The third volume on experiences of the Surgical Research Team of Korea embodies the studies carried out in the clinical management of war casualties. This volume is divided into three parts. Part One represents the general aspects of surgical care. Part Two includes the management of specific clinical problems, such as vascular trauma, burns, débridement, and Clostridial myositis. Part Three reviews certain laboratory surveys of the clinical material, including bacteriologic studies, postmortem examinations, and an analysis of experiences with fat embolism.
The surveys and studies in the clinical care of patients were made at the 46th Surgical Hospital. This hospital was located on the eastern front 10 miles behind the main, line of resistance. It supported the 45th Infantry Division, the 40th Infantry Division, and the Philippine Expeditionary Forces. It received casualties from such memorable battles as the Punch Bowl, Sandbag Castle, Heartbreak Ridge, and Christmas Hill. During the last 7 months of the war, it remained in the same position. The hospital was constructed of several tropical shells fastened together; and it had a concrete floor. Most of the hospital was lined with plywood. Several views of the interior of the hospital are shown in Figures 1 through 4. The patients arrived by ambulance and by small helicopter (Fig. 5). They were transported by ambulance to an airstrip about 10 miles away from the Surgical Hospital, and then flown to evacuation hospitals. Sometimes they were flown directly from the Surgical Hospital by large cabin-type helicopters (Fig. 6).
The clinical studies reflect experiences of the last 18 months of the Korean conflict. Captain John M. Howard, of the Surgical Research Team, and Captain Frank K. Iuni, Chief of the Surgical Service at the 46th Mobile Army Surgical Hospital, conducted many of these studies in 1952. Major Curtis P. Artz and Captain Yoshio Sako of the Surgical Research Team, and Captain Alvin W. Bronwell, Chief of the Surgical Service of the 46th Surgical Hospital, completed the studies in 1953. The results were compiled from operating room records and from statistical data sheets. The statistical data sheets were prepared as study sheets and incorporated, on admission, as part of the patient`s chart. The surgeon responsible for a patient`s care completed these sheets at the time he was evacuated; then they were kept on file with the Surgical Research Team.
The statistical data sheets gave rather extensive data on the care of each casualty. This method of maintaining records provided an opportunity for compiling the experiences of the hospital each month.
FIGURE1. Scene in preoperative section of the 46th Surgical Hospital. This severely injured casualty is receiving blood rapidly through three intravenous portals. A surgeon member of the Surgical Research Team, the Chief of the Surgical Service, an anesthesiologist, and a staff surgeon are assisting in his care.
FIGURE2. The X-ray section of the forward surgical hospital. facilities were available for roentgenographic examination.
FIGURE3. The operating room of the 46th Surgical Hospital on a busy afternoon. In the foreground, two surgeons are performing a minor débridement. They do not wear operating room gowns. At the adjoining table, a major abdominal operation is under way. Lighting facilities were excellent.
FIGURE4. Postoperative section. Immediately after operation, the patient`s litter was placed on a cot. As soon as he reacted, he was moved to an iron bed farther back in the ward.
FIGURE5. A small helicopter. This type of aircraft was used to bring selected casualties from the battalion aid stations to the surgical hospital. The helicopter landed only a few feet from the door of the admission section. Patients were then transported immediately by littercarry to the preoperative section.
The results were discussed at monthly surgical meetings, thereby giving the surgeons at the hospital an opportunity to review their experiences. This constant study of the care of large numbers of casualties resulted in "on-the-spot" improvement in management.
Most of the studies were carried out at the 46th Mobile Army Surgical Hospital in Korea, with the laboratory aspects being conducted at the 406th General Laboratory in Tokyo. Captain David B. Lester, MC, and 1st Lieutenants Faust Durden, MC, Richard L. Jankowska, MC, Walter Lawrence, Jr., MC, Robert C. Smith, MC, Donald L. Weeks, Jr., MC, and Joel W. Williamson, MC, members of the surgical staff of the 46th Surgical Hospital, participated in the evaluation of the material compiled from the statistical data sheets.
The investigations concerning arterial injuries were initiated by Major Edward J. Jahnke, Jr., MC, at the 43d Mobile Surgical Hospital in Korea during 1952; and data were then completed by Lieutenant Colonel Carl W. Hughes, MC, at the same hospital during the last 8 months of the war.
The Surgical Research Team took a very active part in coordinating the work at the hospital with the care at the battalion aid stations. Many battalion surgeons returned to the hospital frequently to discuss problems. Likewise, members of the Surgical Research Team
FIGURE6. A large helicopter. This type of aircraft was used to transport patients between forward hospitals and from a forward hospital to the rear. Six litter patients could be carried at one time. This large helicopter was especially valuable when the casualty load at one hospital was too heavy for its facilities and several casualties had to be transported to an adjoining hospital.
FIGURE7. The medical photographic team in operation Two motion picture cameras were used to cover the operative field, one for long shots, the other for closeups. In addition, several still cameras were available to record significant findings. This team of photographers was available only during the last month of the war.
visited the battalion aid stations, and the free interchange of ideas contributed to improvement in the care of casualties.
In keeping with the aim that these studies of the Surgical Research Team of Korea would provide a basis forteaching the technics of care of large numbers of casualties, a staff of movie photographers was sent to the 46th Mobile Army Surgical Hospital during the last month of the war. Under the direction of First Lieutenant Stephen P. Dittmann of the Army Medical Service Graduate School, this group took over 8,000 feet of colored movies on initial care of the casualty and of procedures in the operating room. This footage was obtained for the purpose of preparing training films in the management of severely injured casualties (Fig.7). Several hundred still photographs in color were also taken in order to assist in the teaching of the management of war casualties.
From the material contained in this volume, considerable information may be gained from practical clinical studies conducted during the time of combat. These studies proved to bean exceptional aid in improving patient care in Korea. They served as a guide for changes of policy in the care of casualties; and they also increased the efficiency of the Medical Department in time of combat. It must be emphasized that several members of the Surgical Research Team worked in the hospital as operating surgeons and they assumed the entire responsibility for the care of patients under study.
In any future conflict, it would seem imperative to assign a group of surgeons interested in clinical surgery and research to a forward installation to study casualties. They should be provided with the research equipment and an additional staff whose primary duty would be to carry out investigations to aid in improving the care of the wounded soldier.
Curtis P. Artz
Lieutenant Colonel, MC, USA
Fort Sam Houston, Texas
June 1, 1955