US History/US History (Bureau Development Inc.)(1991).ISO/dp/0082/00820.txt

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$Unique_ID{USH00820}
$Pretitle{78}
$Title{United States Army in the Korean War - The Medics' War
Chapter 8   Medical Support Behind a Stable Front}
$Subtitle{}
$Author{Cowdrey, Albert E.}
$Affiliation{US Army}
$Subject{medical
command
korea
hospitals
army
war
service
japan
far
korean}
$Volume{}
$Date{1987}
$Log{Medics Using Plasma*0082001.scf
Bug Dusting*0082002.scf
Dentist at Work*0082003.scf
Research Lab*0082004.scf
Litterbearers*0082005.scf
}
Book:        United States Army in the Korean War - The Medics' War
Author:      Cowdrey, Albert E.
Affiliation: US Army
Date:        1987

Chapter 8   Medical Support Behind a Stable Front

     Prime gainers from the new kind of warfare were the Korean rear areas.
The stabilization of the front permitted rapid maturing of the medical support
system.  Command of the air allowed convoys to roll undisturbed, laden with
all kinds of supplies.  While the Chinese and North Koreans had to burrow
underground, United Nations (U.N.) hospitals and depots could build in the
open, free from attack.  Under the Far East Air Forces' umbrella the medical
system developed in near ideal conditions.  Despite the ruin of war, the
poverty and misery of many Koreans, and the sporadic fighting between South
Korean troops and guerillas, the rear areas slowly began to assume a more
normal aspect.

     Here, as at the front, rotation presented many difficulties for military
commanders and administrators.  Together with the doctor draft and the general
draft it meant near 100-percent turnover in many medical units during 1951,
and continuing turbulence thereafter.  The problems involved in continuous
retraining meant that military medicine, from its simplest to its most
professional aspects, became an art that medics had not only to learn but also
relearn as they worked with soldiers who themselves continuously came and went
through the doorway marked "Big R."  Rotation was one of the ways that America
coped with the Korean conflict once it became apparent that the war would not
be a short one, and in this sense it, too, represented a maturing of the
system that supported the battle.

Organization of the Rear Areas

     Within the Eighth United States Army, Korea (EUSAK), the 2nd Logistical
Command organized and controlled the rear areas.  It provided direct support
to the Eighth Army, requisitioning supplies from the Japan Logistical Command
(JLCOM) and overseeing storage and distribution.  Its police duties included
security in metropolitan Pusan, in Seoul-Inchon, and in other important
military areas.  The increasing burden of housekeeping chores led the Eighth
Army surgeon to suggest making the command a JLCOM advance section.  Instead,
the Far East Command on 10 July 1952 established at Taegu a more weighty and
complex structure - the Korean Communications Zone (KCOMZ).

     Under the new headquarters was a mixture of area commands and
organizations having special functions.  The major subordinate commands were
the Korea Base Section, the United Nations Civil Assistance Command, Korea
(UNCACK), and the Prisoner of War Command.  Over the course of the year that
followed, the 3rd Transportation Military Railway Service and the Taegu
Military Post were added, the first to control the increasingly heavy rail
traffic that supported the front and the second to provide services and
security in and around the KCOMZ headquarters.  UNCACK, on the other hand, was
abolished on 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).  Its
primary functions were and remained advisory, with operations in the hands of
the many specialized subordinate commands.  Of these, the Korea Base Section
was simply the old 2nd Logistical Command under a new title, but with broader
powers.  Its subordinate elements were the 6th Army Medical Depot, the Swedish
Red Cross Hospital, and three evacuation hospitals, which were reorganized as
station hospitals in 1953.  The field hospitals serving the vast prisoner
population fell under the Prisoner of War Command, the medical trains under
the 3rd Transportation Military Railway Service.  Beyond this, the KCOMZ on 1
August 1951 assumed control of all major medical installations in Korea,
except the MASHs and the 11th and 121st Evacuation Hospitals.  Within its
geographical area - mostly south of the 37th Parallel and about seven times
the size of the region under EUSAK - it controlled all medical service units
except those few installations, designated Class II, that remained under the
Eighth Army.  The KCOMZ furnished medical logistical support to the fighting
forces; handled rail evacuation; provided medical, dental and veterinary care
to all U.N. troops in its area, plus the prisoners of war (POWs); and, through
UNCACK, directed U.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
frustrating endeavor.  The draft gave and rotation took away.  The doctor
draft, killed in 1948 by the American Medical Association's opposition, was
revived with over whelming congressional support after the opening of the
Korean War.  Both the medical association and the reserve medical officers now
backed it, motivated in part by a desire to satisfy the needs of the armed
forces by placing in the first priority for the draft six thousand Army and
Navy Specialized Training Program graduates (ASTPs and V-12s) who had not yet
served.  For their part the armed services turned to the draft for the usual
reason: Efforts to persuade physicians to volunteer had no more success after
the war began than before.  As passed by the lawmakers in early September
1950, the draft legislation provided for 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 military service were to be taken in
inverse ratio to the length of their service.

     However, the inevitable delays in making the legislation work meant that
no drafted medical officers reached Korea until January 1951. Meanwhile, amid
complaints from men whose lives were being disrupted and reminders from the
unsympathetic that reserve service was voluntary, the medical reservists -
most of them veterans of World War II - continued to be called.  Few men who
were liable to the draft volunteered for reserve commissions, despite the
Army's initial hopes.  During 1951 regular draft calls summoned medical
professionals into the service.  By the end of August the standard five-week
course at the Medical Field Service School at Fort Sam Houston, Texas, had
given some twenty-five hundred medical, dental and Medical Service Corps
officers their initial introduction to the Army and its ways.  From that time
forward the draft became increasingly important, and during 1952 over 90
percent of the medical officers required by the Army Medical Service in the
Far East Command were procured through the doctor draft.

     In tandem with the general draft, the doctor draft brought a different
kind of medical service into being in the Far East Command.  The key to the
rapidity of the change from an overwhelmingly volunteer to a largely conscript
service was the rotation system.  During 1950 the Medical Service had begun to
rotate medical and dental officers to Japan for professional refreshment, as
well as nurses on grounds of their supposed inability to sustain the stress of
front-line service.  In March 1951 the Far East Command announced a general
rotation policy covering all who served in Korea.  The basic principle was to
return such men and women to the zone of interior, beginning with those who
had the longest combat exposure.  None, however, could leave the war zone
until a qualified replacement had arrived to take his place.  After some
initial confusion the commander-in-chief came up with a plan dividing the
command into three zones.  Those who served with combat units in Korea
received constructive credit 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 for those in forward areas.

     Clearly, such a system implied heavy demands for replacements, and when
they initially failed to arrive on time much bitterness resulted among people
on the line.  By the end of September, however, an influx of replacements,
most drafted, permitted rotation of almost all the eligible medical and dental
officers.  A mass arrival of Medical Service Corps and warrant officers during
that month, producing a temporary surplus on the rolls, did not completely
relieve the backlog of officers eligible for rotation, but by the end of
October most had departed.  The same period also saw the departure of other
groups: residents who had come to the Far East on five months of temporary
duty (TDY) just before the war broke out; Navy doctors, who returned to their
own service; and other military and civilian residents, who went home to
resume their interrupted studies.

     Adding normal losses for death and injury, illness or compassionate
causes, a near revolution in staffing took place.  Among those who departed
was Colonel Dovell, the Eighth Army surgeon.  In a month and a half - mid-
August to 1 October - the chief of every division in the Eighth Army's Medical
Section rotated, obliging Dovell's replacement, Col. Thomas N. Page, to build
up an entirely new staff.  During 1951 the Far East Command saw the departure
of its chief surgeon, General Hume; of its consultant in preventive medicine,
Col. Arthur P. Long; of its psychiatric consultant, Colonel Glass; of its
medical consultant, Col. Francis W. Pruitt; and of many others, both of high
rank and low.

     In the next year upheaval became institutionalized.  In theory rotation
should have distributed the burden of service in Korea, built up a pool of
trained personnel, and avoided turbulence by integrating into units newcomers
who could learn from veterans and then teach others in their turn.  But in
practice the ideal of regularly replacing a certain percent of the command
each month was unattainable.  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 from men who had their thirty-six constructive
months in hand, the Far East Command struggled to maintain morale, avoid
congressional queries, and fend off adverse press reaction by meeting rotation
dates even when replacements were not available.  The result was that the
command was soon understrength in every corps of the Medical Service, except
the Dental.  Late in 1952 the criterion for rotation was raised to
thirty-eight months, but for the forward zone.

     During 1951 the massive turnover had ended in generally satisfactory
staffing levels, for new people were available to replace the old.  During
1952, however, nagging problems emerged as the draft and rotation interacted.
Command experience was at a premium as veterans departed, yet - ironically -
an oversupply of some medical specialists developed.  Nurses were too few,
Medical Service Corps officers were abundant but short on experience, and
trained enlisted people were difficult to come by.

     Washington tended to justify shortfalls by the drop-off in military
activity along the front.  In 1952 the Office of the Surgeon General requested
that the Far East Command accept "a small calculated risk" in regard to the
supply of physicians.  Doctors were said to be too few in civilian life,
casualties in the command were at a low level, and the surgeon general
feared "criticism from civilian medicine that [the] Armed Forces are wasteful
in utilization of physicians"-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 the Far East Command declined to agree to any
decrease, pointing out that it was already taking a risk by operating with
about 85 percent of its authorized strength under the tables of organization
and equipment (T/O&Es) and tables of distribution.  Combat divisions were
functioning with thirty-two doctors each instead of forty-two, evacuation
hospitals with twenty-four instead of twenty-nine, and MASHs with twelve
instead of fourteen.  In Japan itself the number of physicians at each of the
four general hospitals was reduced from twenty-eight to eighteen, and "a
proportionate decrease was effected in most of the other hospitals."  In
consequence, the rotation of doctors for the time being had almost come to a
halt.

     By this time the stabilization of the front and the opening of
negotiations had drastically changed the image of the war, from a crisis in
the international conflict between the Communist and non-Communist powers to a
purposeless struggle in which victory was no longer possible, or at any rate
no longer pursued.  Most Americans who could avoid the war did so; those who
served submitted only as long as they must to a grim necessity. The declining
activity in Korea reminded the Army of its obligations elsewhere in the world.
A sign of the general tendency to minimize the importance of Korea as far as
possible was the curtailment of battlefield promotions in August 1952.  Time
in grade began to count for more than it had during the period of heavy
combat.  First lieutenants in the Medical Corps and Dental Corps were promoted
to captain upon completion of twenty months of active duty; 2nd lieutenants in
the Medical Service Corps and Army Nurse Corps to 1st lieutenant after
eighteen months.  Promotions for enlisted men in medical units were cut back
sharply, with the result that 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 fill
them.  At the end of 1952 the Eighth Army had 6 of its 11 authorized Medical
Corps colonels, 14 of 37 lieutenant colonels, and 15 of 90 majors. It
possessed in all 36 field-grade officers against a T/O&E requirement of 139.
Only three of its eight hospital commanders and only two of its six divisional
medical battalion commanders had had previous commands.  Half the division
surgeons lacked staff experience.  During the first six months of 1952 a
shortage of well-trained board-qualified general surgeons developed, and by
the latter part of the year the Far East Command was obliged to assign
specialists to such slots instead of the major hospitals.  Spot shortages also
occurred in those specialities - anesthesiology, orthopedics, urology,
otolaryngology, neurosurgery - that had experienced problems intermittently
since the war began.  By and large, however, professional expertise was
common, command rank and experience rare. Professionalization, the draft, and
rotation were recreating in Korea the very situation that had typified many
World War II theaters.

     Serious shortages developed as well among enlisted men and nurses.
Theater personnel offices filled first the requirements of the line units,
restricting the supply of aidmen and technicians, especially of those with
prior training.  Because women still could not be drafted, Army nurses went to
Korea on a voluntary basis, and the continuing shortage could not be met by
denying rotation to those who had served.  A severe shortage of nurse
anesthetists appeared in 1951 and, despite training in the hospitals,
apparently continued during 1952.  A gradual erosion of strength in the Army
Nurse Corps - about 7 percent from mid-1951 to the end of 1952 - worsened the
special problems of the 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
in patient care and administration, and enlisted personnel trained as
practical nurses.  In 1951 the Office of the Surgeon General discussed again
the question of opening the Army Nurse Corps to male nurses, only to run into
the baffling tangle 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 women - Danish, Swedish, Thai, Norwegian, Italian, Turkish, French, Dutch,
Belgian and Greek - served in the Far East Command.  Japanese nurses,
graduates of Class A schools, worked in the hospitals in their homeland;
Korean nurses from similar Korean schools in the prisoner-of-war hospitals.
The stable tactical situation of 1952, the continued rapid evacuation, and the
assignment of Army nurses to the hospitals with the heaviest work loads
(rather than strictly by T/O&E) enabled the system to function, though
shortages continued in both the KCOMZ and the Japan Logistical Command.

Training

     High turnover implied training many newcomers.  Skilled medical enlisted
men remained the major problem.  "Rotation was the big news in the Far East
Command about 1 March [1951]," said a report, "and the 'Rotation Blues' was
about to be adopted as a theme song by the Medical Section, GHQ, FEC, since it
was found that adequately trained personnel were not available. . . ."  With a
backlog of almost five thousand eligibles waiting impatiently to go home it
was "fairly obvious" that a training program would have to be instituted.

     At the behest of the FEC chief surgeon, that summer the Japan Logistical
Command established the Far East Medical Service Specialist School at Camp
Shinodayama, near Osaka.  Early courses included four- to twelve-week sections
for X-ray, pharmacy, laboratory, and operating room technicians and for field
medical aidmen.  Students sent by the command returned to their units after
training; men taken from the pipeline were assigned throughout the command,
with first priority to the Eighth Army, which apparently received 80-90
percent of the graduates.  After a brief exchange with the adjutant general,
the 250 spaces allotted to the school by the Japan Replacement Depot were
filled automatically.  Some question remained as to whether the Japan
Logistical Command was selecting the students at random.  Studies showed that
only 4.5 percent had received medical basic, which corroborated the Medical
Service's suspicion that the command was sending infantry, armor, and
artillery-trained men (who made up 90 percent of the allotment) to become
medics and medically trained men to line units.

     Various problems continued to be apparent, some as old as the Medical
Service, some as new as the rotation system.  The Medical Replacement Training
Center at Fort Sam Houston, Texas, found that training divisions were sending
their worst men to be medics, just as line units had done since the American
Revolution.  A second center was set up at Fort George G. Meade in March 1951,
drawing its 220 men per month direct from the induction centers.  A higher
caliber of personnel was noted at once.  During 1951 the highly specialized
military occupational specialty (MOS) 1229 - Medical Equipment Maintenance
Technician - remained critical.  Inferior applicants in the zone of interior
led to an excessive failure rate at the St. Louis Medical Depot, where 1229s
were trained; in Japan brief instruction left many incompetent at the job for
which they were supposedly qualified.  Meanwhile, medical equipment became
ever more complex, often with intricate electronic components.  Complaints to
the Office of the Surgeon General and much retraining resulted, but these
measures apparently did not solve the problem.

     During 1952 the oddities of the rotation system also resulted in severe
problems with the supply of field medical aidmen.  In May, after the Camp
Shinodayama school was abolished, aidmen trained at the Eta Jima Specialist
School.  Serving at the front in Korea, they earned the maximum constructive
service time and consequently rotated in a fashion likely to cause vertigo in
a personnel 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 men with combat MOSs could not be diverted and those with noncombat
MOSs were too few.  As a final note, the dangerous nature of the job meant
high losses by 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 of 1952 the command lacked twenty-four hundred of the more than
eight thousand authorized aidmen. Though the shortage was nearing 30 percent,
no solution had appeared.

     The Far East Command's decision to terminate the Shinodayama school
apparently was based upon assurances that greater numbers of qualified
replacements would be received through the pipeline.  The Japan Logistical
Command was suspicious from the first and recommended that the school be
retained.  When it was abolished, the logistical command set up its own
courses for physical therapy technicians at the Kyoto Army Hospital and for
medical equipment mechanics at the Japan Medical Depot.  In Korea a chorus of
complaints indicated that new technicians received from the zone of interior
were not living up to their billing.  According to the Eighth Army surgeon,


the caliber of laboratory technicians now being sent to this organization is
far below minimum standards.  The graduates of the Laboratory Technicians
School at Fort Sam Houston are universally unprepared to perform any of the
routine procedures employed in the laboratory.  They are not particularly
interested in laboratory work, but rather seem to regard their MOS as
insurance against more rigorous and dangerous assignments.


Pointing out that the quality of medicine in any hospital depends in great
measure on the quality of the laboratory work, the report concluded that the
hospitals must rely upon the few technicians who were both willing and able
and upon the universal Army cure for defective preparation, on-the-job
training.

     Clinical training for doctors moved in familiar grooves, though greater
maturity in the professionalization program was evident by comparison with the
first year of the war.  On arrival in Japan newly assigned physicians attended
orientation courses at the JLCOM hospitals, set up to give them some
familiarity with Army ways.  Dating from the earliest days of the war, the
program apparently underwent little change except for location.  By 1951
instruction was carried out at installations in the Tokyo area to minimize
transport and similar problems.  For newcomer and veteran alike, conferences
and symposia increased in number and sophistication.  Radiologists,
ophthalmologists, internists, and other specialists met at both regional and
general conferences; dispensary physicians attended meetings on general
medicine.

     In the Eighth Army - and in the KCOMZ after its establishment -
postgraduate courses were designed to utilize the talents of visiting
consultants who, while remaining inspectors, became instructors as well.
Such "courses" might last only a few days, for the students were busy people
and the consultants' visits to any given area usually short.  Most were
concerned with imparting the newest wrinkles in one or another specialty to
professionals who already knew the basics, which they practiced every day.
Refresher training was also provided for battalion surgeons and for the
Medical Service Corps officers serving as assistant battalion surgeons.  In
Korea the field and evacuation hospitals were usually the sites chosen. After
the 8228th MASH had become a hemorrhagic fever center, however, lectures there
informed both newcomers and veterans about Korea's surprise contribution to
American medical literature.  A civilian consultant from Harvard spoke in
Pusan on diseases of the chest; at some meetings, papers were presented, and
physicians were encouraged to bring up interesting cases for discussion.
Largely the work of General Ginn, who had succeeded Page as Eighth Army
surgeon, the development of these brief courses indicated that medical 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 medicine
helped to make continuous professional training a feature of the Korean scene.
The end of the war of movement enabled personnel from the general hospitals
down to the battalion level to train and work simultaneously.  Informal but
effective were sessions at the medical and dental societies that sprang up in
Korea - the 38th Parallel Medical Society, the X Corps Medical Society, the
Military Preventive Medicine Society of Korea, and the Korean Communications
Zone Medical and Dental Society. Despite all its faults the system accorded
people with interest and ambition an unusual opportunity to learn, for a wide
range of teaching was open to all.  Classes were well attended, indicating
that many used their chance to learn new skills and hone old ones in study as
well as practice.

Supply

     While personnel fluctuated, supply became more dependable.  Over the
course of 1951-52 a steady influx of zone-of-interior materiel supplanted the
rapidly dwindling World War II stocks.  In some areas - notably
pharmaceuticals - the capacity of Japanese manufacturers increased.  In time,
Army units were able to utilize sturdier American products.  This did not,
however, imply a loss of business for all Japanese manufacturers, because the
needs of Korean relief mounted as the reconstruction of the country began
under U.N. supervision.  Additionally, supplies from all over the world
arrived in the warehouses of the Japan Medical Depot, bound for the
war-battered nation across the Korea Strait.

     Another burden on medical stocks, both in the Far East and in the United
States, resulted from the presence of increasing numbers of troops sent by
other U.N. nations.  Issues of medical supplies and equipment to U.N. forces
increased in 1951 from about 3 percent of total issues in January to about 22
percent in October.  As issues to the Republic of Korea (ROK) Army did not
increase significantly, the diversion of supplies to other U.N. forces
evidently caused the decrease in issues to U.S. troops from 94 to 75 percent
during the same 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
rates of usage.  The opening of armistice talks at Kaesong, signaling the
period of digging in and limited combat actions, meant lower consumption and,
because materiel arrived from the zone of interior uninterruptedly, rising
stocks in most goods.  Until May the 6th Army Medical Depot at Yongdung-po
remained the only supply organization in Korea itself; greatly overextended
during the advance in late 1950, its scattered advance platoons benefited from
the contraction of the front that followed the defeats of November and
December.  Subsequent advances underlined the need for a more elaborate
system, and in May 1951 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 former serving the combat operations and the latter supplying
the Pusan area, requisitioning from Japan, and operating as a transit depot.
Located in small warehouses on the waterfront, the 60th by year's end was in
process of acquiring newly constructed buildings for its work.

     Also in May 1951, the Japan Medical Depot moved from its old quarters in
Yokohama, which the increasingly busy port authorities needed, to Camp Benda,
60 miles northwest of Tokyo.  While stocks rose with shipments from the zone
of interior, dependence on the Japanese economy continued, particularly for
support of the ROK Army and for U.N. forces other than Americans.  Textile
deliveries for dressings were somewhat unsatisfactory, but Japan supplied many
other items with success.

     Striking was the growth of Japanese sophistication in laboratory work and
the production of biologics.  Early in the Occupation the Army had established
tight quality controls over manufacturers to ensure high-quality products
needed for civilian relief.  In 1946 the civil government created a laboratory
control section in the Ministry of Health and Welfare to set and enforce
standards for the production of biologics.  By May 1951, when Japan entered
the World Health Organization, other Asian nations already were turning to the
Japanese for advice and assistance in plant design and construction and for
general technical know-how.  In vaccines, sera, antibiotics (except for some
of the newest), and human blood products, Japan was by this time supplying
itself and a substantial part of the Korean civil assistance program as well.
The Far East Command called Japanese production of penicillin "one of the
sagas of the occupation."  From the little that was turned out in laboratories
at the end of the war, production on the islands rose to compete with the
leading nations of the world: By 1951 the Japanese were making 15 trillion
units a year.  One sign of the nation's remarkable growth in expertise was the
fact that the command routinely submitted drug supplies from U.N. nations to
Japanese government laboratories for assay before including them in medical
assemblies or shipping them to Korea for civilian relief.

     Despite improvements in its sources of supply, the Japan Medical Depot
was not without problems.  By December 1951 the low level of combat had ended
one nagging difficulty - there was at last an adequate supply of litters in
the Far East Command - but short supplies were noted at various times during
1951 in a number of basic items: nitrous oxide (for lack of containers),
plasma, field dressings, and blankets, among others.  The tendency of medical
supplies to leak away into Korea's civilian economy was a factor, notably in
the case of blankets and of items like antibiotics, which brought high prices
on the black market.  "The many and varied uses to which some medical items
may be misapplied," noted the FEC surgeon, "are too numerous to mention, and
are usually quite well 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 during 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 system.  Few shortages lasted to the year's end,
and 1952 held out some promise of putting the depots both in Japan and in
Korea at last ahead of the game.

     As the front stabilized, signs appeared of a typically American abundance
verging on excess.  In this the medical supply situation was one aspect of a
more general trend.  Partly the situation was geographic; supplies entered but
rarely left the Korean cul-de-sac.  More important was the changing character
of the war.  Not only was combat less steady, but the American people sought
to compensate the few who bore the burden of the fight by attempting to
reproduce for 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 far forward.  (Every soldier and marine was supposed to receive
at least one serving of ice cream a week.)  American troops enthusiastically
seconded this trend.  Commanders and men alike gathered into bunkers, camps,
and unit areas as much impedimenta as they could to improve the quality of
life.  Wherever municipal water supplies became available, flush toilets,
sinks, and shower baths followed. The official logistical history somewhat
dourly warned that "it is the 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 to repel local enemy attack."  Encased
in body armor, longing for his rest and recuperation (R&R) leave, and counting
the days to his rotation date, the American soldier comforted himself with
consumer goods - a habit learned at home - while enduring an assignment that
was still bleak and dangerous enough.

     Transport reflected the new situation.  The generally lower level of
combat reduced the need for supplies, and its more predictable course meant
that all medical supplies except whole blood, vaccines, biologics, and goods
needed to meet sudden emergencies could be sent by sea.  Transferred from the
docks by truck to the medical depot in Pusan, materiel moved direct from the
depot to U.N. troops in the area; to ROK Army medical depots; to the 25th
Evacuation Hospital at Taegu, which supplied all U.N. units in that area; to
the 171st Evacuation Hospital in Taejon, which filled the same role there; and
to the 6th Army Medical Depot for distribution to troops in the Seoul area and
to the advanced platoons at Uijongbu (I Corps), Chunchon (IX Corps), and
Yanggu (X Corps).  Supplies for UNCACK were turned over to the Korean
Forwarding Company, a civilian concern, for shipment to another civilian
establishment, the Korean Medical Company, a contractor with the South Korean
government's Office of Supply.

     From the Japan Medical Depot to the forward platoons, integration and
quality of service improved steadily during 1952.  No critical shortages
occurred.  An agreement with the Air Force led to a mutually satisfactory
allocation of medical supplies between the two services in Japan. Procurement
for the Army's needs from civilian sources was in decline throughout the year
as shipments from the zone of interior more closely approximated needs.  In
1951 about 50 percent of expendable supplies needed for the ROK Army and for
POWs had come from Japan; in 1952 the percentage was reduced to 15.  But
civilian aid procurements increased, not only because the relief program was
expanding but also because they were cheaper and of constantly improving
quality.  The Japan Logistical Command boasted of a "very healthy
relationship" between the Medical Service and Japanese suppliers.  Clearly, it
was healthy for the manufacturers.  By the end of September they had sold $4.5
million of goods, including $2.8 million earmarked for Korean relief, to the
Army for medical purposes alone.

     Of considerable importance from the medical angle was the improving
quality of food delivered to the troops in Korea.  During much of the early
fighting field rations were in short supply, and to conserve canned rations
against need, the quartermaster shipped in fresh foods.  The soldiers' taste
for such items did not dissipate with the stabilization of the front,
particularly as supply became easier.  Troops continued to demand two hot
meals a day, battle permitting.  In the spring of 1952 over half the dinners
and suppers served on the line were said to include some fresh meat.  Some
20,000 tons of steaks, eggs in the shell, fresh potatoes, lettuce, and fresh
fruit each month went northward from Pusan.  Not only the Japanese hydroponic
gardens but also refrigerator ships from the zone of interior brought the food
in.  Supplies were transferred to cold storage barges in the Korean ports and
sent to the front by "reefer" cars on the trains of the 3rd Transportation
Military Railway Service.  Technical improvements made even 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, American soldiers
probably ate better in Korea than even their own well-nourished predecessors
during most of the Second World War.

     Food supply was, of course, a Quartermaster responsibility, but members
of the Veterinary Corps continued their accustomed work as food inspectors.
(Their other duty, caring for Army animals, was minimal because the only ones
in the command were 144 war dogs, of which 7 were in Korea at the end of 1951;
furthermore, the health of the dogs was very good.)  Food inspection work, by
contrast, was heavy.  In one month taken at random - January 1952 - nearly 793
million pounds of food had to be inspected; over 850,000 pounds were rejected.
Besides the imports from the United States a variety of food - including
fruit, swordfish, vegetables, recombined milk, and ice cream - was produced in
Japan, though only the fruit and fish came from Japanese sources.  To cab out
inspections, by the end of 1951 thirteen veterinary units operated in Japan
and six in Korea.

     The feeding of an international force presented unique challenges to all
concerned.  The ROK Army ate only one large meal a day - an Oriental ration of
fish, kelp, rice, and beans - but snacked at other times, and exhibited a
boundless appetite for hot peppers.  Inspectors baffled by Korean labels on
canned goods sometimes found their Korean assistants as helpless as
themselves; educated under Japanese rule, they could read that tongue but not
their own.  Turks would eat pork in battle or in camp, but in hospitals often
felt religious qualms and refused it.  Greeks preferred their own food but
would eat American rations, if pressed.  (A request from a Greek Orthodox
priest for virgin lambs for Easter 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 were altogether 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
standardization 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 standard oriental ration that met ROK Army tastes. The chief
questions remaining about the latter were its nutritional value, and, after it
passed out of American hands, 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 during 1952.  Reduced fighting, growing accumulations in the
using units and the maturing of the transport system changed the character of
the soldier's experience.  The lot of the fighter in any war is by definition
harsh, but by that low 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 of the war itself had brought them to a "pampered" state
that critics deplored but did not offer to share.  The medical system kept
pace, delivering sophisticated equipment like electrocardiograph machines to
forward hospitals and maintaining 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
a specialized program stretching from the zone of interior to the battlefield.
Basic both to its value and to many of the problems encountered in handling it
was the 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 degrees F, and used within twenty-one days.  During transport it had
to be handled carefully to prevent the oxygen-carrying red cells from being
destroyed.  A part of the body of the donor, and consequently reflecting his
state of health, both whole blood and plasma (the fluid part of the blood) had
to be carefully controlled to prevent the spread of disease.  Because the
results of new tests revealed that the danger of transmitting serum hepatitis
was much greater than previously realized, the use of plasma during the Korean
War tended to give way to serum albumin and synthetic plasma expanders.  The
lifesaving qualities of whole blood, however, were so remarkable that its use
grew steadily, though no means of sterilizing it were known.

     The year 1951 saw the blood program established during the first months
of the war grow and matured.  In September the secretary of defense set up the
Armed Forces Blood Donor Program, with centers at thirty-one major military
installations across the country.  The Red Cross rapidly increased its own
capacity to obtain and process blood.  Plasma-processing plants were operating
at full capacity.  Blood collections continued high well into 1952, but fell
off in May.  In October, responding to the fierce fighting of that month, they
rose again, only to fall thereafter in response to the general national
disillusionment with the war.  Throughout, the Red Cross supplied about
three-fourths of the blood, the armed services the rest.  Besides obtaining
blood the laboratories typed and otherwise classified it, and processors
salvaged serum albumin from blood unsuitable for plasma, from overage blood,
and from contaminated plasma.  From the zone of interior, Type O blood,
especially the low titer universal donor variety - so called because it caused
fewer problems than other nonmatched types when administered to Type A and
Type B recipients - was shipped to the Far East, most of it being sent on from
the 406th Medical General Laboratory to Korea.

     Once in Korea blood moved through the supply system much like any other
critical item, though medical officers often called for special treatment of a
most unusual and fragile substance.  In medical depots blood was stockpiled
and the oldest that was usable issued to the hospitals - a reasonable
arrangement but one that tended to increase the age of the blood by the time
it got into the recipients' veins.  With nine or ten usable days left for most
when it reached Korea, the blood actually transfused was from nine to twenty
days old.

[See Medics Using Plasma: Medics administering blood plasma.]

     Air transport was the key to the successful forward use of whole blood.
Blood was flown by the Military Air Transport Service (MATS) to Travis Air
Force Base in Oakland, California.  Here the Armed Forces Blood Processing
Laboratory examined and repacked it.  MATS planes then carried it via Hawaii
and Wake 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 the corps areas, containers of blood completed the journey to the MASHs on
medevac helicopters, strapped into the pods like casualties.  As with
casualties, the two great advantages of air travel were speed and smoothness.
Blood came in time and in condition to be used, which was not always true
after spending hours or days in transit over the cocktail-shaker Korean roads.
Though wastage occurred, in considerable part because of the widely
fluctuating needs of the front once the static phase of the war began, the Far
East Command judged the blood supply system on the whole an "extreme success"
and a continuing key to the remarkable survival rates in the hospitals of both
Korea and Japan.

     The problem of hepatitis in plasma proved, however, insoluble during the
Korean War.  Armed with new tests for detecting subclinical hepatitis,
hospitals in Korea found rates that reached 23 percent among men who received
multiple transfusions of plasma and whole blood.  Investigations by the Armed
Forces Epidemiological Board and the National Research Council showed that
ultraviolet radiation did not destroy the virus in plasma. Unlike whole blood,
plasma had no oxygen-carrying ability and functioned in hemorrhaging patients
merely as a filler for the vascular system, preventing a disastrous fall in
blood pressure.  The problems with plasma turned the attention of
investigators to other blood substitutes that might accomplish the same goal
with less risk.  Serum albumin, a natural protein prepared from blood or
plasma, proved to have marked advantages.  It was not infectious and could be
stored easily and used by medics in the field to stabilize the wounded for
their journey to a MASH, where whole blood was available.  Another substitute
was Dextran, a commercial product made from sugars that increased the fluid
within the vascular system by drawing it from the surrounding tissues.
Despite its dehydrating effect it too proved useful, especially to unit aidmen
and in battalion aid stations.  By such means the Medical Service attempted to
minimize the problem of secondary infection until a conclusive answer was
found.

Preventive Medicine

     Apart from the baffling mystery of serum hepatitis, spread by the very
transfusions that saved life, the record of the medics was generally one of
improving control over the sources of disease, even hemorrhagic fever.  The
other form of hepatitis - the infectious variety that was endemic in Korea -
reached near epidemic proportions during 1951.  But change was on the way. The
Army had developed an iodine water purification tablet shortly after World War
II but had hesitated to employ it because of fears that it might prove toxic.
Tests showed, however, that ingestion of the amount needed was not harmful,
and as a result Halazone tablets, long proved unsatisfactory after storage,
were withdrawn and iodine tablets issued.

     Chlorine also continued to have value in water purification.  Troops
located near municipalities increasingly drew their water from civilian supply
systems and adding chlorine provided a margin of safety.  In the Eighth Army,
the standard field requirement rose from 1 to 5 parts per million.  In
response to this change, and to the slackening of combat that enabled troops
to drink treated water, the infectious hepatitis rate fell from 33 to 12 cases
per 1,000 per annum.  With canteen water disinfected, engineer water supply
points multiplying, and municipal supplies hyperchlorinated, hepatitis and
many enteric diseases as well were brought under better control during late
1951 and 1952 than at any time since the outbreak of fighting.

     Control of pests and disease vectors generally improved, though with one
or two exceptions of note.  Insect and rodent control in Korea was carried out
by one preventive medicine company and a number of smaller units.  The larger
unit - designated the 37th Preventive Medicine Company after reaching the Far
East - was a new type of organization that quickly demonstrated its value.
Serving with the IX Corps, the company provided one control section for each
division; its members conducted training sessions for the troops, mixed and
provided poisons, carried out field work, made sanitary inspections, and
collected water samples and insect specimens for testing.  The company's
officers were entomologists or sanitary engineers, and its enlisted men had
received training in one or more phases of preventive medicine.  The company
proved so useful an innovation that the Medical Service began to train a
second in the zone of interior.

[See Bug Dusting: Dusting for mosquitoes with an improvised device.]

     In cooperation with the Air Force, planes were used in what the Far East
Command called the "largest military spray program ever conducted."  Under
Maj. William M. Wilson, four aircraft began to fly missions in June 1951,
spraying a 20-percent DDT emulsion over some 370,000 acres.  Repeated flights
were necessary to suppress insect (especially fly) populations, which tended
to rise quickly after each treatment.  Major cities and all fields were the
favored targets, with special missions to the Munsan peace conference area. As
usual, it 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 troops per annum, markedly lower that its maximum of 31 the
year before.  Possible causes included the fact that prophylaxis was more
rigorously enforced, that weather was unfavorable to mosquitoes, that ground
sprayers were at work as well, and that the new face of the war separated
combatants from civilians more completely than before.  Whatever the reason,
diseases borne by insects and other arthropods were markedly less important
than in the past.  One serious disease, Japanese B encephalitis, almost
disappeared.

     Unfortunately, malaria became a problem in Japan as it ceased to be one
in Korea, for returning personnel infected the local anophelines, which in
turn attacked a population with little natural resistance.  Troops returning
to the zone of interior also had frequent relapses on shipboard, a sharp
reminder of the fact that chloroquine suppressed the symptoms of malaria but
did not kill the parasites.  In December the new antimalarial primaquine came
into use, a promising innovation because tests indicated that it killed the
Plasmodia in the tissues of victims.

     The environmental dangers of using broad-spectrum insecticides were
little appreciated at the time.  Soon, however, it became apparent that body
lice in Korea - probably because of immunity developed during earlier spray
campaigns - were becoming DDT-resistant.  At first medical personnel thought
that the DDT in use must be old, and they obtained freshly made supplies. When
the new DDT also proved ineffective, search for another insecticide began,
with the specter of possible typhus epidemics to encourage speed. Experiments
in Korea during the summer of 1951 included new reliance on an old standby,
pyrethrum, and trials of 1-percent lindane (benzene hexachloride), then in
agricultural use in the United States.  Lindane proved effective, and by the
end of the year the 38th Preventive Medicine Control Detachment reported that
two applications reduced the lice problem among some POWs - the worst
afflicted group in Korea because of initial infestation, crowding, and
restricted movement - from 92 to 0.9 percent. Meanwhile, studies in Japan
showed again a highly specific resistance in lice to DDT, further evidence
that the substance, for almost a decade the nuclear weapon of the war on
noxious insects, was losing its punch.

     Other diseases demanded quite different methods of control.  In December
1950 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 203 per
1,000 troops.  On 22 January the command ordered all U.N. troops immunized
against influenza.  Thereafter the disease fell off, though rates throughout
the command remained higher than in 1950.  Venereal disease (VD), as usual,
showed an inverse relationship to the level of combat, rising in Korea as the
front stabilized and the intensity of fighting fell.  Narcotic addiction was
reported a problem in some parts of Korea, reflecting the ready availability
of both marijuana and heroin. Poliomyelitis was relatively more common, the
bulbar form in particular exhibiting a high mortality rate, and tuberculosis
began to rise among Americans in both Korea and Japan.  Probably for genetic
reasons, blacks were especially susceptible.  No disease, however, was of
major military importance.

     Overall, the changes that appeared in the disease picture during 1951
reflected, not medical innovations, but political and military events.  The
signing of the Japanese peace treaty meant more contacts between Americans and
Japanese and consequent dangers to both.  In Korea the stabilization of the
front drastically altered the possibilities of preventive medicine and, as the
rise in VD rates showed, increased the prevalence of some ills while enabling
medics to suppress others more effectively.  The rotation system, R&R leave,
and the introduction of dependent travel to Japan all produced movements of
people that implied the spread of disease.  When all was said and done,
however, the positive signs far outweighed the negative.

     The following year saw many of these trends continue and intensify. The
activation of the KCOMZ brought into being a headquarters where preventive
medicine throughout the rear areas was a matter of major concern.  At the end
of 1952 the command reported that the health of the troops was, all things
considered, amazingly good.  Systematic immunization, begun in 1950 and
carried on through 1951 and 1952, was basic to the soldiers' ability to resist
the local disease environment.  Increasing numbers now were housed in
permanent or semipermanent quarters.  Messing facilities were good, and the
men themselves were said to be showing considerable self-discipline in
avoiding contaminated water and food, in great measure because their own
rations were palatable and commissary liquor was abundant and cheap.

     Another key to success was the fact that the KCOMZ by this time had four
preventive medicine units operating within its boundaries: the 38th, 152nd,
and 154th Preventive Medicine Control Detachments, and the 219th Preventive
Medicine Survey Detachment.  The 38th was assigned to the Prisoner of War
Command and the 152nd to the Korea Base Section.  The 154th, headquartered in
Pusan, supplied groups of one to five technicians for special assignment to
meet local problems, and the 219th served the entire KCOMZ.  Upon these units
fell the responsibility of controlling what the command surgeon called the
"entomological theater" of Korea, performing work similar to that of the
preventive medicine company in the forward areas.

     The two great medical problems of the forward areas - hemorrhagic fever
and cold injury - were nonexistent in the communications zone.  The main
exceptions to the generally happy picture were infectious hepatitis - much
reduced by chlorination but still too high - and that traditional problem of
the zone, venereal disease.  The command surgeon traced the continued
incidence of hepatitis to three factors.  Most, he noted, occurred in the
Pusan area, a center of the drug traffic and drug addiction, and he raised the
question of whether the two might not be connected.  Occasional slips in
personal discipline, primarily from drinking nonpotable water or eating
seafood or fruit displayed in the street stalls and markets, might also be a
source.  Finally, and seemingly most important in his eyes, he cited the large
and increasing use of Korean food-handlers in messes, clubs, snack bars, and
railroad diners.  Many surveys had shown that Koreans of the laboring class
were all parasitized in some degree; it seemed reasonable that such people
might be a source of hepatitis as well.

     As for venereal disease, rates were high and climbing, in 1952 jumping
between September and November from 176.8 cases per 1,000 troops per annum to
202.  The KCOMZ began to construct prophylactic stations in Korean cities,
sought wider cooperation from South Korean authorities in treating the
civilian population, set up a Public Health Advisory Council composed of
medical officers from its major commands, and began trials of oral penicillin
therapy in hard-hit Taegu.  The usual calls for "wholesome entertainment" for
GIs 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
brothels and inspecting their inmates; the U.S. Army's policy of either
breaking up houses of prostitution or putting them off limits, Koreans pointed
out, merely drove 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.  Because both accusations were probably true, and because the
military and civil authorities were at loggerheads over policy, the prospects
for improvement in VD rates did not, at year's end, appear to be very good.
It was also true that infection on the average of one man out of five once a
year did not, with antibiotic therapy, represent a very serious drain on job
performance.

     Psychiatry in the Korean rear areas showed trends which fitted in well
with the patterns of physical disease.  Neuropsychiatric disorders in the
KCOMZ were higher than in the American Army as a whole, though "not excessive"
in the judgment of the zone surgeon.  Among causes he cited the "boredom of
service in Korea," which certainly had not been a difficulty during 1950.  TDY
to Japan came too seldom; places for sightseeing, given the continuing
presence of guerillas, were few.  He noted, however, that the shortage
of "hobby shops, day rooms, special service activities and equipment, service
clubs and the like" was rapidly being corrected.  The nature of the war was
probably the root problem in that a sense of futility underlay many apparently
superficial complaints.  American soldiers simply did not feel any longer that
they were part of a significant endeavor. Against this background the erratic
supply of replacements and lack of promotions caused serious morale problems,
for every revision in the point score for rotation had "a shattering effect."
Such changes were, of course, particularly noticeable in the rear areas,
because the Far East Command, if faced with a shortage of replacements, would
lengthen the time of service troops rather than that of men on the line.  What
the headquarters found to be - and in fact was - reasonable and just often
appeared to those affected as a heartless "manipulation" of rotation dates.
Meanwhile, the well-nourished monotony of military life was surrounded by the
"squalor, poverty, wretchedness, malnutrition and disease" of a wrecked and
ravaged land - a comfortless prospect.

     Narcotic addiction raised minor furors in the press every few months,
though the Far East Command judged the rate to be "not . . . anything
alarming."  However, heroin was cheap in Korea - between eighty and ninety
cents for about 65 milligrams - and was the most commonly used hard drug.  A
fair percentage of users did not appear to be addicts but rather exhibited a
social pattern of indulgence, similar to the ordinary use of alcohol, which
the command found surprising.  Use in Korea was spotty, "two or three persons
in some companies with four or five hanger-ons [sic]".  Aside from suggesting
that a field for research might exist, the neuropsychiatric consultant
apparently found no cause for concern in the phenomenon.

Dental Care

     The dental service reflected the tendency toward improved care.  The
armed forces had 2,358 dentists on 1 July 1950 and 5,729 one year later.  In
the Far East Command the number of dentists, with few exceptions, was
adequate; but for a very few months, Eighth Army figures hovered within 5
percent of the authorized strength.  Replacements were sufficient in numbers,
though sometimes spasmodic in their arrivals.  Normally, new men requested and
received forward duty, often at division level, in order to earn rotation
points as quickly as possible and to finish their military tours in more
agreeable locations than Korea.  Customary problems remained in the lack of
adequately trained enlisted men, especially well-qualified dental laboratory
technicians.  Replacements often arrived at their assignments with
long-neglected mouths that required lengthy work in the dental chair and
prostheses.  A survey in late 1952 on replacements in a field artillery
battalion showed that 6.5 percent needed emergency treatment, 15 percent
prostheses, 43 percent immediate treatment of advanced dental conditions, 33
percent preventive or corrective action, and only 16 percent no dental work at
all.  Such conditions, the result of personal reluctance to face the dentist
as long as possible plus the Army's failure to survey and treat men adequately
before shipping them overseas, needlessly burdened the Far East Command.  They
were, however, quite in line with the experience of earlier years.

[See Dentist at Work: Forward Dentistry.]

     With the stabilization of the front, dentists began to do a great deal
more dentistry and less emergency filling in for surgeons.  The general
tendency was to increase dental staffing forward.  During 1952 one oral
surgeon was attached to each of five MASHs to give added support to front-
line units.  Each of the Eighth Army's two evacuation hospitals had one
dentist and one oral surgeon.  Evacuation hospitals provided some outpatient
services, and the MASHs made their X-ray facilities available for unit dental
officers in their areas.  In the divisions of the Eighth Army all eighteen
Dental Corps officers were assigned to the medical battalion but were attached
to various units as the situation might require.  Usually, one dental officer
was needed in each regimental collecting station, in the replacement company,
and in the division headquarters.  Battalions serving in difficult or remote
locations often received their own dentist, principally field artillery and
antiaircraft units and combat engineers. The division dental clinic was an
innovation that was proving itself in practice.

     Additionally, the Eighth Army had in the 163rd Medical Battalion an
organization that provided, among other functions, a dental service throughout
the Army area.  The battalion controlled several dispensaries, eleven dental
operating detachments, and a dental prosthetic detachment. The battalion took
up any slack by sending help to needy units.

     In the field the lot of the itinerant dentist was often difficult,
strapped for shelter and for electric power to run his lights and drill.
Dentists permanently attached to units showed considerable skill at digging
in.  Their tents were framed and floored and usually set into the south slope
of a hill, or against the defilade of an east- and west-running ridge.  Where
possible, dental officers used bunkers solidly constructed of logs, railroad
ties, or bridge timbers.  The framed semicylindrical Jamesway tent (usually
called "Janeway") was, however, a dark place when several sections were joined
together, for the only windows were on the ends. Except for the mobile
prosthetic units that carried their own power source, dentists were dependent
on an outside source for electricity, or on small portable generators that
often worked poorly.  With a chair, his dental field operating chest, and
electricity, the Dental Corps officer was ready for work, of which there was
seldom any lack.

     Dentists assigned to rear areas had little to report after 1950, except
the familiar problems among replacements and dependents and ongoing
improvement of facilities.  In Japan, clinics and dispensaries tended to
remain in one place for lengthy periods, adding to the increased sense of
regularity and order among those who worked in them.  The number of dentists
was adequate, and the rapidity of air evacuation from Korea enabled the dental
consultant to recommend primary closure of maxillofacial wounds after
temporary debridement - an important matter from a cosmetic standpoint because
early wound closure resulted in less scarring.  Oral surgeons usually found
wounds fresh and uninfected, and their own numbers were adequate to the
lessened casualty load.

Of Professional Interest

     The work of the FEC consultants continued along familiar lines,
interviewing newcomers, recommending assignments in their own specialties, and
carrying out tours of inspection.  Instruction remained a basic duty, the
consultant's lectures deriving much of their influence from his professional
reputation, experience, and expertise, rather than from his position in the
military hierarchy.  The consultant's manner toward more junior physicians and
surgeons was clearly derived from the tradition of ward rounds in teaching
hospitals.  The surgical consultant wrote in 1951 that


during visits to hospitals, professional ward rounds were made with members of
the surgical staffs.  At all times the Consultant assumed the attitude of a
friend and counselor who was willing and desirous of being of help
professionally.  Suggestions were made in difficult or complicated cases.
Mistakes were brought to the attention of those responsible, in a spirit of
friendliness to the end that the Consultant (at least, so we sincerely hope)
was looked upon, not as an inspector or fault finder, but as a colleague
having a paramount interest in the welfare of the patient and in the service."


     Youth and inexperience in military surgery characterized most of the huge
number of new men who arrived during 1951, obliging the consultant to
distribute the "sprinkling of Board eligible and Board certified officers as
well as possible throughout the Command."  Whenever possible, new surgeons
were assigned to hospitals in the Japan Logistical Command before being sent
to Korea.  Here they could learn from both veteran soldiers and men returned
from the battlefront and could observe at firsthand the consequences of proper
and improper procedure in forward hospitals.  No consultants as such were
assigned to the KCOMZ; specialists working there doubled as consultants.
Frequent visits from those in Japan provided an attraction for the monthly
meetings of the Korean Communications Zone Medical and Dental Society, held at
Pusan, Taegu, and Taejon.

     Deficiencies in the supply of critical specialists continued, mitigated
by the reduced work load.  Rising numbers of orthopedic surgeons during 1951
combined with lessening combat activity to make a continuing shortage less
acute.  General surgeons were trained in orthopedic procedures and, reassigned
to the MASHs, in many instances did outstanding work. Changes on the
battlefield and the rotation policy directly affected the nature and quality
of surgical work.  The advent of body armor noticeably reduced injuries to the
trunk and increased proportionally the number of wounds to the extremities.
Artillery duels across the entrenched lines meant increased injuries from
shell fragments, also mostly to the extremities, for even when fragments
penetrated the armored vests, the wounds were usually quite superficial.
Chest injuries tended now to be the result of crushing forces, such as the
blast effect of nearby explosions, or the result of direct impacts from
high-velocity missiles.  In October and November 1952 a large number of men
with infected wounds reached the hospitals in Japan.  The reason was not only
the increased combat during October but also the amval in the Eighth Army and
the KCOMZ of a large number of surgical replacements with hardly any
experience in the treatment of massive traumas in a septic environment.  The
patients were inadequately debrided, and at least two required lower extremity
amputations that should not have been necessary.  Energetic activity by the
FEC orthopedic consultant and the Eighth Army surgical consultant - with
frequent lectures and demonstrations - apparently ended the problem by
mid-November.

     The general lessening of combat allowed patients to be held longer in the
theater and more elaborate procedures to be undertaken.  Generally speaking,
the duties of forward hospitals in handling wounds were to perform adequate
debridement, leaving most wounds open; to stop bleeding; to treat shock; and
to prevent infection.  In the KCOMZ every effort was made to close wounds as
soon as possible after the fifth day.  Physical therapists worked closely with
orthopedists to restore function to injured limbs.  Fracture victims could now
be held long enough for callus - a flexible tissue formed by the body as the
first stage in healing a break - to form, avoiding complications caused by
attempts to move the patient prematurely. Nailing, or pinning, of broken long
bones was routine.  Though no attempt at elaborate reconstructive surgery was
made in the theater, treatment of chest wounds had become so effective that
only occasional evacuations to the zone of interior were necessary.  For all
wounded who reached medical installations, the mortality rate declined from
World War II's 4.5 percent 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 and
Development Board listed nine: in surgery, anesthesia, wound ballistics, cold
injury, field investigation, malaria, DDT-resistant lice, dysentery, and
hepatitis.  The malaria team's primary function was to study primaquine; that
of the hepatitis team was to study the hospital management of the patient.
Studies by the wound ballistics team led to more rigorous enforcement of the
rule that steel helmets were to be worn by combat troops at all times.
Methadone as a morphine substitute was still undergoing trials, which
generated favorable reports.  The field investigation team aimed to pinpoint
important field medical and surgical problems.  A practical result of its
efforts was the introduction in 1951 of a new field dressing for wounds and
burns.

[See Research Lab: Men at work in a surgical research team laboratory.]

     The surgical research team was especially prolific in its studies of the
clinical management of war casualties.  Though research in combat theaters
dated from World War I, it was further systematized in Korea as a policy of
the Medical Service and the Department of Defense.  Under Dr. Fiorindo A.
Simeone of Western Reserve University and later under Capt. John M. Howard,
the team found a home at the 11th Evacuation Hospital on the relatively quiet
eastern sector of the front.  Here and at the MASHs team members practiced and
taught arterial repair and also studied kidney and liver damage, bum
treatment, and other types of wounds.  Emphasizing the dynamic and pervasive
effects of wounding, Howard and his colleagues helped to make the Korean War a
landmark in battlefield medicine.

The Flow of the Wounded

     All these varied activities had meaning, of course, only in the flow and
treatment of the wounded.  Though increasing numbers stayed in Korea, many
continued to be earned by air or sea to Japan and the zone of interior.
During 1951-52 the railways remained the most important means of evacuation
within Korea, while movement out of the country became more dependent on air
transport than ever before.

[See Litterbearers: Litterbearers carrying casualties to a hospital train.]

     Rail evacuation might begin as far forward as the clearing station, if
tracks were nearby and the tactical situation permitted.  When a line was
available, ambulance buses were attached to the medical battalion.  Fitted
with additional flanged wheels for travel on the rails, the buses also could
move on the roads to and from the rail line in case of need.  With the
stabilization of the front, tracks were extended northward in the I Corps zone
to within 8,000 yards of the front line.  By late 1951 sixty-two hospital ward
cars were reported to be working in Korea.  The standard train now consisted
of thirteen cars - eight ward cars, a kitchen, dining room, and pharmacy car,
an officer personnel car, two orderly cars, and one utility car.  Maintained
and operated by Transportation Corps personnel and staffed by the Medical
Service, the trains evidently had come a long way from the rough early days of
medical railroading in Korea.  With the organization of the KCOMZ, control of
the railroads passed to the new headquarters, but the Eighth Army reported at
the end of 1952 that the "evacuation system has changed very little during the
year."  In terms of function and relative dependence 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 into the
hands of the communications zone, or to airfields for flights to the zone or
Japan.  Assigning the wounded to the proper hospital continued to be the
function of the medical regulating officer at Pusan.  In mid-1951 Lt. Col.
Vincent J. Amato of the 52nd Medical Battalion explained the medical
regulating officer's duties: 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 the location of special equipment (eye
magnets for removing metal fragments, iron lungs, EKGs, to name a few); and he
must know what languages were spoken in the various hospitals so that, if
possible, a U.N. soldier might find himself in a unit with nurses or at least
an interpreter from his own country.  Armed with this information, the medical
regulating officer confronted the inflow by train and plane.  While the most
serious cases were being unloaded first, the officer, using advance data on
the makeup of a particular group of wounded, conferred with accompanying
doctors and nurses and began to make hospital assignments on the basis of
available bed strength and specialty.

     Rear area hospitals underwent considerable change in response to the
lower level of fighting.  At the end of October 1951 the 21st and 22nd
Evacuation Hospitals, Semimobile, replaced the 3rd and 10th Station Hospitals,
respectively, and the 25th Evacuation Hospital replaced the 4th Field
Hospital.  Ironically, during 1952 the rear area hospitals changed
unmistakably into settled installations providing area care.  Though their
titles suggested semimobile organizations, part of a system of emergency
medicine geared to quick evacuation, their functions approximated more and
more closely those of conventional station hospitals.

     As the MASHs had evolved into general-purpose forward hospitals, the
evacuation hospitals in their turn grew as omnicompetent backup facilities.
Lack of a medical field laboratory in EUSAK compelled hospitals to perform
more elaborate tests than their T/O&Es contemplated and led to recommendations
for expanded laboratory facilities.  Evacuation policy shifted frequently, but
the long-range tendency was for the time limit to rise, and studies showed
that when it passed fourteen days a marked increase occurred in the demand for
tests.  But the basic factor in the elaboration of equipment and service was
the stabilization of the rear areas during 1952.  Here troops mainly were
located in a few major concentrations around the urban areas and the ports.
Disease and nonbattle injuries dominated the admission rolls, especially
during quiet periods on the front.  The evacuation hospitals also provided
outpatient clinics and diagnostic and consultant services.  When battle
casualties seemed likely to increase, medical authorities attempted to "clean
out" the lightly injured, only to find that few qualified for the term.
Though complex equipment, such as electrocardiographs and audiometers, had to
be obtained by special authorization from Japan or the zone of interior, the
hospitals were caring for substantial numbers of patients with fairly serious
nonbattle conditions.  As support troops grew in number, and the fighting
along the line remained sporadic, the proportion of such patients held by the
evacuation hospitals could only grow.

     With the creation of the KCOMZ, the 21st, 25th, and 171St Evacuation
Hospitals plus the Swedish Red Cross Hospital were transferred to the new
command.  The remaining step was evident, and in early 1953 the KCOMZ
evacuation hospitals again were reorganized and redesignated as station
hospitals, with the added personnel, equipment, and bed strength of such
installations.  The history of the evacuation hospitals in many ways
symbolized the transformation of the rear areas and, indeed, of the war
itself.

     From the earliest days of the Korean fighting, hospital ships of the
British and American navies - later supplemented by another from Denmark -
served first as seaborne ambulances and later as mobile hospitals.  The
original mission of such ships was to transport patients, giving care en
route.  However, Korean conditions made them far more valuable as floating
hospitals.  Ships loaded patients either by winching up litters directly from
the docks, by lifting them from lighters at sea, or from helicopters landing
on their decks.  The first and third methods were by far the best, and the
advent of the medevac helicopter meant that a hospital ship anchored off a
port could receive patients with as little difficulty as one tied up to a
pier.  In evacuating to Japan, on the other hand, 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 in the early days of the
war, "One movement only is the ideal [for a wounded man]: direct from the
field to a base hospital where he is able to remain for several weeks without
interruption and the sooner this movement from the time of injury takes place
the better."

     The result was what Rear Adm. Lamont Pugh called the "unique decision to
leave 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
from place to place: sometimes supporting the Inchon invasion (as the USS
Consolation did), or doing service in Japan for a while, or aiding the Hungnam
evacuation, or simply shifting about the Korean coast as needed.  Up to the
end of September 1952 admissions to the three U.S. Navy hospital ships totaled
some 40,662, about 35 percent battle casualties and the rest nonbattle
injuries.  Additionally, a large number of outpatients were treated, possibly
equal to the total cared for aboard ship, for a ship at its pier could conduct
a clinic just as capably as a conventional hospital could.  With the early
service of the HMHS Maine and the later arrival of the Danish Jutlandia, five
such ships in all provided an unusual and successful addition to rear area
medical resources, and another example of military hospitals whose function
Korean conditions had transformed.

     Such were a few of the salient points in the evolution of the Korean rear
areas as the war shifted from one of movement to one of static confrontation.
The improvisations of 1950 yielded to a stable, complex system designed to
support a war of low casualties in which victory was not sought and for which
no end could be foreseen.  The KCOMZ assumed the form and many of the
functions of the advance section of a World War II communications zone, while
Japan continued to serve in a manner reminiscent of the British Isles during
the campaigns of the European theater.  In Japan lay the largest, most complex
hospitals, and from the Japanese airports Air Force planes carried the most
severely injured to definitive care at home.