HEADQUARTERS
MOBILE ARMY SURGICALHOSPITAL
8076TH ARMY UNIT
14 January l95l
SUBJECT: Annual Report of MedicalDepartment Activities, Mobile
Army Surgical Hospital, 8076th ArmyUnit.
THRU: The Surgeon
8th US Army Korea (EUSAK)
APO 301
TO: The Surgeon General
Department of the Army
Washington 25, D. C.
1. PRINCIPAL MEDICAL ACTIVITIESOF THE COMMAND
The principal medical activitiesof this command have been; to furnish surgical and medical support to thecombat division, principally in the care of non--transportable casualtiesso seriously wounded that further evacuation to the rear would jeopardizetheir recovery; to co-ordinate evacuation of all casualties, from divisionareas to installations in the rear, and treat slightly wounded cases whocan be returned to duty within ten days, tactical situation permitting.Casualties here receive emergency as well as highly specialized treatment.They are given skilled pre-operative, operative and post-operative care.When transportable these are evacuated to rear installations.
2. ORGANIZATION AND EQUIPMENT
A. This hospital was activated perGeneral Orders No. 161, Hq 8th US Army, APO 343, dated 19 July 1950, underT/O&E 8-571, dated 28 October 1948, and expanded per General OrdersNo. 180, Hq 8th US Army Korea, APO 301, dated 24 November 1950. Due tothe wide variation in the tactical situation encountered in this theatre,the missions of this unit have varied widely. This unit has been operational152 days and had 9,008 admissions. It was first operational at Miryang,Korea, from 2 August 1950 to 5 October 1950. During this 65 day period,5,674 patients passed through the hospital. 244 surgical patients on oneoccasion and 192 on another were admitted during a 24 hour period. Thegreatest number of dispositions in one 24 hour period was 608. It was fortunatethat the unit during its busiest time at Miryang had selected a woolenmill to set up in, for its expansion was unlimited. Storage warehouseswere used as wards and as the patient load increased, new wards were openedup in vacant warehouses. At one time this unit had a census of 427 patients.At the beginning of operations, the unit was organized into a HeadquartersSection, a Professional Service and Administrative Service. The ProfessionalService consisted of operating, Ward, Pharmacy, Laboratory and X-ray Sections.The Administrative Services consisted of Detachment Headquarters, Supply,Mess, Registrar and Motor Sections. On 15 October 1950, per paragraph 211,Hq 2nd Infantry Division, one lieutenant, Dental Corps, and one dentaltechnician, enlisted man, was attached to the command.
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On this date a Dental Section wasadded to Professional Service.
This arrangement while caring forbut surgical cases worked well; but as the situation changed and the missionof the hospital, in addition to being primarily surgical, become one ofan evacuation hospital, minor changes were made which it is believed helpedthe unit to function more smoothly. The Headquarters Section and the DetachmentHeadquarters were consolidated thereby pooling the resources of three clerks.Four Enlisted Men were originally in the Registrar Section; two more wereassigned because of the heavy patient load. An Evacuation Section consistingof one Medical Corps officer, one Medical Service Corps officer and oneNCO was established as a subdivision of the Registrar Section. This providedfor a smooth co-ordination of patients designated for evacuation from theHolding wards to the evacuating medium (i.e. ambulance, train and/or air).
The need for local security, whichbecause of the tactical situation and locations in some areas renderedit impossible for other units nearby to supply local security made it necessaryto add a Guard Section consisting of ten Enlisted Men. By making this apermanent section disruption of night and day personnel shifts was avoidedmaking for a smoother functioning unit.
From 28 October 1950 through 3l December1950, the unit moved six times. Local buildings were utilized in all instancesand supplemented with tents as necessary. Because of the problem of weatherproofing,heating, and lighting these buildings, a separate Utilities Section ofseven Enlisted Men was set up, which greatly facilitated housekeeping.It is believed a trained electrician and carpenter would be a definiteaddition and facilitate greatly the lighting and housekeeping problem encountered.
B. Equipment -- Equipment as basicallysupplied this unit was entirely adequate for function of the operatingsection and ward sections, however, when casualties were exceptionallyheavy there was a shortage of oxygen flow meters, suction apparati andanesthesia machines, but as the need for this additional equipment aroseit was promptly supplied through 8th Army Medical Supply channels.
The following recommendations aresubmitted for the Orthopedic Set as it is supplied. The table portable,field orthopedic, has been satisfactory with the exception of one factor.It is impossible to apply a body jacket or a Minerva jacket to spinal injuriesin hyperextension while the patient is under general anesthesia. Two modificationsof the table could be made very easily - one the addition of the Goldthwaiteirons and their end pieces to the present table for the application ofjackets in the hyperextended supine position and the use of a canvas strapwith fixation at the chest symphisis to apply jackets in the prone position.Minerva jackets can be applied with the same apparatus by the use of theGoldthwaite irons. There is too much equipment available in the orthopedicline of some types and too little of other types in the field. The useof plates, screws, Lohman clamps, twist drills, etc. is of questionablevalue at the field levels and under field conditions but these and othersare included in the field fracture and amputation sets. Coversely [sic]there is very little Kirschner wire and Steinman equipment available andin the Korean Theater up to this time there has been almost none of thisavailable. It is felt that these should be heavily
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stocked in the Mobile Army SurgicalHospitals. These are unquestionably emergency treatment items and are ofmore value than equipment provided for definitive surgical procedures.The stock of wire suture material is largely confined to heavier gauges.This should be available down to the level of No. 36 wire. It is well knownthat wire suture material is inert in the presence of sepsis and the useof it in closing the lateral borders of wounds to decrease their size,when it is known that sepsis will follow, would be of value. Then too,the use of finer gauges of wire in the Bonnel technique of tendon repairpresents itself in cases incurred under clean circumstances and recentlyenough to be repaired, such as one finds in mess and utility personnelof nearby units.
The 250,000 BTU gasoline space heatersas supplied to this organization have been invaluable, however much difficultyhas been experienced in keeping them operational. The chief difficultywith the blower type unit heater being the frailness and lack of stabilityof the gasoline engines which require almost constant maintenance to keepthem in adjustment and in functioning condition. These blower motors canbe only regarded as gadgets rather than as functional pieces of equipment.At present this organization has converted one of these units which becameso unserviceable that it is powered by an electric motor. This modificationhas proved much more dependable and satisfactory than the units supplied.
C. Attached Units -- This unit hasalways been supplied with at least one ambulance platoon and sometimeswith two depending on the tactical situation.
Too much cannot be said in praiseof the helicopters stationed at the hospital who brought seriously woundedpatients from inaccessible areas and evacuated seriously wounded casualtiesfrom forward medical installations, thereby providing a quick, smooth comfortableevacuation from forward areas to the hospital with a minimum of shock anddelay.
3. PHYSICAL AND MENTAL HEALTHOF THE COMMAND
In general, the physical and mentalhealth of this command has been excellent, of all disease encountered inthe past six months, those of infectious origin have predominated. Includedbelow are diseases and incidence of such in this command during the pastsix months.
a. Infectious
Poliomyelitis -- a rapidly fatalcase of bulbar polio was observed. That patient was evacuated to a hospitalship where, despite treatment in a respirator, he died six hours later.
Hepatitis -- There have been fivecases at sporadic intervals. All were evacuated to Japan. Two have returnedto duty.
Dysentery - Dysentery, presumablybacterial, was of moderate incidence during the summer months. All casesresponded quickly to the newer antibiotic agents (aureomycin and chloramphenicol).The source of infection could not be localized, but mess, water and latrinesanitation in hospital area were definitely excluded.
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Upper Respiratory Infections -- Therehave been two mild outbreaks of nasal pharyngitis, acute catarrahal, inthis command. There has been no pneumonia, either viral or bacterial.
Tuberculosis -- One case of suspectedTB of kidney, manifested by persistent hematuria, dysuria, and irregularityof one calyx on retrograde urography was studied and evacuated. No instanceof pulmonary TB has been seen.
Venereal Disease - Gonorrhea fivecases and chancroid two cases have been noted. No suspected luetic lesionshave been observed.
Malaria -- There has been no malariaobserved in this command. All have received by roster weekly prophylacticdoses of chloroquin during the malaria season.
No Cholorea, Tetanus, protozoan,or metazoan diseases have been observed.
b. Organic Disease
One case of hypertensive cardio--vasculardisease in a forty-five year old Enlisted member of the command was observedand evacuated.
c. Accidents and Injuries
Burns -- There have been three casesof burns, all due to gasoline explosions. One case of 1st and 2nd degreeburns involving 10% of body surface required evacuation, others were treatedon duty status.
Injuries -- Four fractures due toinjuries have occurred, two of sufficient severity to require evacuation.Others were treated on duty status. There was one case of severance ofradial artery with concurrent dislocation of radio-carpal joint, treatedhere and evacuated for physio-therapy. He has subsequently returned toduty. One nurse developed torticollis and was evacuated.
There has been no heat exhaustionor frost--bite. There have been no casualties as a result of enemy action.
d. Psychiatric Disease
Two psychiatric casualties have beenevacuated from the theater with diagnoses of paranoid schizo--phrenia,and severe anxiety state, in general the mental health of this commandhas been excellent, and morale has remained high.
4. SANITATION
The officers, nurses and enlistedpersonnel have been housed in local buildings within the hospital compoundwhen these were available. Sectional and squad tents have been used atother times. Ventilation and heating have always been good to excellent.General cleanliness of the quarters has been well maintained. During thesummer months mosquito and fly control was good. DDT spraying was carriedout effectively throughout the hospital area with the occasional assistanceof a sanitation team from a nearby unit. The usual "fly attractive" areassuch as the mess, the latrines, and garbage disposal pits, were kept fly
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free by the usual general measures:frequent changes of pits and latrines, scrubbing of latrine boxes withdisinfectant solutions, and mess cleanliness. Rodents presented no problem.Frequent aerosol bomb spraying of the operating room was carried out duringthe summer months, and mosquito netting was placed so as to cover the entranceto the operating room, as well as to the patients wards. Insect repellentas well as DDT powder was available to all patients. Tissues removed atsurgery, as well as old dressings were burned and buried. Water supplyhas at all times been within easy reach of the hospitals water truck. Thehospital utilities section has made shower baths available to the unitwhenever possible. Occasionally the shower points of nearby larger unitehave been available. Hospital laundry has been handled very efficientlyby the Quartermaster laundries of nearby divisional units. While at Miryang,their facilities were not available and local labor was hired to do thehospital laundry. The hospital supplies and equipment for necessary sanitarymeasures have been quite adequate.
5. INCIDENCE OF INFECTIOUS DISEASESOBSERVED IN HOSPITALIZED CASES
a. Venereal Diseases -- chancroid,gonorrhea, luetic chancre, and lympho-granuloma venereum were the mostfrequently observed infectious illnesses. All diagnoses were clinical,save for smears in suspected gonorrhea and chancroid, as this installationhas no facilities for serological diagnosis. Whenever possible, personswith venereal disease were returned to duty, but often they had to be evacuatedbecause their unit had left the area. Gonorrhea was treated with either300,000 or 600,000 units of procaine penicillin with good effect. Patientswith suspected primary syphillis were started on a course of procaine penicillin,600,000 units daily x 10, and then returned to duty with instruction toreport to their unit dispensary to complete the treatment. Chancroid wastreated with streptomycin 0.7 gms twice a day for five days, initially,but later in the year, good results were obtained with aureomycin 2 to4 gms daily for five to ten days. The same treatment was used in lymphogranulomavenereum.
b. Dysentery - dysentery was thenext most frequent type of infectious disease. No laboratory confirmationas to type was obtained. The majority were presumed to be bacillary, andmost of these responded to aureomycin or chloroimycetin therapy, usuallybeing ready for duty in two to five days.
c. Malaria -- malaria was observedfrequently in August and September. A few cases were found in December,but these occurred among members of the Philippine 10th BCT, and were thoughtto be acute recurrense of chronic malaria acquired before arrival in Korea.All cases beceme clinically well with chloroquin, the most frequent dosageschedule used being 1.0 gm stat, with 0.5 gms three times daily for threedays thereafter.
d. Encephalitis -- Encephalitis ofunknown type, but thought to be Japanese B was seen often in August andSeptember. All had positive spinal fluid findings, usually showing 100to 1200 cells per cu. mm., with lymphocytes and neutrophils varying inpredominance from case to case. All cases were acutely and severely illat the time of evacuation, but no patients died before leaving the unit.Only three eases of poliomyslitis were observed, two of whom expired becauseof respiratory failure.
e. Hepatitis - hepatitis as evidencedby icterus was seen infrequently, and all such cases were quickly evacuatedfor definitive therapy.
f. Respiratory Infections of varioustypes were seen with increasing frequency during late November and December.The most serious of these were
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pnuemonitis, of unknown type, seenmost commonly among Philippine troops and Thailanders. These patients wereevacuated due to the tactical situation before the results of aureomycintherapy could be evaluated. For incidence and control of infectious diseasesin the command, see paragraphs three and tour.
6. OUTSTANDING CLINICAL EXPERIENCES,IMPROVEMENTS IN MEDICAL PRACTICE
This unit was located in an areawhere casualties were extremely heavy, and for a time we received all surgicalcasualties from the 2nd Infantry Division, 24th Infantry Division, 1stCavalry Division, 5th Regiment--1st Marine Brigade, and ROK forces. Inless than a two months period, three hundred (300) laporatomies were performedin this institution. About fifteen (15) ruptured uretheras, numerous injuriesto extremities, chest and head were encountered. TBM [Technical BulletinMedical, TB MED] 147, and its forerunner, the "ETO Manual of Therapy",was familiar to all surgeons, and was used as a basis for all treatments,however, from experiences during this period, it is believed some pointscan be emphasized which can be of future help to the trained surgeon uninitiatedin war surgery. For all wounds or injury other than enumerated below TBM147 very adequately covers the basic procedures.
Intra-Abdominal Wounds
A bold, ample para median incisionprovides better exposure and is much less time consuming than a transverseincision and is in nearly all cases the incision of choice. The surgeonthen quickly assays the amount of work to be performed. The first stepshould be gentle but rapid exploration of the small bowel from Treitz tocecum, with complete evisceration of the small bowel. This maneuver affordsthorough inspection of the small bowel for perforations; inspection ofthe mesentery for bleeders, which if present are promptly secured; directvision of all colic gutters, and easy and thorough inspection of the posteriorabdomen. Intestinal perforations are marked and clamped to prevent furthercontamination of the abdomen, and the remainder of the abdomen surveyed.The viscera are now replaced and the survey completed and the necessaryoperative procedures are now performed. While it is realized that eviscerationis a shocking procedure the operating time and the more thorough explorationafforded, well overweighs the disadvantages.
Severely lacerated livers were encounteredaccompanied in several cases by marked hemorrhage. Fibrinfoam has beenthe only one of the foams available at this installation. Its use in thesecases has in general been disappointing. Best results have been obtainedusing deep mattress sutures with generous fat grafts beneath the loopsto prevent the sutures from lacerating the liver substance. In severalcases rather large hepatic ducts were torn by the missiles, and ratherthan trust entirely a Penrose drain, a latex tube of 26 F with side perforationswas placed along the damaged area or actually incorporated into the bedof the furrow before securing the mattress sutures. The tube, along withthe Penrose drain, was then delivered to the outside through a stab woundin the right flank. Over 350 cc of bile drainage has been obtained fromthese tubes in a 24 hour period.
Chest Wounds
Combined thoraco-abdominal woundswere handled in the main by aspirating the blood from the cheat by catheterand suction prior to closure of the defect in the diaphragm. The case wasthen handled primarily as a chest case. We were very much impressed bythe very small number of wounds of the chest which
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required open thoracotomy. The majorityresponded well to repeated aspirations of blood, maintenance of normalchest physiology in so far as possible, blood transfusions, oxygen andgeneral supportive measures. When catheter drainage of the thorax withunderwater seal was indicated, the use of large catheters cannot be stressedtoo strongly, as smaller ones tend to become blocked and require too muchattention to keep them functioning properly.
Wounds of the G U Tract
Perforated urinary bladders and vesico--rectalfistulas were treated in accordance with TBM 147. There is nothing outlinedin this bulletin as to the care of uretheral wounds. Approximately 15 completelyruptured urethras were observed. These were almost always associated withperineal and pelvic injuries. While it is realized that the procedure assuggested here cannot be properly evaluated until the final end resultsare appraised, it is believed. that difficult secondary reconstructivesurgery has been minimized, in that a patent splinted channel has beenmaintained from the bladder through the urethral meatus in all cases. Ifa catheter could be passed to the bladder and a free flew of urine obtained,the catheter, usually a 20 F or 22 F 5cc Foley, was left indwelling andno further treatment was believed indicated. If, however, a catheter couldnot be passed the defect was explored, and a primary reconstruction wasaccomplished over a splinting catheter. Urinary flow was diverted fromthe anastomosed area by one of two methods, depending on the location ofthe detect. If the rupture was in the bulb or anterior, an external perinealurethrostomy was done with bladder drainage accomplished by a 26 F 5ccFoley catheter, and a No. 20 F or 22 F splint extending through the urethrostomyand out through the urethral meatus. If the lesion was proximal to thebulb, a splinting catheter was passed to the bladder, a suprapubic cystostomyaccomplished, the defect repaired, and the pelvic diaphragm and perinealmuscles repaired as well as possible.
Traumatic lesions of the upper GU tract included many contused kidneys lacerated kidneys, and one casein which the ureter was severed in the upper third. As with lesions ofthe lower tract, there was almost always coexistent pathology. In general,where possible, operative procedure was delayed and serial urinalyses weredone to determine the progression or regression of the hematuria. If thehematuria decreased, and the patient was adequately supported, as one couldbe certain the kidney was the only organ involved, no operative interventionwas attempted. Cases not responding to the treatment as outlined above,were explored, usually transperitoneally, as there was usually associatedabdominal pathology. Resection of a badly shattered lower pole of one kidneywas carried out in one case. Two lacerated parenchymal lesions of renaltissue extending into the pelvis were repaired and nephrostomy tube inserted.The severed ureter was treated by insertion of a splint tube down the ureter,and a nephrostomy on the same side. A pyelostomy probably would have beenpreferable, but the procedure was further complicated because the subjecthad an intrarenal pelvis. At the same procedure three perforations of thesmall intestine were also repaired. Only three nephrectomies were performedduring the entire period of this report.
It is regrettable that due to therush and pressure upon this unit more detailed studies could not be carriedout on these casualties. It is also unfortunate that the results of thework done here cannot be further observed. The salient points learned fromthis experience can only restate that which has so often been stated. Beforeany operative procedure is attempted, the patient
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must be adequately treated for shock,only those measures essentially necessary be done, speed and gentlenessthroughout all procedures must be strictly observed.
7. PERSONNEL
This organization as any other hasencountered personnel
problems. The personnel strengthhas been increased by General Orders 180, HQ EUSAK, and it is felt thatthe proper number of personnel, including medical officers, nurses andenlisted men, is now sufficient to carry out the assigned tasks of thishospital. Under T/O&E 8--571, the following breakdown of personnelis supplied: 14 Medical Corps Officers, 2 Medical Service Corps Officers,1 Warrant Officer, l2 Army Nurse Corps Officers and 97 Enlisted Men. Byissuance of General Orders 180, Hq EUSAK, the following revision was made:15 Medical Corps Officers, 5 Medical Service Corps Officers, 17 Army NurseCorps Officers and 121 Enlisted Men. Attached for administration, duty,rations and quarters was always an ambulance platoon from either the 567thMedical Ambulance Company (Sep) or 584th Medical Ambulance Company (Sep).This was always provided by Medical Section, EUSAK, in order that properevacuation be accomplished.
With the constant moving up and downthe peninsula, administration at times has been hindered, but on the whole,taking into consideration the difficulties of distribution and mail, breakageand occasional loss of equipment, and the shortage of AR's, SR's and othergoverning materials, the organization has been able to keep up its administrationin a very satisfactory manner.
8. TRAINING
During the majority of the time,the personnel of the hospital have been working. Because of the steadyinflux of work, "on the job training" has been the source of knowledgeacquired by personnel. It is believed that "doing" plus an occasional helpingsuggestion is the best way of learning under field conditions.
During the periods of time when thehospital was not abnormally busy, inventories, policing and improvementsof all kinds were and still are generally in order.
9. SUPPLY
Supply problems experienced duringthe period of this report have been relatively small. During the periodof time this unit was located at Miryang, Korea, all medical supplies wereprocured from the 6th Medical Depot in Pusan. Usually a representativeof the supply section was dispatched to Pusan with a requisition to befilled and returned either by hospital or by vehicle, however, from timeto time when emergencies occurred medical items were flown in by liaisonplane and helicopter.
On moving North a constant flew ofsupplies was provided by the advance platoons of the 6th Medical Depot.The use of helicopter transport proved invaluable during periods of actionresulting in large numbers of seriously wounded casualties, when as manyas 100 units of whole blood were used in an 8 hour period and reserve bloodsupplies were depleted.
Blanket and litter exchange provedto be somewhat of a problem at various times due to shortages in the theatre,however, the hospital trains at present are furnishing an adequate exchange.Exchange of blankets and litters on patients evacuated by air has causedsome concern, since no exchange has
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been provided. The exchange of blanketsat Kunu-ri during the latter part of November proved quite a problem dueto the extreme cold weather requiring up to six blankets per patient, theexceptionally high census, and fact that all patients were evacuated byair. Since the supply run to Pyongyang required at least a full day, theshortage was alleviated by airlifts arranged through the 8th Army Surgeon'soffice.
Quartermaster, Signal, Ordnance,Engineer logistical support has been adequately provided by the 2nd InfantryDivision and 24th Infantry Division, as well as the various Army technicalsupply units.
K. E. VAN BUSKIRK
Lt Colonel, MC
Commanding
