History

Medical Science Publication No. 4, Volume II

USE OF MEDICAL CONSULTANTS IN THE FAR EASTCOMMAND*

COLONEL CHARLES L.LEEDHAM, MC

Colonel Hagman has portrayed for you, extremely well, I think, the manyaspects of consultant activities from the point of view of the overallpicture. I shall attempt to depict the subject from a more limited perspective-thatof the medical consultant-because of my own part in it. This role of medicalconsultant to the Far East Command during a period of military operationsagainst an armed enemy was, for me, not only a marked challenge, but oneof the most rewarding experiences of my career with the Army Medical Service.

Colonel Hagman and I were closely associated toward the end of his touras Surgical Consultant to the Far East Command, and the beginning of mineas Medical Consultant. He was very helpful and most cooperative. Were itnot for his early guidance I would have found those first days quite difficult.He figuratively held my hand until I was firmly oriented.

I should like, for purposes of clarity, to divide this discussion intotwo parts, that of the functions of consultants who were an integral partof the medical service of the command, and that of the functions of consultantswho visited the Far East from the United States. The activities of eachof these groups overlapped considerably, since it was normally an obligationon the part of the command consultant to accompany the visiting consultanton his tour throughout the theater.

There were four consultants to the Chief Surgeon of the Far East Command(later named Headquarters, United States Army Forces, Far East), each servingin his own specialty: namely, medicine, surgery, neuropsychiatry and orthopedics.The Eighth Army in Korea and the Korea Communications Zone had similarconsultants.

Responsibilities of the command consultant were varied, but basicallyhis position was that of maintaining proper staffing of hospitals and assuringthe adequacy of medical care in the Far East. To do this job properly hehad to cope with personnel assignment problems, particularly those concernedwith a proper balance in hospital staffing and the utilization of outstandingtalent.

A most important factor of the consultant assignment was that of

*Presented 26 April 1954, to the course on Recent Advances in Medicine and Surgery, Army Medical Service Graduate School, Walter Reed Army Medical Center, Washington,
D. C.

morale. Many of the younger medical officers, who had heretofore knownonly the comforts of living in the United States, found themselves suddenlytransplanted to a strange, alien land, facing the rigors and realitiesof war. The consultant found himself in the most unenviable role of fatherconfessor to these officers, listening to all their tales of woe sympathetically,reassuring them, and frequently representing them and serving as an intermediaryfor them in their grievance with higher headquarters. It was my convictionthat this role was often the most productive accomplishment of the consultant.

Among the many duties of the consultant, teaching was given much prominence.During my visits to medical installations throughout the command, I alwaysgave talks to the unit's personnel, made ward rounds and participated inthe teaching clinics. In addition, one of my principal responsibilitieswas to organize medical meetings and clinics in the Far East. I was fortunatein being able to arrange at least one meeting a month for internists atone or another locale in the command. Many of these meetings proved highlysuccessful and all were very well attended.

Before I continue further, I would like to interject at this point thefact that in addition to those responsibilities noted, I was required toand did function in my primary mission-consultation work. I visited manyhospitals for the purpose of coping with troublesome cases. Eventually,consultations were made on each routine visit. I remember on one occasionhaving to fly to Korea to consult on the illness of The Prime Ministerof the Republic of South Korea. On another occasion I made a quick nightflight to a remote area in Japan to see a patient and decide whether ornot this soldier with lower nephron nephrosis and severe uremia shouldbe flown back to Korea, in a sort of reverse medical evacuation, to receivethe benefits of the artificial kidney.

Accompanying visiting consultants from the United States on prearrangeditineraries of the Far East occupied much of the busy schedule of the commandconsultant. These visiting consultants were men of high caliber, well knownin medicine and usually teachers of some note. Many of them were universityprofessors of international repute. The command consultant planned theitinerary for the visitor, effected the required administrative work, andliterally served as an aide to the visiting medical dignitary. The commandconsultant considered these visits successful if the visitor were ableto visit, within the 30 days he had in the theater, 30 medical installations,or at least a major part of this number. The problem, of course, was toplan the visits so that the consultant from the United States could visitthe more distant installations in the command and speak to the young, eagermedical officers. Such visits were always successful from the

morale viewpoint, and gave these young men a feeling they were not forgotten.

An important facet of the command consultant's assignment was his relationshipto the Chief Surgeon as an adviser. He was required to make recommendationsconcerning physical standards, physical conditions, problems of illness,drugs, adequacy of supplies, and many administrative details incident tohis work. He found this work usually stacked high on his desk upon hisreturn from trips. Among the internal arrangements of the four consultantsto the command was an agreement that one individual would remain in theoffice while the other three were traveling. This schedule was rotatedonce a week, and provides a clue as to the amount of time spent travelingby each consultant.

Consultants to the Far East Command had many excellent opportunitiesto improve the medical service. If they were conscientious in their jobsand did their work well, they served as a buffer between the cold realitiesand necessities of the Army and the personal desires of the medical officerson duty in the command. By patient listening, detailed explanations anda sympathetic attitude a great many problems were solved. One who is ina consultant position soon learns that night sessions after normal dutyhours, possibly over a drink, highlight and bring into the open many ofthe latent problems that the individual medical officer could not approachduring the day. Even if one is a teetotaler, he should attend the nightsessions because it is there the young medical officer with troubles "letshis hair down." One learns much more information about what is goingon in the hospital and what the troubles of the command are in the eveningthan he does during all the official formal visits during the day.

I would like, now, to discuss some of the background pertaining to theutilization of consultants. The concept of noted medical practitionersfrom the United States serving as short-term consultants in overseas commandswas first initiated in 1947. The major theaters, Europe and the Far East,were visited at that time by groups of four each month for the stated purposeof improving training, morale, medical care, and also to provide valuableconsultation services. During the Korean conflict, the Far East Commandused consultants for the purposes I have just described and, in addition,made use of research consultants sent by the Army Medical Service GraduateSchool for specific purposes, usually the investigation of a particularclinical problem. Rather than describe the formal functions and utilizationprocedures of research consultants, I should like to portray their activitiesby an outline of the visits of several groups during the period of theKorean operation and my assignment as consultant in medicine.

The Far East was visited during my tenure therein by approximately 12clinical consultants each year, usually one a month. These consultantswere generally apportioned on a fairly equal basis among the major specialtiesof medicine, surgery, neuropsychiatry and orthopedics. Occasionally a specialtyof lesser importance to the Korean problem was included. These individualstoured the Far East on a schedule that did not permit much deviation, andkept them in constant agitation lest they fail to meet train or plane schedules.The consultants from the United States had only 30 days to spend in thetheater, 30 days in which to visit 30 hospitals located in the principalJapanese islands and throughout Korea and Okinawa. Moreover, the medicalservices of the Air Force and the Navy in the Far East desired them tovisit their installations. Whenever possible the Navy and Air Force hospitalswere similarly visited, with at least one or two days spent making wardrounds, giving talks and conducting teaching clinics. The principal objectiveof the command consultant was to stimulate interest in the visit of theconsultants from the United States, and get as many doctors as possiblefrom surrounding hospitals to attend those meetings at the hospital beingvisited.

For purposes of proper scheduling, the islands of Japan were dividedinto four areas-the Tokyo area, with six hospitals; the Osaka area, similarlywith six hospitals; Hokkaido, or Northern Japan, three hospitals; and Kyushu,Southern Japan, three hospitals. Wherever possible, the major hospitalsin these areas were placed on the itinerary. Smaller hospitals in theseareas were visited for short periods only, usually one-half day. Therewere occasions when three hospitals were visited in one day. I should liketo emphasize again that the aim was to have the consultants seen and heardby as many medical officers as possible within the limited time they couldspend in the Far East.

In Korea, in addition to myself as the command consultant, the EighthArmy Consultant or the Korea Communications Zone Consultant accompaniedthe visiting notables. At three principal centers of the Korea CommunicationsZone, there were held identical meetings. These meetings operated as aChautauqua-like circuit, and on three successive days the speakers wouldtravel as a unit from meeting place to meeting place. The Eighth Army hada similar circuit.

The two major medical societies in Korea were the 38th Parallel MedicalSociety and the X Corps Medical and Dental Society, and whenever possiblethe visitors addressed the Society meetings. All of the consultants hadthree or four talks in their repertoire. Wherever practicable they sawpatients and held teaching rounds. As in my own experience, the visitorsfound that by attending informal evening sessions, usually over a drink,they could learn a great deal

about the problems of assigned medical officers, more so than duringtheir official rounds.

A number of the consultants were excellent teachers and demonstratedinterest in the medical officers, their work and their problems. Otherscame as sight-seers and on shopping tours, indicating very soon that theywere there for purely personal reasons. Through the efforts of the localconsultants, however, this latter group was guided, prodded and pushedinto situations where they had to perform at their assigned mission. Ingeneral, the work of these consultants was effective.

The best consultants were those who had prior Army experience and whowere teachers. It is my recommendation that any plan for the future toutilize consultants overseas should include men who possess both thesequalifications. The accomplishments of this program were great. The moraleof our younger medical officers was markedly raised. They realized theywere not forgotten. The visitors always brought back the most recent informationfrom the United States concerning medical problems and advances in therapyand diagnosis. They proved an inspiration to our men. Those consultantswho had famous names were particularly good teachers. The entire programwas well worth the effort expended on it. I recommend very strongly thatit be continued, not only during peacetime but also during those periodswhen the United States may be involved in a war. Making available to ourmedical officers late technics and fresh concepts that originate from civiliansources not only creates broader horizons for our officers but helps makefor better morale. Conversely, the leaders in civilian medical circlesgain a great deal by becoming aware of the problems and accomplishmentsof medico-military men. They were given an indication of the difficultiesconcurrent with the practice of field medicine in some of the most backwardareas of the world. A rapport and understanding were created between Armymedical officers and notables representing civilian medical institutionsthat provided, in my opinion, a most fruitful relationship. Since my returnfrom the Far East I can add that in my own case, because of this rapportand understanding, problems that were not immediately resolvable were resolved.As a result of their Far East tours of our medical facilities, these consultantshave a greater knowledge of the Army and its problems, and are thus helpingus immeasurably to maintain the highest standards of medical care.

Although I have dwelt at some length upon those consultants in the fieldsof medicine, surgery, orthopedics and psychiatry, I hope that I have notcreated the impression that we were not able to use clinically those researchconsultants who visited the Far East. It was a feather in the cap of thecommand consultant if he were able

to make use of the experience and the talent of the research consultantby having him talk with clinicians. We were particularly fortunate in thisregard in getting all such consultants to talk with our men at Tokyo ArmyHospital. Since there were four other Army hospitals and one Army convalescenthospital in the Tokyo area, and inasmuch as all consultants were requiredto clear through Tokyo before further travel through the command, I wasfrequently successful in getting the research consultant to visit one ormore of these hospitals, and occasionally overnight to one of our lesserknown facilities. The command consultant soon learned to use ingenuitythat he did not believe he possessed to accomplish his ends. He was ableto capitalize on the talents of specialists in narrow research fields,and divert, even for a day or two, these talents to clinical use.

Colonel Hagman spoke at some length on the use of surgical hospitals.Inasmuch as the MASH (Mobile Army Surgical Hospital) units were primarilysurgical in nature, there was little for the medical consultant to do concerningthem. There was usually one, never more than two, internists assigned toa MASH. These medical officers were usually C-3139's, and were used principallyfor preoperative and postoperative care. In this type of work they provedhighly effective. During a lull in the fighting, the MASH units frequentlydid station-hospital-type work. It was then that the internist came intohis own, but these occasions were few and the number of patients small.The medical consultant's job in these units was, therefore, a small one.

I did make, however, several prestige or morale-type visits to thesehospitals. At each hospital I would normally make a clinical talk and showa film. Rarely did I stay longer than a half-day. Nevertheless I alwaysleft with a great lift, with a feeling that here the Medical Service wasaccomplishing great things. I was grateful that I had a part in its accomplishments,small though it was. These hospitals were, to me, the most remarkable fieldinstallations of the Army. The number of lives and limbs saved becauseof the MASH's special location and function cannot be comprehended unlessone could see such a unit during a military operation when the flow ofwounded was heavy. Many a veteran now living owes his life or one or moreof his limbs to these units. Really emergency life-saving surgery was donehere. The job they did was a truly outstanding one, while their accomplishmentswere rarely paralleled. It is no wonder that I, like so many others, alwayscame away with a vicarious feeling of accomplishment, after a visit tothese units.

The Korean operation was a unique one in the history of our Armed Forces.It has been said that from a military viewpoint the end result was notdecisive. The story of the Army Medical Service during this

operation, an operation fought in the most disease-ridden area and underthe worst possible conditions of weather and terrain ever encountered byan American soldier, is a story of success. I was particularly fortunatein serving as the Far East's Consultant in Medicine at this time. I wasgrateful that I could learn first-hand the problems faced by our unitsin every echelon of medical service, and that I could witness the exploitsof all medical personnel. I do not believe that I would be remiss to note,again, that this assignment was one of the most rewarding experiences ofmy Service career.