military dutyf it warned, washaving an "increasingly serious impact . . . upon civilian medical services"'Residencies in civilian hospitals were said to be going empty, or being filled by“aliens, with all that implies in the way of possibly inferior training and oflanguage difficulties.” The committee also pointed out, in what probably wasthe true crux of the matter, that exhaustion of the former Army SpecializedTraining Program graduates and other younger physicians might soon requireolder men with established practices to serve. It therefore recommended the 3 to1,000 ratio, a suggestion that the Defense Department was quick to adopt.^^

“Copy of Briefing, 1 Dec 55, on historical background and present difficulties of medical officerprocurement, in HSF (Briefing-1955), HRB.

^’Quoted words from copies of Memo, Howard A. Rusk, M.D., Chairman, Health ResourcesAdvisory Committee, to Arthur S. Flemming, Acting Director, Office of Defense Mobilization, 29Jan 52, and Ltr, Flemming to Charles E. Wilson, Secretary of Defense, 29 Jan 53, Cut in Ratio ofMilitary Doctors, 1953-54, file. Box 7 (General Green’s Office-Reference File), Accession no.112-79-5, RG 112, WNRC. Some physician shortages existed in rural areas, but there seems noreason to believe that discharged medics would migrate to such regions to fill them. See also copy ofBriefing, 1 Dec 55, HRB.

359

The difficulties of the post-Korean War Medical Service were much the sameas in the past. The United States continued to offer its doctors monetary re-wards, specialized training, personal distinction, and—above all—ideals of in-dividual freedom and choice, which were beyond the ability of the Army tomatch. Even with a draft in place, the civilian profession fought for the reten-tion in service of the smallest number of physicians deemed capable of doing thejob, and the Medical Service, among an abundance of talent and training with-out equal in any other society in the world, provided for the Army with what-ever it could get. Plus qu change.

Civil Assistance Revisited

Meanwhile, the emergence of the new-model Korean Civil Assistance Com-mand (KCAC) signaled a major shift from emergency relief to reconstructionfor the battered Republic. Here, as in the days of the fighting, much of the workto be done was medical. The United Nations Command’s economic coordina-tor, C. Tyler Wood, decided to avoid excessive duplication of effort in Koreanrelief and divided responsibilities for specific fields between KCAC and theUnited Nations Reconstruction Agency (UNKRA). The Army command re-ceived the Korean public health program as its bailiwick and thereafter func-tioned as the operating agency, regardless of the source of funding. The com-mand’s Public Health Branch under Col. James P. Pappas continued to workwith the mixed staff of civilian and military personnel and American and U.N.experts gathered under its predecessor, the United Nations Civil AssistanceCommand, Korea (UNCACK). But now the branch could use the funds itreceived from an array of sources—from Civil Relief in Korea (CRIK), fromWashington’s newly established Foreign Operations Administration, fromUNKRA, and from direct military support—for the long-term rehabilitation ofKorea’s medical and health system.^*

The new approach represented a considerable broadening of the wartimegoal of preventing disease and unrest. Tyler Wood emphasized that the newapproach featured the transformation of Korea not only into a military bastionbut also into a showcase of progress for the American-led anti-Communistcoalition:

We have an opportunity in our work in Korea on the economic side to affect thesituation in this struggle between the free world and the communist world, not only inKorea, but certainly throughout the Far East. I would make bold to say, throughout theworld. The two systems are facing each other on trial here. If we can show, in cooperationwith the brave people of South Korea, who have already proved their courage on thebattlefield, that the kind of conditions we stand for in the free world can be created here,and if we can show in comparison with conditions across the border the advantages of

^“Information on the Korean Civil Assistance Command, unless otherwise stated, is from itsAnnual Report of Public Health in Korea, 1953. The Foreign Operations Administration was set upin August 1953 under Harold E. Stassen, a perennial candidate for the Republican presidentialnomination, to coordinate all foreign assistance activities.

360 THE MEDICS’ WAR

our system and our freedom, it seems to me it will not only have a real effect in SouthKorea, but throughout the Far East.^’

Corollary to the ideological thrust was a practical objective—enabling theKoreans, by developing a modem economy, to reduce American subsidies andto take on the burden of their own defense. The contrast with the situation in1945-48 was striking. Then the Army had stmggled with insufficient means in abackward nation that had been spared the worst ravages of war. Now, withthirty-three thousand dead invested in South Korea’s freedom, and with theCold War deeply embittered by the blood shed there, the United States and itsallies in the United Nations were ready to supply more adequate means in orderto advance the continuing world stmggle. These too were consequences of thewar that had destroyed the nation’s modest advances, killing several million ofits people and laying waste much of the physical substmcture of civilization.

The end of the fighting made more military personnel available for civilrelief and especially aided the Public Health Branch, where, in the days ofUNCACK, extreme shortages were the rule. KCAC, however, retained the inter-national flavor of the earlier effort. UNKRA doctors headed the preventivemedicine, medical care, nursing, and environmental sanitation sections and allthe field teams that assisted the various provincial governments.

The conditions faced by these men and women—women filled all the nursesslots, one physician’s slot and also served as secretaries, typists, and administra-tive assistants—remained difficult even though the war had ended. Publichealth competed within the South Korean government for limited funds againsta host of other, and apparently more urgent, needs for defense and reconstruc-tion. For fiscal year 1954 the nation’s total public health budget was $3.5million, or about $0.16 per capita, as against $0.50 to $0.75 recommended byoutside experts and the World Health Organization. The subsidy in kind em-bodied in CRIK medical supplies left a deficit of several million dollars betweenappropriations and need and provided no assistance to the starveling salaries ofKorean public health workers. (The minister of health earned an estimated U.S.equivalent of $43 a month, a nurse $11 a month.) An invitation to officialcorruption, such pay scales also ensured that abler people would evade govern-ment service. Doctors, for example, continued to migrate to the large citieswhere a physician reportedly could earn in a day ten times what a governmentofficial took home in a month.

Essential tools of public health management, if they had ever existed, van-ished with the war. Vital statistics were hard to come by. Colonel Pappas,remarking that by official figures South Korea had a lower death rate than theUnited States, ruled that “no cognizance [should] be taken of these data.” Mostof the meager funds available were spent on the care of lepers—probably areflection of the interest traditionally felt by Christian missionaries in thisbiblical plague—and of war casualties. Yet the country established its firstschool of public health in the fall of 1953, and Pappas discovered what he called“bamboo roots” support for public health among the people at large, whose

’Ibid.,p. 11.

demand for health services ranged far ahead of the government’s ability toprovide them/®

The thrust of KCAC endeavors was necessarily varied in a situation wherevery little was adequate and, in consequence, where everything must be done atonce. However, the endeavor to control disease and upgrade health care and themedical professions were certainly basic. Among the major diseases, smallpoxremained endemic and had become largely a disease of childhood. The across-the-board vaccination campaign among refugees therefore gave way to a concen-trated effort to immunize the young. Using CRIK-bought vaccine. South Kore-an personnel carried out five million vaccinations in the last quarter of 1953.Plans called for administering two million additional doses during the first halfof 1954 and, in the spring and fall, regular boosters to preschoolers who were thelast large susceptible group in the country. South Korean government andKCAC-UNCACK figures differed widely, with the latter reporting that 1953had seen both the incidence of smallpox more than double the 1952 rate and thenumber of deaths rise from 251 to 470. Either statistic was a far cry from theepidemics of 1951, when UNCACK had estimated over 5,000 deaths and theSouth Korean Ministry of Health nearly 12,000. The first months of peacesuggested the possibility of a future Korea that would be substantially free of theillness, like other modem nations.

With improved water supplies, immunization and health education, typhoidand paratyphoid continued to fall during 1953, when only 79 deaths wererecorded by KCAC and 333 by the South Korean government. The number ofdeaths from diphtheria was low for the year, at 43 nationwide, but parentalresistance, for obscure reasons, made it less easy to inoculate children againstthis disease than against smallpox. Malaria was a particularly difficult question.It was not a reportable disease, and the almost 14,000 cases and 2 deathsreported by KCAC probably had little or nothing to do with its actual preva-lence. No dependable data were available on dysentery, either, though the com-mand noted 19 deaths and over 8,000 reported cases.

Above all, tuberculosis remained a statistical enigma. Some 6 percent of thepopulation were believed to have the illness in more or less serious form, nearly1.3 million people in all. Budgetary constraints made the increase of hospitalbeds for tuberculosis patients slow, and the operations of the Korean draft andlack of money to pay workers dismpted a program to inoculate the young. But1953 at least saw an apparent breakthrough in public interest. The ROK Armymade plans to X-ray its troops and screen recmits, and the South Koreangovernment established a National Tuberculosis Association to raise funds forpublic education and a pilot control center. CRIK funds bought Japanese-madetuberculin for a thorough study in Pusan orphanages carried out by the SwedishRed Cross Hospital. (Almost 16 percent of the children tested had active tuber-culosis.) The year’s work seemed to point toward a more systematic approach toa problem whose solution, if any, still lay in the distant future.

Programs to improve care included CRIK and UNICEF contributions tomaternal and child health care programs; supplying additional equipment to

’Ibid.,p. 1.

THE MEDICS’ WAR

national, provincial, and city laboratories; enforcement of quarantine regula-tions upon American and U.N. nations ships by the Korea Base Section sur-geon; and aid to the National Vaccine Laboratory by the 406th Medical GeneralLaboratory in Japan. The Italian Red Cross Hospital at Yongdung-po continuedto function as the only U.N. forces hospital under KCAC, caring for thousandsof civilian patients during 1953. KCAC also assisted voluntary agencies that hadtaken an interest in Korean relief—religious groups, the International RedCross, the American-Korean Foundation. It sought to upgrade medical educa-tion and to bring nursing education back into the path of systematic profession-al improvement that was under way during 1945-50. Extending the list ofKCAC endeavors only would underline the point that many improvements hadto be made at once and that supplies of money and especially of trained person-nel, though greater than during wartime, were still inadequate to accomplish thejob.

One thing was clear, however. The war had awakened a worldwide interest inKorea that had never existed before. Nations that had expended blood andtreasure there—especially the United States—now could not abandon the peo-ple whose fate had so unexpectedly become entangled with their own. Outsideintervention had divided Korea and provided the basic cause of the war thathad leveled the country. Now many of the outsiders who remained were build-ing and curing, teaching and administering, giving money, advice, and time tothe process of reconstruction. With such aid the Korean people over the nextgeneration would build a progressive economy and a small, provincial, butmodem country out of the mins. The Hermit Nation had become a crossroads,and in 1953 KCAC was for the time being at the center of the internationaleffort to remake Korea in the field of public health.

The Korean Experience

For the medics who served, the Korean War provided extraordinarily di-verse experiences. Aid station and general hospital, refugee camp and prison,death march and child care clinic—the faces of wartime medicine were endless-ly varied. Over the war years the strength of the Army rose from under 600,000to almost 1.5 million. Strength in the Far East went from 148,000 to 510,000.To serve this swelling array, the Medical Service relied upon a smaller numberof medical units than normally would have been available. The 750-bed evacua-tion hospital, normally the large backup unit to the 400-bed type and the smallerfield and surgical hospitals, never appeared in Korea. Instead, a unique systemevolved from the objective facts—the paucity of medical personnel when thewar began; the closeness of Japan, with its existing hospital system; and theavailability of air transport. Evacuation took up the slack created by a lack oftrained personnel and bed space. Within Korea the helicopter was one of thesurprise triumphs of the time, and the MASH worked exceedingly well, thoughas a flexible multipurpose organization rather than as the specialized T/O&Eunit. Many of the successes of the Medical Service in Korea were revivals of

THE END OF THE FIGHTING

363

Repatriated Army Doctors Sharing Their Experience. Left to right: Capt.Clarence L. Anderson, Capt. Gene N. Lam, Surgeon General Armstrong, Capt.William R. Shadish, Capt. Sidney Esensten, and Capt. Alexander M. Boysen.

World War II practice, notably in the blood program and in combat psychiatry.Basic military surgical techniques, like debridement and delayed closure, had tobe relearned again and again as new generations of surgeons arrived in the FarEast.

Korea also registered the advances of medicine since World War II, andmade contributions of its own to organization and clinical practice. Neurosurgi-cal injuries were managed with unwonted skill. An array of antibiotics aided allmedical endeavors. The early repair of vascular injuries by grafts and othermeans not only had a lifesaving function but also provided experience of consid-erable research value, because such injuries were comparatively rare in civilianpractice. The kidney machine received an important field trial. Shock was betterunderstood, and the plasma expanders introduced in World War II were usedwidely and with success. With its helicopters and ambulances, radio dispatchersystem, and shock treatment facilities, the MASH gave a foretaste of the emer-gency medicine of the future."”

■‘‘Copy of Rpt, Lt Col Spurgeon H. Neel, Jr., MC, Commander, 30th Medical Group, September1953, sub: Significant Lessons Learned in Korea, HSF (Neel-1953), HRB; New York Times, 23 Aug53.

THE MEDICS’ WAR

The most striking departure for Army medicine in the prewar years—theresidency program with its emphasis on specialization to the detriment of fieldmedical experience—had a mixed record in Korea. Tragic was the situation ofyoung doctors, deficient in all the military arts, who were plucked from comfort-able hospitals and thrust into battalion aid stations to organize retreats before aruthless foe. Often their patients must have paid with their lives (as doctors didalso) for the effort of the Medical Department during 1945-50 to follow tooclosely a civilian model that military medicine could at best only hope toapproximate. Yet heightened professional skill meant increased chance of sur-vival for the wounded who reached hospitals. Interacting with the other advan-tages of the Medical Service in Korea, such skill was essential, especially in the1950 emergency when drafted doctors were not available and the medics had tolive (and save the lives of others) largely by their own resources. How was amilitary medical organization to be put together and held together in affluentAmerica that had the professional capabilities of the civilian physician, who didnothing else, and the varied soldierly and administrative skills demanded by thebattlefield? The question that dominated the years 1945-53 would only bealleviated, not cured, by the continuing draft of young doctors in the postwaryears.

As for the men and women who served in Korea, this entire volume seeks todescribe their services and achievements, often under most difficult conditions.An array of individual and unit citations recognized the medics at the time, notonly for carrying out their professional duties under fire but also for standingbeside the line troops in a war where the enemy’s indifference to a medicalbrassard made all perforce into fighters. No less remarkable, perhaps more sofor the rarer quality of courage displayed, were the actions of medics whovoluntarily remained with their wounded to be captured. In enemy prisoncamps, lack of medical supplies might make curing impossible, but caring wasalmost always an option.'*^

Throughout the medical system the work of many men and women tran-scended their formal mission of conserving the fighting strength of the Army.Compassion was not the property of any branch or service, but the nature of themedics’ task allowed them to embody the compassionate spirit of their people.Any candid history of medicine in war must in great part be a litany of thecomplicated and awful woes that men inflict upon one another. From it, how-ever, may come a renewed respect for the equally human urge to save andrestore war’s victims through the healing art.

''^See, for example, Medical Company, 223d Infantry Regiment, Annual Report of MedicalService Activities, 1953, Enel to 40th Infantry Division, same report, 1953, file 319.1-2 (40th InfDiv) Far East-1953, HRB; Eighth United States Army General Order no. 81, 14 Sep 51, andGeneral Order no. 696, 15 Oct 54, MMFB; Department of the Army General Order no. 77, 5 Nov51, General Order no. 102, 21 Nov 51, and General Order no. 104, 5 Dec 51, PAB. No overall countof awards and decorations to medics was found; however, see Military Surgeon 108 (May 1951):438-39 for a partial total. Anyone with the inclination to do so could compile a complete list fromthe monthly Surgeon’s Circular Letters, Medical Section, FEC, on file in HRB.

Bibliographical Note

The Medics’ War is based primarily on manuscript sources available in theWashington, D.C., area. A large collection of note cards, either copies of orextracts from official records, is in the custody of the Historical Records Branch(HRB) of the U.S. Army Center of Military History. Prepared by researchersworking for the Historical Unit of the Office of the Surgeon General, these cardswere particularly valuable because some of the original documents have sincedisappeared, or have become impossible to trace. (In all cases where I, and mydiligent editor, were able to check the cards against the originals, the transcrip-tions proved to be accurate.)

The records of many medical units for the Korean War period, primarily theAnnual Report of Medical Service Activities and the monthly Report of Essen-tial Technical Medical Data, also are housed at the Center of Military History.Here, too, are many ephemeral publications and handouts that played their partin recreating the flavor of the era. At some point in time the center will acces-sion these records to the National Archives and Records Administration inWashington, D.C.

Similar medical reports, generally for the pre-Korean War period but insome cases duplicates and in other cases complementary, and useful letters,memorandums, directives, diaries, and related materials are in the possession ofthe National Archives’ Modem Military Field Branch (MMFB) at Suitland,Maryland. The record groups (RG) for these retired documents are RG 112,Records of the Office of the Surgeon General (Army); RG 153, Records of theOffice of the Judge Advocate General (Army); RG 319, Records of the ArmyStaff; RG 331, Records of Allied Operational and Occupation Headquarters,World War II; RG 338, Records of U.S. Army Commands, 1942-; and RG 407,Records of the Adjutant General’s Office, 1917-. At Suitland, too, in the Na-tional Archives’ Washington National Records Center (WNRC) under the careof The Adjutant General, are the central files of the Office of the SurgeonGeneral, Department of the Army (RG 112), which yielded many valuableinsights.

Of considerable importance was a collection of manuscripts written by his-torical units and detachments during and immediately after the Korean War,now deposited at the National Archives’ Modem Military Headquarters Branch(MMHB) in RG 319 and also preserved on microfilm at the Center of MilitaryHistory. These accounts range from after-action reports to lengthy official histo-ries of various phases of the conflict. Those treating surgical hospitals, helicop-ters, the care of refugees and prisoners, medical unit actions, and the LittleSwitch-Big Switch operations were especially useful to my own study.

THE MEDICS’ WAR

Other materials I would have been hard-pressed to do without include anumber of contemporary professional papers on medical subjects, preserved inthe Medical Historical Unit Collection of the Archives, U.S. Army MilitaryHistory Institute, Carlisle, Pennsylvania; the enlightening manuscript autobiog-raphy “Medic,” kindly supplied me by its author, Brig. Gen. Crawford F. Sams,MC, USA (Ret.) and now in the Center of Military History’s Library (LIB); andthe forthcoming operational narrative prepared by my colleague, Billy C. Moss-man, which in time will join this volume in the center’s United States Army inthe Korean War series.

Interviews were very helpful in dealing with a war so recent, and I was ableto carry out several, notably with General Sams and with John W. Vester, M.D.,a former MASH officer. In the 1960s historian Samuel Milner of the HistoricalUnit of the Office of the Surgeon General interviewed over 150 people whowere prominent in military medical affairs during the post-World War II period.Others, in response to his queries, submitted personal narratives of exceptionalinterest. Unfortunately, the interviews were not taped in most cases, but theinterviewer’s notes preserve a fund of useful observations by participants, someof whom are no longer living. Now housed at the Center of Military History,these materials will find their way ultimately into the medical collection atCarlisle.

The germ warfare episode sent me to sources that were unfamiliar to me,teaching me a little more about the breadth of materials available in this city.Information kindly made available by the Central Intelligence Agency and theDefense Intelligence Agency was most useful, and the unclassified collections oftranslated press reports from China and Korea preserved on microfilm at theLibrary of Congress were of at least equal value. Precise references to these andother sources will be found, chapter by chapter, in the notes.

Books

Appleman, R. E. South to the Naktong, North to the Yalu. United States Army inthe Korean War. Washington, D.C.: Office of the Chief of Military History,Department of the Army, 1961.

Bums, James M.; Gugeler, Russell A.; and Stevens, John. Okinawa: The

Last Battle. United States Army in World War II. Washington, D.C.: His-torical Division, Department of the Army, 1948.

Armfield, Blanche B. Organization and Administration in World War II. Medi-cal Department, United States Army. Washington, D.C.: Office of the Sur-geon General, Department of the Army, 1963.

Biderman, Albert D. March to Calumny: The Story of American POW’s in theKorean War. New York: Macmillan, 1963.

Bowers, John Z. When the Twain Meet: The Rise of Western Medicine in Japan.Baltimore: Johns Hopkins University Press, 1980.

367

Civil Affairs/Military Government Public Health Activities. Medical Department,United States Army. Edited by Ebbe Curtiss Hoff. Washington, D.C.: Of-fice of the Surgeon General, Department of the Army, 1976.

Cohen, Bernard M., and Maurice Z. Cooper. A Follow-up Study of World War IIPrisoners of War. Veterans’ Administration Medical Monograph. Washing-ton, D.C.: Government Printing Office, 1954.

Collected Reprints of the U.S. Armed Forces Epidemiological Board. Vols. 11and 12. Washington, D.C.: Office of the Surgeon General, Department ofthe Army, 1953 and 1954.

Committee for the Compilation of Materials on Damage Caused by the AtomicBombs in Hiroshima and Nagasaki, ed. Hiroshima and Nagasaki: The Phys-ical, Medical, and Social Effects of the Atomic Bombings. Translated byEisei Ishikawa and David L. Swain. New York: Basic Books, 1981.

Committee on Federal Medical Services, United States Commission on Organi-zation of the Executive Branch of the Government. Federal Medical Ser-vices [Appendix O]: A Report With Recommendations. January 1949. InHoover Committee Reports and Appendices no. 15-18.

Cookson, John, and Nottingham, Judith. A Survey of Chemical and BiologicalWarfare. New York: Monthly Review Press, 1969.

Craig, William. The Fall of Japan. New York: Penguin Books, 1979.

Cumings, Bruce. The Origins of the Korean War: Liberation and the Emergenceof Separate Regimes, 1945-1947. Princeton: Princeton University Press,1981.

Dean, William F. General Dean's Story. New York: Viking Press, 1954.

Deane, Philip [Gerassimos Svoronos-Gigantes]. / Was a Captive in Korea. NewYork: Norton, 1953.

Fearey, Robert A. The Occupation of Japan, Second Phase: 1948-50. New York:Macmillan, 1950.

Fishbein, Morris, ed. Doctors at War. New York: Dutton, 1945.

Freidson, Eliot. Profession of Medicine: A Study of the Sociology of AppliedKnowledge. New York: Dodd, Mead, 1970.

Futrell, Robert Frank. The United States Air Force in Korea, 1950-1953. NewYork: Duell, Sloan and Pearce, 1961.

Goulden, Joseph C. Korea: The Untold Story of the War. New York: TimesBooks, 1982.

Halle, Louis J. The Cold War as History. New York: Harper & Row, 1967.

Harrison, Tinsley Randolph. Harrison's Principles of Internal Medicine. Editedby Kurt J. Isselbacher et al. 9th ed. New York: McGraw-Hill, 1980.

Heinl, Robert D., Jr. Victory at High Tide: The Inchon-Seoul Campaign. [An-napolis, Md.]: Nautical & Aviation Publishing Company of America, 1979.

Hermes, Walter G. Truce Tent and Fighting Front. United States Army in theKorean War. Washington, D.C.: Office of the Chief of Military History,Department of the Army, 1966.

Hooker, Richard [H. Richard Homberger]. M*A*S"^H. New York: PocketBooks, 1968.

Howard, John M., ed. Battle Casualties in Korea: Studies of the Surgical Team.4 vols. Washington, D.C.: U.S. Army Medical Service Graduate School,Walter Reed Army Medical Center, 1955.

Hurst, Arthur, with the cooperation of H. W. Barber et al. Medical Diseases ofWar. 4th ed. Baltimore: Williams and Wilkins, 1944.

James, D. Clayton. The Years of MacArthur: Triumph and Disaster, 1945-1964.Vol. 3. Boston: Houghton Mifflin, 1985.

Jones, Vincent C. Manhattan: The Army and the Atomic Bomb. United StatesArmy in World War II. Washington, D.C.: U.S. Army Center of MilitaryHistory, 1985.

Kelley, Frank Raymond, and Ryan, Cornelius. Star-Spangled Mikado. NewYork: McBride, 1947.

Kendrick, Douglas B. Blood Program in World War II. Medical Department,United States Army. Washington, D.C.: Office of the Surgeon General,Department of the Army, 1964.

Kreidberg, Marvin A., and Henry, Merton G. History of Military Mobilizationin the United States, 1775-1945. DA Pamphlet 20-212. Washington, D.C.:Department of the Army, 1955.

Lee, Harriet S., and McDaniel, Myra L., eds. Army Medical Specialist Corps.Washington, D.C.: Office of the Surgeon General, Department of the Army,1968.

Levie, Howard S. Prisoners of War in International Armed Conflict. Internation-al Law Studies, vol. 59. Newport, R.I.: U.S. Naval War College Press,[1978].

Link, Mae Mills, and Coleman, Hubert A. A History of the Origin of the U.S. AirForce Medical Service, 1907-1949. Washington, D.C.: Office of the SurgeonGeneral, U.S. Air Force, 1969.

Lynch, Charles; Ford, Joseph H.; and Weed, Frank W. Field Operations. TheMedical Department of the United States Army in the World War. Vol. 8.Washington, D.C.: Office of the Surgeon General, War Department, 1925.

Marshall, S. L. A. Commentary on Infantry Operations and Weapons Usage inKorea, Winter of 1950-51. ORO-R-13. Chevy Chase, Md.: OperationsResearch Office, Johns Hopkins University, 1952.

The River and the Gauntlet: Defeat of the Eighth Army by the Chinese

Communist Forces, November 1950, in the Battle of the Chongchon River,Korea. New York: Morrow, 1953.

Martin, Edwin M. The Allied Occupation of Japan. Stanford: Stanford Universi-ty Press, 1948.

Materials on the Trial of Former Servicemen of the Japanese Army ChargedWith Manufacturing and Employing Bacteriological Weapons. Moscow:Foreign Languages Publishing House, 1950.

McCune, George M. Korea Today. Cambridge, Mass.: Harvard UniversityPress, 1950.

Munroe, Clark C. The Second United States Infantry Division in Korea,1950-1951. Tokyo: Toppan Printing Co., 1952.

369

Orr, Kenneth D., and Cold Injury Research Team. Cold Injury—Korea,1951-52. Report no. 113. Fort Knox, Ky.: Army Medical Research Labora-tory, 1953.

Oughterson, Ashley W.; LeRoy, George V.; Liebow, Averill A.; Hammond, E.Cuyler; Barnett, Henry L.; Rosenbaum, Jack D.; and Schneider, B. Aubrey.Medical Effects of Atomic Bombs: The Report of the Joint Commission forthe Investigation of the Effects of the Atomic Bomb in Japan. Oak Ridge:United States Atomic Energy Commission, 1951.

Plumridge, John H. Hospital Ships and Ambulance Trains. London: Seeley,1975.

Recent Advances in Medicine and Surgery Based on Professional Medical Exper-iences in Japan and Korea, 1950-1953. Medical Science Publication no. 4.2 vols. Washington, D.C.: Walter Reed Army Institute of Research, [1955].

Reister, Frank A. Battle Casualties and Medical Statistics: U.S. Army Experiencein the Korean War. Washington, D.C.: Office of the Surgeon General,Department of the Army, [1973].

Sawyer, Robert K. Military Advisors in Korea: KM AG in Peace and War. ArmyHistorical Series. Edited by Walter G. Hermes. Washington, D.C.: Office ofthe Chief of Military History, Department of the Army, 1962.

Schnabel, James F. Policy and Direction: The Eirst Year. United States Army inthe Korean War. Washington, D.C.: Office of the Chief of Military History,Department of the Army, 1972.

Smith, Clarence McKittrick. The Medical Department: Hospitalization andEvacuation, Zone of Interior. United States Army in World War II. Wash-ington, D.C.: Office of the Chief of Military History, Department of theArmy, 1956.

Starr, Paul. The Social Transformation of American Medicine. New York: BasicBooks, 1982.

U.S. Army Medical Service. Neurological Surgery of Trauma. Edited by ArnoldM. Meirowsky. Washington, D.C.: Office of the Surgeon General, Depart-ment of the Army, 1965.

U.S. Bureau of Medicine and Surgery. The History of the Medical Department ofthe United States Navy, 1945-1955. NAVMED P-5057. Washington, D.C.:Government Printing Office, 1958.

U.S. Congress. Senate. Committee on Armed Services. National Defense Estab-lishment (Unification of the Armed Services): Hearings on S. 758. 80thCong., 1st sess. 18, 20, 25, 26 March and 1-3 April 1947. Part 1. Washing-ton, D.C.: Government Printing Office, 1947.

Committee on Military Affairs. Demobilization of the Armed Eorces:

Hearings on S. 1355. 79th Cong., 1st sess. 17-18 October 1945. Part 2.Washington, D.C.: Government Printing Office, 1945.

Committee on Veterans’ Affairs. Medal of Honor Recipients, 1963-1973.

93d Cong., 1st sess. 22 October 1973. Committee Print no. 15. Washington,D.C.: Government Printing Office, 1973.

Ward, Orlando. Civil Assistance in Korea. FEC Printing Plant, 1951.

370 THE MEDICS’WAR

Weigley, Russell F. History of the United States Army. The Wars of the UnitedStates. New York: Macmillan, 1967.

Weintraub, Stanley. The War in the Wards: Korea's Unknown Battle in a Prison-er-of-War Hospital Camp. New York: Doubleday, 1964.

Whayne, Tom F., and DeBakey, Michael E. Cold Injury, Ground Type. MedicalDepartment, United States Army. Washington, D.C.: Office of the SurgeonGeneral, Department of the Army, 1958.

White, William L. Back Down the Ridge. New York: Harcourt, Brace, 1953.

Wiltse, Charles M. The Medical Department: Medical Service in the Mediterra-nean and Minor Theaters. United States Army in World War II. Washing-ton, D.C.: Office of the Chief of Military History, Department of the Army,1965.

Wound Ballistics. Medical Department, United States Army. Edited by JamesC. Beyer. Washington, D.C.: Office of the Surgeon General, Department ofthe Army, 1962.

Yergin, Daniel. Shattered Peace: The Origins of the Cold War and the NationalSecurity State. Boston: Houghton Mifflin, 1977.

Zinsser, Hans. Rats, Lice and History: Being a Study . . . Which . . . DealsWith the Life History of Typhus Fever. New York: Blue Ribbon Books,1935.

Articles

Albert, Janice. “Air Evacuation From Korea—A Typical PXighX.'"Military Sur-geon 112 (April 1953).

Anderson, Clarence L., et al. “Medical Experiences in Communist POW Campsin Korea: Experiences and Observations of Five Medical Officers WhoWere Prisoners.” Journal of the American Medical Association 156 (Septem-ber 1954).

Barbers, G. J., et al. “Clinical and Laboratory Study of Thirty-one Patients WithHemorrhagic Fever.” AMA Archives of Internal Medicine 91 (February1953).

Baxt, William G., and Moody, Peggy. “The Impact of a Rotorcraft AeromedicalEmergency Care Service on Trauma Mortality.” Journal of the AmericanMedical Association 249 (June 1983).

Beebe, G. W. “Follow-up Studies of World War II and Korean War Prisoners,II: Mortality, Disability, and Maladjustments.” American Journal of Epide-miology 101 (May 1975).

Bennett, H. J. “‘Maine’ Chance.” Journal of the Royal Naval Medical Service 37(Winter 1951).

Berlin, Richard B. “Impressions of Japanese Medicine at the End of World WarII.” Scientific Monthly 64 (January 1947).

Biderman, Albert D. “Dangers of Negative Patriotism.” Harvard Business Re-view 40 (November-December 1963).

Boatner, Haydon L. “How I Crushed the Reds on Koje Island.” ITiar Stories(Summer 1964).

Boyer, Paul. “Physicians Confront the Apocalypse: The American Medical Pro-fession and the Threat of Nuclear War.” Journal of the American MedicalAssociation 254 (August 1985).

Buerger, Paul T. “Medical Support for Mountain Fighting in Military

Surgeon 109 (December 1951).

Bzik, Karl D., and Bellamy, Ralph F. “A Note on Combat Casualty Statis-tics."" Military Medicine 149 (April 1984).

Chalmers, Thomas C., et al. “The Treatment of Acute Infectious Hepatitis:Controlled Studies of the Effects of Diet, Rest, and Physical Reconditioningof the Acute Course of the Disease and on the Incidence of Relapses andResidual Abnormalities.’Vowr/ta/ of Clinical Investigation 34 (July 1955,pt. 2).

“Civilian Specialists Eligible for Army Reserve Commissions.""Bulletin of theU.S. Army Medical Department 8 (October 1948).

Cowdrey, Albert E. “‘Germ Warfare’ and Public Health in the Korean Con-flict. of the History of Medicine and Allied Sciences 39 (April 1984).

Coyl, E. B. “Hospital Ships in Korea.” Military Surgeon 112 (May 1953).

Dayand, Barbara, and Waitzkin, Howard. “The Medical Profession and NuclearWar.” Journal of the American Medical Association 254 (August 1985).

Duke, Raymond E. “Training Activities of the Army Medical Depart-ment.""Military Surgeon 102 (May 1948).

Fang, Shih-Shan. “Effect of War on the Health of the People.” Chinese MedicalJournal 11 (September-October 1953).

Gauld, R. L., and Craig, J. P. “Epidemiological Pattern of Localized Outbreaksof Epidemic Hemorrhagic Fever.” American Journal of Hygiene 59 (Janu-ary 1954).

Ginn, L. Holmes, Jr., and Ziperman, H. Haskell. “Surgery in Division ClearingStations.” Military Surgeon 113 (December 1953).

Ginn, Richard V. N. “Of Purple Suits and Other Things: An Army OfficerLooks at Unification of the Department of Defense Medical Ser-wiccs.""Military Medicine 143 (January 1978).

Harris, John F. “Practice of Field Medicine on Operation ^YAWcr".""MilitarySurgeon 109 (December 1951).

“Helicopters in Emergency Trauma Care.” Journal of the American MedicalAssociation 249 (June 1983).

Hughes, Carl W. “Acute Vascular Trauma in Korean War Casualties.""Journal ofSurgery, Gynecology, and Obstetrics 99 (July 1954).

“Arterial Surgery During the Korean War.” Annals of Surgery 147 (April

1958).

Jahnke, Edward J. “Late Structural and Functional Results of Arterial InjuriesPrimarily Repaired.” Surgery 43 (February 1958).

Kater, N. M. “Air Evacuation of Casualties in the Korean ax.""Medical Journalof Australia 2 (July 1953).

THE MEDICS’ WAR

“Some Experiences in a Korean Prisoner-of-War Camp Hospi-tal/’1 (March 1953).

Lifton, Robert J. “Home by Ship: Reaction Patterns of American Prisoners ofWar Repatriated From North Korea.” American Journal of Psychiatry 110(April 1954).

Lucka, Mildred V. “Korea: A Challenge to Western Cursing "'American Journalof Nursing A6 (October 1950).

Maluf, Noble S. R. “Use of Veins in Surgery: A History.” Sudhoffs Archiv,Zeitschrift fuer Wissenschaftsgeschichte 67 (1983).

“Medical Department Affiliation Program.” Bulletin of the U.S. Army MedicalDepartment 9 (August 1949).

“Medical Department Training Program.” Military Surgeon 102 (April 1948).

Neel, Spurgeon H., Jr. “Medical Considerations in Helicopter Evacua-tion.” United States Armed Forces Medical Journal 5 (February 1954).

Nefzer, M. D. “Follow-up Studies of World War II and Korean War Prisoners,I: Study Plan and Mortality Findings.” American Journal of Epidemiology91 (February 1970).

Norris, John. “East or West? The Geographic Origin of the BlackBulletin of the History of Medicine 51 (Spring 1977).

“Nursing Affairs in Military Government.” Bulletin of the U.S. Army MedicalDepartment 5 (June 1946).

Pugh, Lamont. “Mercy Is Their Mission.” Army Information Digest 8 (August1953).

Rake, Richard H., and Genender, Ellen. “Adaptation to and Recovery FromCaptivity Stress.” Military Medicine 148 (July 1983).

“Regular Army Appointments in Women’s Corps.” Military Surgeon 101 (De-cember 1947).

Robinson, Paul I. “About the Army Medical Department.” United States ArmedForces Medical Journal 1 (May 1950).

“About the Medical Corps.” Bulletin of the U.S. Army Medical Depart-ment 8 (August 1948).

“About the Medical Department.” Bulletin of the U.S. Army Medical

Department 8 (December 1948) and 9 (February 1949).

Sams, Crawford F. “American Public Health Administration Meets the Prob-lems of the Orient in Japan.” American Journal of Public Health and theNation s Health 42 (May 1952).

Spencer, Frank C., and Grewe, Roy V. “The Management of Arterial Injuries inBattle Cdisudihits." Annals of Surgery 141 (March 1955).

Steger, Byron L., and Domina, Donald E. “Armed Services Medical RegulatingOffice.” United States Armed Forces Medical Journal 2 (July 1951).

Sullivan, Arthur D. “The Training of Korean Army Medical Service Person-nel. Bulletin of the U.S. Army Far East 11 (October 1953).

Thornton, W. H. “The 24th Division Medical Battalion in Korea.

Surgeon 106 (July 1951).

Veith, Ilza. “On the Mutual Indebtedness of Japanese and WesternBulletin of the History of Medicine 52 (Fall 1978).

BIBLIOGRAPHICAL NOTE

373

Webb, Joseph E., Jr. “Problems of Insect Control.” United States Armed ForcesMedicalJournal 3 (April 1952).

Willard, William R. “Some Problems in Public Health Administration in theU.S. Army Military Government in Korea.” Yale Journal of Biology andMedicine 19 (March 1947).

Winokur, George. “The Germ Warfare Statements: A Synthesis of a Method forthe Extortion of False Confessions.” Journal of Nervous and Mental Dis-eases 111 (July 1955).

Yoon, Hun Chan. “Preventive Medicine in a Korean UiYisionJMedical Bulle-tin of the U.S. Army Far East 11 (October 1953).

List of Abbreviations

| ADCOM

Admin

AH

AKA

ANC

ANCs

AP

APCs

ASCOM 24

ASF

ASTPs

AU

AUS | Advance Command and Liaison Group

Administrative

Hospital ship code

Attack (amphibious) cargo ship code

Army Nurse Corps

Army Nurse Corps officers

Transport ship code

Armored personnel carriers

Army Service Command 24

Army Service Forces

Army Specialized Training Program graduatesArmy Unit

Army of the United States |
|---------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| BB                                                                        | Battleship code                                                                                                                                                                                                                                                                                                                         |
| Cav

CHA

Chem

CINCFE

CMH

CRIK                                         | Cavalry

Clinical History Activity, CMHChemical

Commander in Chief, Far EastCenter of Military HistoryCivil Relief in Korea                                                                                                                                                                                                            |
| DA

DC

DD

Div                                                           | Department of the ArmyDental CorpsDestroyer codeDivision                                                                                                                                                                                                                                                                                |
| ETMD

ETO

EUSAK                                                          | Essential Technical Medical DataEuropean Theater of OperationsEighth United States Army, Korea                                                                                                                                                                                                                                          |
| FEC                                                                       | Far East Command                                                                                                                                                                                                                                                                                                                        |

THE MEDICS’ WAR

| G-1

G-2

G-3

G-4                                        | Personnel section of divisional or higher staffIntelligence section of divisional or higher staffOperations section of divisional or higher staffLogistics section of divisional or higher staff                                                                                                             |
|-----------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| HRB

HSF                                                  | Historical Records Branch, CMHHistorian’s source file, CMH                                                                                                                                                                                                                                                   |
| Inf                                                       | Infantry                                                                                                                                                                                                                                                                                                     |
| JAG

JLCOM                                                | Judge Advocate GeneralJapan Logistical Command                                                                                                                                                                                                                                                               |
| KATUSAs                                                   | Korean Augmentation to the United States Army personnel                                                                                                                                                                                                                                                      |
| KBC

KCAC

KCOMZ

KMAG                                    | Korea Base Command

Korean Civil Assistance Command

Korean Communications Zone

United States Military Advisory Group to the Republicof Korea                                                                                                                                                               |
| KSCs                                                      | Korean Service Corps personnel                                                                                                                                                                                                                                                                               |
| LIB                                                       | Library, CMH                                                                                                                                                                                                                                                                                                 |
| MASHs

MATS

MC

MCs

MIAs

MMFB

MMHB

MOS(s)

MSC

MSCs | Mobile army surgical hospitals

Military Air Transport Service

Medical Corps

Medical Corps officers

Missing in Action casualties

Modern Military Field Branch, NARA

Modem Military Headquarters Branch, NARA

Military occupational specialty(ies)

Medical Service CorpsMedical Service Corps officers |
| NARA

NPs                                                 | National Archives and Records AdministrationNeuropsychiatric cases                                                                                                                                                                                                                                           |

LIST OF ABBREVIATIONS

2>11

| ODs

OSG                                           | Dress uniforms

Office of the Surgeon General, DA                                                                                                                                                                                                             |
|----------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| PAB

PF

POWs                                      | Printed Archives Branch, NARAFrigate codePrisoners of war                                                                                                                                                                                                     |
| Rees

RG(s)

ROK

ROTC

R&R                    | Records

Record Group(s)

Republic of Korea

Reserve Officers Training Corps

Rest and recuperation                                                                                                                                                           |
| SG

SCAP                                           | Surgeon General

General Headquarters, Supreme Commander for the AlliedPowers                                                                                                                                                                                 |
| Sig

SOP

SSB

Surg                                | Signal

Standard operating procedureStaff Support Branch, CMHSurgeon                                                                                                                                                                                          |
| T

TD(s)

TDY

T/0&E(s)                        | Military Sea Transportation Service codeTable(s) of distributionTemporary duty

Table(s) of organization and equipment                                                                                                                                        |
| U.N.

UNC

UNCACK

UNICEF                          | United NationsUnited Nations Command

United Nations Civil Assistance Command, KoreaUnited Nations Children’s Fund {Acronym taken from formername: United Nations International Children s                                                                    |
| UNKRA

U.S.

USA

USAFFE

USAFIK

USAFPAC

USAMGIK | Emergency Fund)

United Nations Korean Reconstruction Agency

United States

United States Army

United States Army Forces, Far East

United States Army Forces in Korea

United States Army Forces, Pacific

United States Army Military Government in Korea |

THE MEDICS’ WAR

V-12s

VD

WDWDGSWNRCWW II

Navy Specialized Training Program graduatesVenereal disease

War DepartmentWar Department General StaffWashington National Records Center, NARAWorld War II

Index

Acheson, Dean: 225Adams, Lt. Raymond: 74Adjusted Service Rating: 7Administrators, medical: 7, 14-15, 21, 35, 77Advance Command and Liaison

Group (ADCOM): 4-5, 69, 71, 73, 136Aid stations: 73-75,95, 121, 126, 128, 138, 164,173, 188, 193, 201, 213-14, 216Air Force: 126, 161,241,336, 347airlift of supplies: 138, 244becomes separate service: 22-24helicopter evacuation of wounded: 85, 94, 96,150, 165, 167, 170, 173,265-68hospitals: 274-75, 335medical personnel: 28, 190, 284, 291spraying program: 146, 246-47Air Force, Fifth: 340Air Rescue Squadron, 3d: 94Air Sea Rescue Squadron: 268Airborne Division, 82d: 168Aircraft. See also Helicopters.

C-47: 123, 146, 262C-54: 173, 262Corsair: 121

fixed-wing: 105, 111, 120, 150, 244, 341Airlift of wounded: 65, 77-79, 82-83, 101,111,262-64, 335. See also under Helicopters.Allen, Dr. Raymond B.: 28Almond, Maj. Gen. Edward M.: 98, 100-101,122

Amato, Lt. Col. Vincent J.: 257Ambulances: 65, 76-77, 83, 114, 120, 126, 150,199-200, 202, 207, 257, 268Amebiasis: 50, 56, 61American Dental Association: 31American-Korean Foundation: 362American Medical Association: 26, 28-31, 190,229-30, 328, 357-58American Mission in Korea: 62Anderson, Capt. Clarence L.: 75Anesthesiologists: 142, 159, 233-34, 255, 276Anju: 115, 122-23Ansong: 74

Antibiotics: 131, 134, 159, 174, 239, 249Antung: 222Anui: 105

Anyang-ni: 101, 104

Armed Forces Assistance to Korea Program:

356

Armed Forces Blood Donor Program: 243Armed Forces Blood Processing Laboratory:

244

Armed Forces Epidemiological Board: 244-45Armed Forces Medical Advisory Committee: 27Armed Forces Medical Policy Council: 189-90Armed Services Medical Regulating Office:292-93, 336

Armor, body: 210-11, 254Armored personnel carriers (APCs): 200, 214Armstrong, Maj. Gen. George E.: 29, 66-67,188, 190, 192-95, 297, 332Army Air Forces: 13

Army Epidemiological Board to Japan: 50Army Medical Departmentpost-WWII loss of personnel: 7-11program to upgrade, 1946-49: 11-21Army Medical Depot6th: 106, 136, 138, 229, 238, 240, 3368065th: 136

Army Medical Research and Graduate School:15

Army Medical Research Laboratory: 284Army-Navy Medical Procurement Office: 23Army Nurse Corps: 11, 16-19,21, 140, 142,234, 357. See also Nurses.

Army Service Command 24. See ASCOM 24.Army Service Forces (ASF): 11Army Specialized Training Program. SeeASTPs.

Arterial repair: 205-07

Ascom City: 53, 59, 102, 106-08, 124-25, 129ASCOM 24: 53, 59-60ASTPs: 11-12, 16, 32, 66, 230, 295,358dissatisfaction among: 10, 13release of: 29, 33, 67, 139Atabrine: 46

Atchley, Maj. Oren C.: 114Atomic bomb: 22-23, 36, 44Australian forces: 181, 277, 290

Bailey, Pvt. Donald V.: 96Ball, Capt. James A.: 84Banta, Pvt. Thomas J.: 82Barbero, Capt. Julio: 186Barnett, 1st Lt. Joseph C.: 205Battle Mountain (Hill 665): 84, 88, 97Bayne-Jones, Brig. Gen. Stanhope: 218Beers, Dr. Robert M.: 33Belgian forces: 182, 287Benevolence (AH-13), USS: 263Bethea, Maj. Gen. James A.: 67Big Switch, Operation: 351-55

THE MEDICS’ WAR

Blacks in medical units: 10-11Bliss, Maj. Gen. Raymond W.: 9, 16-17, 24-27,30, 32-34, 95, 100, 158-59Blood

emergency treatment with: 129-30, 141, 164local donors: 134, 155program: 154-55, 243-45, 276, 363supply: 79, 83, 85, 127, 154-55, 217, 239-40Bloody Ridge: 179Boatner, Maj. Gen. Haydon L.: 317Bohman, Capt. Gunnar: 307Bolen, Pvt. Jack: 96Bolibaugh, Col. Oral B.: 64Boone, Rear Adm. Joel T.: 24Bowers, Col. Warner F.: 190, 192Bowler, 1st Lt. Joseph L.: 166-67Boysen, Capt. Alexander M.: 75, 191, 301Bradley, Capt. Ernest M.: 84British Air Force: 290

British Command of Forces: 182, 273a?, 290British Commonwealth Brigade, 7th: 119British forces: 88, 1 19, 181-82, 263, 272, 277,287, 290, 303

Brooke Army Medical Center: 190, 290, 296

Brown, Lt. Col. James M.: 166

Brown, Maj. Jesse F.: 168

Bryson, T. Sgt. James: 167

“Bug-out fever”: 122

Burla, Capt. William O.: 120

Burn treatment: 159, 256, 276-77, 282

CampsBenda: 239Detrick: 218Drew: 274King: 277, 286Nara: 286

Shinodayama: 235-36Sobinggo: 62Zama: 302, 335

Canadian forces: 181, 277, 290Carle, Col. Donald E.: 95-96Casualties: 133, 138, 140-41, 154battle: 73, 77-79, 113, 170, 183, 194,

199-202, 215, 268-69, 271-72, 277, 285,293, 344

Chinese: 118, 160, 162civilian: 101-02Marine: 129, 190, 194, 293, 336non-battle: 162, 183, 187, 204, 268North Korean: 86, 106, 161, 201-02ROKArmy: 49, 106, 161,201U.N. forces: 111-12, 119, 128, 152-53, 272,277, 290

Cavalry Division, 1st: 44, 67, 70, 77, 82, 85, 88,119, 128, 130, 157, 179-80, 185-86, 287,302

Certification, specialty board: 14, 254, 357Changjin (Chosin) Reservoir: 116, 120, 126, 190Chechon: 168Cheju: 326, 328

Chiang Kai-shek: 316

China. See People’s Republic of China.

Chinese Communist Forces (CCF)casualties: 118, 160, 162intervention by: 120, 124, 127, 160-62, 197,200, 213, 215

medical support to troops: 174-75, 177Chinese unitsArmy, Fifteenth: 213Division, 45th: 213Chinju: 83, 107Chipyong-ni: 141Chisholm, Pvt. Joseph: 162Chloroquine: 84, 146, 247Chochiwon: 71, 75-77, 96, 301Cholera: 42, 50, 53-55, 60, 147, 221, 224-25Cholla-Namdo Province: 325Chonan: 71

Chongchon River: 115,119Chongong-ni: 179-80Chongpyong-ni: 355Chonju: 105-06Chonui: 96Chorwon: 179, 198Chou En-lai: 223,351Chunchon: 56, 168, 240, 330Church, Maj. Gen. John H.: 73, 83Civil Relief in Korea (CRIK): 326-27, 359, 361Civilians: 52, 291. See also Refugees,casualties: 101-02

consultants: 16, 128, 158-59, 173,237,253-54,285contract dentists: 30, 33contract doctors: 30, 33, 66, 139, 274and fraternization of soldiers: 47, 59-60internship program: 34, 139Japanese employed in medical units: 66, 274Koreans employed in medical units: 60, 62,208

medical aid to Koreans: 56, 59, 84, 88, 241,339

North Korean: 174-75in the Pusan Perimeter: 84, 146Clark Air Base: 290Clark, Lt. Eugene F.: 175Clark, General Mark W.: 198«, 320, 348Clearing companies: 114, \26. See alsoClearing Companies (Separate).

Clearing stations: 95, 101, 106, 114, 157,342-44

Clothing: 210-11Cogan, Isaac: 29

Cold injury: 118, 162, 176, 197, 248, 255, 272,278, 283-84, 340. See also Frostbite.

Cold War: 19, 22, 29-30, 358, 360Collecting stations: 74, 79, 164, 217Colombian forces: 182, 287, 290Colson, Brig. Gen. Charles F.: 317Combat Cargo Command: 150Commando, Operation: 179Commission on Organization of the ExecutiveBranch of the Government. See Hoovercommission.

381

Commissions, ArmyArmy of the United States: 14, 17-18Regular: 18-19Reserve: 15-18

Committee on Medical and Hospital Services ofthe Armed Forces: 24Commonwealth Division, 1st: 182Commonwealth forces: 182, 287, 290Communications in Korea: 53Communists: 51, 86, 98, 176-77. See also Ch.\-nese Communist Forces (CCF); North Ko-rean Army.

Congress: 17, 20, 232, 326abolishes Army of the United States commis-sions: 18

and the draft: 30-31and incentive pay: 16, 33and post-WWII demobilization: 8, 10and service unification: 22-23, 27-28Connors, Capt. Genevieve A.: 90Consolation (AH-15), USS: 101, 152, 259, 263Consultants, medical: 16, 128, 158-59, 173,237,253-54, 285Cooper, Charles P.: 27, 32Cooper Committee: 27-28Coppens, Father Francis Xavier: 161Corps

I: 46-47, 111, 119, 170, 179, 185, 240, 257IX: 111, 119, 163-65, 185,240, 246,355X: 98, 100, 103-04, 109-10, 112-14, 120,

122, 125-27, 137, 140, 160-61, 163, 168,170, 179, 201, 208, 238, 240-41, 307, 312XXIV: 51, 53, 58-59Corps, ROK ArmyI: 109, 112II: 109, 119

Corps of Engineers: 137, 200Cortisone: 134Crosby, Capt. Leonard A.: 81Cullen, Col. John K.: 53

DDT: 41, 46, 55-56, 84, 145, 149, 159-60, 174,183, 246-47,255, 307-08,312Dean, Maj. Gen. William F.: 63, 71, 73, 222,227

Deane, Philip: 74-75, 77, 300-301, 304Death rates: 38, 42, 141, 152, 159, 187-89,193-96, 276, 304,332Delousing:41,247, 308,351Demilitarized Zone: 351, 356Demobilization: 7-8, 10, 13, 47, 59-60Dengue fever: 146-47Denit, Brig. Gen. Guy B.: 44Dental care: 157, 250-53, 278-79Dental Corps: 16, 232, 251Dental Laboratory Technicians School,Yokohama: 66

Dentists: 12, 29-30, 33, 67, 77, 156-58, 250-52Department of the Army: 64, 139-40, 156, 202Department of Defense: 23, 28, 154, 256, 284,289,358

Department of Public Health and Welfare,Korea: 52, 57

Diarrhea: 42, 62, 137, 146, 221, 304Diphtheria: 43, 147

Discipline, Japanese health: 41, 46, 48, 50Distinguished Service Cross: 96-97, 176«Doctors. See also under Draft, and by specialty,and career service: 10civilian consultant: 16, 128, 158-59, 173,237,253-54, 285

civilian contract: 30, 33, 66, 139, 274dislike of military duties: 26losses of: 7, 9, 231military consultant: 128quality of North Korean: 88ratio to troop strength: 32, 233, 358recruitment of: 26

shortages of: 21-22, 30, 66-67, 82, 128,139-42,233, 249,254, 328, 338underutilization of: 22, 233, 270, 357Dodd, Brig. Gen. Francis T.: 316-17“Doodlebugs”: 76-77Doren, Maj. Austin C.: 77Dovell, Col. Chauncey E.: 64, 66, 81, 84, 89,94-96, 100, 108, 111, 116, 123, 128,130-31, 132, 231, 300, 330-31, 341Draft: 49, 336, 338and Congress: 30-31of doctors and dentists: 29-31, 141, 145,228-30, 232, 234of female personnel: 143-44military: 22, 29

Drug addiction: 247-48, 250, 304Duerk, Capt. Donald L.: 75DUKW: 200

Dusek, Pvt. Ronald R.: 96Dutch forces: 88, 181-82, 277, 287Dysentery: 26, 42-43, 50, 61, 75, 127, 255, 311,319, 361

Eberstadt committee: 26Eckhardt, Col. Richard H.: 64, 261Eighth Army: 37, 63, 116, 122, 312. See alsoEUSAK.

and Chinese intervention: 114, 119-20,161-62

commander: 348

evacuation procedures: 201-02, 204, 257headquarters: 132

Headquarters, Civil Assistance: 324-25helicopter support: 96, 165hospitals: 203-05, 302, 310Inchon landing: 101

MASH units supporting: 71, 89-90, 109, 115,167, 170, 187, 283

and medical problems of occupation: 49-50medical regulating officers: 335medical supply officer: 135-36, 331medical support for: 130, 140, 143, 145, 150,172, 229, 245, 250-51, 254, 261, 268, 270,336-41

THE MEDICS’ WAR

Eighth Army—Continuedmoves to wartime footing: 69, 181organizational changes: 111, 132-33, 160-61POW responsibilities: 45and Pusan Perimeter: 83, 98, 105, 264and Pyongyang: 125

surgeon: 100, 132, 135-37, 149, 165, 191,\92n, 202-04, 228-29, 231, 236, 310, 338,341-43

T/O&E: 233, 235training: 237, 355-56troop strength: 49-50, 67Eighth United States Army, Korea. See EUSAK.Eisenhower, General of the Army Dwight D.:22-23,25,335Electrical power: 137, 251Eliasson, Capt. Arne H.: 165Encephalitis: 38, 43, 53, 64, 84, 147, 220, 247,272

Engineer Special Brigade, 2d: 101, 307Enlisted personnel: 193shortage of trained medical: 7, 28, 66-67,

139, 143,234,273,338strength, 1945-50: 8trained by nurses: 67Enoch Arden: 302

Enteric diseases: 38, 42, 50, 137, 146, 245Epidemics

in Korea: 54, 56, 62, 173-74, 177, 186, 247in occupied Japan: 40, 42, 47, 64among refugees: 321Esensten, Capt. Sidney: 191Eta Jima Specialist School: 235Ethiopian forces: 182, 287EUSAK: 81, 85, 133, 228-29, 258. See alsoEighth Army.

Evacuation of wounded: 65, 83, 163-64, 199,

202, 214-15

from battle area: 78,82,201,214,216effectiveness of: 187-95to Japan: 152, 186, 202, 204, 257, 260,262-64, 266, 268-69, 287-88, 335, 346to zone of interior: 272, 287, 289-94, 335Evacuation Hospitals, Semimobile: 6911th: 203, 205,229,256,35621st: 203, 258-5922d: 258

25th: 203, 240, 258-59

121st: 100, 102-03, 108, 113-15, 117,

126-27, 129-30, 142, 170-73, 180, 185-86,

203, 205, 229, 307, 348

171st: 112, 123, 142, 203, 240, 259, 274, 308,329

8054th: 79, 84, 92, 94, 142, 148, 150, 152-54,157-58, 262,3108079th: 286-87

Fabing, Dr. Howard D.: 141Fah, Dr. Yang Chang: 220Famine: 177

Far East Air Forces: 150, 268

Far East Command (FEC): 43, 62, 173, 335, 357cold injury treatment center: 117evacuation policy: 192, 268-70, 274, 287-88,336

Joint Strategic Plans and Operations Group:100

Medical Section: 63, 99, 116, 234, 261, 347and medical treatment: 65-66, 84, 116, 118,129, 138, 155, 186-87, 230, 239, 247,271-72, 274, 296, 349nurses: 60, 67, 142-44, 230-31, 233-34personnel rotation policy: 60, 67, 142-45,

193, 200, 230-33, 235, 250, 337and POWs: 346-47and reports of germ warfare: 225shifts to wartime footing: 69-70, 73, 82shortage of doctors: 30, 128, 139-42, 249, 338shortage of enlisted personnel: 143, 338surgeon: 140, 235, 240, 261T/O&E: 132-33, 136, 229, 233-34, 262and training: 159, 234-36Far East Medical Service Specialist School:235-36

Field Artillery Battalions38th: 14163d: 79

Field Hospitals: 1313d: 153, 310, 312, 314, 316-174th: 100, 102-04, 106, 108-11, 124-25, 128,142,258, 308

14th (Provisional): 310, 312, 314, 316-1764th: 108, 112, 123-24, 142, 274, 310, 312,316-17, 320-21

Fitzsimons Army Hospital: 293-95, 297Fleischmann, Pfc. Richard L.: 96Food

inspected by veterinarians: 60, 242military, released to Japanese: 39POW: 303,315,317, 320provided to civilians in combat area: 84provided for various nationalities: 128, 242quality of: 241-42, 333Type B rations: 170Forrestal, James: 23-25, 27-28, 31-33Forts

Benning: 202Bragg: 168

George G. Meade: 235Knox: 284

Sam Houston: 15, 143, 230,235-36, 296,331Fred C. Ainsworth (T-AP-181), USNS: 126,181Freedom Village: 348, 354French forces: 181-82, 211, 287Frostbite: 114, 116, 118-19, 127, 268-69, 277Fukuoka: 262-63, 266, 277

Gaddis, Capt. Hubert D.: 166Gans, Capt. Harry L.: 81, 135Gas gangrene: 281-82Gastroenteritis: 42, 99

383

Gay, Maj. Gen. Hobart R.: 130

General Depot, 60th: 312

General Edwin D. Patrick (AP-124), USS: 112

General H. B. Freeman (T-AP-143), USNS:

126

General Hospitals. See also under WilliamBeaumont; Letterman; McCormack;Murphy; Oliver; Percy Jones; Valley Forge.42d: 45141st: 275279th: 274, 288343d: 274382d: 274

GeneralJ. H. McRae{T-AP-\A9), USNS: 290General LeRoy Eltinge (T-AP-154), USNS: 290General W. A. Mann (AP-112), USS: 102Geneva Conventions: 299, 306, 314, 321Germ warfare: Ml,1X1-11Giffen, 1st Lt. Robert B, Jr.: 5“Gilded Lily”: 101Gilstrap, Sgt. Robert: 120Ginn, Brig. Gen. L. Holmes, Jr.: 191, \91n, 196,203-04, 213, 215, 237, 331, 337, 341-44,348

Glass, Col. Albert J.: 128-29, 156, 231Gonorrhea: 48, 61Gorby, Col. Alvin L.: 100, 126Goriup, Col. Othmar F.: 20“Great Naktong Offensive”: 95-96, 264Greekforces: 181-82,287Gregory, Capt. Oree: 83, 85, 302Grow, Maj. Gen. Malcolm C.: 24

Halazone tablets: 75, 137, 245

Hamhung: 113-15, 122, 125-26, 129

Han River: 101, 108, 160, 326

Haneda International Airport: 269, 289

Harbin, Manchuria: 218, 222

Harsh, Capt. Griffith R.: 172

Haven (AH-12), USS: 263

Hawley, Paul R.: 24-26

Hawley committee: 24-28

Hays, Brig. Gen. Silas B.: 133-34, 261, 111

Heartbreak Ridge: 179

Heat exhaustion: 84

Helicopter Ambulance Company (Provisional),1st: 341

Helicopter Detachments1st: 164«

2d: 1633d: 1634th: 163-64

8190th Army Unit: \6An8191st Army Unit: 163, 166,2158192d ArmyUnit: 163, 165, 1678193d Army Unit: 164Helicopters: 84, 244Bell H-13D: 165, 167, 345,348evacuation of wounded by: 85, 93-96, 111,127, 130, 141, 150, 163-64, 170, 173, 199,206, 209, 215, 265-68, 341-42, 362

Helicopters—ContinuedHiller 23A: 165H-19: 165, 345, 348

Hemorrhagic fever: 184-87, 199, 237, 245, 248,276, 283-86, 339, 344Hepatitis: 61, 127, 147, 173, 176, 185, 221,243-45, 248, 255, 269, 272, 285, 339Heritage, Maj. Wade F.: 4, 78Heuman, Capt. Philip W.: 215Hewitt, Col. Reuel E.: 47Hickam Air Force Base: 291Hill 598: 213, 215

Hill 665 (Battle Mountain): 84, 88, 97Hiroshima: 8, 36, 39, 44Hodge, Lt. Gen. John R.: 51, 59Hoengsong: 163, 170Hokkaido: 39-40, 273Holmes, Lt. Col. Robert H.: 211Hongchon: 168

Honshu: 51, 150, 266, 276, 286Hooker, Richard: 209-10. Hornberger,

Capt. H. Richard.

Hookworm: 42, 45Hoover commission: 26-28Hornberger, Capt. H. Richard [pseud. Hooker,Richard]: 209

Hospitals: 25, 27, 132. See also Evacuation Hos-pitals, Semimobile; Field Hospitals; MASH;Station Hospitals; Surgical Hospitals (Mo-bile Army).

admissions: 152, 170-71, 273, 310backup, in Japan: 86, 101, 127, 140, 143, 156,261,270-89, 294,296, 348, 362civilian, in Korea: 106closed in 1950: 33-34enemy comandeering of: 87integrated general: 28number of beds: 294, 328in postwar Japan: 46-47, 65-66rear area: 258

ships: 46, 115, 126, 129, 153, 259, 262-64,335,353teaching: 16, 34

trains: 65, 75, 78, 83-84, 149-50, 199, 202,229,257, 268U.N.: 228

zone-of-interior: 27, 65, 258, 291-94, 335Hourglass Division. See Infantry Division, 7th.Howard, Capt. John M.: 207, 256Hughes, Lt. Col. Carl W.: 207Hume, Maj. Gen. Edgar Erskine: 63-64, 95,

100, 112, 114, 116, 131, 139-40, 143-44,186, 188, 194,231,261Hume, Col. Wayne S.: 302Hungnam: 122, 125-26, 170, 259Hyesanjin: 113-14Hyop, Hwang Jung: 224

Imjin River: 160, 111Immunization

North Korean: 174, 221, 224

THE MEDICS’ WAR

Immunization—Continuedin occupied Korea: 54, 60postwar: 361ofPOWs: 314, 351of refugees: 327

SCAP program in Japan: 40-42, 47in wartime Korea: 84, 148, 247-48Inchon: 50, 53, 60, 99-100, 103, 105, 112, 124,129, 171, 228, 259, 263-64, 307-10, 312,325,353

Infantry Divisions

2d: 84-85, 88, 92-93, 95-96, 105, 1 1 1,119-20, 123, 128, 141, 157, 163, 167, 179,188, 198-200, 3553d: 115, 125-26, 167, 344-457th: 50, 58-59, 63, 67, 98, 100, 102, 104, 112,114, 1 16, 157, 161, 167, 213, 215, 21924th: 4, 63, 67, 70-71, 73-74, 77-78, 81-83,85, 88, 109-1 1, 119, 128, 135-36, 156, 16125th: 67, 77, 79, 82-84, 88, 106, 1 19, 128,

157, 160, 183, 197, 34440th: 201, 34445th: 198-99, 201, 344Infantry Regiments7th: 11514th: 19715th: 11517th: 84

21st: 71, 75, 161-6223d: 96, 141, 17924th: 84, 16031st: 213-1532d: 120,214-1534th: 75, 79, 8235th: 84

38th: 105, 120, 16365th: 115

Infiltration, enemy: 95, 195Influenza: 49, 127, 247Insects, 40-41, 53, 83, 145, 183, 187, 245International Scientific Commission for the In-vestigation of the Facts Concerning Bacteri-al Warfare in Korea and China: 226Interns: 15,34, 86, 139, 237Iron Triangle: 179, 198Ishii, Lt. Gen. Shiro: 218-19Italian Red Cross Hospital: 203, 362Itami Air Base: 266-69, 289Itazuki Air Base: 266Iwon: 112-14

Jahnke, Maj. Edward J.: 207Jamesway tent: 210, 251Japan: 7. See also under Hospitals;Immunization.

epidemics in occupied: 40, 42, 47, 64hospitals in: 86, 101, 127, 140, 143, 156, 261,270-89

medical evacuation to: 152, 186, 202, 204,257, 260, 262-64, 266, 268-69, 287-88,290, 335, 346, 349, 353

Japan—Continuedand medical supplies: 39, 241, 325medical training in: 230, 235peace treaty with: 248public health in: 39-44, 48, 65andR&R: 156, 183, 248U.S. occupation of: 36-50, 63-68Japan Logistical Command (JLCOM): 156, 204,229, 234, 236, 254, 262, 268, 272, 278, 325evacuation process: 263, 289hospitals: 144, 237, 268, 273-74, 276, 289and materiel: 99, 228, 241, 325medical regulating officer: 269surgeon: 100, 133, 235, 261, 269, 275, 283,289

Japan Medical Depot: 236, 238-39, 241, 336Japan Replacement Depot: 235Japan-U.S. Joint Commission for the Investiga-tion of the Effects of the Atomic Bomb inJapan: 44

Johnson, Capt. Elizabeth N.: 89Johnson, Louis: 23, 28, 33, 66, 220Joint Chiefs of Staff: 22, 177, 293Joung, Lt. Comdr. Youn: 175Jutlandia: 260, 290

Kaesong: 106, 108-09, 177, 238Kansas: 178

KATUSAs: 148, 216, 329, 334KCOMZ: 202-04, 229, 234, 237, 248-49, 254,257, 259-60, 306, 319, 329, 335-36, 341,348, 356

Kean, Maj. Gen. William B.: 82

Khabarovsk: 218

Killer, Operation: 161

Kim II Sung: 223

Kim II Sung Medical College: 219

Kimpo Airfield: 98, 101, 111

Kirk, Maj. Gen. Norman T.: 7, 14, 22

Kobe: 46, 98, 100, 263

Koehn, Lt. Col. Carl J.: 320, 333

Koje: 222, 226, 312, 314, 316, 318, 326

Kokura: 266

Kolansky, Capt. Harold: 128Korea Base Command (KBC): 59-60Korea Base Section: 229, 248, 336, 362Korean Augmentation to the United States Ar-my. See KATUSAs.

Korean Civil Assistance Command (KCAC):229, 329, 357, 360-62

Korean Communications Zone. See KCOMZ.Korean Forwarding Company: 241Korean Medical Company: 241Korean Service Corps. See KSCs.

KSCs: 208,214,216,334, 340Kum River: 76, 78, 81, 96Kumchon: 79, 82-83, 106-07Kumhwa: 179, 213, 215Kunu-ri: 115, 122-23, 141Kupaballi: 107-08Kure: 182, 273/?, 290

385

Kyonggi Province: 326Kyoto: 44, 46, 147,273,285Kyoto Army Hospital: 236, 285-86Kyushu: 150, 266

Laboratory Technicians School, Texas: 236Lackland Air Force Base: 292LaConte, Capt. Phyllis M.: 77Leptospirosis: 185

Letterman General Hospital: 28, 188Liaotung Province: 222Libby, Sgt. George N.: 97Lice: 41, 159, 247, 255, 308, 312, 351Litters: 150, 165, 207, 214Little Switch, Operation: 345-51, 353-54Logistical Commands2d: 137, 150, 228-29, 319, 3213d: 137, 307,312

Logistics: 132-33. S’ec Japan LogisticalCommand (JLCOM).

Long, Col. Arthur P.: 231Lovett, Robert: 190, 194

McAllister, Lt. Col. Charles A.: 81MacArthur, General of the Army Douglas: 161,188

dismissal: 161, 188

and germ warfare charges: 219-21, 225and GHQ, United Nations Command: 132and Inchon landing: 98, 101and invasion of North Korea: 109medical policy under: 37, 69-70, 95, 150,

159, 175, 189, 324and Pusan Perimeter: 105, 160as supreme commander: 36, 51, 62McConkie, Col. Howard S.: 22McCormack General Hospital: 29MacDuffee, Maj. Robert C.: 179McGregor, M. Sgt. Owen: 119McNair, Lt. Col. Joel N.: 163Madigan Army Hospital: 354Maine, HMHS: 152, 260, 263Majon-ni: 115

Malaria: 38, 43, 50, 56, 60-61, 84, 127, 146,

149, 159, 174, 177, 183, 185, 221, 247, 255,339-40,350, 361Malnutrition: 39, 45, 334Manchuria: 55-56, 113-14, 175, 186,218Manhattan District: 44Manpower. See Personnel.

Mao Tse-tung: 305

Marine Brigade, 1st Provisional: 84-85Marine Division, 1st: 98, 100, 118Marine Corps: 96casualties: 129, 190, 194, 293, 336surgeons: 85

Marshall, George C.: 190, 193

Martin, Maj. Gen. Joseph I.: 192-93, \9An, 195

Masan: 83-84, 97, 106,331-32

MASH: 135, 153, 203, 229, 244, 256, 267, 281.See also Surgical Hospitals (Mobile Army),concept and T/O&E: 69-70, 1 13,131,171,182, 202, 208-10, 213, 215, 233, 254, 258,342-43, 362-63and dental care: 157, 251, 279and evacuation by helicopter: 95-96, 165,193,215, 342, 362first units activated: 69, 74support for 1st Cavalry Division: 82support for Eighth Army: 71, 89-90, 109, 115,167, 170, 181, 187, 283MASH, Norwegian: 170, 180MASH units

1st: 100, 102, 104, 112-14, 116, 126-27,142-43, 164, 167-68, 170, 3072d: 168,274

8055th: 69-70, 77-79, 84, 88, 90, 107-11,

115, 123-25, 130, 140, 154, 163, 168,179-80, 207,209, 302

8063d: 69-70, 82-84, 106-07, 115, 123-25,130, 140, 163, 205,2138076th: 69-70, 84-86, 89-90, 95, 106-07,115, 123, 125, 130, 140, 157, 164, 168,2888209th: 168, 173,201,2058225th: 168, 3428228th: 187,237,283MASH units (ROK)

5th: 3486th: 201

Maxson, Lt. Paul A.: 120Mayo, Dr. Charles H.: 188-89Medal of Honor: 97, 197Medical Administrative Corps: 16-17, 20Medical Air Evacuation Squadrons801st: 3351453d: 289, 3356481st: 335

Medical Ambulance Companies559th: 142-43560th: 142-43

Medical Base Depot Company, 60th: 238Medical Battalions2d: 92, 105, 1223d: 115, 125, 3447th: 101, 112, 114, 126, 21315th: 82, 17924th: 4, 77, 106, 156, 16125th: 83, 106

52d (Separate): 150, 172, 202, 203«, 257, 341115th: 344

163d (Separate): 100, 203,251,341188th (Separate): 168Medical Clearing Companies (Separate)

514th: 143618th: 143, 215Medical Corps: 132blacks in: 11

post-WWII personnel strength: 7-8, 13, 29post-WWII reorganization: 16-17, 20-21professionals in: 132, 140-41, 179, 186,358and professionalization: 14-15, 20-21

THE MEDICS’ WAR

Medical Corps—Continuedand training: 191-93, 337Medical DepartmentASTPsin: 12-13in occupied Japan: 46-47, 50, 66organizes for war: 74, 90, 93post-WWII reorganization: 8, 11, 16-22, 24,28-30, 32-34, 36, 70and specialization: 15-16and training: 14, 90Medical Depot, 60th: 330, 336Medical Depot Company, 9th: 59Medical Detachments (Helicopter Ambulance)37th: 34149th: 34150th: 34152d: 34154th: 34156th: 341

Medical Equipment Maintenance Technician(MOS 1229): 235

Medical Field Laboratory, 1st: 340Medical Field Service School: 15, 190-91, 195,230, 331,338

Medical General Laboratory, 406th: 134, 137,154, 186, 244,272, 362Medical Groups30th: 202, 203«, 340-41,35580th: 59

Medical Holding Company, 123d: 205Medical Replacement Training Center: 143, 235Medical Service: 146, 196, 241, 256blacks in: 11and civilians: 98, 274and cold injuries: 116, 127hospitals: 27, 66, 362

personnel: 139, 142, 145, 148, 152, 154, 158,230, 232, 246, 257, 270, 355, 364and POWs: 307and ROK Army: 334and water supply: 137Medical Service Corpsestablishment of: 20

experienced officers of: 140-42, 163, 190-91,193

Medical Allied Sciences Section: 21personnel: 64, 74-75, 114, 122, 131, 207, 215,230-32, 357

personnel shortages: 67, 77, 338, 357and training: 237, 338, 355Medical societies in Korea: 238Meiling, Dr. Richard L.: 28, 33, 189-90, 192-93Meirowsky, Lt. Col. Arnold M.: 173, 205«Meningitis: 147Methadone: 159, 256“Mickey Mouse boots”: 210“Midnight Charlie”: 124Mikos, WO(jg.) Joseph A.: 81Military Advisory Group to the Republic of Ko-rea (KMAG): 62, 69, 108, 136, 330-31, 340Military Air Transport Service (MATS): 244,268, 290-91,335

Military occupational specialty (MOS): 235, 237

Military Sea Transportation Service: 290Ministry of Health, South Korean: 327, 361Ministry of Health and Welfare, Japanese: 42,48,239

Ministry of Public Health, North Korean:223-24

Miryang:85, 92,95, 106-07Missouri 126

Mites: 187, 339

Mobile army surgical hospitals. See MASH.Mobile Medical Laboratory, 8217th Army Unit:186

Mollohan, Col. Cecil S.: 261, 324-25Moore, Maj. John B.: 331Moral Suasion Campaign: 31, 33Morale: 75, 159, 200, 232North Korean: 87POW: 304, 350

and preventive psychotherapy: 156and R&R: 156, 183, 248-49of U.N. soldiers: 88, 91-92, 177Mothershead, Lt. Col. John L.: 286Muccio, John J.: 62Mungdung-ni: 178Munsan: 165, 246, 348Murphy General Hospital: 293, 296-97

Nagasaki: 36, 44Naktong River: 83, 88, 105National Board of Licensure and Registration:58

National Extraordinary Anti-Epidemic Com-mittee: 223

National Military Establishment: 23National Veterinary Laboratory, Pusan: 54Navarre, Capt. Vincent J.: 120-22Navy: 165

Bureau of Medicine and Surgery: 24doctors: 85, 140, 163, 168, 231, 284enlisted hospital corps: 190hospital ships: 46, 115, 126, 129, 259,262-64, 335

hospitals: 25, 291, 293-94, 335and unification: 22-25Neuman, Maj. Frank A.: 83Neurologists: 142

Neuropsychiatric (NP) cases: 91-93, 102-04,128-29, 200, 205, 271-72, 275-76, 282,285-87

Neurosurgery: 90, 142, 172-73, 201, 205, 233,271

Neurosurgical Detachment, 1st Provisional:172-73

New Zealand forces: 181, 290

Night soil, fertilization with: 43, 53, 74-75

Nimitz, Admiral Chester W.: 36

Nisin Baktin: 177

North Korean Army: 59, 69, 86-88, 105, 114,177, 179, 197, 213, 221, 268, 301North Korean Infantry Divisions1st: 87

387

North Korean Infantry Divisions—Continued2d\ 876tk 83, 879th\ 87

North Kyongsang Province: 323Norwegian medical support; 170, 180, 203Novosad, M. Sgt. Jerry J.; 141Nurses: 67, 267-68. See also Army Nurse Corps,and career service: 10, 17-19civilian contract: 19, 33FEC rotation policy: 60, 142-44, 230-31graduate Korean: 62male: 234, 357post-WWII losses of: 7

shortages of: 19, 142, 234, 273, 276, 293, 338training in postwar Japan: 43U.N.: 234, 274

Occupation

of Japan, medical problems during; 38-50,63-68

of Korea: 50-63Okinawa: 36, 51, 138Old Baldy; 198, 200, 275Oliver General Hospital: 293Omiya: 286-87Orr, Lt. Col. Kenneth D.: 283Orthopedists: 90, 233, 254, 271, 281Osaka: 40-41, 46, 48, 66, 83, 235, 263, 266-67,269,272,276, 280-81,289Osaka Army Hospital: 4, 82, 117,154, 268,272-78, 282-84Osan: 73

Otolaryngologists: 233On, Col. Harold G.: 64Overholt, 1st Lt. Edwin L.: 73-74

Pace, Frank: 194Paengnyong River: 119Page, Col. Thomas N.: 192^,231,237, 341Panmunjom: 222, 345-46, 348-50Pappas, Col. James P.: 359-60Parasitic diseases: 45, 53, 56, 61, 279Partin, Lt. Col. Everett W.: 4, 138People’s Republic of Chinacharges germ warfare: 217,219-20, 226diseases introduced from: 55, 175immunization program: 222intervention by: 114, 129, 140-41, 145, 167and POWs: 299-300

Percy Jones General Hospital: 293, 296-97Personnel. See also Rotation, personnel,freeze: 140losses: 7, 30, 163, 231shortages of trained: 15-16, 19,21,29-30,65-67, 82, 139-43, 233-34, 254, 273, 276,293, 328, 338strength, 1945-50: 8transfer from ETO: 7, 9Peters, Sgt. Edward A.: 81

Pharmaceuticals: 238Pharmacy Corps: 16-17Philippine forces: 88, 182, 277, 279, 284, 287Philippines: 37, 50-51Physical therapy: 255, 282Pierce, Hawkeye: 183-84Pingfan, Manchuria: 218Plague: 55-56, 147, 175-76, 219-20, 223-25Pneumonia: 45Pohang-dong: 70, 82, 97Poliomyelitis: 50, 64, 147, 247Porkchop Hill; 198Postgraduate training: 14, 16, 34, 237Potter, Col. Laurence A.: 53, 60Powell, Capt. George M.: 186Preventive medicine: 26, 145-49, 183, 189,245-50, 262

Preventive Medicine Association of Korea: 340Preventive Medicine Company, 37th: 186, 246Preventive Medicine Control Detachments38th: 247-48152d: 248154th: 248

Preventive Medicine Survey Detachment,

219th: 248

Primaquine: 159, 247, 255, 339-40Prisoner of War Command; 229, 248, 306, 319,356

Prisoner of War Field Hospital (Provisional),

1st: 150, 152-53, 310

Prisoners of war: 191, 194, 222, 225, 229, 241,321,334

Allied, in Japan: 44-46American: 224, 300, 302, 355Communist: 306-14

in Communist camps: 86-87, 108, 221, 299,305

death rates: 304exchanges: 345-56and immunization: 314, 351interrogation of: 354medical assistance to enemy: 111, 118,152-53, 158, 174, 203, 221, 234, 314, 316,319-20

morale: 304, 350

political indoctrination of: 305-06psychiatric problems: 304, 354-55as sources of propaganda: 301, 305, 317in South Korea: 89, 102, 104-06, 147, 198U.N.: 300-306Procurement: 22-23, 28, 241Professionalization: 14-16, 34, 65, 188-89, 234,237

Pruitt, Col. Francis W.: 231Psychiatric Detachment, 212th: 205Psychiatric problems: 155-56Army vs. Marine: 304battle-related: 84, 91-93, 102-03, 128, 146,271,363centers: 275

in Korean rear areas: 249-50of occupation: 49, 61, 64POW; 45, 304, 354-55

THE MEDICS’ WAR

388

Psychiatrists: 92-93, 128-29, 156, 200, 231,285-86, 305

Public health: 38-44, 48, 52, 59, 64-65, 245-50,

261- 62, 326-27, 339-40, 360-62Pugh, Rear Adm. Lamont: 259Pujon Reservoir: 116

Pukchong: 114, 116Punchbowl: 178-79Pungsan: 114

Pusan: 53-54, 60, 70-71, 75, 79-86, 94-95,104-05, 107, 127, 136, 148-50, 157, 202,222, 228, 237-41, 244, 248, 254, 257,

262- 63, 308, 310-12, 314, 316, 323, 326,330, 335, 339, 361. See also PusanPerimeter.

Pusan Base Command: 79, 136Pusan Logistical Command: 136Pusan Perimeter: 79-86, 92, 98, 103, 105, 128,133, 146, 155-56, 159-60, 188, 264, 323,332

Pyonggang: 179

Pyongyang: 1 1 1-12, 1 15, 122-23, 125, 179,

219, 301-02,310

Quarantine controls: 39, 55-56, 262, 362

Railroads. See Hospitals, trains.

Rations. See Food.

Recruits. See Replacements.

“Red Ball” ships: 152

Red Cross. See also Italian Red Cross Hospital;Swedish Red Cross Hospital.

American: 154-55, 243, 111, 292Chinese: 220

International: 39, 225-26, 318, 320, 347, 362Japanese: 276

Refugees: 53-54, 74, 76-77, 84, 127, 225,321-29

Regimental Combat Teams5th: 84, 161-6215th: 11517th: 11432d: 101

187th Airborne: 115, 167, 317Regular Army: 9-11, 14-15, 17-18, 20, 35, 191Relapsing fever: 147, 174, 221Replacement Depot, 4th: 49Replacements: 8, 11-14, 30, 33, 49, 59-60, 66,231,249-50

Repose (AH-16), USS: 263, 269Republic of Korea: 22, 51, 62, 74, 81Republic ofKorea(ROK) Army: 102, 112, 123,161, 179, 213, 215-16, 241, 333-34, 336casualties: 49, 106, 161, 201medical support to: 148, 205, 238-39, 328,330-32, 340, 345, 348supply depots for: 134, 136, 240Reserves: 11, 15, 230

Residents: 16, 27, 34-35, 67, 142, 231, 358, 364Respiratory problems: 59, 61, 176, 304, 310-11

Rhee, Syngman: 51, 62, 333, 345, 351Rheumatic fever: 50Rice, Brig. Gen. George W.: 44Ridgway, Lt. Gen. Matthew B.: 160-61, 177,198«, 221Rinderpest: 56

Roads: 53, 66, 76, 95, 1 13, 163, 199-200Robinson, Col. Paul I.: 29-30Rodents: 56, 245, 339Rosenberg, AnnaM.: 188-89, 194Rotation, personnel: 60, 67, 142-45, 193, 200,228-32, 234-35, 237, 248-50, 254, 261,336, 344

Roundworms: 42, 50, 279Royall, Kenneth C.: 27, 32R&R: 156, 183, 248-49

St. Louis Medical Depot: 15, 235

Sams, Brig. Gen. Crawford F.: 38-41, 43-44,

52, 175-76, 187-91, 193-95, 220, 261,323-24

Sandstead, Col. H. D.: 320, 333Sanitary Corps: 16-17Sanju: 82Sariwon: 107Sasebo: 70,98, 176Sausalito{V¥-A), USS: 175SCAP: 37, 218-19, 262and public health in Japan: 39-44, 48, 65and public health in Korea: 52, 261, 326-27Public Health and Welfare Section: 38, 323Scarlet fever: 49-50, 61Schumacher, Capt. Martin J.: 92Secretary of the Army: 27, 34, 192Secretary of Defense: 23, 28, 66, 192-93, 358Selective Service System: 29Selwyn, Col. Robert E.: 64, 261Seoul: 53, 60, 71, 98, 101, 103, 105-06, 108-09,111-12, 125, 129, 146, 160-61, 170-71,183, 185, 203, 205, 228, 240, 244, 301, 324,330, 335, 348

Sgt. Andrew Miller (T-AK-242), USNS: 152,263

Sgt. George D. Keathley {l-KY-Wl), USNS:152, 263

Shambora, Maj. Gen. William E.: 225, 261-62,337

Sheldon, Lt. Col. Paul C.: 83Shigellosis: 146

Shock: 129, 155, 185, 193, 205, 209, 363

Shoepac: 160, 210

Showdown, Operation: 213, 343

Simeone, Dr. Fiorindo A.: 256

Sinanju: 115, 122-23, 167

Sinmak: 109

Sinpori: 161

Sixth Army: 37, 44, 46

Smallpox: 39, 42, 47, 53-54, 60-61, 134, 160,176, 221,325, 327,339,351,361Smith, Lt. Col. Charles B.: 71, 73-74

389

Society of United States Medical Consultants inWorld War II: 15Songhwan: 75

Songo region, Manchuria: 186Songu-ri: 187South African forces: 182South Chungchong Province: 328Soviet Union: 36, 174, 177Soyang River: 168

Specialization: 14-15, 35, 189, 205, 236-37,337, 364

Stacey, Capt. Richard M.: 4Stapleton, Col. James B.: 297State-War-Navy Coordinating Committee: 218Station Hospitals: 131, 1563d: 153,25810th: 258

35th: 147, 272,275, 28589th: 62

118th: 82, 150, 262, 266, 272, 275-77128th: 277155th: 4, 276161st: 273

361st: 147, 272, 275-76, 283-85, 289376th: 267, 2778079th Army Unit: 287Stokes litters: 165Struthers, Capt. Charles M.: 188Sukchon: 115, 122Sumida River: 276, 284Sunchon: 115Supplies: 22, 132, 240, 336adequacy of medical: 127, 134, 238-41by air: 135-36, 138and JLCOM: 99, 228, 241, 325medical, released to Japanese: 39medical, released to Koreans: 57-58, 134North Korean medical: 86, 176-78, 330-31pre-stocked at Yokohama: 135shifted to Pacific after V-E Day: 36sources of: 133-35

storage and issue of medical: 24, 59, 79,133-35,336

transportation to troops: 136, 240unification of medical: 22-24, 28Supreme Commander for the Allied Powers(SCAP). See SCAP.

Surgeon General: 11-12, 20, 34. See also Arm-strong, Maj. Gen. George E.; Bliss, Maj.Gen. Raymond W.; Kirk, Maj. Gen. Nor-man T.; Surgeon General (OSG), Office ofthe.

Surgeon General (OSG), Office of the: 13, 67,150, 190, 232, 234-35, 296, 314, 332, 357Enlisted Branch: 10Hospital Division: 66Personnel Division: 66post-WWII policy: 7-8, 16, 35Research and Development Board: 255Resources Analysis Division: 29Surgery, front-line: 85, 112, 129, 215

Surgical Hospitals (Mobile Army)

44th: 34445th: 344, 34847th: 342

Suwon: 71, 73, 105, 125, 168

Swanson, Rear Adm. Clifford A.: 24

Swedish medical personnel: 153

Swedish Red Cross Hospital: 150, 203, 229, 361

Swift, Maj. Gen. Innis P.: 46

Syphilis; 48, 61

Tachikawa Air Base: 138, 267-68, 335Taebaek Range: 53, 83Taedong River: 302

Taegu: 71, 75, 77, 79, 81, 83, 106-07, 135, 149,202, 229, 240, 249, 254, 308, 323, 330Taejon: 69-71, 73-74, 76-79, 82, 97, 105-09,111, 170-71, 240, 254, 310Takami, Capt. Ralph M.: 221, 225Tanks: 73, 75, 79Taylor, General Maxwell D.: 348Technical Equipment and Maintenance School,Yokohama: 66

Technicians School, Osaka: 66Tender, Lt. Col. Isaac J.: 70, 125, 130Tetanus: 87, 147-48, 282, 307Thai forces: 88, 181, 277, 28738th Parallel: 56, 61, 125Korea divided along: 36, 51, 58North Korean forces cross: 69, 161U.N. forces cross: 106, 109Thompson, Capt. Frank D. Jr.: 75-76, 79Tibbetts, Capt. Oscar N.: 94, 167Titania (AKA-13), USS: 70Tojo, Hideki: 44

Tokyo: 36, 39, 44, 48, 66, 154, 161, 204, 229,237, 244, 266-69, 271-72, 276-77, 280,284,289,335,349

Tokyo Army Hospital: 66, 82, 154, 268, 272,275,277,282,289,357Tongduchan-ni: 179Towanda Victory (cargo ship): 126Training: 52, 143, 230field, for medical personnel: 190-93, 195,237, 355-56

inadequate: 49, 59, 66, 234-36specialized: 14-16, 236-37, 337, 364Transportation Companies6th: 34513th: 345

Transportation Military Railway Service: 268Transportation Military Railway Service, 3d:229, 241

Travis Air Force Base: 244, 292Triage: 82, 268, 272Tripler Army Hospital: 291-92, 354Troop strength: 8-9, 49Truman, Harry S.: 292dismisses MacArthur: 161, 188

THE MEDICS’ WAR

Truman, Harry S.—Continuedand post-WWII demobilization; 8and service unification: 23Truman Doctrine; 22Tsingtao: 222Tsugaru Strait: 40Tsutsugamushi fever: 64Tuberculosisin occupied Japan: 42, 45in occupied Korea: 53, 57among POWs: 307, 310, 350in wartime Korea: 247-48, 294-95, 327, 361Tuksong-dong: 170Turkey: 22

Turkish forces: 88, 1 19, 123-24, 181, 277, 279,284, 287, 344

Typhoid; 39, 41-42, 60, 147, 175, 224, 314,326-27, 361Tvphoon Jane: 100

Typhus: 38-41, 50, 53-54, 60, 64, 147, 149,

160, 174, 176, 219, 221,224, 247, 326Typhus Commission, United States of America:40

Uijongbu: 170, 240Unification, service: 22-28UNCACK. See United Nations, Civil Assis-tance Command, Korea.

United Nations

Civil Assistance Command, Korea (UN-CACK): 174, 229, 241, 325-29, 359-61Commission for the Unification and Rehabil-itation of Korea: 324Disarmament Commission: 226Korean Reconstruction Agency (UNKRA):324, 328, 359

and POW exchanges: 346, 350resolution to invade North Korea: 108-09Security Council: 221

United Nations Command; 132, 174, 176,217,219, 229, 262, 299, 307, 316, 321, 325,328-29, 345, 350

United Nations forces: 86-88, 98, 102, 105-06,111-12, 114, 118-19, 125, 127-28, 152-53,160-61, 170, 175, 177, 181-82, 197-98,202, 213, 238-39, 263, 272, 277, 290United Nations Prisoner of War Camp No. 1:312

United States Army Forces, Far East

(USAFFE): 204, 262, 333, 335, 337, 342,348, 352, 356-57

United States Army Forces in Korea: 73, 136United States Army Forces, Pacific(USAFPAC): 37, 44, 48United States Army Hospitals8162d Army Unit: 2758164th Army Unit: 2758167th Army Unit: 285, 348United States Military Government (in Korea):52

United States Fleet Epidemic Control Unit: 314United States Military Advisory Group. SeeMilitary Advisory Group to the Republic ofKorea (KMAG).

Urologists: 142, 171-72,233

Valley Forge General Hospital: 293Van Buskirk, Lt. Col. Kryder E.: 85-86, 123,130

Van Fleet, Lt. Gen. James A.: 161, 178V-E Day: 34, 36

Venereal disease: 44, 47-49, 61, 65, 148-49,170, 172, 183-84, 247-49, 287Veterans Administration: 13, 23, 32, 295-96Veterinarians: 56, 60Veterinary Corps: 16, 28, 148Veterinary Food Inspection Detachment95th; 148476th: 148

Virus and Rickettsial Commission: 50V-J Day: 36, 49Voorhees, Tracy S.: 32Voorhees committee: 26-27V-12 program: 13, 230

Wagoner, Sfc. D. E.; 120-22Wakayama: 46

Walker, Lt. Gen. Walton H.: 81, 83-84, 97, 100,111, 119, 124, 130, 132, 136, 160Wallace, Lt. Col. Herbert C.: 84Wallace L. L/W(DD-703): 176Walter Reed Army Hospital: 14, 19, 70, 90, 207War Department: 7-8, 11, 18, 52Water supply: 46, 53-55, 60, 99, 145, 245, 249,327,361Weasel: 200

Weather; 111, 114-17, 160, 163, 176, 197,275Weible, Maj. Gen. Walter L.: 133, 272Weintraub, 1st Lt. Stanley: 316-18Wergeland, Col. Floyd L.: 22White, Lt. Col. George S.: 187Wickstrom, Capt. Arthur P.: 84Willard, Col. William R.: 53William Beaumont General Hospital: 29Willis, Lt. Col. John M., Jr.: 79, 152Wilson, Pfc. Richard G.: 115Wilson, Maj. William M.: 246Wittrock, Maj. Jack E.: 148Womack, Pfc. Byrant E.; 197Women in uniform: 17-19, 21, 35, 143-44, 360.See also Nurses.

Women’s Medical Specialist Corps: 11, 18, 67Wonju: 168, 202Wonsan: 112, 115, 175-76Wood, C. Tyler: 359

World Health Organization: 225-26, 239Worms. See Hookworm; Parasitic diseases;Roundworm.

INDEX

391

Worrell, Col. John A.: 132-33Wound ballistics: 255-56Wunderlich, Col. Frederick R.: 132Wyoming: 178

Yalu River: 112, 114, 222Yanggu: 240Yellow Beach: 101Yellow Sea: 107

Yokohama: 38, 44-45, 48-49, 69-70, 98, 132,239, 263,276,290, 325Yokohama Medical Depot: 133-36Yokosuka: 136, 269Yonchon: 179-80Yongdong: 71, 78-79

Yongdung-po: 103, 123, 170-71, 173,203,238,348, 362

Zolenas, Maj. Anthony J., Jr.: 330-31

DATE DUE

r

LIBRARY

Hm

Amazing Researeh.Amazing Halp.

http://nihlibraiy.nih.go¥

10 Center Drive

Bethesda, MD 20892-1150301-496-1080

nih library

3 1496 01035 8011

V

# EPUB/images/img_0011.png

# EPUB/images/cover.png

# EPUB/images/img_0015.png

# EPUB/images/img_0014.png

# EPUB/images/img_0013.png

# EPUB/images/img_0012.png

# EPUB/images/img_0019.png

# EPUB/images/img_0018.png

# EPUB/images/img_0017.png

# EPUB/images/img_0016.png

# EPUB/images/img_0020.png

# EPUB/images/img_0010.png

# EPUB/images/img_0022.png

# EPUB/images/img_0009.png

# EPUB/images/img_0021.png

# EPUB/images/img_0006.png

# EPUB/images/img_0026.png

# EPUB/images/img_0005.png

# EPUB/images/img_0025.png

# EPUB/images/img_0008.png

# EPUB/images/img_0024.png

# EPUB/images/img_0007.png

# EPUB/images/img_0023.png

# EPUB/images/img_0027.png

# EPUB/images/img_0002.png

# EPUB/images/img_0001.png

# EPUB/images/img_0004.png

# EPUB/images/img_0003.png