US History/US History (Bureau Development Inc.)(1991).ISO/dp/0082/00823.txt

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$Unique_ID{USH00823}
$Pretitle{78}
$Title{United States Army in the Korean War - The Medics' War
Chapter 11  The End of the Fighting}
$Subtitle{}
$Author{Cowdrey, Albert E.}
$Affiliation{US Army}
$Subject{medical
army
hospital
korea
war
service
korean
command
health
personnel}
$Volume{}
$Date{1987}
$Log{Fitting a Cast*0082301.scf
Ward 236*0082302.scf
Greeting Returnee*0082303.scf
Enemies Leaving*0082304.scf
}
Book:        United States Army in the Korean War - The Medics' War
Author:      Cowdrey, Albert E.
Affiliation: US Army
Date:        1987

Chapter 11  The End of the Fighting

     Nineteen fifty-three began with the war, the fighting front, and the
relations of the contending powers all in a state of deep freeze.  Routine
patrol activity and a few unsuccessful attacks on strongpoints by the
Communist forces occupied the men on the line.  From the United States Army
Forces, Far East (USAFFE), headquarters to the forward bunkers habit ruled a
conflict that had settled into routine.  On the world scene harbingers of
change appeared with the inauguration of Dwight D. Eisenhower as president of
the United States in January and with the death of Russia's dictator, Joseph
Stalin, in March.  But the early months of the year gave small indication of
the events to come.

The Medical Picture

     The Medical Section, USAFFE, had reached full development.  Its major
functions had matured but changed little from 1952.  In evacuation, air still
predominated, both for carrying casualties from Korea to Japan and from Japan
to the zone of interior, though naval hospital ships occasionally played a
part when rotating back from assignments in the war zone.  The 801st (later
redesignated the 6481st) Medical Air Evacuation Squadron was chiefly
responsible for moving patients within Japan and from Korea to Japan.  The
1453rd Medical Air Evacuation Squadron of the Military Air Transport Service
carried evacuees from Japan and the Ryukyus Command to the United States.
Army medical regulating officers operated at Seoul for the Eighth Army, at
Pusan for the Korean Communications Zone (KCOMZ), and at Camp Zama for the Far
East Command.  Typically, a hospital would report on patients ready for
evacuation to the appropriate medical regulating officer, who would then
contact the 6481st at Tachikawa Air Base to provide transport.  The officer at
Camp Zama, upon notification from Korea, designated the hospitals in Japan
that were to receive the evacuees. All services were involved, for liaison
officers from the Air Force and Navy coordinated use of their own services'
hospitals.  U.N. personnel were hospitalized in the Tokyo area.  Though as a
rule each service cared for its own people, hospitalization was primarily on
an area not a service basis, and in consequence individual American wounded or
sick might find themselves in any convenient facility.

     Throughout, the customary evacuation policies ruled - 30 days for Korea
and 120 for Japan.  On return to the United States evacuees received their
hospital assignments from the Armed Services Medical Regulating Office in
Washington, D.C., with most Army patients going to the large general hospitals
for specialized care.  What had once been a flood, however, had fallen by the
early months of 1953 to a relative trickle.  For all three armed services, a
total of about two thousand battle casualties and fourteen hundred others were
received from Korea during the first six months of 1953.  The Army had
slightly more casualties 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 mission
to provide medical support for the Eighth Army caused some difficulties.  Bed
requirements and staffing in the communications zone had to be justified on
the basis of its troop strength alone.  Only the lack of activity on the front
prevented the deficiency from having serious consequences.  The problems of
evacuating U.N. patients through American channels were likewise of little
practical importance.  Over the years the situation had grown familiar, and
linguistic difficulties continued to be minimal, even with tongues like
Amharic (Ethiopian), which almost no Americans spoke.  Units still provided
their own medical personnel at the lower echelons, and the Ethiopian surgeon,
by good fortune, was an Englishspeaking European versed in a number of
languages.  The commander of the Ethiopian unit found that the system of
evacuating through American channels "works very satisfactorily.  We don't
think any changes in the present arrangements are necessary."

     Supply similarly had become standardized and remained virtually unchanged
through 1953.  Lack of fighting in the early part of the year enabled the
inventories at medical depots to reach their most satisfactory condition since
the beginning of the conflict, with materiel on hand that proved very useful
when 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 the
KCOMZ.  In turn the communications zone depot supplied the Eighth Army through
the 6th Army Medical Depot, the Republic of Korea (ROK) Army through its
medical depot, and the units of the zone directly.  The Eighth Army and the
ROK Army together took about three-fourths of the materiel issued, while the
KCOMZ absorbed the rest.  As before, the 60th Medical Depot operated under
KCOMZ'S subordinate command, the Korea Base Section.  One oddity of the early
part of the year was the reluctance of depot personnel in Japan to maintain
stocks at a high level. Rotation and the draft had by now eliminated all
workers with experience of heavy combat, and as a result medical supply people
found it hard to believe that the levels established by their predecessors had
any relevance 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 the need arose.

     The personnel picture in USAFFE continued to resemble the familiar image
of a revolving door.  The problem was not only the old one of rotation - which
as late as September was still calculated on the basis of constructive months
of service - but of special early-out provisions that began to emanate from
the Department of the Army following the first breakthroughs toward peace in
the early spring.  "What the public may regard as overstaffing," wrote the
surgeon general to General Shambora, "in fact, is not such.  However, we
already have begun to receive a trickle of letters originated by individuals
in oversea[s] commands and coming to us through various channels including
members of congress.  I anticipate that this trickle will grow into a fair
size stream and refutation of the allegations [of overstaffing] is most
difficult without breaking security."  Unpredictable changes in policy made
advance planning and requisitioning of replacements as baffling a problem as
the physical turnover itself.  Not until October did a fixed-tour requirement
for service in the Far East Command finally promise a return to order.
Meanwhile, under pressure from civilian medicine, the Army rushed to release
its physicians upon the mere promise of peace.

     Doctors in the Far East Command continued to be young, professionally
able, and short on field experience.  Reflecting the obsessive specialization
of American medicine as well as the Army's own deliberate policy, too many
medical officers were trained in specialities and too few in general practice.
Because of the shortage of general practitioners, who were needed most, the
specialists had to fill slots for which they overqualified.  Men of
sophisticated training had to go forward into field assignments that provided
them much physical discomfort and little professional excitement.  Meanwhile,
the lack of experienced officers to fill command positions brought older
specialists into jobs as division surgeons and hospital commanders, rather
than allowing them to use their clinical skills.  The problem of finding
officers who combined military experience, administrative knowledge, and board
certification was not easily solved, and, on the whole, experience continued
to be at a greater premium than clinical expertise.  Shortages became more
pronounced in units that were closer to the sound of gunfire.  The Eighth Army
complained of a "continuing shortage" throughout the year, extending to all
grades, but critical in field-grade officers.  Of 130 field-grade Medical
Corps officers authorized, only 43 actually were assigned at the end of 1953;
only 6 had previous command experience and only 3 of the 6 division surgeons
had staff experience.

     Veteran Medical Service Corps officers were likewise in short supply,
diminishing a source of compensating strength.  Because they were so often
pulled into Medical Corps administrative slots, their usual role in training
medical units for combat was less easy to perform.  Nurses were at about 70
percent of authorized strength.  In the Army as a whole, the sharpest drop in
any category during 1953 was in Medical Service enlisted men.  Falling draft
quotas at home in the first six months of the year were reflected in a decline
from about eighty thousand to sixty-four thousand - a 20 percent drop-off.
But the Far East Command apparently was not affected before the armistice.

     Preventive medicine, best performed under conditions of stability and
careful routine, reached a high level of competence and success despite the
problems of the command.  At division and corps headquarters general medical
officers who had taken a short preventive medicine course at the Medical Field
Service School in Texas but who had no lengthy experience in the field usually
filled available slots.  Or nonmedical officers with a background in civilian
public health might take on the job.  The competence displayed by the latter
group indicated that very elaborate training was not a practical necessity for
the work in Korea. (At major headquarters, however, fully qualified medical
officers, sanitary engineers, and entomologists were the rule.)  One
preventive medicine control detachment served with each division, carrying out
the work of sanitary inspection, insect and rodent control, and so forth.
Technical supervision from the Office of the Surgeon, Eighth Army,
supplemented the knowledge of the division surgeons but led to some grumbling
about interference from above. By year's end, however, the units were still
attached to the divisions but under Army 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 also received a complete change of clothing.  During cold
weather he spent several hours in a warming bunker every three to four days.
In effect, this bunker was a dayroom where he read, wrote letters, washed his
clothes, and received a haircut.  Rest periods in a rear area were allotted on
a rotating basis, and, as in the past, each man received a five-day rest and
recuperation leave in Japan at some time during his service in Korea.  Whether
or not combat was occurring, the company aidman remained the key to
maintaining health in his unit, especially while it was on the line.  Each man
had to change his socks daily as a precaution against trenchfoot, and one duty
of the aidman was to inspect the feet of all members of his unit every day.
The aidman also sprayed bunkers with disinfectant once a month and spread rat
poison to control the rodent population.  He checked 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 spring
hemorrhagic fever repeated its by now familiar seasonal pattern.  Despite
intensive study by epidemiologists and ceaseless work in medical laboratories,
the agent was not isolated, the vector was not found, and the natural
reservoir was not identified.  No therapeutic agent appeared.  On the
reasonable assumption that a virus caused the disease, that its reservoir was
among wild rodents and its vector a chigger or mite, an extensive mite control
program continued, with quartermaster laundries routinely soaking newly washed
outer clothing in miticide.  During the April to September season medics could
congratulate themselves that only 148 cases were reported, as against 487 for
the same period in 1952.  Unfortunately, during the fall season 279 cases
occurred, a few more than in the 1952 autumnal outbreak.  Was the mite control
program wrong in principle (as later proved), or was it improperly carried
out?  A carefully supervised program for an entire division was planned for
1954; however, the war ended with 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 among
Army personnel, about one a month from December 1952 to March 1953. All were
in the Pusan area, and all reflected unsuccessful vaccinations. Hepatitis
declined throughout the Far East Command, with the greatest change noted in
the Eighth Army area.  With only 2.5 cases per 1,000 troops per annum, the
forward areas were benefiting from the improved water, better mess discipline,
and enforced lack of contact with infected civilians.  More rigorous medical
testing of civilian employees in rear areas, where they were widely employed,
revealed that 4 percent of those who had passed earlier testing had active
tuberculosis.  The use of routine X-rays thus provided a new means of guarding
troops against one of the commonest of local ills.  Malaria control was even
more effective in 1953 than in earlier years.  In Korea the reported incidence
of 8.4 per 1,000 troops per annum in 1951 had declined to 3.2 in 1952 and
dropped again to 1.9 in the last year of the war.  Primaquine treatment of
Korean veterans returning to the United States appeared to be successful, with
a resulting drop in the cases among rotated Army personnel.  More than 10,000
such cases were reported in 1952, but only 848 came to light in 1953.
Checking for toxic side effects 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 fourteen days 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 of fighting.  Aerial spraying of insecticides continued during warm
weather, carried out jointly by the Fifth Air Force and Eighth Army.  Vector
control details were set up in every company and battery, or separate unit,
and their members trained by the preventive medicine units.  A newly
established Preventive Medicine Association of Korea, which held regular
monthly meetings, proved a valuable educational tool, especially because so
many of the people engaged in the effort were to some extent amateurs. Every
meeting was built around a lecture by a visiting consultant, or other expert,
and all personnel involved in the work were encouraged to attend.

     Prevention of disease extended to Koreans, both civilian and military. In
the late summer and early autumn an epidemic of Japanese encephalitis swept
the country, though few cases were reported among American troops. However,
the needs of the local population and the ROK Army got increasing attention
during the lull in the winter and spring and again after the signing of the
armistice.  The Preventive Medicine Association served as adviser to the
Korean School of Public Health, giving assistance in planning curricula and
providing lecturers from its own members and its visiting experts.  A
preventive medicine section was set up within the United States Military
Advisory Group to assist the ROK Army.  Members of the Korean Service Corps
were surveyed in some divisions for tuberculosis, though the results at year's
end were termed inconclusive.  The prevalence of rabies in Korea's animal
population - rabid animals had bitten about a hundred U.S. soldiers during
1953 - led to an intensive program to immunize pets acquired by military
personnel.  Efforts to improve animal health apparently were due largely to
civil assistance officers.  Work with and for the Koreans would increase
greatly after the armistice, but the final months of the 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
medical care was the activation of the 30th Medical Group on 25 March 1953. By
early June this subordinate command had taken charge of the surgical
hospitals, the separate medical battalions, the 1st Medical Field Laboratory,
and an array of small units of company, dispensary, and detachment size.  Its
fundamental mission was to coordinate the operations of units providing
third-echelon support to the Eighth Army, and this comprehended evacuation;
initial hospitalization; and area medical service, including dental care.

     As the largest medical field command ever assembled by the Army, up to
the Korean War, the 30th Medical Group unified under a single headquarters
evacuation and area medical service, previously the domain of the 163rd
Medical Battalion.  Fixed-wing aircraft and the two Eighth Army evacuation
hospitals remained outside its jurisdiction.  Like the 52nd Medical Battalion,
which was attached to the medical group, the 30th's function was not to fix
policy - that remained the concern of the Eighth Army surgeon, General Ginn -
but to act as his executive agency, a sort of Eighth Army medical command.
The group represented the third stage in defining the relationship between the
Eighth Army surgeon and the field units.  Colonel Dovell, patching together
his jerry-built service in the early days of the war, had simply run
everything himself, as far as possible.  Colonel Page, a somewhat shadowy
figure between Dovell and Ginn, apparently made few changes.  But the
increasing number of diverse units compelled action, and Ginn gave the 52nd
the functions of a group while he embarked on the bureaucratic ordeal of
getting the larger headquarters he needed onto his troop list.  Whether, with
the creation of the KCOMZ and the winding down of the war, the group was as
necessary in mid-1953 as it had been a year earlier is another question.
Fully functional for only seven weeks before the armistice, the group saw
plenty of action, for its brief wartime span coincided with almost continuous
enemy assaults.

     Under the group another new unit appeared in June with the creation of
the 1st Helicopter Ambulance Company (Provisional) to provide a command
structure for the isolated medevac detachments.  This innovation completed a
process begun in December 1952, when the 49th, 50th, and 52nd Medical
Detachments (Helicopter Ambulance) replaced the three functioning helicopter
evacuation units.  With this change the helicopter evacuation detachments
formally became medical outfits, a part of the medical troop list, under
tables of organization and equipment (T/O&Es).  In February 1953 the three
detachments were combined with a fourth unit, the 37th Medical Detachment
(Helicopter Ambulance) and two paper units, the 54th and 56th, to form the new
provisional company.  Beyond all question, dedicated medical aircraft were now
a reality, though proposals to bring small fixed-wing planes into the company
did not materialize.  Because training of Medical Service Corps officers as
helicopter pilots had begun the previous autumn in the United States, the
future of the medevac chopper as a true ambulance staffed and controlled by
trained paramedics was clearly indicated, though no Medical Service Corps
officer flew a helicopter in Korea before the end of the war.

     By now both the power and the current limitations of the helicopter had
become fairly clear.  Though the figures are at best uncertain, it appears
that medevac helicopters carried 5,040 casualties during the first twelve
months of operation (January-December 1951); 7,923 during the second year
(January-December 1952); and 4,735 during the last seven months of the war.
Assuming that the twelve assigned machines were available throughout, a
statistical convenience in view of the shortage of helicopters and the
maintenance problems that put them into the shops six hours for every one in
the air, each craft carried an average of about 1.5 casualties per day. During
1951, a year for which total hours of flying time are available, the medevac
helicopter was in the air about one hour and fifteen minutes on an average
day.  Recognizing that nonmedical machines carried many patients unrecorded,
the available figures suggest that medical helicopters carried between 3.5 and
4 percent of the 443,163 hospital admissions recorded for all causes.

     Of the helicopter's effectiveness in saving the lives of the seriously
over-wounded, no more needs to be said here.  A specialized vehicle of high
cost and limited effectiveness, the medevac chopper won its fame as an
evacuation vehicle under conditions that were unique to the Korean War.  As a
wealthy nation that admired technical innovation and placed a high value on
individual life, the United States was well fitted to finance such a
pioneering effort. Preexisting medical skills of a high order were necessary
to make the trial a success, for only a medical service of great
sophistication could have dealt competently with the massive and near fatal
injuries that were the helicopter's specialty.  The endeavor was not
militarily significant, but it boosted morale by demonstrating that, against
all purely material considerations, the nation intended to save every possible
life.  The typically high-cost, low-yield experimental period during the
Korean War proved the potential of a vehicle whose future impact on all
emergency medicine, both military and civilian, would be great indeed.

     Meanwhile, the helicopter's partner, the MASH, assumed its final form of
the 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 the changeover from the table of distribution strength to T/O&E
size and makeup for the surgical hospitals.  In the following months the MASHs
underwent two changes in nomenclature as well.  On 2 February, for example,
the 8225th MASH was formally discontinued and the 47th Mobile Army Surgical
Hospital activated, only to be redesignated on 25 March as the 47th Surgical
Hospital (Mobile Army).  Despite these vicissitudes, everyone continued to
call the surgical hospital a MASH.

     Yet the changeover did not go unchallenged.  The USAFFE surgical
consultant, for one, bitterly opposed General Ginn's plan on the grounds that
the clearing stations were unequipped to perform surgery.  But in the end the
Eighth Army surgeon had his way.  Already in the fall of 1952 the MASHs
supporting Operation SHOWDOWN had begun to receive only nontransportable
cases.  In February 1953 Ginn issued a standard operating procedure defining
the types of surgery to be performed in the clearing stations - in essence,
minor operations that did not involve fractures of the long bones, penetrating
wounds of the peritoneal or pleural cavities, major nerves, or the brain.  He
defined surgical principles and techniques for clearing stations and surgical
and evacuation hospitals in order to standardize, as far as possible, what
each level would contribute to the care of the patient.

[See Fitting a Cast: Medics at the 47th Surgical Hospital Fitting a Cast.]

     For several reasons, however, the surgical hospital still was not located
adjacent 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 improved
ground transport combined to make this possible, but rotation made it
desirable.  MASH personnel received credit for only two constructive months
instead of three, as they would have in division areas, an essential move to
slow the turnover among their often decimated staffs.

     In divisional medical battalions the old pattern continued of rotating
off the line to rest areas, back on the line to replace another unit.
Customary complaints followed any move.  The new location, if previously
occupied by another unit, usually was described as a mess.  As cleanup and
beautification proceeded, a rise in morale was recorded.  Medical work was
partly traditional, partly a creation of Ginn's new policies.  In the clearing
station, seasonal diseases came and went like the flowers of spring: upper
respiratory infections during cold weather and hemorrhagic fever in its
familiar two-humped pattern.  Typical for 1953 was the experience of the 3rd
Medical Battalion, 3rd Infantry Division.  Beginning the year in reserve, the
division relieved the 25th Infantry Division late in January and the medical
battalion moved forward a few days later.  In line with Ginn's policy it
operated a consolidated clearing station with a 55-bed medical ward and 25-bed
surgical ward, plus an admissions and dispositions section.  It evacuated to
the 44th Surgical Hospital (Mobile Army).  Seasonal maladies brought a sharp
rise in admissions during April, including 8 cases of suspected hemorrhagic
fever.  In June patrolling and probing gave way to fierce fighting as the
enemy attacked the division sector.  A total of 918 battle casualties flooded
in, and the clearing station recorded 198 surgical procedures.

     The 115th Medical Battalion, 40th Infantry Division, encountered heavy
action during enemy attacks in May and June, not only supporting its own
division but aiding the overtaxed medics of the ROK 12th Division.  During the
crisis the 45th Surgical Hospital (Mobile Army) sent a surgical team, which
set up in a hospital tent about a mile south of the clearing station. Facing
augmented responsibilities, an increased number of units to support, and an
enemy assault, the battalion operated at about 75 percent of its assigned
strength; only two of its three clearing platoons could be manned, and the
ambulance company did not have enough drivers to use all the vehicles.  The
unit traded support with other battalions.  The 115th took care of the 3rd
Division artillery that was firing in support of the 40th Division, while, for
a time during June, some casualties were evacuated to the clearing station of
the 45th Infantry Division to save an hour's ride. Despite the pressure, the
medical battalions seem to have liked the additional responsibility they had
acquired under Ginn's system.  A medical battalion," noted the commander of
the 115th, "is capable of rendering medical service far beyond its designed
capacity without overtaxing its facilities or disrupting 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
hit Turkish and American outposts at the end of May and June.  The unrelenting
pressure forced minor withdrawals of U.N. forces.  In June the main enemy
drive shifted to the ROK Army lines in the east, with the 3rd Division
receiving its share of the fighting.  Then on 18 June President Rhee of South
Korea, in an attempt to disrupt armistice negotiations that threatened to
leave his nation permanently divided, ordered his forces guarding
nonrepatriate prisoners of war (POWs) to allow a mass escape.  Now the Chinese
prepared a massive assault seemingly aimed at convincing the South Koreans
that they could not hope to fight on alone.  Meanwhile, other attacks on U.S.
held salients enabled the Chinese to improve their position at severe cost.
The last attacks in mid-July pierced the ROK Army lines and compelled the
United Nations Command to move forces from Japan to bolster the Koreans.

     Thus the battalions, the hospitals, and the medical group had ample
opportunity to gain new combat experience.  As the ROK Army medical service
became overburdened, evacuees were diverted into American channels.  A new
kind 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 of 1953.  Large machines intended to provide short-haul transport for
men and supplies, the H-19's were under the control of transportation
companies but carried wounded on return flights.  Despite the fact that
evacuation was only a secondary mission, the 6th Transportation Company
carried 701 casualties between March and the end of the fighting in July, and
the 13th Transportation Company 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 fact that the wounded could receive medical
attention in flight, which was difficult at best in the little H-13's where
patients were carried outside on litter racks. This was an innovation whose
significance to future medevac missions transcended 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
breakthroughs toward peace.  In the United States a new administration warned
of severe consequences, including the possible use of nuclear weapons, if the
Communist nations did not agree to end the conflict.  In the Soviet Union the
death of Joseph Stalin in March signaled a power struggle over the succession.
Under the circumstances 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 to agree to U.N. proposals for the exchange of sick and wounded POWs.
As worked out between the negotiators, the United Nations was to return 700
Chinese and 5,100 Koreans, or 4.5 percent of the 132,000 prisoners then in its
custody, and the Communists 450 Korean and 150 non-Korean POWs, or 5 percent
of the 12,000 men whom they held.  The agreement provided for the exchange to
take place at Panmunjom and allowed the Communists to move the wounded 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 in
mid-1951 provoked the first efforts.  The Far East Command had decided then to
evacuate all prisoners to Japan through medical channels and, after
processing, by airlift to the United States.  The subsequent course of the
truce talks did little to encourage hopes that either plans or planes would
soon be needed.  The first look at the problem did, however, identify the
basic aims of the medical processing: to detect the prisoners' physical
problems in order to provide proper treatment; to prevent the spread of
communicable diseases from former POWs to others in Japan and the United
States; to accumulate medical data for future analysis; and to provide a
permanent record of the individual returnees medical condition for his own and
the government's future protection in event of claims. Plans were, according
to the command "drafted, revised and redrafted" and conferences were held "at
which myriad problems were discussed."  How much all this bureaucratic buzzing
had to do with the ultimate welfare of the prisoners remains unclear.

[See Ward 236: Ward 236 at Tokyo Army Hospital Annex, where staff and ward
attendants await returnees.]

     Activity continued during 1952.  Despite the lack of any clear idea of
how many prisoners might still be alive in Communist hands, analyses continued
on such questions as how many spaces on airlift planes should be allotted to
them.  A detailed plan based on the 1951 discussions was prepared, submitted,
and approved.  International Red Cross teams joined in devising schemes for
properly feeding the returnees, and the round of conferences on the subject
continued at the Far East Command among its staff sections, the technical
services, the Air Force, various medical services, the Plans and Operations
Division, and the Medical Section's Preventive Medicine Division.  Under these
circumstances the extremely small numbers of returnees promised by the
Communists - most U.N. POWs had been captured between July 1950 and July 1951
and most of the wounded had either recovered or died - gave the operation
dubbed LITTLE SWITCH the look of a barrage of organized compassion aimed at a
mouse.  Some 2,248 quarts of reconstituted milk were flown in to provide
milkshakes, and the 45th Surgical and 121st Evacuation Hospitals set up to
treat the wounded.  In Japan the Tokyo Army Hospital and the United States
Army Hospital, 8167th Army Unit, were designated to receive the non-Koreans.
The H-19 cargo helicopters stood by to fly the POWs from the reception point,
Freedom Village at Munsan, to the airport at Seoul.  A horde of interrogators
and counterintelligence agents waited, with a larger horde of newsmen.

     By 20 April, the day fixed for the opening of LITTLE SWITCH, the
following situation existed.  A KCOMZ medical team waited at Panmunjom. Three
ambulance companies were ready to evacuate the first POWs to Freedom Village,
15 miles down the Munsan road, where a processing center staffed by marines
was set 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 landing pad at the south end of the hospital the first H-19 helicopter
waited to carry patients onward to the 121st Evacuation Hospital at
Yongdung-po, where guards, litterbearers, and ambulances stood ready to rush
patients to treatment.  At Yongdung-po, as at Freedom Village, adjutant
general personnel prepared to process the returned soldiers and
counterintelligence agents to screen them from unauthorized contacts with the
press, to fingerprint them, and to confirm their identities.

     Into this situation walked, or were carried, the first "packet" of fifty
prisoners at 0600.  Processing and loading at Panmunjom took about forty-five
minutes.  Because their condition was better than expected, the medical team
at the exchange site took only the litter patients, four in number, and placed
a call for the H-13's to pick them up.  Eight ambulances left for Freedom
Village with the rest.  In Munsan the ambulances carrying ROK Army patients
turned off to the ROK 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 Ginn
and the Eighth Army commander, General Maxwell D. Taylor - were on hand to
meet each helicopter with the litter patients.  Other dignitaries from USAFFE
and the Eighth Army command milled about as well.  After arriving at the
Freedom Village processing center, returnees who could walk had their first
physicals and then had their identities verified.  Chaplains provided
spiritual comfort.  When they passed on to the 45th, the men filled out new
medical forms and underwent thorough physicals.  They then were led in sixes
to the landing pad, where they boarded helicopters, and twenty-two minutes
later they arrived at the 121st Evacuation Hospital.  The men already had
changed clothes once, from new attire the Communists had issued them in
anticipation of their release to fresh dress uniforms (ODs).  Now they doffed
their ODs, put on pajamas, and took another physical.  Adjutant general and
counterintelligence personnel took over again, doing new records checks and
reconfirming identities.  A few returnees had had brief interviews with the
press at Freedom Village, but most were held incommunicado to prevent leaks of
any useful information they might have about the enemy.  In some cases agents
went so far as to accompany them to the showers.  Even their diet gave
evidence of a somewhat excessive concern, for it was served without salt,
apparently in the belief that salt would increase the nutritional edema that
they were expected to have. Fortunately, most appear to have spent only
thirty-six hours in processing before their planes left for Japan.

     In plain fact, the medical aspect of LITTLE SWITCH was a dull affair.
Everything went smoothly, and even giving the men three physicals and forcing
sequential changes of attire upon them did not suffice to keep the medical
personnel busy.  Initial evaluations showed the POWs to be in better shape
than expected, and the work resolved itself into routine poking and prodding
and the filling out of forms.  The process was tedious, and some surgeons,
finding nothing to do, departed.  The emergency team at Panmunjom was almost
without a job.  In the midst of this overproduced affair the prisoners
themselves impressed most of their interviewers as stolid, except for their
enthusiasm for food.  The curiously "flattened" personalities of those
imprisoned for an extended period were noted; these men answered when spoken
to, volunteered nothing, and showed little emotion.  Men more recently
captured retained their natural spontaneity, reacting emotionally to the
sudden release of tension after doubts that had continued almost up to the
last moment as to whether or not their captors actually would release them.
The old hands continued to act as they had learned to do in order to survive,
going through the routine like sleepwalkers not yet awakened.

     In Tokyo the interrogations got serious.  With no medical personnel among
the returnees, medical intelligence was necessarily limited.  The Far East
Command's G-2 (intelligence), however, had many questions.  Sessions ran from
before breakfast until after supper during the returnees' whole stay in Tokyo.
Different intelligence teams had failed to coordinate their questions, and as
a result the men were asked many of the same questions over and over.  The
similarity between this process and what the men had experienced during their
captivity provoked resentment, increasing uncommunicativeness, and suspicion
as the process wore on.  At the same time, new and even more thorough medical
testing proceeded for the seven to ten days that they lingered in the Japanese
capital.  The 147 Americans who passed through this gauntlet showed, on the
whole, surprisingly good health.  Weight loss was great, ranging from 18 to 46
pounds depending on build, and about 38 percent had parasites of one kind or
another.  But few had tuberculosis or malaria, and 8 out of 10 were rated as
showing good mental health and morale.  Only about 1 percent was diagnosed
psychotic.  As with recovered prisoners of the Japanese during World War II,
the stresses of captivity would show up for many only after a lapse of time.

[See Greeting Returnee: Greeting a Little Switch Returnee at Tachikawa Air
Base.]

     The contrary movement of Communist POWs from the hospitals to Panmunjom
was a far noisier and more exciting affair for all concerned.  To quell new
demonstrations as they broke out, guards warned the POWs that they would lose
their chance of repatriation.  Prisoners riding from the island camps to
landing craft for transport to the mainland threw away their rations of soap
and tooth powder and tossed away cigarette packs containing hand-printed
messages that accused the United Nations Command of "barbarous acts."' Some
went on hunger strikes; many mutilated their clothing to make themselves look
maltreated.  On the whole, the command - and especially the prison hospitals -
benefited by the departure of the 6,670 sick and wounded prisoners.  The gain
of 684 assorted U.N. POWs in return may have saved some lives, but the
exchange was most important as the first firm step on the road to peace.

[See Enemies Leaving: Enemy captives going home.]

Operation BIG SWITCH

     In accepting the United Nation's call for an exchange of wounded POWs,
the enemy also had suggested that the larger prisoner-of-war issue might be
resolved.  A few days after the 28 March breakthrough, Chinese Foreign
Minister Chou En-lai amplified his first delphic proposal by suggesting that
nonrepatriates be turned over for a time to a neutral state to ensure that
coercion played no part in their decision not to return home.  The
negotiations, which had lapsed in October 1952, began again on 26 April 1953.
By the middle of June - when negotiators had ironed out all essential
disagreements, when the neutrals had forwarded their acceptances, and when
staff officers had defined the limits of the Demilitarized Zone that was to
separate the armies (see Map 9)-the Chinese 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
released the Korean nonrepatriates, to sound a warning to the South Korean
government.  Thus almost until the last moment, the armies exchanged blows and
wounded flowed as before through the medical system. Only in the week before
the armistice was signed on 27 July did the fighting wind down.  Then followed
a great movement of prisoners - repatriates toward home and nonrepatriates
toward the Demilitarized Zone for the period of internment and second thoughts
allowed by the armistice document. Americans called the return of their own
men Operation BIG SWITCH.

     Modeled on Operation LITTLE SWITCH, the new exchange went about as
smoothly and with considerably less disproportion between the numbers of
returnees and of those assembled to receive them.  The H-19's, having proved
themselves, were called upon once again and performed excellently, moving nine
times as many people in seven times as many hours as before.  All the returned
prisoners were bathed, deloused, and vaccinated against smallpox. One thing
that immediately became clear was that not all the sick and wounded had
returned during LITTLE SWITCH.  Some new returnees arrived with such patent
conditions as chronic coughs, amputations, amebiasis, mental illness,
epilepsy, cold injury, and malaria.  Some of them believed that the Communists
had chosen the "progressives," whether sick or well, to go first.

     The stream of men divided, the healthy parting from the sick.  American
POWs who were well enough were flown by helicopter to Inchon, where they
boarded ships for home.  Those who required emergency treatment were flown to
Japan, where they underwent a week to ten days of medical processing like that
of the LITTLE SWITCH returnees.  A total of 438 POWs, of whom 345 were
soldiers, were judged in sufficiently serious condition to warrant immediate
return to the zone of interior.  The rest joined other returning ex-prisoners
and rotating troops on troopships or hospital ships. (On the former, patients
were treated in sick bay.)  Accompanying the returnees were USAFFE medical
teams - sixteen officers and sixty-two enlisted men for a troopship, 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
those who had not undergone their experiences would not understand them. But
the factions of the prison camps endured also, the "progressives" keeping
themselves apart while providing interested psychiatrists with voluble
explanations of their conduct.  There were some fistfights between those who
had gone too far along the road marked out by former captors and those who had
resisted, but apparently no very serious clashes.

     As the process went forward, interrogators recorded in casual fashion a
cross section of the varied POW experience.  Many men named as their chief
physical problem during captivity the pervasive dysentery and gastric
complaints caused by coarse and unfamiliar food.  "Stomach trouble right
along," said one, "rough chow had tore my insides."  Most had received medical
care from their captors, though it was often crude and unskillfully applied.
Of those who were treated with acupuncture, a few seemed uncertain whether
this was a form of medicine or an oriental torture.)  Exercise and recreation
had been surprisingly abundant 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 nine hours and put to hard labor because of his "hostile attitude toward
the Chinese Peoples Volunteers."  Those who attempted escape spent months in
"the Hole," typically a cold bare room with "unplaned knotted floor."  A young
airman recalled that "the most common form of punishment for breaking camp
rules was standing at attention for hours.  In the winter time punishment
might be standing at attention in your bare feet upon a cake of ice and
holding a snowball in each hand."

     Some appeared to have gone through their ordeal without injury and with
little inner turmoil, like the sergeant who "made no escape attempts, got into
no fights and had no special punishments."  In this case indoctrination "went
in one ear and out the other."  A black GI underwent "considerable
indoctrination" but said the appeals emphasizing American racism had little
influence on him because he was "pissed off" at the treatment he had received
from the Chinese.  Men of the most varied experiences, however, reported one
reaction in common:  Many had cried at Freedom Village.

     Once in the United States, patients needing immediate specialized
treatment followed men from LITTLE SWITCH into Army hospitals.  As many as
possible were placed on leave.  Those neither in a dangerous condition nor
well enough to visit their homes at once were sent to the hospital nearest
home, where their families and friends could visit them.  Hawaiians went to
the Tripler Army Hospital, Filipinos to Manila, and Canadians to the Madigan
Army Hospital for transfer to their own country.  Of the BIG SWITCH returnees
4 percent showed signs of tuberculosis, about 2 percent had malaria, 16
percent were suffering from malnutrition, and less than 3 percent were
neuropsychiatric casualties.  None had any other major infectious diseases,
for which the systematic inoculations introduced by the Chinese in 1952
probably must be credited.  The lack of serious malnutrition cases reflected
the better diet that most had received during 1953.  The overall physical
condition of the U.N. POWs who survived can be summed up as not too bad,
everything considered.

     The worst consequences of captivity for most surfaced only after a lapse
of time.  Though the concept of posttraumatic stress disorder had not yet
received clinical formulation, the experiences of many former Korean POWs
resembled those of World War II survivors of Japanese prison camps.  In some
respects they were worse.  For years after the war former prisoners showed
higher death rates than other veterans of the fighting.  The degree of stress
during imprisonment directly correlated to later death, which resulted most
commonly from accident, suicide, or homicide.  Persistent psychiatric sequelae
were noted, including schizophrenia.  Nutritional deficiencies endured during
captivity showed up later as an apparently permanent susceptibility to
tuberculosis and to other infectious and parasitic disorders.

     Complicating a difficult homecoming for POWs were attacks by their own
countrymen.  Arguing that Americans had become too soft and slack to meet the
challenge of Communist aggression, energetic charlatans of many stripes spread
the legend that American prisoners during the Korean War had been uniquely
spiritless, dying without cause and yielding without reason to enemy
pressures.  Men who already had suffered much faced an ordeal at the hands of
some fellow Americans, which contrasted sharply with the lavish care that had
attended their release.

After the Battle

     As the guns fell silent, peace came to the Medical Service in varied and
sometimes paradoxical ways.  At the hospitals of the 30th Medical Group only a
temporary decrease in admissions was noted.  Instead of hurriedly giving
emergency treatment and evacuating the wounded, the surgeons at the forward
hospitals screened personnel in the units they served to locate those who were
in need of elective procedures - correction of hernias or hemorrhoids,
circumcisions, and so forth.  In the more relaxed atmosphere of the postwar
hospitals, patients already on hand also were treated for retained foreign
bodies and the like.  Hence, the impact of peace showed most noticeably in
reduced evacuations rather than in a declining hospital census.  In the 2nd
Infantry Division, Medical Corps officers moved out of the aid stations, which
Medical Service Corps officers now could handle adequately.  Training
increased, with refresher courses taking the place of the wartime influx of
wounded in reminding Medical Service personnel of the basics of their
profession.

     A major innovation for improving the skills of enlisted medics was the
establishment under the 30th Medical Group of the Eighth Army Medical Training
Center, located immediately to the rear of the IX Corps area at Chongpyong-ni.
The first class opened on 26 October 1953 and soon specialized training was
under way on a three- to four-week cycle for aidmen, corpsmen, and technicians
of various types.  Classes were small, most of the instructors medical
officers from the 30th Medical Group, though two Medical Service Corps
officers and two Army nurses were on the faculty.  Bivouac and unit training
accompanied classwork, providing a well-rounded curriculum of theoretical and
field instruction.

     Other signs of the times included a construction program during the
second half of the year aimed at replacing tents with semipermanent buildings,
both in hospitals and in troop quarters.  Men and women who still had to live
in winterized tents, however, found the 1953-54 season relatively mild.  The
troops fared well, and no particular problems arose in keeping them healthy
through the cold season.  To care for nonrepatriated POWs in the Demilitarized
Zone pending their final disposition, the KCOMZ transferred four medical units
to the Eighth Army - one field hospital, one clearing company, one veterinary
food inspection detachment, and one ambulance detachment.  Meanwhile, the
Prisoner of War Command closed up shop, shifting its dispensaries to Korea
Base Section and inactivating the remainder if its units.  As in the forward
areas, training activities increased to fill empty time and keep a cutting
edge on the skills of the troops.

     Organized aid to the Koreans as they sought to reconstruct their country
developed during the same period under the Armed Forces Assistance to Korea
Program.  Eighth Army medical units sponsored construction projects and sent
Army medical personnel into Korean civil and military hospitals to assist in
the care of patients and to aid in the training of doctors and nurses.  At the
same time, under orders from USAFFE headquarters, Korean health personnel were
brought into Eighth Army hospitals for training and civilian patients admitted
for treatment.  One evacuation hospital reported that it was aiding about a
thousand civilians a month in various ways and that its personnel additionally
were providing aid and support to an orphanage for refugee children.  At
Christmas 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 of socks and rubber shoes went to every child, plus games; candy,
dolls, and balloons.  Two days later the orphans reciprocated, presenting a
dance and music show at the hospital for patients and staff that earned the
small entertainers candy and oranges, and for all the children new gifts sent
by the fire department of Spokane, Washington.  Typical of many such efforts
by American units, the work of the 11th Evacuation Hospital was practical and
useful, but the oranges and gifts probably remained longest in the memories of
the children.

     At higher headquarters, signs of the changeover to peace were varied:
increased indiscipline and violence among idle troops; a temporary
overstrength in 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 major units from the Far East Command.  Like the planning for
the prisoner exchange, plans for the postwar drawdown went back to the days of
1951, when the truce talks were new and peace had seemed close at hand.
Planning continued in more elaborate fashion during 1952 and became a large
part of the work of the Plans and Operations Division at USAFFE in the
following year.  Though the nature of the armistice inclined the cautious to
delay major deployments until the completion of a less tentative settlement,
readjustments began at the end of the summer.  One convalescent hospital was
closed, operating beds were reduced from a bit over ten thousands to about
eighty-six hundred throughout the command, and a portion of the Tokyo Army
Hospital was shut down.  However, the armed peace that had come to Korea did
not encourage hasty action, and USAFFE did not contemplate reducing the
hospitals available to the military in Korea, where they might be needed at
any time. The Korean Civil Assistance Command, the Republic of Korea, and the
Japanese government all had their eyes on American military hospitals, but no
general transfer of facilities occurred in 1953, and the year ended with the
medical establishment largely in a holding pattern."

     Overall, the post-Korean War Medical Service began to show a marked
similarity to the earlier postwar period of 1945-50, though maintenance of the
general draft ensured that personnel levels would not again sink so low.  The
doctor draft resulted in an overstrength in medical officers during the
July-September quarter in 1953.  The American Medical Association complained,
and the old problem of underuse of doctors again alarmed the Office of the
Surgeon General.  Similarly, the influx of many board-qualified or
board-certified specialists raised the usual difficulties in assigning them to
posts that were suitable to their skills.  Personnel losses in the Medical
Service Corps and Army Nurse Corps resulted in a lower authorization from the
Army's G-l (personnel), with line officer benefiting from the transfer of two
hundred to three hundred slots that the Medical Service could not fill anyway.
Analysis suggested that about one-third of the Medical Service Corps would
turn over during fiscal 1954, and hospital commanders in the zone of interior
were urged to "get any really capable warrant officer or enlisted man" to
apply for a commission, because civilian college graduates who agreed to join
probably would leave after fulfilling their minimum time of service.  In
searching for nurses the old litany of expedients was drawn up again, with
complaints from nurses already serving about work load, nonprofessional
duties, and, above all, the length of overseas tours and the wish of many to
marry and accompany husbands.  While standing firm against commissioning male
nurses in the Regular Army, the surgeon general backed the notion of offering
such men reserve commissions, but the year ended with Congress' views still
uncertain.

     As the draft calls fell and the emergency passed into the uneasy peace of
the central Cold War, the problem of getting sufficient doctors for the Army
again appeared, with all its customary train of subsidies, appeals, and
administrative tours de force.  Plans for scholarships, affiliated units,
hiring of contract physicians, and the use of civilian consultants as
emissaries to the civil profession of medicine all continued as in the past,
or resumed shortly.  Existing Regular Army slots could not be filled; about
two-thirds of the Medical Corps consisted of 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 of the past:"One of the most
serious matters facing the Army today is the problem of providing an adequate
medical service.  The crux of this problem is the critical shortage of Medical
Corps officers.

     Another difficulty resulted from a decision of the secretary of defense
in May 1953 to prescribe a ceiling for the armed forces of 3 doctors per 1,000
troop strength.  This rigid requirement did not become fully operative until
mid-1954 and thus did not affect the Korean War.  It was, however, a new
source of old woes 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 number of units and their makeup and distribution, the number of
dependents, and the number of hospitals and their size were some of the
elements that determined the true needs of the services.  The new rule, which
the Department of Defense adopted in response to pressure emanating from the
White House, may properly be termed a political decision.  In setting up the
doctor draft, Congress had provided for the creation of a Health Resources
Advisory Committee in the Executive Office of the President to enable civil
medicine to influence draft policy. At a time when the president of the
American Medical Association warned that the United States had "25% more
practicing physicians in proportion to population than any other country in
the world," and that physicians were increasing faster than the population,
the advisory committee wrote a presidential assistant to ask that the number
of military physicians be reduced.  The "continuing withdrawal of physicians
for military duty," it warned, was having 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 of language difficulties."  The committee also
pointed out, in what probably was the true crux of the matter, that exhaustion
of the former Army Specialized Training Program graduates and other younger
physicians might soon require older men with established practices to serve.
It therefore recommended the 3 to 1,000 ratio, a suggestion that the Defense
Department was quick to adopt.

     The difficulties of the post-Korean War Medical Service were much the
same as in the past.  The United States continued to offer its doctors
monetary rewards, specialized training, personal distinction, and - above all
- ideals of individual freedom and choice, which were beyond the ability of
the Army to match.  Even with a draft in place, the civilian profession fought
for the retention in service of the smallest number of physicians deemed
capable of doing the job, and the Medical Service, among an abundance of
talent and training without equal in any other society in the world, provided
for the Army with whatever it could get.  Plus ca change.

Civil Assistance Revisited

     Meanwhile, the emergence of the new-model Korean Civil Assistance Command
(KCAC) signaled a major shift from emergency relief to reconstruction for the
battered Republic.  Here, as in the days of the fighting, much of the work to
be done was medical.  The United Nations Command's economic coordinator, C.
Tyler Wood, decided to avoid excessive duplication of effort in Korean relief
and divided responsibilities for specific fields between KCAC and the United
Nations Reconstruction Agency (UNKRA).  The Army command received the Korean
public health program as its bailiwick and thereafter functioned as the
operating agency, regardless of the source of funding.  The command's Public
Health Branch under Col. James P. Pappas continued to work with the mixed
staff of civilian and military personnel and American and U.N. experts
gathered under its predecessor, the United Nations Civil Assistance Command,
Korea (UNCACK).  But now the branch could use the funds it received from an
array of sources - from Civil Relief in Korea (CRIK), from Washington's newly
established Foreign Operations Administration, from UNKRA, and from direct
military support - for the long-term rehabilitation of Korea's medical and
health system.

     The new approach represented a considerable broadening of the wartime
goal of preventing disease and unrest.  Tyler Wood emphasized that the new
approach featured the transformation of Korea not only into a military bastion
but also into a showcase of progress for the American-led anti-Communist
coalition:


We have an opportunity in our work in Korea on the economic side to affect the
situation in this struggle between the free world and the communist world, not
only in Korea, but certainly throughout the Far East.  I would make bold to
say, throughout the world.  The two systems are facing each other on trial
here.  If we can show, in cooperation with the brave people of South Korea,
who have already proved their courage on the battlefield, 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 our
system and our freedom, it seems to me it will not only have a real effect in
South Korea, but throughout the Far East.


     Corollary to the ideological thrust was a practical objective - enabling
the Koreans, by developing a modern economy, to reduce American subsidies and
to take on the burden of their own defense.  The contrast with the situation
in 1945-48 was striking.  Then the Army had struggled with insufficient means
in a backward nation that had been spared the worst ravages of war.  Now, with
thirty-three thousand dead invested in South Korea's freedom, and with the
Cold War deeply embittered by the blood shed there, the United States and its
allies in the United Nations were ready to supply more adequate means in order
to advance the continuing world struggle.  These too were consequences of the
war that had destroyed the nation's modest advances, killing several million
of its people and laying waste much of the physical substructure of
civilization.

     The end of the fighting made more military personnel available for civil
relief and especially aided the Public Health Branch, where, in the days of
UNCACK, extreme shortages were the rule.  KCAC, however, retained the
international flavor of the earlier effort.  UNKRA doctors headed the
preventive medicine, medical care, nursing, and environmental sanitation
sections and all the field teams that assisted the various provincial
governments.

     The conditions faced by these men and women - women filled all the nurses
slots, one physician's slot and also served as secretaries, typists, and
administrative assistants - remained difficult even though the war had ended.
Public health competed within the South Korean government for limited funds
against a host of other, and apparently more urgent, needs for defense and
reconstruction.  For fiscal year 1954 the nation's total public health budget
was $3.5 million, or about $0.16 per capita, as against $0.50 to $0.75
recommended by outside experts and the World Health Organization.  The subsidy
in kind embodied in CRIK medical supplies left a deficit of several million
dollars between appropriations and need and provided no assistance to the
starveling salaries of Korean 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 official corruption, such pay scales also ensured that abler
people would evade government service. Doctors, for example, continued to
migrate to the large cities where a physician reportedly could earn in a day
ten times what a government official took home in a month.

     Essential tools of public health management, if they had ever existed,
vanished 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 the United States, ruled that "no cognizance [should] be taken of these
data."  Most of the meager funds available were spent on the care of lepers -
probably a reflection of the interest traditionally felt by Christian
missionaries in this biblical plague - and of war casualties.  Yet the country
established its first school 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 demand for health services ranged far ahead of the
government's ability to provide them.

     The thrust of KCAC endeavors was necessarily varied in a situation where
very little was adequate and, in consequence, where everything must be done at
once.  However, the endeavor to control disease and upgrade health care and
the medical professions were certainly basic.  Among the major diseases,
smallpox remained endemic and had become largely a disease of childhood.  The
across-the-board vaccination campaign among refugees therefore gave way to a
concentrated effort to immunize the young.  Using CRIK-bought vaccine, South
Korean personnel carried out five million vaccinations in the last quarter of
1953.  Plans called for administering two million additional doses during the
first half of 1954 and, in the spring and fall, regular boosters to
preschoolers who were the last large susceptible group in the country.  South
Korean government and KCAC-UNCACK figures differed widely, with the latter
reporting that 1953 had seen both the incidence of smallpox more than double
the 1952 rate and the number of deaths rise from 251 to 470.  Either statistic
was a far cry from the epidemics of 1951, when UNCACK had estimated over 5,000
deaths and the South Korean Ministry of Health nearly 12,000.  The first
months of peace suggested the possibility of a future Korea that would be
substantially free of the illness, like other modern nations.

     With improved water supplies, immunization and health education, typhoid
and paratyphoid continued to fall during 1953, when only 79 deaths were
recorded by KCAC and 333 by the South Korean government.  The number of deaths
from diphtheria was low for the year, at 43 nationwide, but parental
resistance, for obscure reasons, made it less easy to inoculate children
against this disease than against smallpox.  Malaria was a particularly
difficult question.  It was not a reportable disease, and the almost 14,000
cases and 2 deaths reported by KCAC probably had little or nothing to do with
its actual prevalence.  No dependable data were available on dysentery,
either, though the command noted 19 deaths and over 8,000 reported cases.

     Above all, tuberculosis remained a statistical enigma.  Some 6 percent of
the population were believed to have the illness in more or less serious form,
nearly 1.3 million people in all.  Budgetary constraints made the increase of
hospital beds for tuberculosis patients slow, and the operations of the Korean
draft and lack of money to pay workers disrupted a program to inoculate the
young.  But 1953 at least saw an apparent breakthrough in public interest.
The ROK Army made plans to X-ray its troops and screen recruits, and the South
Korean government established a National Tuberculosis Association to raise
funds for public education and a pilot control center.  CRIK funds bought
Japanese-made tuberculin for a thorough study in Pusan orphanages carried out
by the Swedish Red Cross Hospital. (Almost 16 percent of the children tested
had active tuberculosis.)  The year's work seemed to point toward a more
systematic approach to a problem whose solution, if any, still lay in the
distant future.

     Programs to improve care included CRIK and UNICEF contributions to
maternal and child health care programs; supplying additional equipment to
national, provincial, and city laboratories; enforcement of quarantine
regulations upon American and U.N. nations ships by the Korea Base Section
surgeon; and aid to the National Vaccine Laboratory by the 406th Medical
General Laboratory in Japan.  The Italian Red Cross Hospital at Yongdung-po
continued to function as the only U.N. forces hospital under KCAC, caring for
thousands of civilian patients during 1953.  KCAC also assisted voluntary
agencies that had taken an interest in Korean relief - religious groups, the
International Red Cross, the American-Korean Foundation.  It sought to upgrade
medical education and to bring nursing education back into the path of
systematic professional improvement that was under way during 1945-50.
Extending the list of KCAC endeavors only would underline the point that many
improvements had to be made at once and that supplies of money and especially
of trained personnel, though greater than during wartime, were still
inadequate to accomplish the job.

     One thing was clear, however.  The war had awakened a worldwide interest
in Korea that had never existed before.  Nations that had expended blood and
treasure there - especially the United States - now could not abandon the
people whose fate had so unexpectedly become entangled with their own. Outside
intervention had divided Korea and provided the basic cause of the war that
had leveled the country.  Now many of the outsiders who remained were building
and curing, teaching and administering, giving money, advice, and time to the
process of reconstruction.  With such aid the Korean people over the next
generation would build a progressive economy and a small, provincial, but
modern country out of the ruins.  The Hermit Nation had become a crossroads,
and in 1953 KCAC was for the time being at the center of the international
effort to remake Korea in the field of public health.

The Korean Experience

     For the medics who served, the Korean War provided extraordinarily
diverse experiences.  Aid station and general hospital, refugee camp and
prison, death march and child care clinic - the faces of wartime medicine were
endlessly varied.  Over the war years the strength of the Army rose from under
600,000 to 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 number of medical units than normally would have been available.  The
750-bed evacuation hospital, normally the large backup unit to the 400-bed
type and the smaller field and surgical hospitals, never appeared in Korea.
Instead, a unique system evolved from the objective facts - the paucity of
medical personnel when the war began; the closeness of Japan, with its
existing hospital system; and the availability of air transport.  Evacuation
took up the slack created by a lack of trained personnel and bed space.
Within Korea the helicopter was one of the surprise triumphs of the time, and
the MASH worked exceedingly well, though as a flexible multipurpose
organization rather than as the specialized T/O&E unit.  Many of the successes
of the Medical Service in Korea were revivals of World War II practice,
notably in the blood program and in combat psychiatry.  Basic military
surgical techniques, like debridement and delayed closure, had to be relearned
again and again as new generations of surgeons arrived in the Far East.

     Korea also registered the advances of medicine since World War II, and
made contributions of its own to organization and clinical practice.
Neurosurgical injuries were managed with unwonted skill.  An array of
antibiotics aided all medical endeavors.  The early repair of vascular
injuries by grafts and other means not only had a lifesaving function but also
provided experience of considerable research value, because such injuries were
comparatively rare in civilian practice.  The kidney machine received an
important field trial.  Shock was better understood, and the plasma expanders
introduced in World War II were used widely and with success.  With its
helicopters and ambulances, radio dispatcher system, and shock treatment
facilities, the MASH gave a foretaste of the emergency medicine of the future.

     The most striking departure for Army medicine in the prewar years - the
residency program with its emphasis on specialization to the detriment of
field medical experience - had a mixed record in Korea.  Tragic was the
situation of young doctors, deficient in all the military arts, who were
plucked from comfortable hospitals and thrust into battalion aid stations to
organize retreats before a ruthless foe.  Often their patients must have paid
with their lives (as doctors did also) for the effort of the Medical
Department during 1945-50 to follow too closely a civilian model that military
medicine could at best only hope to approximate.  Yet heightened professional
skill meant increased chance of survival for the wounded who reached
hospitals.  Interacting with the other advantages of the Medical Service in
Korea, such skill was essential, especially in the 1950 emergency when drafted
doctors were not available and the medics had to live (and save the lives of
others) largely by their own resources.  How was a military medical
organization to be put together and held together in affluent America that had
the professional capabilities of the civilian physician, who did nothing else,
and the varied soldierly and administrative skills demanded by the
battlefield?  The question that dominated the years 1945-53 would only be
alleviated, not cured, by the continuing draft of young doctors in the postwar
years.

     As for the men and women who served in Korea, this entire volume seeks to
describe their services and achievements, often under most difficult
conditions.  An array of individual and unit citations recognized the medics
at the time, not only for carrying out their professional duties under fire
but also for standing beside the line troops in a war where the enemy's
indifference to a medical brassard made all perforce into fighters. No less
remarkable, perhaps more so for the rarer quality of courage displayed, were
the actions of medics who voluntarily remained with their wounded to be
captured.  In enemy prison camps, lack of medical supplies might make curing
impossible, but caring was almost always an option.

     Throughout the medical system the work of many men and women transcended
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
the medics' 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 the complicated and awful woes that men inflict upon one another.  From it,
however, may come a renewed respect for the equally human urge to save and
restore war's victims through the healing art.