Medical Science Publication No. 4, Volume II
TUESDAY MORNING SESSION
27 April 1954
MODERATOR
COLONEL FRANCIS W. PRUITT, MC
GENERAL ASPECTS OF MEDICINE IN KOREA AND JAPAN 1950-53*
COLONEL FRANCIS W.PRUITT, MC
The commitment of United States and United Nations troops to combatin Korea brought with it many medical problems. It was the first time inthe history of the American Army that troops had fought in the environmentalconditions experienced on the Korean peninsula. The immediate and mostpressing problem was medical support of troops. In the summer of 1950 wewere at an all-time low in Medical Corps personnel in the Far East. TheEighth Army staffed the medical units in Japan, as well as those committedto Korea.
At the onset of hostilities there were only 156 Medical Corps officersin the Eighth Army; 346 was the authorized strength. It was immediatelynecessary to staff the 8054th Evacuation Hospital and the 8055th, 8063rdand 8076th Mobile Army Surgical Hospitals. Obviously, there were not enoughsurgeons initially to staff these units and internists were assigned toaugment the surgical staff. All personnel were taken from units in Japan,depleting these facilities to an extraordinarily low level. Tokyo GeneralHospital, for example, had only seven Medical Corps officers, includingthe hospital commander.
Immediately preceding the Korean War we had lost a large group of physiciansreturning to the United States upon completion of the ASTP obligatory service.The nation's residency program was to declare its first dividend on the30th of June. We were to receive approximately 12 physicians by routineshipment; of these, 10 had completed their residencies and 2 had been droppedfrom the program. In June we had 66 medical officers in internal medicineor its subspecialties, divided as shown in table 1. There were only threecertified internists in the Far East at this time. We were extremely fortunate,however, to have a large group of physicians participating in the residencyprogram in our teaching hospitals in the Zone of Interior. The majorityof these were immediately transferred by air to the Far East.
*Presented 27 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.
98
Table 1. Eighth Army Medical Corps, June 1950
Authorized-346 | D-3139-37 |
Actual-156 | C-3139-11 |
Total-66 | B-3139-3 |
Internists or | 3112-2 |
Subspecialists | 3116-13 |
By the end of July 333 Medical Corps officers, or more than twice thenumber assigned in June, were present for duty and 240 Medical Corps officershad arrived from the U. S. by the l6th of August. In addition to the incomingphysicians, all Army Medical Service personnel present in the Far Eastwere retained beyond their normal service tour category, commitment orstatutory retirement. This resulted in a saving of 30 Medical Corps officersin the first 2 months alone. In October we were ready to reassign the internistswho had originally gone to Korea to augment the surgical units to theirproper MOS positions. At this time we had 112 Medical Corps officers ininternal medicine or its subspecialties, which included the categorieslisted in table 2. These were all assigned according to their MOS withthe exception of the excess pediatricians. Many of this category were assignedto dispensary duty in Japan and Korea.
Table 2. Eighth Army Medical Corps, 1950
June | October |
D-3139-37 | D-3139-52 |
C-3139-11 | C-3139-30 |
B-3139-3 | B-3139-8 |
3112-2 | C-3112-1 |
3116-13 | A-3112-1 |
66 | D-3116-10 |
C-3116-8 | |
C-3105-1 | |
111 |
By December 472 medical officers were on duty in Korea alone. Theseincluded 1 certified internist, 10 grade C-3139 and 35 grade D-3139. Thisis essentially the same number of internists in various categories as wehad throughout Japan and Korea at the end of June, as seen in table 1.Four Army dermatologists were augmented by four from the Navy. The arrivalof personnel during July and August made it possible for us to augmentthe staff by appropriate MOS of four field hospitals, two evacuation hospitals,one station hospital and one Mobile Army Surgical Hospital alone. At onetime all the medical officers, except the commanding officers of five hospitals,were physicians whose residency training had been interrupted; others wereappropriately assigned to units in Japan. It goes without saying that thebulk of these physicians were not the finished product in their
99
specialty; however, the fact that 98 percent of all casualties arrivingat a medical facility in Korea survived is a monument to this young groupof surgeons and physicians staffing the field units.
It is obvious that a great medical catastrophe was avoided by havingon immediate call physicians taking residency courses in military and civilianhospitals sponsored by the Army Medical Service. Had it not been for thisresidency program we would have faced a tragedy of a crippling inadequacyof physicians when called on to enter a suddenly precipitated and unanticipatedconflict. Certainly, foresight in training could not have been turned toa better advantage.
With the arrival of the first contingent we realized that somethingshould be done in the way of personal interest and orientation of thesemedical officers. In other words, we set about to establish a doctor-doctorrelationship. The majority of these individuals were suddenly separatedfrom their brides or little families and immediately faced with the horrorsof combat in a strange land, far separated from their loved ones. The storiesof Communist tactics and atrocities compounded their fears. On occasionone would see a physician whose anxiety was so acute that he begged withtears in his eyes not to be sent to Korea. Our approach to each newly arrivedgroup was in the form of a team from the GHQ Surgeons Consultants Office.A consultant in surgery, preventive medicine, internal medicine, and soforth, depending on the availability, comprised the team. Each one of theconsultants approached the group with calmness of purpose and explained,sometimes in detail, the various diseases or types of casualties the newlyassigned medical officers could anticipate. Suggestions regarding theirpersonal comfort and welfare were made. This proved extremely worth while.One might encounter a group somewhat noncommunicative in its behavior which,at the end of an hour or so of deliberate explanation of the work and problemslying ahead, would begin to relax and ask questions. The interviews wereusually terminated by friendly discussions of Stateside mutual friends.
At the time, we who had been in combat in Korea did not realize theimpact of the discussion of our experiences with these young physicians-untrainedfor the field and with fear for their personal safety in combat. The effortswere indeed rewarding, both to the Army Medical Service and the theatersurgeon. As the war went on and many individuals were returned to the U.S. it was not unusual for one of these physicians to go out of his wayto see us or write a letter regarding the reception and orientation givenhim on his arrival.
Upon arrival in the Far East each physician was given a 5 x 8 card onwhich he was to list his professional biography together with special interests,research, and any other pertinent remarks. This system had been establishedpreviously for all internists and the subspecialists in
100
internal medicine. It was now expanded to include other professionalfields. This provided a ready office index which could be rapidly reviewedwhen searching for a physician with the appropriate background when organizinga special study or center. This was continued throughout the campaign.
The physicians whose residencies were interrupted were told that theywould be returned to their residencies in approximately 6 months. As timewent on, the arrival of additional personnel made it possible for The SurgeonGeneral's Office to keep its promise in this regard. As would be obvious,this did much for morale among Medical Corps personnel.
Special Problems in Medicine
Diarrhea and Dysenteries
One of the major problems with troops fighting in Korea in the earlydays was diarrhea and dysenteries. Quite frequently troops were deprivedof water, either by Communist infiltration or other disruption of watersupply. Rice paddy water or heavily polluted streams were frequently theonly source available.
During the early weeks of the operation in Korea both forward and rearunits suffered severely from gastrointestinal cramps and diarrhea. Themaximum rate of 120 per thousand average strength per year occurred inAugust of 1950. With the onset of winter this dropped strikingly and, withthe exception of a sharp rise in August of 1952, never presented a problemthroughout the remainder of the Korean conflict. The striking number ofcases in the early weeks, however, was significantly lower than peak ratesfor troops in the China-Burma-India Theater during World War II, the highestbeing 376 in August of 1942, more than three times the incidence in theearly weeks of Korea. The rates just given include common diarrhea anddysenteries. It is interesting to note that the rate for dysenteries alonein U. S. troops was approximately 14 cases per thousand initially, andshowed a rapid decline thereafter. No deaths were reported.
Food poisoning was never a problem, and it is interesting to note thatwhile there were practically no cases at the onset there were cases appearingthe following year. This is likely on the basis of more messing facilities,including the availability of more fresh food and unit-prepared dishes;this would present a greater opportunity for food contamination.
One of the following etiological agents was generally found in eachcase; use of impure water, ingestion of indigenous food or drink, inhalationand ingestion of road dust, emotional disturbances associated with servicein a combat area, and the ingestion of food, often unappetizing, duringthe first few months of the war. In order to
101
afford efficacious management and to retain a high degree of combateffectiveness these were divided into three categories on clinical grounds:(1) Simple, acute diarrhea, a watery, light green, explosive type of diarrheacontaining flakes of mucus, but void of blood. Nausea and vomiting mayor may not be present. These were treated by six tablets of sulfaguanidine,given immediately, and three tablets with each succeeding bowel movement.(2) Bacillary dysentery. If bacillary dysentery was suspected, the localuse of a microscope was encouraged. If macrophages were seen it was feltthat the case could be considered as shigellosis and the patient treatedwith chloramphenicol as far forward as possible. (3) Amebiasis. If it wasfelt that one was dealing with amebiasis, evacuation to a hospital withappropriate staff and facilities was recommended. Amebic dysentery wastreated in some hospitals with aureomycin and terramycin with good response.
Malaria
Malaria was endemic in the Korean peninsula. Although prophylaxis wasavailable the highest rate experienced was 41.4 in August of 1950. Relativelyfewer cases were seen except for a sharp increase in June and July of 1952.This is explained in part by the fact that malaria occurring in two divisionsrotating to Japan was charged to the incidence in Korea. From the startof the war through December 1953 there were 6,199 cases reported in Koreaand 2,290 in Japan with 1 death throughout the campaign.
Infestation by Plasmodium vivax was the cause of most clinicalmalaria in the campaign. We were on the alert, however, for the possibilityof falciparum infestation, particularly after the entry of the Chineseinto the conflict. Falciparum malaria is prevalent, particularly in SouthChina. Fortunately, this did not materialize. The only case of falciparummalaria was that in a newly arrived Ethiopian soldier.
Of the number of antimalarial compounds developed during and since WorldWar II, the 4- and the 8-aminoquinoline compounds have been the most efficacious.Chloroquine is the suppressant drug of choice, free of side effects andeffective in weekly doses. Malaria prophylaxis will be discussed in detaillater in the program. Chloroquine was discontinued in the middle of September1950. By the middle of March 1951 clinical manifestations of tertian malariawere seen in troops who were in, or had been evacuated from, Korea. Presumably,these troops were parasitized in Korea during the time they were on suppressivetherapy and the plasmodia were in the tissue phase during the winter monthsof 1950 to 1951. This phase has been well explained by Short (1).Medical personnel were urged not to
102
waste time in searching for the plasmodia in a thin smear and to useonly the thick smear preparations. Camoquin, one of the 4-aminoquinolinecompounds, was recommended for use (2). This compound is effectivein a single dose of 10 milligrams per kilogram. As the quinoline nucleusis broken down the degredation products are toxic to the plasmodia. Thisprovided a nontoxic compound which could be given to ambulatory patientsfor the control of clinical cases.
The tissue, or exo-erythrocytic phase was treated early with quinineand chloroquine and, starting in 1951, with pentaquine and quinine. Becauseof the toxicity of pentaquine and the other 8-aminoquinoline compounds,all patients were hospitalized. All medical personnel were urged to beon the alert for appearance of methemoglobinemia in patients treated withthe 8-aminoquinolines. Personnel were also warned against the administrationof sulfa drugs or atabrine during this regimen, as both compounds willgreatly increase the toxicity. While instructions were sent out (3)for the management of cerebral malaria, fortunately no cases appeared.
In the summer of 1951 primaquine, one of the 8-aminoquinoline compounds,was considered safe to use in a dose of 15 mg. daily on troops returningto the U. S. by ship. As time went on, however, it became apparent thatthis regimen was not 100 percent effective. In the 6 months from July 1952to January 1953, nine patients with positive Plasmodium vivax wereadmitted to Letterman Army Hospital. These had all received and retained15 mg. of primaquine for 9 to 14 days aboard ship and all had been on 300mg. of chloroquine, prophylactically, in Korea. There was also one caseof laboratory-proven methemoglobinemia severe enough to cause cyanosisin a Caucausian male (4). There is ample evidence that the 8-aminoquinolinecompounds should be used under supervision. With the use of chloroquinesuppressively, the availability of the other 4-aminoquinolines for clinicalrelapse and the 8-aminoquinolines for the tissue, or exoerythrocytic phase,malaria no longer appears to be the devastating scourge of U. S. troopsserving in endemic areas. The British had excellent success with paludrine,prophylactically. Quinine and pamaquine were used therapeutically in theCommonwealth forces.
Venereal Disease
Venereal disease is a common associate of hunger, famine, loss of homesand the presence of troops with funds and food. The highest reported incidenceof 210 cases occurred early in 1952 when large numbers of troops were rotatedto Japan; however, this does not quite equal the peak occurrence of venerealdisease in the Mediterranean Theater in the post-combat years of WorldWar II. It is interesting to note that 87 percent of 610 native girls examinedin Seoul were
103
found to be infected with venereal disease, almost equally divided betweensyphilis and gonorrhea. No free clinic facilities were available for thenatives and penicillin, although available, could not be afforded. Chancroidalmost constantly paralleled the total of all other venereal diseases.Dispensary treatment for venereal disease was inaugurated by the EighthArmy while in Japan in 1949 and continued throughout the Korean campaign.
Japanese B Encephalitis
This presented a perplexing problem early in the war, with some 335cases occurring in late 1950 with a 10 percent mortality. Following this,Japanese B encephalitis was no problem. There were only 2 cases confirmedserologically in 1951 and 11 in 1952.
Poliomyelitis
Poliomyelitis, meningitis and other infections of the central nervoussystem were no problem in the United Nations Command.
Smallpox
Korea is an endemic area for smallpox and this disease was frequentlyseen in prisoners of war. During 1950 and 1951, 39 cases of acute fulminatinghemorrhagic smallpox were seen. In none of these cases was there a scarfrom primary vaccination. Colonel Arthur Long, Consultant in PreventiveMedicine, deserves the credit for intensifying the immunization programwith the result that no further cases occurred in United Nations personnel.
Hepatitis
The relationship of viral hepatitis to a military campaign is well knownto all. Undoubtedly, many of the cases of jaundice recorded during theCivil War were cases of viral hepatitis. Shortly after our troops werecommitted in Korea we established a center for the management of hepatitis.The peak incidence occurred that fall and winter, with some 4,000 admissionsto the center and 4 deaths. In spite of the adversities experienced andunfavorable sanitary conditions, the 1950 and 1951 incidence was belowthat experienced in the Philippines in 1944 and 1945. The incidence duringthe Philippine campaign was more than three times the greatest incidencein Korea. By late 1951 this had leveled off and continued at about thelevel of the post World War II occupation experience. It may be well topoint out the fact that we felt we were definitely dealing with acute infectioushepatitis. This was based on the lack of receiving blood or blood productsand the history of a rather abrupt onset of the disease.
Many interesting problems arose in connection with hepatitis. Considerabledifficulty was experienced in maintaining a level of brom-
104
sulphalein to carry out a liver function test used in our criteria forambulation. Rehabilitation was carried out locally prior to the openingof the Rehabilitation Center in Nara in January 1951. Other necessary correctiveprocedures were also carried out after ambulation and prior to discharge.All of these factors added to prolonged hospitalization during the firstwinter. In spite of this, hospital stay was shortened by the use of vitaminB-12, which also was effective in combating the anorexia and reducing theserum bilirubin at an earlier time (5). A still greater improvementwas noted when folic acid was combined with B-12. There is an apparentplace for these agents in the majority of cellular repair, particularlyin a desoxyribosenucleic acid of the nucleus and the ribonucleic acid ofthe cytoplasm.
In an effort to make additional beds for wounded casualties we almostlost this vital treatment center. General Silas B. Hays realized the detrimentthat would come from moving hepatitis patients thousands of miles and savedthe center for us early in 1951. It was our recommendation that these patientsbe assigned to duty in Japan. We soon learned that they were being returnedto their units in Korea. We cannot statistically state the incidence ofrelapses but know that clinically it was negligible. In all cases of relapsethe patients would normally have been evacuated to the center and we wereconstantly on the lookout for these patients who did not appear. When combatconditions became more favorable and nutrition improved, hepatitis ceasedto be a major problem.
Cold Injury
Subsequent to the entry of the Chinese Communists into the war in Novemberof 1950 ground-type frostbite became a major medical problem that winter.During the withdrawal of the Eighth Army many troops became pinned downby enemy fire and required evacuation because of frostbite. A center wasestablished in Japan for the management of these cases. The first winterthere were 2,257 admissions to this center, in 84 percent of which thediagnosis was frostbite (6). It was remarkable how much tissue couldbe saved in these individuals with conservative treatment. Patients withfourth degree frostbite, involving the toes and distal part of the foot,were placed at bed rest and given intravenous procaine and heparin. Within30 to 40 days there was usually a reversal of the process with the patientlosing perhaps only the tip of his great toe. After the first winter frostbiteceased to create a problem.
Hemorrhagic Fever
In the summer of 1951 we experienced a disease new to Western medicine.We felt, initially, that we were dealing with leptospirosis; however, manyof the subjective symptoms and the lack of jaundice
105
directed our attention elsewhere. It soon became apparent that we weredealing with acute hemorrhagic fever, a disease previously described bythe Japanese when they occupied Manchuria and also documented by the Russians.We soon learned that these highly febrile, toxic individuals could nottolerate intravenous fluids. After our people in Korea had observed a numberof these cases a tentative brief on the clinical management was drawn upand distributed from this experience. To this day the therapeutic managementis essentially the same. The initial mortality of 14.6 percent droppedto 2.7 percent as we learned more about the management of these cases.Since the establishment of a center for detailed study of this diseasein early 1952 many interesting observations have been made and documentedelsewhere (7). The British Commonwealth forces experienced 60 casesthe first fall and recorded 94 during 1952.
Common Respiratory Disease
Because of the severity of the winter in Korea and the inadequacy ofthe housing in the early days we expected a high incidence of common respiratorydisease and influenza; however, this was not extraordinarily high whenviewed in the light of common respiratory disease and influenza elsewhere.
Pneumonia
Except for the first winter the incidence was not quite as high as thatexperienced in the Mediterranean during World War II.
Post-traumatic Renal Insufficiency
Early in the Korean War it was recognized that we were seeing post-traumaticacute renal insufficiency or, if you will, lower nephron nephrosis. Realizingthat sulfonamides are a contributing factor, etiologically, to the entityin individuals already subjective to trauma and blood transfusions, itwas recommended that sulfonamides not be authorized for use in advanceof the semi-fixed hospitals. Penicillin was readily available. This recommendationwas disapproved by the Chief Consultant and subsequently cases of acuterenal insufficiency were seen following sulfonamide administration withinadequate fluid. It was estimated that 1 out of every 300 to 500 traumatizedcasualties developed post-wounding renal insufficiency. A surgical researchteam with an artificial kidney was set up during 1952 to care for thesecasualties. These were received by helicopter after the clinical diagnosiswas made. No patients with transfusion reactions or diazine-precipitatedreactions were treated by this group; hence, all cases were post-traumatic.These patients were dialyzed when the serum potassium reached 7 to 9 milliequivalentsper liter and a nonprotein nitrogen upwards of 200 mg. per 100 cc. Thisusually occurred by
106
post-wound day 3 or 4. It was felt that such a rapidly developing biochemicalcourse was greatly altered by dialysis. This is borne out by the fact thatdialyzing reduces the mortality from about 80 percent to 50 percent.
It is interesting to note that of the fatal cases uremic coma was aninfrequent cause of death. Pneumonia was commonly seen, and peritonitisin those with belly wounds. All organisms, both pulmonary and systemic,were sensitive to streptomycin. It is interesting to note that in thesepatients and in those who recovered, there was a failure of wound healingand granulation did not appear until the onset of diuresis. This may bedelayed to post-wound day 19. As would be apparent, conventional suturesgave way, causing hemorrhage during this period of oliguria. Norepinephrinewas useful where shock developed in the presence of adequate blood volume;oliguria is not a contraindication to its use (8).
Table 3 portrays the total number of diseases encountered in the FarEast from the onset of the Korean War through December 1953.
Table 3. Diseases in Far East from Onset ofKorean War through December 1953
| Number of cases | Number of deaths | ||||
Total FECOM | Korea | Japan | Total FECOM | Korea | Japan | |
Cold Injury | 8,260 | 7,920 | 339 | 1 | ----- | 1 |
Smallpox | 24 | 24 | ----- | 4 | 4 | ----- |
Epidemic Hemorrhagic Fever | 2,168 | 2,158 | 10 | 125 | 124 | 1 |
Tuberculosis (all forms) | 1,130 | 615 | 419 | 9 | ----- | 3 |
Venereal Disease (total) | 183,830 | 115,946 | 60,419 | ----- | ----- | ----- |
Gonorrhea | 111,748 | 68,764 | 38,829 | ----- | ----- | ----- |
Syphilis | 3,277 | 1,696 | 1,423 | ----- | ----- | ----- |
All Other1 | 68,805 | 45,486 | 20,167 | ----- | ----- | ----- |
Dysentery (All) | 3,549 | 2,877 | 498 | 1 | ----- | ----- |
Food Infection and Poisoning | 1,125 | 936 | 157 | ----- | ----- | ----- |
Typhus (Louse-borne) | 1 | ----- | 1 | ----- | ----- | ----- |
(Tick-borne) | ----- | ----- | ----- | ----- | ----- | ----- |
(Flea-borne) | ----- | ----- | ----- | ----- | ----- | ----- |
(Mite-borne) | 4 | 3 | 1 | ----- | ----- | ----- |
Malaria | 8,686 | 6,199 | 2,290 | 1 | ----- | ----- |
Infectious Hepatitis | 9,487 | 6,969 | 2,152 | 20 | 3 | 17 |
Poliomyelitis | 166 | 126 | 31 | 19 | 11 | 8 |
Encephalitis Infectious | 427 | 377 | 36 | 29 | 22 | 6 |
Rheumatic Fever | 471 | 302 | 163 | ----- | ----- | ----- |
Scarlet Fever | 51 | 29 | 21 | ----- | ----- | ----- |
Pneumonia (all forms) | 10,225 | 7,031 | 2,821 | 16 | 6 | 6 |
Common Respiratory Diseases | 109,962 | 68,408 | 37,951 | 2 | 2 | ----- |
1Includes chancroid and other venereal disease.
Neuropsychiatry
We were all aware of the problem of the psychiatric casualty duringcombat. Early in the Korean combat, and about 3 months before, we werefortunate in receiving the experience of a consultant in psychiatry andeach division was staffed with a psychiatrist. It was interesting to seethese casualties managed in a rear division area with the result that 50to 60 percent of all psychiatric casualties were returned to duty withoutleaving the division area.
Prisoner of War Patients
The management of this category of patients presented a considerableproblem, both from the standpoint of administration and from that of professionalcare. Dysentery was a constant problem and in December 1950 four thousandprisoners of war were hospitalized, with six hundred deaths. Tuberculosiswas the second leading cause for admission of prisoners of war and duringDecember 1950 five hundred were hospitalized. Late in 1951 a pilot studywas made of five hundred North Korean prisoners of war and five hundredChinese which revealed an incidence of new or old pulmonary tuberculosisin 6.6 percent.
Nutritional edema was common in the newly admitted prisoners of war.This was corrected by the addition of powdered milk and powdered eggs tothe diet. The magnitude of the burden of caring for these people by theEighth Army can be surmised by the fact that during the first 6 months140,000 prisoners were in our custody.
Education
As the war became more stabilized in 1951 it was recommended that amedical group be organized in Korea for the purpose of conferences, clinics,and so forth. The first one of these was in the Pusan area. These werewell attended. The 38th Parallel Medical Society was organized the sameyear and was a very stimulating group. When making out the itinerary fora Surgeon General's Office consultant a visit to this group was alwaysplanned for the day of their scheduled meeting. These conferences werelater expanded to include short postgraduate courses within the EighthArmy area in 1952. Each visiting consultant from the United States woulddiscuss a series of subjects or present papers. The regularly scheduledmedical meetings in Japan were disrupted by the onset of the Korean conflict;however, one such meeting was held in the late spring of 1951 and thesemeetings were resumed regularly in 1952.
Consultants
In general, consultants from the Zone of Interior were invaluable, notonly from the standpoint of presenting newer advances in medi-
108
cine from the United States, but because of their tremendous moralevalue to Medical Corps personnel, particularly in the forward area of Korea.The value of selected consultants interested in teaching and sympatheticwith military problems in such a situation cannot be overemphasized. Frequentuse was made of regional consultants in medicine or a subspecialty withgratifying results; for example, a dermatologist was assigned to an evacuationhospital which previously had evacuated 49 percent of the dermatologicalpatients to Korea. This figure dropped to 18 percent after the assignmentof a dermatologist.
Role of Our Allies
A medical document of this nature would not be complete without referenceto the splendid support given by the Medical Services of our Allies. Inthe late summer of 1950 the Swedish Red Cross established a well-staffedhospital in Pusan. The Danish Government, a few weeks later, provided thewell-equipped and staffed hospital ship "Juliana." In 1951 theNorwegians furnished an equally well-staffed Mobile Army Surgical Hospitalfor forward operation. The extremely effective role that these units providedcannot be overemphasized.
References
1. Short, A. G., et. al.: Pre-erythrocytic Stage of HumanMalaria, Plas. vivax. Brit. M. J. 1 : 547, 20 Mar. 1948.
2. Pruitt, F. W.: Malaria. Symposium on Military Medicinein the Far East Command, p. 24, Sept. 1951.
3. Ibid.
4. Hansen, Howard, Cleve, E. A., and Pruitt, F. W.: Relapseof Vivax Malaria Treated with Primaquine and Report of One Case of Methemoglobinemiadue to Primaquine. Am. J. Med. Sc. 227 : 9, 1952.
5. Campbell, R., and Pruitt, F. W.: Vitamin B-12 in theTreatment of Viral Hepatitis; a Preliminary Report. Am. J. Med. Sc. 224: 252, Sept. 1952.
6. Pruitt, F. W.: Experience with Cold Injury in the KoreanWar. J. Neb. Med. Assoc., Jan. 1954.
7. Pruitt, F. W., and Cleve, E. A.: Epidemic HemorrhagicFever. Am. J. Med. Sc. 225 : 661, 1953.
8. Pruitt, F. W.: Acute Post-traumatic Renal Insufficiencyand Its Management. Neb. State Med. J. 39 : 137, Apr. 1954.
